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.
Most Internet of Vehicles (IoV) applications are delay-sensitive and require resources for data storage and tasks processing, which is very difficult to afford by vehicles. Such tasks are often offloaded to more powerful entities, like cloud and fog servers. Fog computing is decentralized infrastructure located between data source and cloud, supplies several benefits that make it a non-frivolous extension of the cloud. The high volume data which is generated by vehicles’ sensors and also the limited computation capabilities of vehicles have imposed several challenges on VANETs systems. Therefore, VANETs is integrated with fog computing to form a paradigm namely Vehicular Fog Computing (VFC) which provide low-latency services to mo
... Show MoreThe convergence speed is the most important feature of Back-Propagation (BP) algorithm. A lot of improvements were proposed to this algorithm since its presentation, in order to speed up the convergence phase. In this paper, a new modified BP algorithm called Speeding up Back-Propagation Learning (SUBPL) algorithm is proposed and compared to the standard BP. Different data sets were implemented and experimented to verify the improvement in SUBPL.
The European Unit has never been affected by a serious phenomena as the phenomena of the advancing of the far right parties. Though these parties vary in their impact in their original countries, they agree on one important issue which is the deconstruction of the European unit and limiting its supernational powers. These increasing popular parties aim at more national independence in decision making away from the decisions taken by Brussels. Moreover, they criticize the financial and administrative corruption accompanied many of the rescuing procedures directed for example towards countries like Greece and Spain during the international economic crisis. This failure nourishes many of the negative feelings against the European unit which
... Show MoreThe city is a built-up urban space and multifunctional structures that ensure safety, health and the best shelter for humans. All its built structures had various urban roofs influenced by different climate circumstances. That creates peculiarities and changes within the urban local climate and an increase in the impact of urban heat islands (UHI) with wastage of energy. The research question is less information dealing with the renovation of existing urban roofs using color as a strategy to mitigate the impact of UHI. In order to achieve local urban sustainability; the research focused on solutions using different materials and treatments to reduce urban surface heating emissions. The results showed that the new and old technologies, produ
... Show MoreReceipt date:06/23/2020 accepted date:7/15/2020 Publication date:12/31/2021
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The executive authority differs from one country to another, as it differs from a federal state to another according to the nature of the applied political systems, so this research focused on federal states according to their political systems, then going into the details of the executive authority and its role In the federal states by referring to the four federal experiments
... Show MoreThis study employs wavelet transforms to address the issue of boundary effects. Additionally, it utilizes probit transform techniques, which are based on probit functions, to estimate the copula density function. This estimation is dependent on the empirical distribution function of the variables. The density is estimated within a transformed domain. Recent research indicates that the early implementations of this strategy may have been more efficient. Nevertheless, in this work, we implemented two novel methodologies utilizing probit transform and wavelet transform. We then proceeded to evaluate and contrast these methodologies using three specific criteria: root mean square error (RMSE), Akaike information criterion (AIC), and log
... Show MoreBuffering of Local anaesthesia (LA) has been suggested as a mechanism to improve injection comfort and hasten the onset of anaesthesia. Aim This study aimed to evaluate the effectiveness of buffered LA in the extraction of maxillary premolars and molars. Materials and Methods This randomized controlled study included 100 patients who were indicated for extraction of maxillary posterior teeth, they were randomly divided into two groups; a study group that received infiltration of buffered 2% lidocaine hydrochloride with 1:80,000 epinephrine LA, and a control group that received non-buffered 2% lidocaine hydrochloride with 1:80,000 epinephrine LA. The buffering was performed using the Onset® LA buffering system (Onpharma®). The outcome va
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