An anal fissure which does not heal with conservative measures as sits baths and laxatives is a chronic anal fissure. Physiologically, it is the high resting tone of the internal anal sphincter that chiefly interferes with the healing process of these fissures. Until now, the gold standard treatment modality is surgery, either digital anal dilatation or lateral sphincterotomy. However, concerns have been raised about the incidence of faecal incontinence after surgery. Therefore, pharmacological means to treat chronic anal fissures have been explored. A Medline and pub med database search from 1986-2012 was conducted to perform a literature search for articles relating to the non-surgical treatment of chronic anal fissure. Pharmacological sphincterotomy using Glyceryl trinitrate , Isosorbide dinitrate or calcium channel blockers are exciting alternative treatment , that relaxes the anal sphincter and, therefore, promote healing, the drawback of such medications are headache and poor compliance. With the introduction of Botulinum toxin as mean of chemical sphincterotom, topical injection of Botulinum toxin reduces the anal hypertonia which lasts for few months, allows the fissure to heal, thus eliminating the need for surgery without incidence of incontinence. Cure rates are over 60%, and the procedure can be repeated safely. Therefore, Botulinum toxin is a reasonable first-line management of chronic anal fissure and the relapses can be managed by surgery Keywords: Non-surgical treatment of anal fissure, fissure in ano, sphicterotomy,botulinum toxin in anal fissures, glyceryl trinitrate. Chemical sphincteratomy, pharmacological sphincteratomy.
The increasing drinking water demand in many countries leads to an increase in the use of desalination plants, which are considered a great solution for water treatment processes. Reverse osmosis (RO) and electro-dialysis (ED) systems are the most popular membrane processes used to desalinate water at high salinity. Both systems work by separating the ionic contaminates and disposing of them as a brine solution, but ED uses electrical current as a driving force while RO uses osmotic pressure. A direct comparison of reverse osmosis and electro-dialysis systems is needed to highlight process development similarities and variances. This work aims to provide an overview of previous studies on reverse osmosis and electro-dial
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Our research sheds light on one of the most important aspects of David Grossman's play, "Ricky's Garden, גן ריקי " which is characterized by its realistic portrayal of characters. Grossman gradually moves towards the inner awareness of his characters, expressing their emotions and thoughts through conversations and emotional conflicts, referring to their past and rooted background. Grossman transformed the main subject of his play (psychological depth) into a presentation and arrangement of all the elements of the play in a way that expresses emotional nature more powerfully by each child in the garden. This is reflected in their actions and words, making Grossman's works suitable for study and always of interest to specialized resear
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Succinic acid is an essential base ingredient for manufacturing various industrial chemicals. Succinic acid has been acknowledged as one of the most significant bio based building block chemicals. Rapid demand for succinic acid has been noticed in the last 10 years. The production methods and mechanisms developed. Hence, these techniques and operations need to be revised. Recently, an omnibus rule for developing succinic acid is to find renewable carbohydrate Feedstocks. The sustainability of the resource is crucial to disintegrate the massive use of petroleum based-production. Accordingly, systematically reviewing the latest findings of bacterial production and related fermentation methods is critical. Therefore, this paper aims to stud
... Show MoreConstitutional Review of 1992 and 1996 and the role of the Party of Progress and Socialism
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The human stomach is home to the Gram-negative bacterium Helicobacter pylori, which has been connected to several gastrointestinal disorders. There may be a link between H. pylori infection and the start of autoimmune disorders, according to recent research. This review examines the intricate connections between persistent H. pylori infection, immune system dysregulation, and their possible role in initiating autoimmune disorders. The study begins with a summary of H. pylori infection and its prevalence worldwide, emphasizing the mounting data that connects this bacterium to autoimmune disorders. Then, using experimental data from animal models and epidemiological research as support, it undertakes a thorough review of autoimmune di
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The main objective of this study is to understand the work of the pile caps made of lightweight aerated foam concrete and study the many factors affecting the ability and the capacity of the shear. The study was done by analyzing previous practical and theoretical experiences on the reinforced concrete pile caps. The previous practical results indicated that all specimens failed by shear diagonal compression or tension modes except one specimen that failed flexural-shear mode. Based on test specimens' practical results and behavior, some theoretical methods for estimating the ultimate strength of reinforced concrete pile caps have been recommended, some of which evolved into the design documents available on the subject.
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Incorporating modern technology into education is becoming imperative. Numerous pharmacy institutions are incorporating virtual reality (VR) technology training into their curricula to enhance educational experience. This review examines the current state, historical evolution, and application of VR programs in pharmacy education and training. The review also provides details about the main challenges and limitations associated with the use of this technology. The VR technology, including virtual laboratories and simulations, significantly improves clinical training and educational outcomes. The utilization of VR in clinical teaching encounters numerous barriers, including ethical concerns and technological constraints, as well as other res
... Show MoreRepresent choices Behaviorism available to the Managerial leaders one of the prerequisites to run any beginnings of a psychological or dilemmas Managerial barriers to working in the field of work has been varied these options until it had taken several kinds of which contributed to the left different impacts on the alleviation of these problems, which prompted the researcher to raising the problem of study within the framework of questionable content how to contribute to that shown by Choices Behaviorism accredited to the Managerial leaders in the management of frustration
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