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 covid-19 pandemic sweeping the world and has rendered a large proportion of the workforce as they are unable to commute to work. This has resulted in employees and employers seeking alternative work arrangements, including the software industry. Then comes the need for the global market and international presence of many companies to implement the global virtual teams (GVTs). GVTs members are gradually engaged in globalized business environments across space, time and organizational boundaries via information and communication technologies. Despite the advancement of technology, the project managers are still facing many challenges in communication. Hense, to become a successful project manager still a big challenge for them. This study
... Show MoreThe total and individual multipole moments of magnetic electron scattering form factors in 41Ca have been investigated using a widely successful model which is the nuclear shell model configurations keeping in mind of 1f7/2 subshell as an L-S shell and Millinar, Baymann, Zamick as L-S shell (F7MBZ) to give the model space wave vector. Also, harmonic oscillator wave functions have been used as wave function of a single particle in 1f7/2 shell. Nucleus 40Ca as core closed and Core polarization effects have been used as a corrective with first order correction concept to basic computation of L-S shell and the excitement energy has been implemented with 2ћω. The
... Show MoreThis work evaluates the influence of combining twisted fins in a triple-tube heat exchanger utilised for latent heat thermal energy storage (LHTES) in three-dimensional numerical simulation and comparing the outcome with the cases of the straight fins and no fins. The phase change material (PCM) is in the annulus between the inner and the outer tube, these tubes include a cold fluid that flows in the counter current path, to solidify the PCM and release the heat storage energy. The performance of the unit was assessed based on the liquid fraction and temperature profiles as well as solidification and the energy storage rate. This study aims to find suitable and efficient fins number and the optimum values of the Re and the inlet tem
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Cysteine-cysteine chemokine ligand 5 (CCL5) is known to play an important role with immunoregulatory and inflammatory activities in the formation of granuloma during infection with Mycobacterium tuberculosis. About 90 subjects, involving 50 patients with pulmonary TB and 40 apparently healthy individuals (as a control group) were collected from primary health care center\AL-Sadur city sector/ Baghdad City/ Iraq, and at specialized chest and respiratory diseases center in Wassit City /Iraq during the period from January 2019 to May 2019. The study was carried out to investigate serum level of CCL-5 of both patients and control by using enzyme linked immunosorbent assay (ELISA), and to determine the association between CCL5 genotypes with pul
... Show MoreDespite the global economic downturn, online e-commerce, especially the sale of counterfeit goods, continues to witness a rise in sales, and one of the important players in e-commerce is the owners of e-commerce auction sites. Although they do not have a direct role in trademark infringement, they still consider them indirectly responsible (secondary liability) for infringing on their trademarks. Thus, many cases have been filed by the owners of the original trademarks (which have been infringed by persons who have sold some of the goods and products that are imitating their marks through some electronic auctions) against the owners of those auctions. In view of the international character of the Internet, in different countries, and despit
... Show MoreKE Sharquie, KI Al-Hamdi, AA Noaimi, AA Al-Mohammadi, J Clin Exp Invest www. clinexpinvest. org Vol, 2011 - Cited by 1
Intrusion detection system is an imperative role in increasing security and decreasing the harm of the computer security system and information system when using of network. It observes different events in a network or system to decide occurring an intrusion or not and it is used to make strategic decision, security purposes and analyzing directions. This paper describes host based intrusion detection system architecture for DDoS attack, which intelligently detects the intrusion periodically and dynamically by evaluating the intruder group respective to the present node with its neighbors. We analyze a dependable dataset named CICIDS 2017 that contains benign and DDoS attack network flows, which meets certifiable criteria and is ope
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