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.
The aims of this study are to measure the defect rate and analyze the problems of production of ready concrete mixture plant by using Six Sigma methodology which is a business strategy for operations improvement depending basically on the application of its sub-methodology DMAIC improvement cycle and the basic statistical tools where the process sigma level of concrete production in the case study was 2.41 σ.
Background: Osteoporosis is an extra-articular complication of rheumatoid arthritis that results in increased risk of fractures and associated morbidity, mortality, and healthcare costs. Objective: To evaluate changes in bone mineral density in a sample of rheumatoid arthritis (RA) patients on biological (anti tumor necrosis factor (TNF) alpha) and non-biological agent disease modifying antirheumatic drugs (DMARDs). Patients and Methods: A cross sectional study enrolled 60 RA patients diagnosed by rheumatologist according to the 2010 American College of Rheumatology/European League Against Rheumatism (2010 ACR/EULAR) classification criteria for RA. Thirty patient on biological agent (anti TNF alpha) and 30 patient on non-biological agent (D
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The research aims to identify the application of corporate governance requirements according to the international standard (ISO 26000:2010) in the National Insurance Company. Strengths and weaknesses were identified to study the current state of this requirement's application in the company under investigation. The descriptive-analytical approach was utilized through a checklist derived from ISO 26000:2010. Several personal interviews and field visits were conducted to understand the extent of application and documentation based on various statistical methods. The results revealed a level of applic
... Show MoreThis study aimed at some of the criteria used to determine the form of the river basins, and exposed the need to modify some of its limitations. In which, the generalization of the elongation and roundness ratio coefficient criterion was modified, which was set in a range between (0-1). This range goes beyond determining the form of the basin, which gives it an elongated or rounded feature, and the ratio has been modified by making it more detailed and accurate in giving the basin a specific form, not only a general characteristic. So, we reached a standard for each of the basins' forms regarding the results of the elongation and circularity ratios. Thus, circular is (1-0.8), and square is (between 0.8-0.6), the blade or oval form is (0.6-0
... Show MoreThe corrosion behavior of low carbon steel in washing water of crude oil solution has been studied potentiostatically at five temperatures in the range (30–70)°C .The corrosion potential shifted to more negative values with increasing temperature and the corrosion current density increased with increasing temperature. Folic acid had on inhibiting effect on the corrosion of low carbon steel in washing water at a concentration (5× 10-4-- 5× 10-3 ) mol/dm3 over the temperature range (30–70)°C. Values of the protection efficiency were calculated from the corrosion current density .From the general results for this study, it can be seen that thermodynamic and kinetic function were also calculated (?G, ?S, ?H and Ea )
... Show MoreBackground: Incorporation of chemical additives has long been a technique used to improve properties of the gypsum products. The purpose of this work was to study the effects of adding a combination of gum Arabic and calcium hydroxide to a type III dental stone and type IV improved die stone with different proportion. The effect on water/powder ratio, and surface hardness was determined. Material and method: Both material stone and die stone were blended with two proportion of additives so that each material was mixed twice but with different proportion of gum Arabic (0.1% and 0.2%) and calcium hydroxide (0.5 % and 0.3%). Data for hardness were subjected to two-way analysis of variance. Results: The results revealed that the chemical additi
... Show MoreBackground: Saliva is one of the most important etiological host factors in relation to dental caries. It affects the carious process by its organic and inorganic constituents; in addition to its physiological functions as (flow rate, pH and buffer capacity). The aims of this study were to determine the concentrations of major elements (calcium and phosphorus) and trace elements (ferrous iron, nickel, chromium and aluminum) in saliva among a group of adolescent girls, and to explore the relation of these elements, flow rate and pH with dental caries. Material & Methods: The study group consisted of 25 girls with an age of 13-15 years old. Dental caries was diagnosed by both clinical and radiographical examinations following the criteria of
... Show MoreOne of the most common public liver diseases over the world is fatty liver which contain alcoholic and non-alcoholic fatty liver. One-fourth among general population are impact Non-Alcoholic Fatty Liver Disease (NAFLD) in the worldwide.Retinol binding protein 4 (RBP4) is known as an adipokine, mainly synthesized and secreted from the liver and form adipose tissues. RBP4 acts as a transporter and specifically bound to retinol from liver to others tissues. Visfatin is an adipocytokine and mainly produced from visceral fat tissue, skeletal muscles as well as liver. Vitamin A absorbed, transported as retinyl esters to the liver then hydrolyzed to the retinol form and storage in hepatic stellate cells (HSCs) after reesterified with rigly
... Show MoreIn the age of information and communication revolution, education as one of life
aspects has influenced with that revolution by integrating technology in education, which
have become as an important learning tools of the whole educational process . Technology,
when used appropriately, can help make science classroom a site of active learning and
critical thinking, furthering student inquiry and connections with different materials. It is
necessary to develop human rights education programs and materials for discretionary and
extracurricular activities as it provide them with the skills and tools so that they are
empowered to take action to realize their rights. Human rights education is a critical means of
instill
Background: Langerhans' cell histiocytosis (LCH) is a group of conditions affecting the reticuloendothelial system. It includes Letterer-Siwe disease, Hand-Schuller-Christian disease and eosinophilic granuloma and most often presents in childhood. Materials and methods: Twenty-five cases of LCH were diagnosed histologically and confirmed by CD1a antibody and assessed immunohistochemically using anti-RANKL and anti-RANK antibodies to evaluate osteoclastogenic mechanism. Results: Regarding jaw cases, there was a significant correlation between CD1a and RANK (P=0.016). While in the skull, highly significant correlation existed between RANK and RANKL (p=0.001). Among the sites, there was no statistically significant difference found for each
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