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.
In this article, we aim to define a universal set consisting of the subscripts of the fuzzy differential equation (5) except the two elements and , subsets of that universal set are defined according to certain conditions. Then, we use the constructed universal set with its subsets for suggesting an analytical method which facilitates solving fuzzy initial value problems of any order by using the strongly generalized H-differentiability. Also, valid sets with graphs for solutions of fuzzy initial value problems of higher orders are found.
In this research, a factorial experiment (4*4) was studied, applied in a completely random block design, with a size of observations, where the design of experiments is used to study the effect of transactions on experimental units and thus obtain data representing experiment observations that The difference in the application of these transactions under different environmental and experimental conditions It causes noise that affects the observation value and thus an increase in the mean square error of the experiment, and to reduce this noise, multiple wavelet reduction was used as a filter for the observations by suggesting an improved threshold that takes into account the different transformation levels based on the logarithm of the b
... Show MoreBackground: Lymphomas are group of diseases caused by malignant lymphocytes that accumulate in lymph nodes and caused the characteristics lymphadenopathy. Occasionally, they may spill over into blood or infiltrate organs outside the lymphoid tissue. The major subdivision of lymphomas is into Hodgkin lymphoma and non–Hodgkin lymphoma and this is based on the histologic presence of Reed-Sternberg cells in Hodgkin lymphoma. Salivary immunoglobulin A is the prominent immunoglobulin and is considered to be the main specific defense mechanism in oral cavity. The aim of this study was to determine the level of salivary immunoglobulin A in lymphoma patients before and after chemotherapy treatment. Subjects, materials and methods: The study i
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Among the things that have happened and that have emerged from the developments in society is the phenomenon of dairy banks, where institutions collect milk from donating mothers or sellers of milk and benefit from it by sterilizing and selling it.
This topic is considered one of the important topics, as Islam considers breastfeeding as a link as well as parentage, and it has the same genealogy as the spread of sanctity. Therefore, Imamate jurists addressed this topic with research despite its absence in Islamic societies.
The importance of r
... Show MoreThis paper deals with the determination of stresses and deflections of clamped circular diaphragm strengthened by one or two ring-shaped concentric ribs, under uniform static and dynamic pressures. The simulation has been achieved by using the well-known engineering software finite element package MSC/NASTRAN.
As a design study, the effect of using a clamped ring, and the effect of using a ring-shaped rib on both surfaces of diaphragm instead of one, has been discussed in this work. To show the effectiveness of this study, results of this work have been compared with published data [1].
In the conclusion, the authors underline the validity of the&n
... Show MoreThe grasping stability of robotic manipulators is crucial to enable autonomous manipulation in an environment where robots are facing obstacles in their route, where abrupt changes in the robot’s speed are induced. These speed variations will produce forces affecting the robotic manipulator, hence its grasping stability. In this research, the grasping stability of a robotic manipulator that functions according to a frictional self-locking mechanism is investigated statically and dynamically. Both theoretical and experimental results showed that the grasped object size, weight, and its orientation inside the gripper have a great effect on grasping stability. Both the theoretical and experimental results indicated that the grasping object p
... Show MoreA vocative expression can be defined as an expression of direct address where the participant identity is set forth explicitly within a sentence. This study aims at showing how the vocative particles are used in literally texts, namely in the short story “The Garden Party" written by Kathryn Mansfield and identifying the forms of these vocative particles as used by the characters along with the functions of these vocative particles. For the analysis of vocative forms, the researcher used Quirk and Greenbaum (1973) model. Functionally, the data were analyzed based on Quirk et al. (1985) model. However, the results of this study shows that the characters in “The Garden Party” short story used various forms of vocative particles and
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