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 prevalence of gastrointestinal symptoms of COVID-19 is variable with different types of presentations. Some of them many present with manifestations mimicking surgical emergencies. Yet, the pathophysiology of acute abdomen in the context of COVID-19 remains unclear. We present a case of a previously healthy child who presented with acute appendicitis with multisystemic inflammatory syndrome. We also highlight the necessity of considering the gastrointestinal symptoms of COVID-19 infection in pediatric patients in order to avoid misdiagnosis and further complications. |
Abstract
The study discussed three areas in strategic thinking, namely, (patterns elements, outcomes) , this study aimed to measure extent to which strategic leaders have the type or types of patterns of strategic thinking, and measure the extent of their use of the elements of strategic thinking, and measurement of strategic thinking outcomes for managers at various levels , And to know the relationship between the modes of strategic thinking, elements and outcomes in organizations. the study included five banks and four hospitals and four colleges and universities, has been a research sample consisted of 168 individuals, distributed in positions (Director General , Director of Directorate , Director of
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Background: Considering the antioxidant, anti-inflammatory, and antimicrobial properties of green tea, this study aimed to evaluate the histopathological effect of the sulcular irrigation of green tea extract in the treatment of experimental gingivitis in rabbit.
Materials and methods: For this experimental study, 45 male rabbits, separated in two groups, control non- irrigated group (5rabbits) and study group (40 rabbits), gingivitis induced by ligatures was packed subgingivally in the lower right central incisors of the experimental group for seven days. Then, the animals were randomly designated to two irrigated groups (20 rabbits
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In this research tri metal oxides were fabricated by simple chemical spray pyrolysis technique from (Sn(NO3)2.20 H2O, Zn(NO3)2.6 H2O, Cd(NO3)2.4 H2O) salts at concentration 0.1M with mixing weight ratio 50:50 were fabricated on silicon substrate n-type (111). (with & without the presence of grooves by the following diemensions (20μm width, 7.5μm depth) with thickness was about ( 0.1 ±0.05 µm) using water soluble as precursors at a substrate temperature 550 ºC±5, with spray distance (15 cm) and their gas sensing properties toward H2S gas at different concentrations (10,50,100,500 ppmv) in air were investigated at room te
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This paper deals the prediction of the process of random spatial data of two properties, the first is called Primary variables and the second is called secondary variables , the method that were used in the prediction process for this type of data is technique Co-kriging , the method is usually used when the number of primary variables meant to predict for one of its elements is measured in a particular location a few (because of the cost or difficulty of obtaining them) compare with secondary variable which is the number of elements are available and highly correlated with primary variables, as was the&nbs
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Silica-based mesoporous materials are a class of porous materials with unique characteristics such as ordered pore structure, large surface area, and large pore volume. This review covers the different types of porous material (zeolite and mesoporous) and the physical properties of mesoporous materials that make them valuable in industry. Mesoporous materials can be divided into two groups: silica-based mesoporous materials and non-silica-based mesoporous materials. The most well-known family of silica-based mesoporous materials is the Mesoporous Molecular Sieves family, which attracts attention because of its beneficial properties. The family includes three members that are differentiated based on their pore arrangement. In this review,
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Mental disorders (MDs) are a common problem in Primary Health Care Centers (PHCCs). Many people with serious MDs are challenged by symptoms and disabilities that result from the disease and by stereotypes and prejudice due to misconceptions about mental illness. This study aims at evaluating the knowledge, and attitude toward mental health concepts and services and causes of the reluctance to seek those services among people attending PHCCs. A descriptive cross-sectional study was conducted. The random sampling technique was used to include (10) of Directorates of Health (DoHs) coverage north, middle, and south of Iraq. The study was executed in (50) selected PHCs, (5) PHCCs in each DoH involved randomly selected (30) people attending th
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