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.
This work presents a design for a pressure swing adsorption process (PSA) to separate oxygen from air with approximately 95% purity, suitable for different numbers of columns and arrangements. The product refill PSA process was found to perform 33% better (weight of zeolite required or productivity) than the pressure equalization process. The design is based on the adsorption equilibrium of a binary mixture of O2 and N2 for two of the most commonly used adsorbents, 5A & 13X, and extension from a single column approach. Zeolite 13X was found to perform 6% better than zeolite 5A. The most effective variables were determined to be the adsorption step time and the operational pressure. Increasing the adsorption step
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This research aims to understand complexity management and its impact on the use of the dynamic capabilities of a sample of private colleges. Private colleges are currently facing many crises, changes, unrest and high competitive pressures. Which is sometimes difficult or even impossible to predict. The recruitment of dynamic capabilities is also one of the challenges facing senior management at private colleges to help them survive and survive. Thus, the problem of research was (there is a clear insufficiency of interest in Complexity Management and trying to employ it in improving the dynamic capabilities of Colleges that have been discussed?). A group of private colleges was selected as a
... Show MoreThe Target costing is an important modern techniques strategic managerial accounting.which is been shown active adoption to changes in contemporary business environments Inaddition,they had been adopted by the units as aresult of the growth in the strategic approach in the man agement..the goal of using target costing is to build and strengthen competitive abilities of economic units thvough introducing appropriate ways to decrease cost and improving quality of product The hypothesis reflects interest in achieving the goal of the research,ie.research question,The hypothesis use target costing to assist economic units to decrease cost and in the manner that leads to competitive advantages while surviving and flourishing in current busines
... Show MoreToday’s academics have a major hurdle in solving combinatorial problems in the actual world. It is nevertheless possible to use optimization techniques to find, design, and solve a genuine optimal solution to a particular problem, despite the limitations of the applied approach. A surge in interest in population-based optimization methodologies has spawned a plethora of new and improved approaches to a wide range of engineering problems. Optimizing test suites is a combinatorial testing challenge that has been demonstrated to be an extremely difficult combinatorial optimization limitation of the research. The authors have proposed an almost infallible method for selecting combinatorial test cases. It uses a hybrid whale–gray wol
... Show MoreIn this paper, an algorithm is suggested to train a single layer feedforward neural network to function as a heteroassociative memory. This algorithm enhances the ability of the memory to recall the stored patterns when partially described noisy inputs patterns are presented. The algorithm relies on adapting the standard delta rule by introducing new terms, first order term and second order term to it. Results show that the heteroassociative neural network trained with this algorithm perfectly recalls the desired stored pattern when 1.6% and 3.2% special partially described noisy inputs patterns are presented.
A new method for determination of allopurinol in microgram level depending on its ability to reduce the yellow absorption spectrum of (I-3) at maximum wavelength ( ?max 350nm) . The optimum conditions such as "concentration of reactant materials , time of sitting and order of addition were studied to get a high sensitivity ( ? = 27229 l.mole-1.cm-1) sandal sensitivity : 0.0053 µg cm-2 ,with wide range of calibration curve ( 1 – 9 µg.ml-1 ) good stability (more then24 hr.) and repeatability ( RSD % : 2.1 -2.6 % ) , the Recovery % : ( 98.17 – 100.5 % ) , the Erel % ( 0.50 -1.83 % ) and the interference's of Xanthine , Cystein , Creatinine , Urea and the Glucose in 20 , 40 , 60 fold of analyate were also studied .
This paper proposes a new approach, of Clustering Ultrasound images using the Hybrid Filter (CUHF) to determine the gender of the fetus in the early stages. The possible advantage of CUHF, a better result can be achieved when fuzzy c-mean FCM returns incorrect clusters. The proposed approach is conducted in two steps. Firstly, a preprocessing step to decrease the noise presented in ultrasound images by applying the filters: Local Binary Pattern (LBP), median, median and discrete wavelet (DWT), (median, DWT & LBP) and (median & Laplacian) ML. Secondly, implementing Fuzzy C-Mean (FCM) for clustering the resulted images from the first step. Amongst those filters, Median & Lap
Museum education is of great importance to an appropriate representation of museums’ collections and exhibits, including traditional fashion. Therefore, museum educators/curators need to be equipped with the most essential skills in their profession in order to adequately present the museum’s history and holdings. This could be achieved through specialized training programs. However, Arab countries are still behind in terms of museum education. Therefore, this article aims to shed light on this issue by assessing the knowledge and skills possessed by museum educators/curators and how training programs could affect them