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 surgeryKeywords: Non-surgical treatment of anal fissure, fissure in ano, sphicterotomy,botulinum toxin in anal fissures, glyceryl trinitrate. Chemical sphincteratomy, pharmacological sphincteratomy.
يمثل الأخذ بالنظام الفيدرالي أطاراً تنظيمياً لشكل الدولة و مرحلة تحول مهمة في بنية الدولة العامة في مختلف مجالاتها، فالانتقال من المركزية في أدارة الشؤون العامة للدولة الى النمط الفيدرالي يمثل تحولا بنيوياً وسيكولوجياً ،حيث يكون هنالك توزيع مكاني - عمودي للسلطة والثروة بين الوحدات المكونة للدولة بشكل يختلف كليا عن الحالة المركزية، ونجد صور تنظيمية عديدة تتأسس ضمن اطار الفيدرالية العام ،
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Trimethoprim derivative Schiff bases are versatile ligands synthesized with carbonyl groups from the condensation of primary amines (amino acids). Because of their broad range of biological activity, these compounds are very important in the medical and pharmaceutical fields. Biological activities such as antibacterial, antifungal and antitumor activity are often seen. Transition metal complexes derived from biological activity Schiff base ligands have been commonly used.
Presentation of urinary calculus ranges from painful urination to acute retention. Diagnosed by x-ray pelvis and non-contrast CT and removal of stone by various methods is the management. Variety in symptoms, sometimes make clinical diagnosis difficult until radiological investigations confirm it. In this case presentation, initial diagnosis was made of Urethrocutaneous fistula may be due to distal stricture, but on investigating, he was diagnosed as urethral calculus in urethral diverticulum , as the reason for his symptoms
Since its discovery in December 2019, corona virus was outbreak worldwide with very rapid rate, so it described by WHO as pandemic. It associated with severe acute respiratory distress syndrome, and can enter to cells through Angiotensin Converting Enzyme 2 (ACE 2) receptor which play an important role as regulator for blood pressure. Hypertension is a potential risk factor for sever acute respiratory syndrome COVID-19, and associated with high mortality rate as shown in many epidemiological studies. Moreover, specific antihypertensive medications that infected patients were receiving are not known; only data about renin-angiotensin-aldosterone system (RAAS) are available.
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An excellent reputation earned by initiating and practicing sustainable business practices has additional benefits, of which are reducing environmental incidents and an improvement in operational efficiency as this has the potential to help firms improve on productivity and bring down operating costs. Taken further, with ever-increasing socially and environmentally-conscious investors and the public alike, this act of natural resources management could have a significant implication on market value and income of the practicing firms.
The above proposition has been supported by sustainable business practices literature that is continuously conversing and deliberating upon the impact of efficient resource d
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Protein arginine methyltransferases (PRMTs) play important roles in transcription, splicing, DNA damage repair, RNA biology, and cellular metabolism. Thus, PRMTs have been attractive targets for various diseases. In this study, we reported the design and synthesis of a potent pan-inhibitor for PRMTs that tethers a thioadenosine and various substituted guanidino groups through a propyl linker. Compound II757 exhibits a half-maximal inhibition concentration (IC50) value of 5 to 555 nM for eight tested PRMTs, with the highest inhibition for PRMT4 (IC50 = 5 nM). The kinetic study demonstrated that II757 competitively binds at the SAM binding site of PRMT1. Notably, II757 is selective for PRMTs over a panel of other methyltransferases, w
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Many academics have concentrated on applying machine learning to retrieve information from databases to enable researchers to perform better. A difficult issue in prediction models is the selection of practical strategies that yield satisfactory forecast accuracy. Traditional software testing techniques have been extended to testing machine learning systems; however, they are insufficient for the latter because of the diversity of problems that machine learning systems create. Hence, the proposed methodologies were used to predict flight prices. A variety of artificial intelligence algorithms are used to attain the required, such as Bayesian modeling techniques such as Stochastic Gradient Descent (SGD), Adaptive boosting (ADA), Deci
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