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.
The current research is concerned with studying the decisive answers which are considered quick and conclusive. These answers can effectively interrupt the opponent's argument and close the dialogue.This research is concentrated on deliberative methodology focusing on the decisive answer's activity and ending them through several completing and argument sides. This research consists of an introduction and three parts, the current introduction is focused the light on the concept of decisive answers and its uses in literature and the scarce of speech, and how to consider it with one dialogue description,that dialogue constitute by ? The first part is concerned with those answers through the deliberative methodology and classifying decisive
... Show MoreAn indoor spraying robot is built in this research to solve numerous challenges associated with manual spraying. The mechanical, hardware and essential technologies used are all detailed and designed. The proposed spraying robot's conceptual design is split into two parts: hardware and software. The mechanical design, manufacturing, electrical, and electronics systems are described in the hardware part, while the control of the robot is described in the software section. This robot's kinematic and dynamic models were developed using three links that move in the x, y, and z directions. The robot was then designed using SolidWorks software to compute each connection's deflection and maximum stresses. The characteristics of the stepper moto
... Show MoreIn the present paper, discuss the concept of fuzzy topological spectrum of a bounded commutative KU-algebra and study some of the characteristics of this topology. Also, we show that the fuzzy topological spectrum of this structure is compact and T1 -space.
Several Intrusion Detection Systems (IDS) have been proposed in the current decade. Most datasets which associate with intrusion detection dataset suffer from an imbalance class problem. This problem limits the performance of classifier for minority classes. This paper has presented a novel class imbalance processing technology for large scale multiclass dataset, referred to as BMCD. Our algorithm is based on adapting the Synthetic Minority Over-Sampling Technique (SMOTE) with multiclass dataset to improve the detection rate of minority classes while ensuring efficiency. In this work we have been combined five individual CICIDS2017 dataset to create one multiclass dataset which contains several types of attacks. To prove the eff
... Show More: Sound forecasts are essential elements of planning, especially for dealing with seasonality, sudden changes in demand levels, strikes, large fluctuations in the economy, and price-cutting manoeuvres for competition. Forecasting can help decision maker to manage these problems by identifying which technologies are appropriate for their needs. The proposal forecasting model is utilized to extract the trend and cyclical component individually through developing the Hodrick–Prescott filter technique. Then, the fit models of these two real components are estimated to predict the future behaviour of electricity peak load. Accordingly, the optimal model obtained to fit the periodic component is estimated using spectrum analysis and Fourier mod
... Show MoreProverbs are considered as a major source of ancient events and happenings. Similar to other past events related to life, proverbs have many important and famous values in people's life. This study will shed lights on the use of proverbs as short sentences based on long experiences. The aim of the study is to explicate the roles, and the importance of proverbs in our life and how they are used to convey thoughts to people throughout simple words with denotation. Thus, proverbs explicate the truth and experience of our grandfathers when directed for criticism. Few proverbs were used by writers to criticize, mimic and reprint their personalities. Hence, proverbs will achieve portions of the unique roles of understanding. The model to
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Debate is a teaching strategy in nursing education that enhances students' critical thinking. Although debate can be an effective teaching strategy, it is not without limitations. This article discusses the advantages and disadvantages of debate as a teaching strategy in nursing. Also, evaluating debates and choosing topics are highlighted.
The physician's commitment to medical insight is affected by several factors that vary from patient to patient in terms of the nature of the disease, the severity of the disease, the age of the patient, and the purpose of undergoing medical intervention. There are circumstances surrounding patients that require the physician to reduce the insight towards them, by concealing medical information. The physician must firmly commit to expanding the scope of his vision to a wider extent than in normal medical work. Therefore, we will discuss in this regard the cases in which medical explanation is reduced and the cases that require confirmation in the following order.