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 health care industry is witnessing an increasing trend in the use of generic medicines because of their presumed low cost compared with innovator medicines. The aim of this study was to determine and compare the performance of the copy drug Osveral®and its innovator drug deferasirox (Exjade®).
A prospective observational study including 223 patients receiving the branded medicine Exjade®and 101 patients receiving the copy Osveral®was carried out. Data were assessed for a 1-year period and included clinical symptoms, serum ferrit
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The effects of T-shaped fins on the improvement of phase change materials (PCM) melting are numerically investigated in vertical triple-tube storage containment. The PCM is held in the middle pipe of a triple-pipe heat exchanger while the heat transfer fluid flows through the internal and external pipes. The dimension effects of the T-shaped fins on the melting process of the PCM are investigated to determine the optimum case. Results indicate that while using T-shaped fins improves the melting performance of the PCM, the improvement potential is mainly governed by the fin’s body rather than the head. Hence, the proposed T-shaped fin did not noticeably improve melting at the bottom of the PCM domain; additionally, a flat fin is ad
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Catalytic wet air oxidation of aqueous phenol solution was studied in a pilot plant trickle bed reactor using copper
oxide catalyst supported on alumina and silica. Catalysts were prepared by impregnating method. Effect of feed solution
pH (5.9, 7.3, and 9.2), gas flow rate (20%, 50%, 80%, and 100%), WHSV (1, 2, and 3 h-1), temperature (120°C, 140°C,
and 160°C), oxygen partial pressure (6, 9, 12 bar), and initial phenol concentration (1, 2, and 4 g/l).Generally, the
performance of the catalysts was better when the pH of feed solution was increased. The catalysts deactivation is related
to the dissolution of the metal oxides from the catalyst surface due to the acidic conditions. Phenol oxidation reaction
was strongly
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In order to reduce the environmental pollution associated with the conventional energy sources and to achieve the increased global energy demand, alterative and renewable sustainable energy sources need to be developed. Microbial fuel cells (MFCs) represent a bio-electrochemical innovative technology for pollution control and a simultaneous sustainable energy production from biodegradable, reduced compounds. This study mainly considers the performance of continuous up flow dual-chambers MFC
fueled with actual domestic wastewater and bio-catalyzed with anaerobic aged sludge obtained from an aged septic tank. The performance of MFCs was mainly evaluated in terms of COD reductions and electrical power output. Results revealed that the C
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The study aimed to identify the treatment of the press image of the Great Return Marches in the French international news agency AFP by knowing the most important issues, their direction and the degree of interest in them. The study belongs to the descriptive research, and used the survey method, within the context of the content analysis method, and the researcher relied on the content analysis form tool and the interview tool to collect data. The study population is represented in the photos published by the French News Agency about the Great Return Marches during the period (end of March / 2018 until the end of November / 2019. The researcher chose an intentional sample using the Complete Census method. The study material represented
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The Arabic pronouns received a lot of attention from the ancient Arab grammarians, so they explained their origins, the different forms of their structure, and the aspects of the Arabs’ use of them, and explained the aspects and reasons for these uses, with what they had of linguistic insight, which guided them to clarify the truth of these pronouns.
And recently, this research seeks new knowledge of the development of the structure of the nominative pronouns (he), (she), (them), (taa), and (waw) between dialects and towards classical Arabic, by analyzing the structure of these pronouns into their components. Its linguistic formulas are traced from the ancient Arabic texts, and by ancient I mean the texts of the era of linguistic ci