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.
عند إطلالتنا على هذا البلد العربي لابد من التقصي ولو بعجاله عن اقتصاده وهو الاهم باعتبار ان الاقتصاد هو شريان الحياة لأي أمة فلا غنى ولا تهاون في نفس الوقت عن هذا الجانب المهم الذي يرتبط مدى تطوره بتطور البلد وهذا الاخير مرتبط بما متوفر لديه من موارد بشريه ومادية وان تفاوتت النسبة بينها فلا ضير في ذلك فالاهم هو وجود الموجه والمخطط بالاتجاه الصحيح نحو الاستغلال الامثل لهذه الموارد
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A prey-predator interaction model has been suggested in which the population of a predator consists of a two-stage structure. Modified Holling's disk equation is used to describe the consumption of the prey so that it involves the additional source of food for the predator. The fear function is imposed on prey. It is supposed that the prey exhibits anti-predator behavior and may kill the adult predator due to their struggle against predation. The proposed model is investigated for existence, uniqueness, and boundedness. After determining all feasible equilibrium points, the local stability analyses are performed. In addition, global stability analyses for this model using the Lyapunov method are investigated. The chance of occurrence of loc
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... Show MoreThe current study aimed to review previous scholarly efforts to understand the concept of sustainable development, its practices, and its significance for public institutions. The study focuses on the dimensions of sustainable development—environmental, social, and economic—within public institutions. Sustainable development allows these institutions to balance environmental protection, economic growth, and social justice, ensuring the prosperity of both current and future generations. Furthermore, sustainable development is crucial for maintaining organizational performance. The review bridges knowledge gaps related to sustainable development and utilizes an analytical approach, surveying previous studies on the topic. The sele
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Cressa cretica (Shuwwayl) is a halophytic that belongs to Convolvulaceae, naturally grown in the Middle East including Iraq. Traditionally the plant is used as a paste for sore treatment, also it is used for fever, jaundice, and other illness. Regarding nonclinical use it is used as goat, sheep, and camel feed also as an oil source. Flavonoids including quercetin, kamepferol, apigenin, and their glycosides, phenolic acid as chlorogenic acid, and phytosterols mainly ?–sitosterol were the most important phytochemicals that were detected in this halophyte. Crude ethanolic, methanolic extracts and ethyl acetate fraction of the areal parts were used in clinical studies and demonstrated various effe
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