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.
Dicephalus parapagus twinning (DPT) is the rarest conjoined twinning entity of all conjoined twins. The presence of DPT is always associated with mortality before or after delivery. Antenatal diagnosis is crucial for planning labor, assembling a team, and providing counseling. Case presentation: A 23-year-old patient (G2P1A0) at 21 weeks of pregnancy attended the ultrasound clinic for routine care. A monoamniotic-monochorionic pregnancy was observed; the twin fetuses had two heads but one body, which corresponded to dicephalus parapagus twinning. A detailed ultrasound and fetal echocardiography reveal one heart without congenital anomalies. The liver, kidneys, and bladder appeared to be normally developed. Fetal MRI and karyotyping wer
... Show MoreA remarkable correlation between chaotic systems and cryptography has been established with sensitivity to initial states, unpredictability, and complex behaviors. In one development, stages of a chaotic stream cipher are applied to a discrete chaotic dynamic system for the generation of pseudorandom bits. Some of these generators are based on 1D chaotic map and others on 2D ones. In the current study, a pseudorandom bit generator (PRBG) based on a new 2D chaotic logistic map is proposed that runs side-by-side and commences from random independent initial states. The structure of the proposed model consists of the three components of a mouse input device, the proposed 2D chaotic system, and an initial permutation (IP) table. Statist
... Show MoreThe importance of this study lies in shedding the light on the impact of Islam and Prophet Mohammed (peace be upon him) on the western culture and English literature in particular. While some writers were looking at Islam as a dangerous element, others were completely taken by the oriental spirit of Arabic and Islamic culture and glorifying it. Writers from Chaucer to later ones mostly make references to this impact showing how vast was the gap of misunderstanding between the east and the West. Thus, this study aims at breaking the barrier between East and West in its three sections as it introduces the meaning of Islam and its common features with other religions in the first section. The second section briefly presents writers’ reflecti
... Show MoreIn this paper, some commonly used hierarchical cluster techniques have been compared. A comparison was made between the agglomerative hierarchical clustering technique and the k-means technique, which includes the k-mean technique, the variant K-means technique, and the bisecting K-means, although the hierarchical cluster technique is considered to be one of the best clustering methods. It has a limited usage due to the time complexity. The results, which are calculated based on the analysis of the characteristics of the cluster algorithms and the nature of the data, showed that the bisecting K-means technique is the best compared to the rest of the other methods used.
This work has been accomplished through a dense field work on the Sawa Lake. The aim of this work is to highlight on characteristics that are consistent with outstanding universal values to be a new Iraqi site belongs to the World Natural Heritage. This study sorted many unique characteristics might ensure that Sawa Lake as a world natural heritage sites. This study shows that the lake had met four natural criteria of the outstanding universal values: (1) the seventh criterion which states to contain superlative natural phenomena or areas of exceptional natural beauty and aesthetic importance. (2) The eighth criterion which stated to be outstanding example representing major stages of earth's history, including the rec
... Show MoreMedia studies have focused mostly on the issue of the mental image because the image that is formed in the mind has become not only a photo of a human being and having kept for himself. This image has an outside influence which may sometimes up to the formation of the fate of others and it sometimes includes individuals and groups together.
This study comes in the context of identifying the image of Iraqi political parties among Iraqi university students and the nature of the view that students have in their minds about these parties.
Chapter one includes the problem of the research, the importance of the study, the goals and method used. Chapter two is divided into two sections: section one deals with the concept of the mental i