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.
يعد هذا النص أحد النصوص المسمارية المصادرة التي بحوزة المتحف العراقي، ويحمل الرقم المتحفي (235869)، قياساته )12،7x 6x 2،5سم). يتضمن مدخولات كميات من الشعير،أرخ النص الى عصر أور الثالثة (2012-2004 ق.م) و يعود الى السنة الثالثة من حكم الملك أبي-سين (2028-2004 ق.م)،أن الشخصية الرئيسة في هذا النص هو)با-اَ-كا مسمن الماشية( من مدينة أري-ساكرك، ومقارنته مع النصوص المسمارية المنشورة التي تعود الى أرشيفه يبلغ عددها (196) نصاً تضمنت نشاطاته م
... Show MorePurpose: The research seeks to develop the implications of intellectual human capital, and social capital in business organizations, and will be accomplished on three levels, the first level (the level of description) to identify, diagnose and display content philosophical Strategic Human Resource Management at the thought of modern administrative represented by human capital and Ras social capital. The second level (level of analysis) and the analysis of the extent of the impact of alignment between human capital, and social capital in the organizational strength of the organizations. The third level (Level predict) the formulation of a plan to strengthen the organizational strength in business organizations and to develop speci
... Show MoreIn this paper, the dynamical behavior of a three-dimensional fractional-order prey-predator model is investigated with Holling type III functional response and constant rate harvesting. It is assumed that the middle predator species consumes only the prey species, and the top predator species consumes only the middle predator species. We also prove the boundedness, the non-negativity, the uniqueness, and the existence of the solutions of the proposed model. Then, all possible equilibria are determined, and the dynamical behaviors of the proposed model around the equilibrium points are investigated. Finally, numerical simulations results are presented to confirm the theoretical results and to give a better understanding of the dynami
... Show MoreKE Sharquie, GA Ibrahim, AA Noaimi, HK Hamudy, J Saudi Soc Dermatol Dermatol Surg, 2010 - Cited by 2
Abstract The research investigates in detail the fascinating story of its title character, which may work as an allegory for Africa itself in its past. Ama Ata Aidoo is miscellaneous writers who wrote in different literary genre like drama , short stories novel and , poetry and criticism . She is also an active feminist. Aidoo is against the colonial practice and its influence on African minds. Aidoo's play Anowa confronts painful issues in Africa's past, mostly those of the slave trade. She goes further to tackle issues of patriarchal domination and African feminism, like the relationships between individuals and society, women and motherhood, men and women, husbands and wives, mothers and daughters, and above all the future invasion
... Show MoreNumeral recognition is considered an essential preliminary step for optical character recognition, document understanding, and others. Although several handwritten numeral recognition algorithms have been proposed so far, achieving adequate recognition accuracy and execution time remain challenging to date. In particular, recognition accuracy depends on the features extraction mechanism. As such, a fast and robust numeral recognition method is essential, which meets the desired accuracy by extracting the features efficiently while maintaining fast implementation time. Furthermore, to date most of the existing studies are focused on evaluating their methods based on clean environments, thus limiting understanding of their potential a
... Show MoreObjective: To conduct a standardized method for cavity preparation on the palatal surface of rat maxillary molars and to introduce a standardized method for tooth correct alignment within the specimen during the wax embedding procedure to better detect cavity position within the examined slides. Materials and methods: Six male Wistar rats, aged 4-6 weeks, were used. The maxillary molars of three animals were sectioned in the frontal plane to identify the thickness of hard tissue on the palatal surface of the first molar which was (250-300µm). The end-cutting bur (with a cutting head diameter of 0.2mm) was suitable for preparing a dentinal cavity (70-80µm) depth. Cavity preparation was then performed using the same bur on the tooth
... Show MoreOur goal in the present paper is to recall the concept of general fuzzy normed space and its basic properties in order to define the adjoint operator of a general fuzzy bounded operator from a general fuzzy normed space V into another general fuzzy normed space U. After that basic properties of the adjoint operator were proved then the definition of fuzzy reflexive general fuzzy normed space was introduced in order to prove that every finite dimensional general fuzzy normed space is fuzzy reflexive.