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 paper develops a fuzzy multi-objective model for solving aggregate production planning problems that contain multiple products and multiple periods in uncertain environments. We seek to minimize total production cost and total labor cost. We adopted a new method that utilizes a Zimmermans approach to determine the tolerance and aspiration levels. The actual performance of an industrial company was used to prove the feasibility of the proposed model. The proposed model shows that the method is useful, generalizable, and can be applied to APP problems with other parameters.
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Micro-perforated panel (MPP) absorber is increasingly gaining popularity as an alternative sound absorber in buildings compared to the well-known synthetic porous materials. A single MPP has a typical feature of a Helmholtz resonator with a high amplitude of absorption but a narrow absorption frequency bandwidth. To improve the bandwidth, a single MPP can be cascaded with another single MPP to form a double-layer MPP. This paper proposes the introduction of inhomogeneous perforation in the double-layer MPP system (DL-iMPP) to enhance the absorption bandwidth of a double-layer MPP. Mathematical models are proposed using the equivalent electrical circuit model and are validated with experiments with good agreement. It is revealed that the DL-
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Increasing hydrocarbon recovery from tight reservoirs is an essential goal of oil industry in the recent years. Building real dynamic simulation models and selecting and designing suitable development strategies for such reservoirs need basically to construct accurate structural static model construction. The uncertainties in building 3-D reservoir models are a real challenge for such micro to nano pore scale structure. Based on data from 24 wells distributed throughout the Sadi tight formation. An application of building a 3-D static model for a tight limestone oil reservoir in Iraq is presented in this study. The most common uncertainties confronted while building the model were illustrated. Such as accurate estimations of cut-off permeab
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Renewable energy resources have become a promissory alternative to overcome the problems related to atmospheric pollution and limited sources of fossil fuel energy. The technologies in the field of renewable energy are used also to improve the ventilation and cooling in buildings by using the solar chimney and heat exchanger. This study addresses the design, construction and testing of a cooling system by using the above two techniques. The aim was to study the effects of weather conditions on the efficiency of this system which was installed in Baghdad for April and May 2020. The common weather in these months is hot in Baghdad. The test room of the design which has a size of 1 m3 was situated to face the geographical south. The te
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William Shakespeare's play Coriolanus explores the journey of power and the transformation of a skilled warrior into a statesman. This paper employs Machiavelli’s framework of pragmatic statecraft to analyse Coriolanus’s tragic failure as a political leader despite his unparalleled prowess as a Roman general. It analyses Coriolanus's political career, revealing how his military skills, while effective in warfare, do not translate into political success. The paper shows that Coriolanus’s contempt for performative politics, refusal to adopt civic diplomacy, and failure to soften aristocratic pride with populist appeal turn plebeians against him and alienate patricians. His upholding of martial honour — fostered by his mother Volumnia
... Show MoreThe study explored applications of artificial intelligence and its dialectical relationship with international human rights law of individuals, which requires assessing the effects of this technology on human rights and freedoms. The problem of privacy of humanity, as AI technologies can control human rights and freedoms, while monitoring potential violations in this context. The study use of documentary research and qualitative lens to analyze the data. In conclusion, unawareness of the use of AI may impose significant hurdles on future generations and may infringe on human rights across all sectors of society. The government should mandate obligations for artificial intelligence businesses concerning education, health, human right
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