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.
The research problem lies in the fundamental questions that revolve around the role of each of the tools of promotion, namely advertising, personal sale, public relations, sales promotion, and direct marketing in achieving leadership for business organizations. Research to know the role of promoting the service in the researched company and whether the promotion of the service is qualified to lead the researched company to leadership, and for this purpose formulated research hypotheses of three hypotheses, the first hypothesis says that there is a significant impact relationship between promotion and entrepreneurship. The second hypothesis aimed to determine the role played by promotion in the researched company to achieve unique
... Show MorePraise be to God, Lord of the worlds, and prayers and peace be upon our master Muhammad and upon his family and companions.
And after:
Muslim scholars have fought in the extent of regard to these interests, each according to his opinion and according to his evaluation, and his consideration of this interest, but it remains important that the legislation in them needs more precaution and caution against the predominance of passions, because the passions often decorate spoilers so they see an interest, so practical application must To realize the spirit of Islamic Sharia in its entirety of its rulings, and the preponderance between the interests and evils that prevail in our societies, which c
... Show MoreAdolescent pregnancy is common health problem still found in both developed and developing countries; as adolescent may have early sexual practice or early marriage. Adolescent mothers face substantially higher maternal and perinatal morbidity and mortality than adult women. This is a randomized prospective clinical study conducted at Al-Elwiya Maternity Teaching Hospital, Baghdad, Iraq. The objective of this work is to assess the adverse maternal, fetal and neonatal outcomes in early and late teenage pregnant mothers. Study sample consisted of 220 primigravid women with a singleton, cephalic, viable fetus and no congenital abnormality that gave birth at Al-Elwiya Maternity Teaching Hospital, Baghdad, Iraq. The 1stgroup: early teenage (46 w
... Show MoreThe Innovation Of Knowledge Is An Important And A Key Element In The Progress And Business Excellence Organizations, Therefore Requires Several Elements To Help Create And Implement And Move The Innovation Process Of Knowledge, Including The Strategic Empowerment Associated With The Element Of The Process Of Strategic Momentum Engine Driven Wheel Continuous Dynamic Innovation, And Focused Research Problem By Measuring The Availability Of Strategic Empowerment When Individuals From By Senior Departments And Ways To Help Organizations To Provide Empowerment Commensurate With The Requirements Of Achieving The Goals Of Time And Place Appropriate For The Individual, And The Importance Of Research Stems From The Importance Of The Varia
... Show MoreThe achievement of world peace is a humanitarian demand that humanity has sought since its existence. Despite the international and regional efforts to achieve this demand, it is still reaching its desired ambitions if conflicts, contradictions, and internal and external wars continue to justify us clearly in terms of ethnic, religious and sectarian conflict. The revolution of informatics and the impact of globalization opened a new era of communication and openness and the negative and positive impact of others, which re-published and distributed values, ideas and new cultures Some of them carries extremist ideas urging violence and destruction and other abolition, it became necessary to follow policies and reward The culture of peace,
... Show MoreBackground: Chronic hepatitis B virus (HBV) infection is a common health problem that has a worldwide distribution. Apart from the direct effect of the virus on the liver, there are many extrahepatic manifestations among which the probable effect on bone turnover associated with low bone mineral density (BMD). Objectives: This study aimed to determine the association between treated and untreated chronic HBV infection with BMD. Methods: This is a cross-sectional study which included a total of 48 patients with chronic HBV (28 patients treated with tenofovir-disoproxil-fumarate [TDF] antiviral drug and 20 patients have not yet started treatment). Other age- and sex-matched 30 apparently healthy individuals were recruited to represent the hea
... Show MoreTwitter is becoming an increasingly popular platform used by financial analysts to monitor and forecast financial markets. In this paper we investigate the impact of the sentiments expressed in Twitter on the subsequent market movement, specifically the bitcoin exchange rate. This study is divided into two phases, the first phase is sentiment analysis, and the second phase is correlation and regression. We analyzed tweets associated with the Bitcoin in order to determine if the user’s sentiment contained within those tweets reflects the exchange rate of the currency. The sentiment of users over a 2-month period is classified as having a positive or negative sentiment of the digital currency using the proposed CNN-LSTM
... Show MoreThe aim of the research is to measure the relationship and effect of the application of total production maintenance TPM in the operational strategy, as it is considered one of the most important strategies for the process of restoring production losses because of inefficient equipment. Competitive edge in the global market by upgrading the operational strategies of OS in the application of TPM in those institutions that apply both H-OS-oriented and P-OS-oriented strategies where the strategy has been identified as a critical success factor. The aim of this study is to attempt to consider the application of comprehensive productive maintenance in industrial establishments