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.
Rehabilitation robotics has developed into an interdisciplinary field which uses mechanical design and control theory and optimization techniques together with information technologies to create better recovery results for people who suffer from motor disabilities. The present review assesses rehabilitation robotics research through engineering application studies which use more than 120 peer-reviewed articles published between 2014 and 2024. The discussion covers four main areas which include control strategies that start from basic PID methods and extend to sophisticated adaptive and intelligent control systems. The study utilizes bio-inspired and metaheuristic optimization methods to enhance system functionality and develop control paths
... Show MoreThe dangerous and potentially blinding condition known as Acanthamoeba keratitis is caused by free-living amoebae of the genus Acanthamoeba. The prevalence of AIDS patients and contact lens wearers has increased in recent years, making cannaeba infections more significant. It's interesting to note that, depending on the parasite, host, and environmental conditions, the pathways linked to Acanthamoeba pathogenesis are frequently extremely complex. Notwithstanding our progress in antibiotic therapy and supportive care, the prevalence of Acanthamoeba keratitis has not decreased
Bombay (Oh) and Para-Bombay are rare variants of the ABO blood group system that carry significant clinical importance. They are characterized by the absence or a marked reduction in the expression of the H antigen on red blood cells (RBCs). This deficiency leads to a failure in the synthesis of A and B antigens, predisposing patients—particularly those with the Bombay phenotype—to developing potent anti-H antibodies, which can cause severe hemolytic transfusion reactions. Objective: The primary goal is to provide clinicians and laboratory specialists with a practical and comprehensive framework to prevent avoidable blood mismatch and improve clinical outcomes for patients suffering from H-deficient phenotypes. Methods: This rev
... Show MoreSome genetic factors are not only involved in some autoimmune diseases but also interfere with their treatment, Such as Crohn's disease (CD), Rheumatoid Arthritis (RA), ankylosing spondylitis (AS), and psoriasis (PS). Tumor Necrosis Factor (TNF) is a most important pro-inflammatory cytokine, which has been recognized as a main factor that participates in the pathogenesis and development of autoimmune disorders. Therefore, TNF could be a prospective target for treating these disorders, and many anti-TNF were developed to treat these disorders. Although the high efficacy of many anti-TNF biologic medications, the Patients' clinical responses to the autoimmune treatment showed significant heterogeneity. Two types of TNF receptor (TNFR); 1 an
... Show MoreNeurogenic inflammation is pivotal in dental pulp repair, involving complex interactions between sensory nerves, immune cells, and dental pulp stem cells (DPSCs). This review aimed to identify the favorable pathways of neurogenic inflammation and neurogenic differentiation of DPSCs in the pulpal healing process. Also, to identify the techniques used to evaluate these inflammatory and differentiation processes. Both PubMed and Google Scholar databases were employed in the search strategy using keyword combinations based on MeSH terms. The search was performed for published articles in English from January 2014 to November 2024, including studies with histological and molecular findings. 29 articles only met the inclusion criteria. Neurogenic
... Show MoreMulti-belled piles are piles with enlarged ends; these piles have one or further bells at the lower third part of the pile. These piles are suitable for many soils with problems such as softening clay, the variation of groundwater table, expansive soils, black cotton soil, and loose sand. The current study reviewed the behavior of belled piles in multi-layer soils subjected to axial compression and pullout loading. The review covered the experimental and theoretical works on belled piles in multi-layered soils. These piles were subjected to static and dynamic loadings in compression and pullout cases. Most theoretical results focused on software such as PLAXIS 3D. The axial load applied on the piles comes from the upper
... Show MoreThe process of coordination and joint cooperation between SAIs and internal auditors in the public sector is considered one of the very important matters in performing efficient audits and are of high quality, especially if this coordination and cooperation is implemented in accordance with international standards, as it leads to avoiding duplication in auditing work. And the distribution of work in a distribution that achieves the objectives of auditing in general and is of general benefit to the economic unit.
The research problem lies in the weakness of the relationship between internal auditing and external auditing as a result of not applying INTOSAI Standard (9150) coordination and joint cooperation
... Show MoreHealth and safety problem can be described by statistics it can only be understood by knowing and feeling the pain, suffering, and depression. Health and safety has a legal responsibility to protect it for everyone who can affect in the workplace. This includes manufacturers, suppliers, designers and controllers of work places and employees. Work injury is one of the major problems in manufacturing and production systems industries; it is reduced production efficiency and affects the cost. To gain flexibility from a traditional manufacturing system and production efficiency, this paper is about the application of estimating technology to preview and synthesis of Lost Time of Work Injuries in industry systems aims to provide a safe workin
... Show More