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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Hard-grade asphalt binders like AC20-30 typically exhibit excessive stiffness, reduced penetration, and compromised workability, necessitating modification before use in paving applications. This study evaluates the efficacy of regular polyalphaolefin (PAO), a synthetic olefin-based lubricant, as a performance-enhancing modifying agent for such binders. AC20-30 was blended with PAO at dosages ranging from 2 wt.% to 10 wt.%, and the modified binders were characterized via penetration, ductility, softening point, and rotational viscosity measurements, alongside advanced rheological and chemical-morphological analyses. Incorporating PAO in AC20-30 asphalt progressively reduced the binder stiffness and enhanced its flexibility, with all modifie
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Background: Polycystic ovarian syndrome is one of the common gynaecological diseases encountered nowadays in the gynaecological clinic. Many criteria and diagnostic test had been evolved to be used with different classifications methods.Objectives: The present study aimed to measure the anti-mullerian hormone levels in serum of the women with Polycystic Ovary Syndrome and to test the possibility that if it can be used as a marker for diagnosis of polycystic ovary syndrome patients.Methods: A cross sectional study that had been conductedat Kamal AL-Samaraee Hospital, AL-Suwayrah Hospital andAl-Elwiya Maternity Teaching Hospital during the periodfrom July, 1st, 2013 – Jan. 1st, 2014. Where forty women withPolycystic ovarian syndrome (wit
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An inert matrix that is used to control the release of (PTX) was prepared using Eudragit RL100 and RSPM types as matrix forming agent . The matrices were prepared by either dry granulation(slugging) , or wet granulation method using chloroform as a solvent evaporation vehichle. The cumulative release was adjusted by using polyvinylpyrollidone (PVP) or ethylcellulose (EC) polymers .The results indicated that both methods of preparation were valid for incorporation PTX as a sustained release granules .Moreover ,the results revealed that best polymer used was Eudragit RSPM in 3:20 polymer drug ratio .Besides to that , the results indicated that the release profiles were affected by pH- medium&
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abstract
the research discussed a stage of strategic management. The strategic of the evaluation of the proposed strategy through feedback is to ensure that it is implemented with the least possible variation. The research aims at evaluation a proposed strategy for the Ministry of Planning for the years 2018-2022 in line with the orientations of the state, taking into account the surrounding environmental conditions. It relies on scientific bases and steps to formulate the strategy The extent of the strategy suitability was tested through a set of statistical means and its objectivity was verified through a survey of a number of specialized experts who were selected in accordance with the principle
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In this paper, variable gain nonlinear PD and PI fuzzy logic controllers are designed and the effect of the variable gain characteristic of these controllers is analyzed to show its contribution in enhancing the performance of the closed loop system over a conventional linear PID controller. Simulation results and time domain performance characteristics show how these fuzzy controllers outperform the conventional PID controller when used to control a nonlinear plant and a plant that has time delay.
This research was designed to investigate the factors affecting the frequency of use of ride-hailing in a fast-growing metropolitan region in Southeast Asia, Kuala Lumpur. An intercept survey was used to conduct this study in three potential locations that were acknowledged by one of the most famous ride-hailing companies in Kuala Lumpur. This study used non-parametric and machine learning techniques to analyze the data, including the Pearson chi-square test and Bayesian Network. From 38 statements (input variables), the Pearson chi-square test identified 14 variables as the most important. These variables were used as predictors in developing a BN model that predicts the probability of weekly usage frequency of ride-hai
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