Background: Ruptured posterior communicating artery (PCoA) aneurysms are common; they usually present with subarachnoid haemorrhage (SAH) and oculomotor nerve palsy. The aneurysmal dome projection may influence the safety access and aneurysmal neck clipping. Here, we discuss additional intraoperative steps that may be required to widen the surgical field to ensure safe surgical clipping of a rupture pure posteriorly directed PCoA aneurysm. Case description: A previously healthy 38-year-old male reported sudden severe headache and disturbed level of consciousness with a Glasgow coma scale (GCS) of 13. His initial computed tomography (CT) scan of the head showed SAH in the basal cistern. 3D-constructed CT angiography (CTA) revealed a left pure posteriorly directed PCoA aneurysm. In the surgery, through the left pterional approach, all intraoperative steps were carried out. Additional steps were performed as well. Three additional intraoperative steps were contemplated because a pure posteriorly directed PCoA aneurysm is not well appreciated and is often hidden behind the supra cliniold internal carotid artery (ICA). First, the extension of Sylvian fissure dissection to include the distal part and the proximal. Second, temporal pole mobilization is performed by cutting small anterior temporal veins. Third, a brain retractor is placed on the temporal lobe to gently tract the superficial part of the lobe. All these steps widened the surgical corridor to ensure the aneurysm's safe clipping. Conclusion: Surgical clipping is influenced by the aneurysmal dome projection. In a ruptured pure posteriorly directed PCoA aneurysm, further intraoperative steps may facilitate complete access and safe clipping of the aneurysm.
Language is an important means through which one can construct one's social world. Accordingly, the way we view ourselves and the world is basically formed by language use whereby identities, relations, and values are constructed and maintained. Most discourse analysts consider narrative not only the locus of construction and enactment of identity, but also a distinguished genre for its analysis.The present study is concerned with how identity can poetically be informed, hence exploring the way black poets use language when reflecting their identity and culture. The poem, right on: white america by the black American poetess Sonia Sanchez, is chosen to be analyzed based on Simpson's stylistic model (2004). In this model, the ana
... Show MoreDigital tampering identification, which detects picture modification, is a significant area of image analysis studies. This area has grown with time with exceptional precision employing machine learning and deep learning-based strategies during the last five years. Synthesis and reinforcement-based learning techniques must now evolve to keep with the research. However, before doing any experimentation, a scientist must first comprehend the current state of the art in that domain. Diverse paths, associated outcomes, and analysis lay the groundwork for successful experimentation and superior results. Before starting with experiments, universal image forensics approaches must be thoroughly researched. As a result, this review of variou
... Show MoreThe unpredictable and huge data generation nowadays by smart computing devices like (Sensors, Actuators, Wi-Fi routers), to handle and maintain their computational processing power in real time environment by centralized cloud platform is difficult because of its limitations, issues and challenges, to overcome these, Cisco introduced the Fog computing paradigm as an alternative for cloud-based computing. This recent IT trend is taking the computing experience to the next level. It is an extended and advantageous extension of the centralized cloud computing technology. In this article, we tried to highlight the various issues that currently cloud computing is facing. Here
... Show MoreProfessional learning societies (PLS) are a systematic method for improving teaching and learning performance through designing and building professional learning societies. This leads to overcoming a culture of isolation and fragmenting the work of educational supervisors. Many studies show that constructing and developing strong professional learning societies - focused on improving education, curriculum and evaluation will lead to increased cooperation and participation of educational supervisors and teachers, as well as increases the application of effective educational practices in the classroom.
The roles of the educational supervisor to ensure the best and optimal implementation and activation of professional learning soci
... Show MoreBackground: Obesity tends to appear in modern societies and constitutes a significant public health problem with an increased risk of cardiovascular diseases.
Objective: This study aims to determine the agreement between actual and perceived body image in the general population.
Methods: A descriptive cross-sectional study design was conducted with a sample size of 300. The data were collected from eight major populated areas of Northern district of Karachi Sindh with a period of six months (10th January 2020 to 21st June 2020). The Figure rating questionnaire scale (FRS) was applied to collect the demographic data and perception about body weight. Body mass index (BMI) used for ass
... Show MoreThis article proposes a new strategy based on a hybrid method that combines the gravitational search algorithm (GSA) with the bat algorithm (BAT) to solve a single-objective optimization problem. It first runs GSA, followed by BAT as the second step. The proposed approach relies on a parameter between 0 and 1 to address the problem of falling into local research because the lack of a local search mechanism increases intensity search, whereas diversity remains high and easily falls into the local optimum. The improvement is equivalent to the speed of the original BAT. Access speed is increased for the best solution. All solutions in the population are updated before the end of the operation of the proposed algorithm. The diversification f
... Show MoreThis review delves deep into the intricate relationship between urban planning and flood risk management, tracing its historical trajectory and the evolution of methodologies over time. Traditionally, urban centers prioritized defensive measures, like dikes and levees, with an emphasis on immediate solutions over long-term resilience. These practices, though effective in the short term, often overlooked broader environmental implications and the necessity for holistic planning. However, as urban areas burgeoned and climate change introduced new challenges, there has been a marked shift in approach. Modern urban planning now emphasizes integrated blue-green infrastructure, aiming to harmonize human habitation with water cycles. Resil
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