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.
This study aims to develop a recommendation engine methodology to enhance the model’s effectiveness and efficiency. The proposed model is commonly used to assign or propose a limited number of developers with the required skills and expertise to address and resolve a bug report. Managing collections within bug repositories is the responsibility of software engineers in addressing specific defects. Identifying the optimal allocation of personnel to activities is challenging when dealing with software defects, which necessitates a substantial workforce of developers. Analyzing new scientific methodologies to enhance comprehension of the results is the purpose of this analysis. Additionally, developer priorities were discussed, especially th
... Show MorePraise be to God, Lord of the Worlds, and prayers and peace be upon the Master of Messengers, Muhammad and his family
The good and pure and after his companions
God Almighty said: ( ) Do they not contemplate the Qur’an? If it had been from other than God, they would have found in it much discrepancy. God Almighty has made the well-being of people and their lives linked to faith in it. So what is the need of people today to return to the Book of their Lord so that they may return to the right path that God intended for His servants so that they may attain sustenance? Security and the good life. How could it not be, when many of the nations of the world no longer see security or stability because their leaders and politic
... Show MoreAccording to the prevalence of multidrug resistance bacteria, especially Pseudomonas aeruginosa, in which the essential mechanism of drug resistance is the ability to possess an efflux pump by which extrusion of antimicrobial agents usually occurs, this study aims to detect the presence of mexB multidrug efflux gene in some local isolates of this bacteria that show resistance towards three antibiotics, out of five. Sensitivity test to antibiotics was performed on all isolates by using meropenem (10μg/disc), imipenem (10μg/disc), amikacin (30 μg/disc), ciprofloxacin (5μg/disc) and ceftazidime (30 μg/disc). Conventional PCR results showed the presence of mexB gene (244bp) in four isolates out of ten (40%). In addition,25, 50μg/ml of cur
... Show MoreDiyala river is the most important tributaries in Iraq, this river suffering from pollution, therefore, this research aimed to predict organic pollutants that represented by biological oxygen demand BOD, and inorganic pollutants that represented by total dissolved solids TDS for Diyala river in Iraq, the data used in this research were collected for the period from 2011-2016 for the last station in the river known as D17, before the river meeting Tigris river in Baghdad city. Analysis Neural Network ANN was used in order to find the mathematical models, the parameters used to predict BOD were seven parameters EC, Alk, Cl, K, TH, NO3, DO, after removing the less importance parameters. While the parameters that used to predict TDS were fourte
... Show MoreIn this paper, the density of state (DOS) at Fe metal contact to Titanium dioxide semiconductor (TiO2) has been studied and investigated using quantum consideration approaches. The study and calculations of (DOS) depended on the orientation and driving energies. was a function of TiO2 and Fe materials' refractive index and dielectric constant. Attention has focused on the effect of on the characteristic of (DOS), which increased with the increasing of refractive index and dielectric constant of Fe metal and vice versa. The results of (DOS) and its relation with and values of system have been discussed. As for contact system is increased, (DOS) values increased at first, but the relation is disturbed later and transforms into an inve
... Show MoreThe present study aimed to identify the availability of the National Council of Teachers of Mathematics (NCTM) standards in the content of mathematics textbooks at the basic education stage in the Sultanate of Oman. The study used the descriptive-analytical approach, adopting the method of content analysis through using a content analysis tool that included (43) indicators distributed on the four NCTM standards related to the field of geometry, after verifying their validity and reliability. The study population consisted of mathematics textbooks (first and second semesters) for ninth-grade students in the Sultanate of Oman in the academic year 2018/2019, while the sample consisted of Geometry units in the content of those books, which a
... Show MoreThis paper presents seven modified Adomian Decomposition Method (ADM) techniques for efficiently solving initial value problems, especially those involving non-homogeneous and nonlinear differential equations. While the classical ADM is effective for linear homogeneous cases, it has difficulties solving more complex problems. The proposed modifications—from MADM1 to MLADM—include Maclaurin and Taylor expansions, Laplace transforms, and single-step iterations.• These modifications enhance convergence, reduce complexity, and improve accuracy.• Each method offers specific advantages, such as accelerating convergence (MADM2, RADM4), simplifying computation (TSADM5), and achieving higher accuracy (MLADM).• Numerical examples confirm th
... Show MoreIn recent years, the positioning applications of Internet-of-Things (IoT) based systems have grown increasingly popular, and are found to be useful in tracking the daily activities of children, the elderly and vehicle tracking. It can be argued that the data obtained from GPS based systems may contain error, hence taking these factors into account, the proposed method for this study is based on the application of IoT-based positioning and the replacement of using IoT instead of GPS. This cannot, however, be a reason for not using the GPS, and in order to enhance the reliability, a parallel combination of the modern system and traditional methods simultaneously can be applied. Although GPS signals can only be accessed in open spaces, GP
... Show MoreThis book includes three main chapters: 1. Functions & Their Derivatives. 2. Minimum, Maximum and Inflection points. 3. Partial Derivative. In addition to many examples and exercises for the purpose of acquiring the student's ability to think correctly in solving mathematical questions.
Many of the signs that the global energy system indicate the start of a period of transition from total dependence on fossil energy sources, especially oil, into a new era in which alternative energy sources play an important role in meeting the growing needs of energy demand, so sought many of the developed countries through research the studies carried out to try to bring renewable energy sources and non-renewable (shale oil, oil sands, solar energy, wind energy .... etc) replace traditional fossil energy sources (oil, gas, coal) and despite the recent availability dramatically and spread throughout the the world, but they are going to dry up in the foreseeable future. So many countries, especially the developed sought to find
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