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.
(7)
It is widely accepted that early diagnosis of Alzheimer's disease (AD) makes it possible for patients to gain access to appropriate health care services and would facilitate the development of new therapies. AD starts many years before its clinical manifestations and a biomarker that provides a measure of changes in the brain in this period would be useful for early diagnosis of AD. Given the rapid increase in the number of older people suffering from AD, there is a need for an accurate, low-cost and easy to use biomarkers that could be used to detect AD in its early stages. Potentially, the electroencephalogram (EEG) can play a vital role in this but at present, no reliable EEG biomarker exists for early diagnosis of AD. The gradual s
... Show More
(51)
(32)
Double-layer micro-perforated panels (MPPs) have been studied extensively as sound absorption systems to increase the absorption performance of single-layer MPPs. However, existing proposed models indicate that there is still room for improvement regarding the frequency bands of absorption for the double-layer MPP. This study presents a double-layer MPP formed with two single MPPs with inhomogeneous perforation backed by multiple cavities of varying depths. The theoretical formulation is developed using the electrical equivalent circuit method to calculate the absorption coefficient under a normal incident sound. The simulation results show that the proposed model can produce absorption coefficient with wider absorption bandwidth compared w
... Show More
(21)
(19)
(20)
(18)
(10)
The paper aims to build a model that supports organizational sustainability by analyzing the correlations and revealing the impact between the two main variables (entrepreneurial leadership) with its dimensions of proactive outlook, risk, and creativity (Van Zyl & Mathur-Helm, 2007), and (organizational sustainability) with its economic, environmental, and societal dimensions (Hansmann et al., 2012). As well as identifying the level of awareness and informing managers in the General Company for the Automotive and Equipment Industry, of the theoretical implications and performance, and its vital importance to society and the surrounding ecological environment, and drawing attention to that and improving performance, and indicatin
... Show More
(5)
(7)
(2)
Purpose To test the effect of strategic Supremacy on strategic success A case study in Thi Qar Governorate, methodology/approach – this is a mandatory entry.
a case study was used and applied to the Department managers of Government of the province of Thi Qar, Research limitations/implications – It is clear that the strategic Supremacy variable is not being used effectively to achieve strategic success.
Practical implications – use strategic supremacy positively to Support for strategic success. implementing and monitoring ignorance of them in how to use thi
... Show More
(3)
