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.
Background: In the past, an association between Tuberculosis (TB) and Diabetes Mellitus (DM) was widely accepted, today the potential public health and clinical importance of this relationship seems to be largely ignored. The national clinical and policy guidance in the UK on the central of TB, for example, does not consider the relationship with DM.Objectives: To determine the risk of association between diabetes mellitus and pulmonary TB.Methods: A retrospective study conducted in Ibn Zuhr hospital for chest diseases from Jan 2008 – sep 2010 , included in the study 402 patients with TB divided into diabetic & non diabetic, 96 (23.8%) were diabetic while other 306 were TB not diabetic.Results: Risk of TB among DM patients were cle
... Show Moreالنظام السياسي اليمني : دراسة في المتغيرات الداخلية
The moon tree, the lover of the night, cholera, the sea changes its colors are poetic products left by the pioneer of free poetry, as many have called her. She used to write poetry and publish it in magazines and newspapers until she published it with collections that came into existence from an early age. Several factors helped her in that that contributed to the formation of her personality and the maturity of her talent, including factors Family, including environmental, and psychological, until she later became the focus of attention of many, so she became taught in the universities of London, and students stood by her method of writing free poetry, this poetic color that Badr Shaker Al-Sayyab participated in pioneering. Whoever exam
... Show MoreGiven a matrix, the Consecutive Ones Submatrix (C1S) problem which aims to find the permutation of columns that maximizes the number of columns having together only one block of consecutive ones in each row is considered here. A heuristic approach will be suggested to solve the problem. Also, the Consecutive Blocks Minimization (CBM) problem which is related to the consecutive ones submatrix will be considered. The new procedure is proposed to improve the column insertion approach. Then real world and random matrices from the set covering problem will be evaluated and computational results will be highlighted.
The state did not witness the emergence of independent bodies because of the nature of the ruling regimes that were characterized by political tyranny represented by the king at the time, as is the case with Greece and the Greeks and Persia and the Romans and others. As for the Islamic state, which emerged later, it saw the emergence of what looks like independent bodies that we see today, There was the so-called Diwan Al-Hesba and the Ombudsman's Office as an independent body from the Islamic State, which operated independently to support the oppressed and the equitable distribution of financial resources, even though it was headed by well-known governors of justice and honesty. A state in the modern era, many countries, especially in E
... Show More<p>Photovoltaic (PV) systems are becoming increasingly popular; however, arc faults on the direct current (DC) side are becoming more widespread as a result of the effects of aging as well as the trend toward higher DC voltage levels, posing severe risk to human safety and system stability. The parallel arc faults present higher level of current as compared with the series arc faults, making it more difficult to spot the series arc. In this paper and for the aim of condition monitoring, the features of a DC series arc fault are analyzed by analysing the arc features, performing model’s simulation in PSCAD, and carrying out experimental studies. Various arc models are simulated and investigated; for low current arcs, the heur
... Show Moreيمثل الأخذ بالنظام الفيدرالي أطاراً تنظيمياً لشكل الدولة و مرحلة تحول مهمة في بنية الدولة العامة في مختلف مجالاتها، فالانتقال من المركزية في أدارة الشؤون العامة للدولة الى النمط الفيدرالي يمثل تحولا بنيوياً وسيكولوجياً ،حيث يكون هنالك توزيع مكاني - عمودي للسلطة والثروة بين الوحدات المكونة للدولة بشكل يختلف كليا عن الحالة المركزية، ونجد صور تنظيمية عديدة تتأسس ضمن اطار الفيدرالية العام ،
... Show MoreA quadruped (four-legged) robot locomotion has the potential ability for using in different applications such as walking over soft and rough terrains and to grantee the mobility and flexibility. In general, quadruped robots have three main periodic gaits: creeping gait, running gait and galloping gait. The main problem of the quadruped robot during walking is the needing to be statically stable for slow gaits such as creeping gait. The statically stable walking as a condition depends on the stability margins that calculated particularly for this gait. In this paper, the creeping gait sequence analysis of each leg step during the swing and fixed phases has been carried out. The calculation of the minimum stability margins depends up
... Show MoreThe study aims to build a water quality index that fits the Iraqi aquatic systems and reflects the environmental reality of Iraqi water. The developed Iraqi Water Quality Index (IQWQI) includes physical and chemical components. To build the IQWQI, Delphi method was used to communicate with local and global experts in water quality indices for their opinion regarding the best and most important parameter we can use in building the index and the established weight of each parameter. From the data obtained in this study, 70% were used for building the model and 30% for evaluating the model. Multiple scenarios were applied to the model inputs to study the effects of increasing parameters. The model was built 4 by 4 until it reached 17 parame
... Show MoreMaximizing the net present value (NPV) of oil field development is heavily dependent on optimizing well placement. The traditional approach entails the use of expert intuition to design well configurations and locations, followed by economic analysis and reservoir simulation to determine the most effective plan. However, this approach often proves inadequate due to the complexity and nonlinearity of reservoirs. In recent years, computational techniques have been developed to optimize well placement by defining decision variables (such as well coordinates), objective functions (such as NPV or cumulative oil production), and constraints. This paper presents a study on the use of genetic algorithms for well placement optimization, a ty
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