Introduction. Intraoperative rupture (IOR) of an aneurysm is a frightful complication that causes significant morbidity and mortality worldwide. IOR can be attributed to various parameters, including hypertension, increased intracranial pressure (ICP), fragility of the vessels, and inadequate anaesthesia. IOR due to insufficient anaesthesia is scarcely reported in the literature. Here, we describe a re-ruptured anterior communicating artery (ACoA) after incomplete clipping of the neck during craniotomy closure due to unintended early wake-up from anaesthesia with a discussion about the management. Case description. A 38-year-old male suddenly developed a severe headache, a brief loss of consciousness, and vomiting. Computed tomography (CT) scan showed a subarachnoid haemorrhage in the basal cistern. CT angiography showed a bilobed right ACoA aneurysm with a wide neck and Murphy's teat. The patient was considered for surgery. Clipping of the aneurysm neck was done through two curved clips. During craniotomy closure, the patient started coughing and gagging then a huge IOR was encountered. These events can be mainly attributed to unintended inadequate anaesthesia, particularly muscle relaxants. The bleeding ceased after two suction catheters were inserted, temporary clips were applied, and the readjustment of permanent clips. After surgery, the patient showed a left-sided weakness. His postoperative CT scan showed a right distal anterior cerebral artery (ACA) territory infarction. The weakness improved in the follow-up period. Conclusion. Delayed IOR due to early awaking from anaesthesia should be considered a potential source of complications and bad outcomes in aneurysm surgery.
Visceral leishmaniasis is a neglected tropical disease on the rise in different regions of Iraq, especially in areas with poor hygiene and among refugee populations. The effectiveness of existing chemotherapy for leishmaniasis is constrained by its high toxicity, cost, and the development of drug resistance. The current research examined various concentrations (ranging from 125 to 1000 μM) of lupeol to evaluate its ability to boost the generation of nitric oxide, which has anti-leishmanial properties, in an ex-vivo macrophage model. Griess assay was used to detect the nitric oxide (NO) production in Leishmania donovani infected U937 cell-line macrophages along 24 and 48 hours post treated. The nitric oxide concentration was signifi
... Show MoreRheumatoid arthritis (RA) is characterized by persistent joint inflammation, which is a defining feature of this chronic inflammatory condition. Considerable advancements have been made in the field of disease-modifying anti-rheumatic medicines (DMARDs), which effectively mitigate inflammation and forestall further joint deterioration. Anti-tumor necrosis factor-alpha (TNF-α) drugs, which are a class of biological DMARDs (bDMARDs), have been efficaciously employed in the treatment of RA in recent times Adalimumab, a TNF inhibitor, has demonstrated significant efficacy in reducing disease symptoms and halting disease progression in patients with RA. However, its use is associated with major side effects and high costs. In addition,
... Show MoreEthanolic crude extracts of leaves from Laurus nobilis and Alhagi maurorumfor were screened for alkaloids, saponins, tannins, anthraquinones, steroids, flavonoids, glycosides, and glucosides contents. Biochemical activities, including antibacterial activity, antioxidant, and antihemolytic activity, were investigated. Antibacterial activity against Three types of pathogenic bacteria was detected by disc diffusion analysis and characterized by zone of inhibition (ZOI). Antioxidant properties were determined by a diphenyl-1- picrylhydrazyl (DPPH) method. Results revealed that the inhibitory activity of the plants against G+ve and G-ve bacteria were different, where the greatest ZOI of Alhagi maurorum a
... Show MoreThe necessary optimality conditions with Lagrange multipliers are studied and derived for a new class that includes the system of Caputo–Katugampola fractional derivatives to the optimal control problems with considering the end time free. The formula for the integral by parts has been proven for the left Caputo–Katugampola fractional derivative that contributes to the finding and deriving the necessary optimality conditions. Also, three special cases are obtained, including the study of the necessary optimality conditions when both the final time and the final state are fixed. According to convexity assumptions prove that necessary optimality conditions are sufficient optimality conditions.
... Show MoreDue to the wide distribution through the Iranian Plateau, especially in its western parts adjacent to Iraq’s northeastern borders, the occurrence of Brandt’s Hedgehog