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.
Show the greatness of Allah Almighty when contemplating the benefits of trees and plants in
Life in general and trees mentioned in the Koran in particular, do not have to meditate that
He acknowledges the greatness of the Almighty Creator, and his preference over man, that he is prepared for his livelihood
And give him what he can do in this life to the fullest.
The study also stressed the need to urge people to this great blessing trees
By preserving them and wasteful wastefulness.
The study also pointed to the need to guide people towards the aesthetics and improvements of
Look through and enjoy the beauty of trees, flowers, greenery and fruits ..
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Software Defined Network (SDN) is a new technology that separate the control plane from the data plane. SDN provides a choice in automation and programmability faster than traditional network. It supports the Quality of Service (QoS) for video surveillance application. One of most significant issues in video surveillance is how to find the best path for routing the packets between the source (IP cameras) and destination (monitoring center). The video surveillance system requires fast transmission and reliable delivery and high QoS. To improve the QoS and to achieve the optimal path, the SDN architecture is used in this paper. In addition, different routing algorithms are used with different steps. First, we eva
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An environmentally begnin second derivative spectrometric approach was developed for the estimation of the dissociation constants pKa(s) of metformin, a common anti-diabetic drug. The ultraviolet spectra of the aqueous solution of metformin were measured at different acidities, then the second derivative of each spectrum was graphed. The overlaid second derivative graphs exhibited two isobestic points at 225.5 nm and 244 nm pointing out to the presence of two dissociation constants for metformin pKa1 and pKa2, respectively. The method was validated by evaluating the reproducibility of the acquired results by comparing the estimated values of the dissociation constants of two different strategies that show excellent matching. As we
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As one type of heating furnaces, the electric heating furnace (EHF) typically suffers from time delay, non-linearity, time-varying parameters, system uncertainties, and harsh en-vironment of the furnace, which significantly deteriorate the temperature control process of the EHF system. In order to achieve accurate and robust temperature tracking performance, an integration of robust state feedback control (RSFC) and a novel sliding mode-based disturbance observer (SMDO) is proposed in this paper, where modeling errors and external disturbances are lumped as a lumped disturbance. To describe the characteristics of the EHF, by using convection laws, an integrated dynamic model is established and identified as an uncertain nonlinear second ord
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In general, path-planning problem is one of most important task in the field of robotics. This paper describes the path-planning problem of mobile robot based on various metaheuristic algorithms. The suitable collision free path of a robot must satisfies certain optimization criteria such as feasibility, minimum path length, safety and smoothness and so on. In this research, various three approaches namely, PSO, Firefly and proposed hybrid FFCPSO are applied in static, known environment to solve the global path-planning problem in three cases. The first case used single mobile robot, the second case used three independent mobile robots and the third case applied three follow up mobile robot. Simulation results, whi
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The objectives of the study were to identify the incidence rate and characteristics of adverse drug events (ADEs) in nursing homes (NHs) using the ADE trigger tool and to evaluate the relationships between resident and facility work system factors and incidence of ADEs using the System Engineering Initiative for Patient Safety (SEIPS) model. The study used 2 observational quantitative methods, retrospective resident chart extraction, and surveys. The participating staff included Directors of nursing, registered nurses, certified nurse assistants (CNAs). Data were collected from fall 2016 to spring 2017 from 11 NHs in 9 cities in Iowa. Binary logistic regression with generalized estimated equations was used to measure the association
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A harvested prey-predator model with infectious disease in preyis investigated. It is assumed that the predator feeds on the infected prey only according to Holling type-II functional response. The existence, uniqueness and boundedness of the solution of the model are investigated. The local stability analysis of the harvested prey-predator model is carried out. The necessary and sufficient conditions for the persistence of the model are also obtained. Finally, the global dynamics of this model is investigated analytically as well as numerically. It is observed that, the model have different types of dynamical behaviors including chaos.
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