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.
Measurement of construction performance is essential to a clear image of the present situation. This monitoring by the management team is necessary to identify locations where performance is exceptionally excellent or poor and to identify the primary reasons so that the lessons gained may be exported to the firm and its progress strengthened. This research attempts to construct an integrated mathematical model utilizing one of the recent methodologies for dealing with the fuzzy representation of experts’ knowledge and judgment considering hesitancy called spherical fuzzy analytic hierarchy process (SFAHP) method to assess the contractor’s performance per the project performance pa
Soil wetted pattern from a subsurface drip plays great importance in the design of subsurface drip irrigation (SDI) system for delivering the required water directly to the roots of the plant. An equation to estimate the dimensions of the wetted area in soil are taking into account water uptake by roots is simulated numerically using HYDRUS (2D/3D) software. In this paper, three soil textures namely loamy sand, sandy loam, and loam soil were used with three different types of crops tomato, pepper, and cucumber, respectively, and different values of drip discharge, drip depth, and initial soil moisture content were proposed. The soil wetting patterns were obtained at every thirty minutes for a total time of irrigation equ
... Show MoreElectronic Health Record (EHR) systems are used as an efficient and effective method of exchanging patients’ health information with doctors and other key stakeholders in the health sector to obtain improved patient treatment decisions and diagnoses. As a result, questions regarding the security of sensitive user data are highlighted. To encourage people to move their sensitive health records to cloud networks, a secure authentication and access control mechanism that protects users’ data should be established. Furthermore, authentication and access control schemes are essential in the protection of health data, as numerous responsibilities exist to ensure security and privacy in a network. So, the main goal of our s
... Show MoreThis paper develops a fuzzy multi-objective model for solving aggregate production planning problems that contain multiple products and multiple periods in uncertain environments. We seek to minimize total production cost and total labor cost. We adopted a new method that utilizes a Zimmermans approach to determine the tolerance and aspiration levels. The actual performance of an industrial company was used to prove the feasibility of the proposed model. The proposed model shows that the method is useful, generalizable, and can be applied to APP problems with other parameters.
In this paper, we have examined the effectiveness exchange of optical vorticity via three-wave mixing (TWM) technique in a four-level quantum dot (QD) molecule by means of the electron tunneling effect. Our analytical analysis demonstrates that the TWM procedure can result in the production of a new weak signal beam that may be absorbed or amplified within the QD molecule. We have taken into account the electron tunneling as well as the relative phase of the applied lights to assess the absorption and dispersion characteristics of the newly generated light. We have discovered that the slow light propagation and signal amplification can be achieved. Our results show that the exchange o
Micro-perforated panel (MPP) absorber is increasingly gaining popularity as an alternative sound absorber in buildings compared to the well-known synthetic porous materials. A single MPP has a typical feature of a Helmholtz resonator with a high amplitude of absorption but a narrow absorption frequency bandwidth. To improve the bandwidth, a single MPP can be cascaded with another single MPP to form a double-layer MPP. This paper proposes the introduction of inhomogeneous perforation in the double-layer MPP system (DL-iMPP) to enhance the absorption bandwidth of a double-layer MPP. Mathematical models are proposed using the equivalent electrical circuit model and are validated with experiments with good agreement. It is revealed that the DL-
... Show MoreIncreasing hydrocarbon recovery from tight reservoirs is an essential goal of oil industry in the recent years. Building real dynamic simulation models and selecting and designing suitable development strategies for such reservoirs need basically to construct accurate structural static model construction. The uncertainties in building 3-D reservoir models are a real challenge for such micro to nano pore scale structure. Based on data from 24 wells distributed throughout the Sadi tight formation. An application of building a 3-D static model for a tight limestone oil reservoir in Iraq is presented in this study. The most common uncertainties confronted while building the model were illustrated. Such as accurate estimations of cut-off permeab
... Show More