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.
In some cases, researchers need to know the causal effect of the treatment in order to know the extent of the effect of the treatment on the sample in order to continue to give the treatment or stop the treatment because it is of no use. The local weighted least squares method was used to estimate the parameters of the fuzzy regression discontinuous model, and the local polynomial method was used to estimate the bandwidth. Data were generated with sample sizes (75,100,125,150 ) in repetition 1000. An experiment was conducted at the Innovation Institute for remedial lessons in 2021 for 72 students participating in the institute and data collection. Those who used the treatment had an increase in their score after
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Sotileza , localismo santandrino de sutileza , es la parte más fina del aparejo de pescar donde va el anzuelo. Es la obra maestro de José María de Pereda.Su ambiente , el Santander viejo, anterior al año 50,evocado emocionadamente - emociόn romántica contenida en los trazos sobrios y firmes de un naturalism psicolόgico y paisajista,el Santander que el autor confiesa poseer en el fondo de su corazόn,«y tenerlo esculpido en la memoria de tal suerte que ,a ojos cerrados,me atrevería a trazarle con todo su perímetro y sus calles, y el color de sus piedras, y el número, y los nombres, y hasta las caras de sus habitantes».Dentro de la grandeza primaria de las criaturas de Pere
... Show MoreThis title may have something strange or paradoxical; it is unusual or natural to look for violence in literature, or that literature is a tool for killing through the contribution of writers and poets in generating, feeding or advocating violence. The Zionist literature belongs to the 20th century, is almost the only literature among the etiquette of peoples, which professes racism and boasts of betraying its human role, and wants to be a vehicle for terrorism domination. It also tends to be a means in the hands of killers and adventurers. Writers of this Literature show that no solution to the Jewish problem is only by Zionist presence to replace the Palestinian presence and to build the state of "Israel" on the ruins of Pa
... Show MoreThe aim of the study was to find out the correlations and impact between the variable of ethical leadership behavior and university performance at Sumer University. Use the descriptive analytical method by adopting the questionnaire tool to collect data. The questionnaire was distributed electronically to 113 teachers at Sumer University and the response was from 105 teachers. The research results showed that there is a correlation and effect relationship between the search variables. In addition, the responding university does not have ethically defined standards in terms of performance of the work of the cadres working there. Finally, the research presented a set of recommendations aimed at tackling problems in the ethical lead
... Show MoreBackground: Most prevalent chronic liver disease in developed and developing nations is non-alcoholic fatty liver disease. From fatty liver, which often has benign, non-progressive clinical history, to non-alcoholic steatohepatitis, a more serious variant of fatty liver that can lead to cirrhosis and end-stage liver disease, non-alcoholic fatty liver disease encompasses broad spectrum of diseases. The gold standard for determining extent of hepatic fibrosis is still liver biopsy; however, number of noninvasive tests have been established to make diagnosis and assess effectiveness of treatment.
Objective: Aim of study was to assess effectiveness of the combination of fibroscan and
... Show MoreThe investment government expenditure is considered the fundamental of enhancing the economic activity as it has become a mean for achieving capital accumulation in all economic sectors, The Iraqi economy is characterized of being yield unilateral depending petroleum revenues as an essential resource of financing government expenditure , as the contribution of petroleum sector in GDP is large in proportions to other economic sectors contribution.
The relationship between investing government expenditure, and non-oil GDP is about to be not existent during the
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The article is devoted to the study of modal framework of the utterance with the semantics of “disappearance” in modern Russian language. The empirical basis of the study was the works of Russian writers, such as M.A. Bulgakov, F.M. Dostoevsky, A.I. Kuprin., L.M. Leonov, B.L. Pasternak, K.G. Paustovsky, L.N. Tolstoy, I.S. Turgenev and others. The author focuses special attention on the role of the modal component in the formation of the sentences and its modal semantics. A lot attention is paid to the analysis of the reasons of productivity / low productivity in the functioning of the temporal forms of the verbs that form these utterances. The nature of the material of study determined the choice of
... Show MoreAbnormalities in the Lipid and lipoprotein levels are common in the general population and are considered as very important risk- factors for cardiovascular disease .In this context the effect of cholesterol, which is one of the most clinically relevant lipids is very important. Aim of the present study was to determine the levels of GLP-1 and GPCR in non- diabetic dyslipidaemic patients and compare the results with the control group, which may be used as a novel biomarker to predict heart disease in these patients. The study was also aimed to find the relationship between GLP-1 and GPCR with lipid profile and glucagon in the patient group. The study involved 90 non-diabetic dyslipidaemia patients, with 90 healthy controls. The subjects wer
... Show MoreObjective: To evaluate male patients complaining of
urethritis clinically according to the isolated organisms.
Method: A total of 100 male patients attending to of
Dermatological and Venereal private clinics for the period
April 2003 to November 2003 were included in the study.
Urethral swab was obtained from each male for culture and
direct immunofluorescence examination was done.
Demographic data was obtained, also.
Results: N. gonorrhoea was the predominate cause of
infection in 22%. A peak of infection was reported in the
second decade of age. Highest rate reported among single
males. A significant association was noticed between
profuse discharge and infection with gonorrhoea.
Conclusion: This
Non-alcoholic fatty liver disease (NAFLD) is one of chronic liver and defines by fat accumulation ≥5% in liver which can progresses to non-alcoholic steatohepatitis (NASH). NAFLD related to obesity as well as non obese individuals. Adiponectin is a cytokine secreted from adipose tissue involved NAFLD pathogenesis and liked with obesity. Irisin is a myokine, has a convenient effect against metabolic diseases such as obesity, disylipemia diabetes type 2 and reversed liver steatosis and may be related with NAFLD. Vitamin D is one of the fat soluble vitamins and more precisely as a pro-hormone through its metabolite (1,25(OH)2 cholecalciferol) the major steroid hormone. After the skin exposure to the light, vitamin D undergoes to
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