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.
It is well known that the spread of cancer or tumor growth increases in polluted environments. In this paper, the dynamic behavior of the cancer model in the polluted environment is studied taking into consideration the delay in clearance of the environment from their contamination. The set of differential equations that simulates this epidemic model is formulated. The existence, uniqueness, and the bound of the solution are discussed. The local and global stability conditions of disease-free and endemic equilibrium points are investigated. The occurrence of the Hopf bifurcation around the endemic equilibrium point is proved. The stability and direction of the periodic dynamics are studied. Finally, the paper is ended with a numerical simul
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In this paper, previous studies about Fuzzy regression had been presented. The fuzzy regression is a generalization of the traditional regression model that formulates a fuzzy environment's relationship to independent and dependent variables. All this can be introduced by non-parametric model, as well as a semi-parametric model. Moreover, results obtained from the previous studies and their conclusions were put forward in this context. So, we suggest a novel method of estimation via new weights instead of the old weights and introduce
Paper Type: Review article.
another suggestion based on artificial neural networks.
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It is proposed and studied a prey-predator system with a Holling type II functional response that merges predation fear with a predator-dependent prey's refuge. Understanding the impact of fear and refuge on the system's dynamic behavior is one of the objectives. All conceivable steady-states are investigated for their stability. The persistence condition of the system has been established. Local bifurcation analysis is performed in the Sotomayor sense. Extensive numerical simulation with varied parameters was used to explore the system's global dynamics. A limit cycle and a point attractor are the two types of attractors in the system. It's also interesting to note that the system exhibits bi-stability between these 2 types of attractors.
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Today in the digital realm, where images constitute the massive resource of the social media base but unfortunately suffer from two issues of size and transmission, compression is the ideal solution. Pixel base techniques are one of the modern spatially optimized modeling techniques of deterministic and probabilistic bases that imply mean, index, and residual. This paper introduces adaptive pixel-based coding techniques for the probabilistic part of a lossy scheme by incorporating the MMSA of the C321 base along with the utilization of the deterministic part losslessly. The tested results achieved higher size reduction performance compared to the traditional pixel-based techniques and the standard JPEG by about 40% and 50%,
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This research takes up address the practical side by taking case studies for construction projects that include the various Iraqi governorates, as it includes conducting a field survey to identify the impact of parametric costs on construction projects and compare them with what was reached during the analysis and the extent of their validity and accuracy, as well as adopting the approach of personal interviews to know the reality of the state of construction projects. The results showed, after comparing field data and its measurement in construction projects for the sectors (public and private), the correlation between the expected and actual cost change was (97.8%), and this means that the data can be adopted in the re
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Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease that affects 43.7 per 100,000 people worldwide, most commonly presenting in childbearing years. SLE pregnancies are complicated by cardiovascular events in up to 7.8% of cases, which translates to a 3.2- to 31.5-fold increase in severe maternal morbidity and a seven-fold increase in maternal mortality, compared to the general obstetric population. The highest risk is reported in cases with concurrent lupus nephritis or antiphospholipid syndrome [1]. These complications are not surprisingly seen; they are the end result of endothelial dysfunction, immune aberration, and placental dysfunction that precedes clinical decompensation by weeks [2,3].The current approach in mana
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