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.
Variable-Length Subnet Masks (VLSM), often referred to as "subnetting a subnet", is used to maximize addressing efficiency. The network administrator is able to use a long mask on networks with few hosts, and a short mask on subnets with many hosts. This addressing scheme allows growth and does not involve wasting addresses. VLSM gives a way of subnetting a network with
minimal loses of IP addresses for a specific range. Unfortunately, the network administrator has to perform several mathematical steps (or use charts) to get the required results from VLSM. In this paper, a simple graph simulator is proposed (using Visual Basic 6.0 Language) to perform all the required mathematical steps and to display the obtained required informatio
SummaryBackground: Rotavirus infection is the most commoncause of watery viral diarrhea in children younger than 5 years of age; it is a major cause of childhood morbidity and mortality.Objective:The aim of the study is todetermine the clinical picture, age distribution of patients with rotavirus infection and their maternal educational background.Patients &methods: A total of 202 patients suffering from diarrhea were included in this study, over 6 months period( from 1stof March 2011to 30th of August 2011),in Children Welfare Teaching hospital. History and physical examinationwere carried out, anthropometrics measures were done and plotted on Centers for Disease Control& World Health Organization charts to determine the nut
... Show MoreThis research includes theoretical and evaluation design of a polarizer filter of high transmission in the near IR region of (900-1200nm) for different incidence angles to obtain a long wave and short wave pass filter using analytical calculations. Results refer to a new configuration design in fewer layers than used in previous studies in the long wave pass at incidence angles (45o,50o,55o). Adopted Hafnium dioxide (HfO2) and Magnesium fluoride (MgF2) as coating material at design wavelength (933nm), the study also included design short wave pass polarizer by using the same coating material.
It is axiomatic that languages mirror the world view of their users. Manipulating honorific forms among people inevitably reflects this truth . Honorifics are conventionalized forms or expressions manifested in all the world's languages and are used to express the social status of the participants in the verbal interaction and to convey indications like politeness and respect . English is no exception. However the question is what exactly creates these forms and their meanings. Although honorifics have been extensively researched from a grammatical and semantic angle , yet they haven’t received that significant attention i
... Show MoreMaxillofacial trauma in females is not widely reported. This study aimed to analyze the clinical characteristics and the patterns of maxillofacial injuries in females and to determine the differences in these patterns among different causes. This retrospective study analyzed several variables, including demographic, social, injury-related, and treatment-related variables, and compared these variables in relation to the main etiologies of maxillofacial trauma. The main etiologies of maxillofacial injuries involving females were assault, followed by road traffic accidents, and falls. There were significant differences in relation to the 3 etiologies in age groups (
Debate is a teaching strategy in nursing education that enhances students' critical thinking. Although debate can be an effective teaching strategy, it is not without limitations. This article discusses the advantages and disadvantages of debate as a teaching strategy in nursing. Also, evaluating debates and choosing topics are highlighted.
Variable-Length Subnet Masks (VLSM), often referred to as "subnetting a subnet", is used to maximize addressing efficiency. The network administrator is able to use a long mask on networks with few hosts, and a short mask on subnets with many hosts. This addressing scheme allows growth and does not involve wasting addresses. VLSM gives a way of subnetting a network with minimal loses of IP addresses for a specific range. Unfortunately, the network administrator has to perform several mathematical steps (or use charts) to get the required results from VLSM. In this paper, a simple graph simulator is proposed (using Visual Basic 6.0 Language) to perform all the required mathematical steps and to display the obtained required information (the
... Show MoreFor the graph , the behavior associated with to the majority of the graphical properties of this graph is covered in this article. The reflection of the capabilities of on the Ly constructions is one of the key ideas addressed throughout this paper. For instance, by this technique we can comprehend the mechanism via which groups of relatively tiny structure are exist within Ly.
This study sought to determine malformation caused by Ochratoxin-A (OTA) on mouse embryos. Twenty adult female white Swiss mice (mus msculus) were divided into four groups, with five females per group, and with one male placed with two females in a cage. Avaginal plug was observed in the early morning and the day of mating was considered as day of pregnancy followed by the first day of pregnancy. Three sub lethal concentrations of OTA were applied to the respective groups (other than the control), 1mg/kg, 2mg/kg and 4mg/kg. The animals were given 0.1 ml per 10 gm body weight per concentration of OTA once a day during days 7-14 of pregnancy. The control group animals were given distilled water. The pregnant mice were dissected, and the embry
... Show More