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.
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The influence of 5-10 kHz audio frequency on the power dissipation in ac discharge of argon gas was studied experimentally, at pressures 50-80 mTorr and electrodes separation 10 cm (pd range 0.5-0.8 Torr.
cm). The measurements have shown that the discharge behavior in the ac circuit is equivalent to a series RC circuit. It is observed that the variation curve of discharge power P with the frequency f is approximately has a Gaussian shape. It is also observed that the curve of Pm- pd is the inverse of Paschen curve, where Pm is the maximum power in the frequency range. The time of breakdown is estimated from the curve of P- f.
Treatment of a high strength acidic industrial wastewater was attempted by activated carbon
adsorption to evaluate the feasibility of yielding effluents of reusable qualities. The experimental
methods which were employed in this investigation included batch and column studies. The
former was used to evaluate the rate and equilibrium of carbon adsorption, while the latter was
used to determine treatment efficiencies and performance characteristics. Fixed bed and expanded
bed adsorbers were constructed in the column studies. In this study, the adsorption behavior of acetic acid onto activated carbon was examined as a function of the concentration of the adsorbate, contact time and adsorbent dosage. The adsorption data was mo
In this research, the removal of cadmium (Cd) from simulated wastewater was investigated by using a fixed bed bio-electrochemical reactor. The effects of the main controlling factors on the performance of the removal process such as applied cell voltage, initial Cd concentration, pH of the catholyte, and the mesh number of the cathode were investigated. The results showed that the applied cell voltage had the main impact on the removal efficiency of cadmium where increasing the applied voltage led to higher removal efficiency. Meanwhile increasing the applied voltage was found to be given lower current efficiency and higher energy consumption. No significant effect of initial Cd concentration on the removal efficie
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The physician's commitment to medical insight is affected by several factors that vary from patient to patient in terms of the nature of the disease, the severity of the disease, the age of the patient, and the purpose of undergoing medical intervention. There are circumstances surrounding patients that require the physician to reduce the insight towards them, by concealing medical information. The physician must firmly commit to expanding the scope of his vision to a wider extent than in normal medical work. Therefore, we will discuss in this regard the cases in which medical explanation is reduced and the cases that require confirmation in the following order.
This study investigated the cubic intuitionistic fuzzy set of TM-algebra as a generalization of the cubic set. First, a cubic intuitionistic ideal and a cubic intuitionistic T-ideal are defined, followed by a discussion of their properties. Furthermore, the level set of a cubic intuitionistic TM-algebra is defined, and the relationship between a cubic intuitionistic level set and the cubic intuitionistic T-ideal is established. A novel definition of a cubic intuitionistic set under homomorphism is proposed, and several significant results are demonstrated.
Over the past few years, ear biometrics has attracted a lot of attention. It is a trusted biometric for the identification and recognition of humans due to its consistent shape and rich texture variation. The ear presents an attractive solution since it is visible, ear images are easily captured, and the ear structure remains relatively stable over time. In this paper, a comprehensive review of prior research was conducted to establish the efficacy of utilizing ear features for individual identification through the employment of both manually-crafted features and deep-learning approaches. The objective of this model is to present the accuracy rate of person identification systems based on either manually-crafted features such as D
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In this paper a nonlinear adaptive control method is presented for a pH process, which is difficult to control due to the nonlinear and uncertainties. A theoretical and experimental investigation was conducted of the dynamic behavior of neutralization process in a continuous stirred tank reactor (CSTR). The process control was implemented using different control strategies, velocity form of PI control and nonlinear adaptive control. Through simulation studies it has been shown that the estimated parameters are in good agreement with the actual values and that the proposed adaptive controller has excellent tracking and regulation performance.