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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A single-blind randomized controlled clinical trial in patients with deep caries and symptoms of reversible pulpitis compared outcomes from a self-limiting excavation protocol using chemomechanical Carisolv gel/operating microscope (self-limiting) versus selective removal to leathery dentin using rotary burs (control). This was followed by pulp protection with mineral trioxide aggregate (MTA) and restoration with glass ionomer cement and resin composite, all in a single visit. The pulp sensibility and periapical health of teeth were assessed after 12 mo, in addition to the differences in bacterial tissue concentration postexcavation. Apical radiolucencies were assessed using cone beam computed tomography/periapical radiographs (CBC
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As technology advances and develops, the need for strong and simple authentication mechanisms that can help protect data intensifies. The contemporary approach to giving access control is through graphical passwords comprising images, patterns, or graphical items. The objective of this review was to determine the documented security risks that are related to the use of graphical passwords, together with the measures that have been taken to prevent them. The review was intended to present an extensive literature review of the subject matter on graphical password protection and to point toward potential future research directions. Many attacks, such as shoulder surfing attacks, SQL injection attacks, and spyware attacks, can easily ex
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Epithelial mesenchymal transition (EMT) is a process comprising cellular and molecular events which result in cells shifting from an epithelial to a mesenchymal phenotype. Periodontitis is a destructive chronic disease of the periodontium initiated in response to a dysbiotic microbiome, and dominated by Gram-negative bacteria in the subgingival niches accompanied by an aberrant immune response in susceptible subjects. Both EMT and periodontitis share common risk factors and drivers, including Gram-negative bacteria, excess inflammatory cytokine production, smoking, oxidative stress and diabetes mellitus. In addition, periodontitis is characterized by down-regulation of key epithelial markers such as E-cadherin together with up-regulation of
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Although language research has focused on blackmail in general, less attention has been paid to emotional blackmail. To date, researchers could not locate any literature that examines emotional blackmail from a linguistic standpoint. The current study is intended to fill this gap by scrutinizing emotional blackmail from a pragma-stylistic point of view by examining the style of the characters in selected episodes extracted from the American Breaking Bad series. To carry out the study, an eclectic model comprising kinds of emotional blackmailers by Forward and Frazier (1997), Searles’ speech acts (1979), Grice’s maxims (1975), Brown and Levinson’s politeness (1987), Culpeper’s impoliteness (1996), and Simpson’s stylistic le
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Objective: To determine the effectiveness of a dietary educational program upon the hypertensive client’s
information.
Methodology: The sample of the study consists of (60) hypertensive clients who attended Al Anbar Health Office –Al
Andalus Health Center during the period of the study from the14th of March 2010 to the 30th of September 2010. The
sample is divided into two groups; study group (30) hypertensive clients who received dietary educational program
and control group (30) hypertensive clients who received a routine care from the center. Three major instruments
were used; these instruments included (1) knowledge test which was applied on both groups pretest and eight weeks
post-test (2) questions to know
Fluorescence excitation by Nd:YAG pumped dye laser and single vibrational level fluorescence
spectra of 1,3 benzodioxole in a supersonic jet have been obtained and interpreted. The previous assignment of
the 0 0
0 band was incorrect. In addition, many other bands involving n20 and n19 vibrations of a2 symmetry were
confirmed. As far as a1 totally symmetric vibration is concerned. The n14 was assigned to be located in the fivemembered
ring whereas n13 seem to be located in the benzene ring as a result of the electronic transition in the
benzene ring which affects n13 and not n14 wavenumber.
The outstanding evidence of phthalimide pharmacophore in securing enhanced biological activities had encouraged further research and development into phthalimide-based derivatives as potential new drugs. In this study, phthalimide core was hybridized with aldehydes giving integrated imines displaying different types of functionalities and at alternating positions. The resulting compounds, therefore, provide an innovative window to explore possible differential biological effects as antioxidants and anticancer agents. A total of sixteen compounds were synthesized, and each was verified by FT-IR, H NMR, C NMR, and MS characterization. Herein, a facile single-step synthesis method was employed substituting the conventional two-step che
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