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.
Enhancing fatigue resistance in asphalt binders and mixtures is crucial for prolonging pavement lifespan and improving road performance. Recent advancements in nanotechnology have introduced various nanomaterials such as alumina (NA), carbon nanotubes (CNTs), and silica (NS) as potential asphalt modifiers. These materials possess unique properties that address challenges related to asphalt fatigue. However, their effectiveness depends on proper dispersion and mixing techniques. This review examines the mixing methods used for each nanomaterial to ensure uniform distribution within the asphalt matrix and maximize performance benefits. Recent research findings are synthesized to elucidate how these nanomaterials and their mixing proce
... Show MoreThis systematic review aimed to investigate the relation between orthodontic treatment (OT) and the incidence of the gingival black triangle (GBT) after completing treatment with a fixed orthodontic appliance, as well as the associated risk factors and the level of alveolar bone. Electronic and hand searches were conducted in three electronic databases for relevant articles published up to March 2022. Retrieved articles went through a two-step screening procedure, and the risk of bias (RoB) was assessed by the Joanna Briggs Institute checklists. The incidence of GBT after OT was set as the primary outcome, while the secondary outcomes were the risk factors associated with GBT and alveolar bone loss following OT. Out of 421 papers, 5
... Show MoreThe energy requirements of corn silage harvesters and the application of precision agricultural techniques are essential for efficient and productive agricultural practices. The article aims to review previous studies on the energy requirements needed for different corn silage harvesting machines, and on the other hand, to present methods for measuring corn silage productivity directly in the field and monitoring it based on microcontrollers and artificial intelligence techniques. The process of making corn silage is done by cutting green fodder plants into small pieces, so special harvesters are used for this, called corn silage harvesters. The purpose of harvesting corn silage is to efficiently collect and store as many digestible nutrien
... Show MoreWater, an essential element for life, is becoming increasingly contaminated due to the continuing discharge of hazardous substances into our water sources. Pharmaceuticals, industrial chemicals, dyes, colorants, heavy metals, and pesticides are examples of some of the organic and inorganic substances that persistently contaminate water systems and traditional wastewater treatment systems are not designed to remove dissolved organic constituents, which is why their entry into the environment is so ubiquitous. Common pharmaceuticals such as aspirin, amoxicillin, ciprofloxacin, paracetamol, and ibuprofen, are amongst the most substantial contributors to water pollution The efficient and eco-friendly management of pharmaceutical pollutants pres
... Show MoreThe role of teacher of kindergarten plays an important role in the educational institution for kindergarten role in the educational institution for kindergarten and the failure of its role in the development of the mental processes of children kindergarten means failing in this institution .and hence the importance and effectiveness of the role of the student applied section kindergarten application period it is there fore necessary to be aware of the importance of learning. in preschool and good professional setting and enjoy a significant level of psychological and social systems and mental qualities and study is the urgent need to find generations hare systematic thinker's mind so stay away from memorization and trad
... Show MoreThe research aims to clarify the COBIT5 framework for IT governance and to develop of a criterion based on Balanced Scorecard that contributes in measuring the performance of IT governance. To achieve these goals, the researchers adopted the deductive approach in the design of balanced scorecard to measure the IT governance at the Bank of Baghdad that was chosen because it relied heavily on IT.
The research has reached a number of conclusions, the most important of which is that the performance of IT department in the Bank of Baghdad falls within the good level that requires constant monitoring, the most committed items of Balanced Scorecard by the Bank were customer, internal operation, growth and finally the financial item; IT
... Show MoreThe current research aims at finding out how to properly and correctly manage waste and solid waste and reduce the difficulties faced by all countries. However, it is becoming increasingly acute in developed cities because their economies are growing rapidly. It is necessary to identify the modern methods used in developed countries in managing wastes. The use of modern waste management techniques is a coordinated effort by international agencies within the borders responsible for them. The problem of the study can be identified in the lack of clarity of environmental management procedures in place. The importance of the research contributes to providing greater capacity to the administrative and technical leadership in the municipality
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The current research problem includes a variety of research motivations to serve the private health sector, which is witnessing a great competition from internal and external environments. In this regard, private medical clinics are increasingly seeking to attract and retain customers through the quality of their service offerings represented by health services. Innovative and effective marketing methods to improve performance and stay in competition, by relying on the physical evidence of the product as a component of the marketing mix of services and its role in particular in packaging and supporting the health service with concrete evidence that affects the customer an
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