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.
Metal-organic frameworks (MOFs) have emerged as revolutionary materials for developing advanced biosensors, especially for detecting reactive oxygen species (ROS) and hydrogen peroxide (H₂O₂) in biomedical applications. This comprehensive review explores the current state-of-the-art in MOF-based biosensors, covering fundamental principles, design strategies, performance features, and clinical uses. MOFs offer unique benefits, including exceptional porosity (up to 10,400 m²/g), tunable structures, biocompatibility, and natural enzyme-mimicking properties, making them ideal platforms for sensitive and selective detection of ROS and H₂O₂. Recent advances have shown significant improvements in detection capabilities, with limit
... Show MoreThe negotiation phase is gaining great importance in investment loans due to the magnitude of the amounts awarded and the need to obtain adequate lending guarantees and the development of better conditions, and this requires that negotiating policy with fixed principles that balance between meeting the demands of customers and maintain market share and achieve profits and avoid defaults and losses the bank, and so I have touched Find the concept of investment loans and procedures for granting and the concept of the negotiation process for the granting of loans. The practical side to ensure the preparation of examination form consists of questions commensurate with the methodology developed by the researchers, were directed to the officia
... Show MoreCan not reach a comprehensive concept for interior design through the use of Harmonization term according transformations experienced by the terms of the variables associated with the backlog of cultures that characterize concepts according to the nature of the users of the spaces in the design output, which necessitates the meaning of the combination of knowledge, art, science, such as the type of perceptions design the Harmonization cognitive science with art to create products of the use of design configurations that help the designer to put such a product within the reality and like the fact that reliable, as well as the rational knowledge tend somehow to the objective specifically in facilitating the substance subject to perceptible
... Show MoreThis study analyses six political cartoons selected based on their relevance to current Iraqi political issues, specifically the period between 2005 and 2015, from American online newspapers (calgecartooms.com). The selection criteria included the cartoons' satirical elements, visual rhetoric, and their ability to engage with themes such as power dynamics, social issues, and public opinion. It sheds light on how these cartoons can function as mediators of meanings between the cartoonists and the readers. The data is examined using multimodal discourse analysis (MDA), which combines language study with the analysis of other visual elements, like colors, gestures, and images, to understand meaning (O’Halloran et al., 2011). The Visual Socia
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