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 surgeryKeywords: Non-surgical treatment of anal fissure, fissure in ano, sphicterotomy,botulinum toxin in anal fissures, glyceryl trinitrate. Chemical sphincteratomy, pharmacological sphincteratomy.
Background & objective: Difficult intubation remains a risk for patients undergoing general anesthesia (GA) or mechanical ventilation in an intensive care unit (ICU). Macroglossia is a known factor for difficult intubation. But it is not routine to assess the tongue size to predict difficult intubation. Studies are found deficient in comparing usefulness of measuring thyromental distance and the tongue thickness (TT) measured by ultrasonography to estimate difficult intubation. We compared tongue thickness measured by ultrasonography and thyromental distance as a means to anticipate difficult intubation. Methodology: A convenient sample of 60 patients; 32 males and 28 females, who were undergoing elective surgery with GA were i
... Show MoreBackground: Saliva is a specific bio-fluid with important biomarkers. Analyzing any alternation in these markers could give valuable information, in relation to oral health status parameters. The aim of this study was to investigate the level of α -amylase in unstimulated whole saliva of healthy, primary school children in relation to some oral health parameters. Materials and Methods: A questionnaires consisted of demography and medical histories of participants were filled by children families. Saliva samples were collected for 5- minutes between 9:00 -11:00 AM from 114 healthy students aged 6-13 years, divided into four age groups. Flow- rate, Plaque and Gingival Index were assessed and dentition status was investigated by DMFT/dmft
... Show MoreSteady conjugate natural convection heat transfers in a two-dimensional enclosure filled with fluid saturated porous medium is studied numerically. The two vertical boundaries of the enclosure are kept isothermally at same temperature, the horizontal upper wall is adiabatic, and the horizontal lower wall is partially heated. The Darcy extended Brinkman Forcheimer model is used as the momentum equation and Ansys Fluent software is utilized to solve the governing equations. Rayleigh number (1.38 ≤ Ra ≤ 2.32), Darcy number (3.9 * 10-8), the ratio of conjugate wall thickness to its height (0.025 ≤ W ≤ 0.1), heater length to the bottom wall ratio (1/4 ≤ ≤ 3/4) and inclination angle (0°, 30° and 60°) are the main consid
... Show MoreThe United States government allowed Native Americans to abandon their reservations in the 1950s and 1960s. The historical, social, and cultural backgrounds shaped the forms and themes of works by American Indian writers who urged people to refuse their culture's sense of shame. Moreover, their behavior corresponded with the restoration of individuals to their rituals after disappointment, loss of sense of life, and mental illness performed from the influence of mainstream American society. Among these writers, N. Scott Momaday and Leslie Marmon Silko participate in similar interest in portraying characters caught between indigenous beliefs and white mainstream standards.
The construction of
... Show MoreBootstrap is one of an important re-sampling technique which has given the attention of researches recently. The presence of outliers in the original data set may cause serious problem to the classical bootstrap when the percentage of outliers are higher than the original one. Many methods are proposed to overcome this problem such Dynamic Robust Bootstrap for LTS (DRBLTS) and Weighted Bootstrap with Probability (WBP). This paper try to show the accuracy of parameters estimation by comparison the results of both methods. The bias , MSE and RMSE are considered. The criterion of the accuracy is based on the RMSE value since the method that provide us RMSE value smaller than other is con
... Show Morehave suffered from deteriorating residential neighborhoods, poor economic, social and urban living conditions of the population and deteriorating the infrastructural and superior services. These problems were the secretions of these cities' rapid urbanization. Based on the principles of sustainable urban planning and in order to achieve adequate opportunities for the lives of the population and provide them with sustainable livelihoods, policies have emerged to upgrade along the lines of community participation and programmes to reform and develop those neighbourhoods, raise their efficiency and make them livable. Thus, the problem of research was identified "The absence of a comprehensive cognitive perception of the most prominent facto
... Show MoreIn this numerical study a detailed evaluation of the heat transfer characteristics and flow structure in a laminar and turbulent flow through a rectangular channel containing built-in of different type vortex generator has been a accomplished in a range of Reynolds number between 500 and 100,000.A modified version of ESCEAT code has been used to solve Navier-Stokes and energy equations. The purpose of this paper is to present numerical comparisons in terms of temperature, Nusselt number and flow patterns on several configurations of longitudinal vortex generator including new five cases. The structures of heat and flow were studied, using iso-contours of velocity components, vortices, temperature and Nusselt n
... Show MoreAlthough tattooed literary characters are not new in literature, they are still in children’s literature. Inked characters were nearly absent from children’s books and with the dawn of the twenty first century many of them portrayed tattooed characters. The problem of the study lies in the lack of studies concerning these types of characters in children’s books. The researchers aim to study inked characters in selected stories for children to show the different literary uses of tattoos in these stories, serving not only characterization but theme and symbolism as well. Two children's stories are selected for this study: Tell Me A Tattoo Story (2016) by Alison McGhee and My Teacher Has Tattoos (2023) by Darren Lopez. The researchers st
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