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.
The aim of the research is to identify the extent of the direct and indirect relationship of the population growth of the cities as a result of the urbanization process witnessed by the Arab region for the urban development of the city structures and their formative structures, changing the planning criteria of some cities and the extent of their changes in spatial and temporal dimensions and their relation to the standards of the western cities. In changing the concept of the modern Arab city, such as the emergence of new functional uses affecting the change in the pattern of formal formations of its urban fabric associated with its ancient morphology and distinctive human nature. The research seeks to identify the extent to which plann
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XML is being incorporated into the foundation of E-business data applications. This paper addresses the problem of the freeform information that stored in any organization and how XML with using this new approach will make the operation of the search very efficient and time consuming. This paper introduces new solution and methodology that has been developed to capture and manage such unstructured freeform information (multi information) depending on the use of XML schema technologies, neural network idea and object oriented relational database, in order to provide a practical solution for efficiently management multi freeform information system.
The problem of the paper focused on the role of the learning organization in the crisis management strategy, and the extent of the actual interest in both the learning organization and the crisis management and aimed at diagnosing and analyzing that and surrounding questions. The Statistical Package for the Social Sciences (SPSS) program was used to calculate the results and the correlation coefficient between the two main variables. The methodology was descriptive and analytical. The case study was followed by a questionnaire that was distributed to a sample of 31 teachers. The paper adopted a seven-dimensional model of systemic thinking that encourages questioning, empowerment, provision of advanced technologies, and strategic lea
... Show MoreA revised checklist of the robber fly genera (Diptera, Asilidae) was given during this study in Iraq. The investigation showed (21) genera belonging to seven subfamilies, two genera new recorded to entomofauna of Iraq (Promachus Loew, 1848 and Genus: Dysmacus Loew, 1860). Eight genera showed in this investigation and eleven genera were recorded previously to Iraq.
It is certain that marriage has the favor of the continuity of human kind since the Prophet Adam till now. But this important event is threatened by some justifications which lead to its delay or abandonment. In the West, sexual relations, illegal friendships, and disrespect of marriage sacredness lead to this delay. While the reasons behind the delay of marriage in the Arab world refer to high dowries, women go out to work, and the religious and scientific ignorance of the need and importance of marriage. The problem also differs according to the difference between the rural and urban regions. On one hand, we find that early marriage is a necessity in the rural regions; on the other hand, the delay of marriage is a clear and nat
... Show MorePurpose A diagnosis of tuberculosis (TB) of the head and neck has been a dilemma for clinicians, because the clinical and pathologic features tend to mimic different pathologies. Our study aimed to identify the demographic, clinical, and pathologic features of head and neck TB to help healthcare providers in the early detection of the disease. Materials and Methods We performed a retrospective analysis using the medical archives at the pathology laboratory. Twenty-one patients with a clinical and pathologic diagnosis of head and neck TB were identified from 2010 to 2019. Results The age distribution was broad, with 28.5% of the patients younger than 15 years old. Seven patients had oral TB, with the most common sites affected the labial ves
... Show MoreThis paper examines the change in planning pattern In Lebanon, which relies on vehicles as a semi-single mode of transport, and directing it towards re-shaping the city and introducing concepts of "smooth or flexible" mobility in its schemes; the concept of a "compact city" with an infrastructure based on a flexible mobility culture. Taking into consideration environmental, economical and health risks of the existing model, the paper focuses on the four foundations of the concepts of "city based on culture flexible mobility, "and provides a SWOT analysis to encourage for a shift in the planning methodology.
The heat exchanger is a device used to transfer heat energy between two fluids, hot and cold. In this work, an output feedback adaptive sliding mode controller is designed to control the temperature of the outlet cold water for plate heat exchanger. The measurement of the outlet cold temperature is the only information required. Hence, a sliding mode differentiator was designed to estimate the time derivative of outlet hot water temperature, which it is needed for constructing a sliding variable. The discontinuous gain value of the sliding mode controller is adapted according to a certain adaptation law. Two constraints which imposed on the volumetric flow rate of outlet cold (control input) were considered within the rules of the proposed
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