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.
Background: A carefully planned clinical medical education is critical for the provision of supportive clinical educational environment. The latter will ensure effective teaching, active learning and good attitudes and performance at the bedside. The aim of this study was to evaluate clinical learning environment at AL-Diwaniyah Teaching Hospital. Materials and Methods: A descripitive cross-sectional study involved resident doctors from Internal Medicine and Surgery departments who had six months or more residency training in the respective departments. Data were collected using the Postgraduate Hospital Educational Environment Measure. Data where analyzed using the Statistical Package for Social Sciences version 21.0 and presented us
... Show MoreThe application of physiological oxygen (physoxia) concentrations is becoming increasingly commonplace within a mammalian stem cell culture. Human mesenchymal stem cells (hMSCs) attract widespread interest for clinical application due to their unique immunomodulatory, multi-lineage potential, and regenerative capacities. Descriptions of the impact of physoxia on global DNA methylation patterns in hMSCs and the activity of enzymatic machinery responsible for its regulation remain limited. Human bone marrow-derived mesenchymal stem cells (BM-hMSCs, passage 1) isolated in reduced oxygen conditions displayed an upregulation of SOX2 in reduced oxygen conditions vs. air oxygen (21% O2, AO), while no change was noted for either OCT-4 or NA
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The growth of developments in machine learning, the image processing methods along with availability of the medical imaging data are taking a big increase in the utilization of machine learning strategies in the medical area. The utilization of neural networks, mainly, in recent days, the convolutional neural networks (CNN), have powerful descriptors for computer added diagnosis systems. Even so, there are several issues when work with medical images in which many of medical images possess a low-quality noise-to-signal (NSR) ratio compared to scenes obtained with a digital camera, that generally qualified a confusingly low spatial resolution and tends to make the contrast between different tissues of body are very low and it difficult to co
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Rheumatoid arthritis is a chronic systemic inflammatory disease. Inflammation leads to joint damage and increases the risk of cardiovascular diseases. Neutrophil lymphocyte ratio (NLR) is a measure of inflammation in many diseases. Therefore, we aimed to evaluate the usefulness of NLR to detect inflammation in RA, and its correlation to RA disease activity indices and some hematological parameters. A cross-sectional study involving 24 patients with active rheumatoid arthritis (RA) who are using MTX participated in this study. All patients were clinically evaluated using disease activity score of 28 joints (DAS28) and simplified disease activity index (SDAI), whereas functional disability was assessed by health assessment questionnaire di
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The Ottomans ruled Turkey for nearly six centuries, during which the Ottoman Empire passed through varying periods in terms of strength, influence, and the area of land they ruled. In the last decade of its rule, the Ottoman Empire was severely weakened in all political, military, administrative and economic aspects. In addition to the internal strife that was stirred up by the leaders of the Association (Union and Progression), that organization that led the coup movement against the Ottoman Empire later.
After the abolition of the Sultanate and the proclamation of the Turkish Republic, the social fabric in Turkey changed, and many customs and traditions alien to it emerged to society. One of the thing
... Show MoreOBJECTIVE: To evaluate the patient satisfaction to hospital services and identify factors that influences this satisfaction.
A medical- service platform is a mobile application through which patients are provided with doctor’s diagnoses based on information gleaned from medical images. The content of these diagnostic results must not be illegitimately altered during transmission and must be returned to the correct patient. In this paper, we present a solution to these problems using blind, reversible, and fragile watermarking based on authentication of the host image. In our proposed algorithm, the binary version of the Bose_Chaudhuri_Hocquengham (BCH) code for patient medical report (PMR) and binary patient medical image (PMI) after fuzzy exclusive or (F-XoR) are used to produce the patient's unique mark using secret sharing schema (SSS). The patient’s un
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