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 surgery Keywords: 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 Iraqi culture faced a set of challenges that can be diagnosed with the most prominent features as follows:
- The dominance of authoritarian political systems which entails authoritarian regimes with the absence of contemporary political concepts of human rights.
- The prevalence of non- informed cultural systems which have the shortage of capabilities that enable them to activate cultural elements in positive references, historical, or seclusion on itself and not be able to interact with the current active cultures.
- Stagnant economic conditions have not had a decent life for individuals, or a certain level of well-being, as well as poor services and others.
- Social life controlled by the prevai
This paper presents a computer simulation model of a thermally activated roof (TAR) to cool a room using cool water from a wet cooling tower. Modeling was achieved using a simplified 1-D resistance-capacitance thermal network (RC model) for an infinite slab. Heat transfer from the cooling pipe network was treated as 2-D heat flow. Only a limited number of nodes were required to obtain reliable results. The use of 6th order RC-thermal model produced a set of ordinary differential equations that were solved using MATLAB - R2012a. The computer program was written to cover all possible initial conditions, material properties, TAR system geometry and hourly solar radiation. The cool water supply was considered time
... Show MoreThis study investigated a novel application of forward osmosis (FO) for oilfield produced water treatment from the East Baghdad oilfield affiliated to the Midland Oil Company (Iraq). FO is a part of a zero liquid discharge system that consists of oil skimming, coagulation/flocculation, forward osmosis, and crystallization. Treatment of oilfield produced water requires systems that use a sustainable driving force to treat high-ionic-strength wastewater and have the ability to separate a wide range of contaminants. The laboratory-scale system was used to evaluate the performance of a cellulose triacetate hollow fiber CTA-HF membrane for the FO process. In this work, sodium chloride solution was used as a feed solution (FS) with a concentratio
... Show MoreBackground: Health professionals have a crucial role in promotion, support and management of breastfeeding. To be effective in this effort, the clinician should focus on the issue from the preconception stage through pregnancy and delivery, and continue in subsequent infant care. Aim of the study: to assess the effectiveness of the UNICEF/WHO 40-hour of breast feeding training through the assess breastfeeding knowledge and attitudes of the health profession staff before and after training course.
Summary
The subject ( meaning of added verbs) is one of the main subjects
which study in morphology since in Arabic language. It is include the meaning
of each format, and the increased meaning occurred by this increment in the
verbs.
The (strain) is one of very important meaning in this subject, it takes a
wide area of morphology studies, and interesting of scientists and
researchists.
There are two famous formats for this meaning; (infa la انفع
ل ), and (ifta
la افتع
ل ). Also There are another formats for the same meaning, but less than
the first two in use, they are; (taf ala تفعّ
ل ), (tafa ala تفاع
ل ), (taf lala ) ,(تفعل
ل
ifanlala افعنلل ), (ifanla .(
As cultures are mainly divided into collectivistic and individualistic, members tend to emphasize, through communication, either their position as part of their group or their independence from the group. This emphasis is manifested in using the pragmatic concepts of positive politeness and negative politeness. The present study looks into the reflection of these two cultures in Rockstar’s renowned video game, Red Dead Redemption 2 (2018). It aims at identifying the two cultures as present in the game and showing their significance to its narrative. It fills the gap in the studies of language used within video games as well as its cultural reflections. The study addresses the following question: What are the positive and negative
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Nonmissile penetrating traumatic brain injuries (pTBIs) are low-velocity injuries which can be caused by a variety of inflicting tools and represent a rare entity in children. Poor outcome has been attributed with an initial admission Glasgow Coma Scale (GCS) of <5, asymmetrical pupil size, and specific initial computed tomography scan findings including brainstem injury.
We report a case of an 11-year-old boy who presented to our ER with a GCS of 6 after being assaulted on his head by a 30 cm length metallic tent hook penetrating his forehead reaching down to the central skull bas
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A remarkable correlation between chaotic systems and cryptography has been established with sensitivity to initial states, unpredictability, and complex behaviors. In one development, stages of a chaotic stream cipher are applied to a discrete chaotic dynamic system for the generation of pseudorandom bits. Some of these generators are based on 1D chaotic map and others on 2D ones. In the current study, a pseudorandom bit generator (PRBG) based on a new 2D chaotic logistic map is proposed that runs side-by-side and commences from random independent initial states. The structure of the proposed model consists of the three components of a mouse input device, the proposed 2D chaotic system, and an initial permutation (IP) table. Statist
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