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 theme of causal attribution has generated a great deal of work and focuses on the factors to which people attribute their behavior. However, its use to explain the results of the evaluation and the support for the regulation of teaching and learning acts has rarely been raised. Indeed, in the evaluation act, which is a privileged moment for reframing the learning process, teachers attribute the results obtained to the student himself, without worrying about the factors to which the student attribute itself these failures. This can distort the regulatory process and increase failure factors. The teacher's attributions of failure often relate to the results of the evaluations and are often explained by factors external to him: such as
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Geotechnical soil problems underneath foundation of hydraulic structures occurs due to engineering soil properties, geological setting and hydraulic properties of the projects. Two finite element programs of Geoslope 2012 software, SIGMA/W and SEEP/W, were used for analysis of in situ stresses, load deformation behavior, seepage quantity and vertical gradient below Teeb weir foundation, to compute factors of safety against seepage uplift. The site soil is a granular (gravel, sand and silt), weakly cemented soil cohered by gypsum and clay materials. The area has low lying topography, with slightly tectonic activities. The model results show that the upstream side stresses are reduced while the pore pressure are in
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In this paper, we proposed a modified Hestenes-Stiefel (HS) conjugate
gradient method. This achieves a high order accuracy in approximating the second
order curvature information of the objective function by utilizing the modified
secant condition which is proposed by Babaie-Kafaki [1], also we derive a nonquadratic
conjugate gradient model. The important property of the suggestion
method that is satisfy the descent property and global convergence independent of
the accuracy of the line search. In addition, we prove the global convergence under
some suitable conditions, and we reported the numerical results under these
conditions.
Competitive advantage is a substantial strategic objective for organizations. It requires high levels in the quality of products and services provided to customers, continuous improvement of costing , care for creativity and innovative employees, and speed unique to the marketing and financial engineering, and business re-engineering processes. The situation in this area, requires actors to attract and develop human resources, including help in proper implementation of the strategic tasks that targeted by those institutions. According to the opinions and viewpoints of management scholars, the competitive advantage resource is the most important issue for organizations in the third millennium, which can be a
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Atenolol was used with ammonium molybdate to prove the efficiency, reliability and repeatability of the long distance chasing photometer (NAG-ADF-300-2) using continuous flow injection analysis. The method is based on reaction between atenolol and ammonium molybdate in an aqueous medium to obtain a dark brown precipitate. Optimum parameters was studied to increase the sensitivity for developed method. A linear range for calibration graph was 0.1-3.5 mmol/L for cell A and 0.3-3.5 mmol/L for cell B, and LOD 133.1680 ng/100 µL and 532.6720 ng/100 µL for cell A and cell B respectively with correlation coefficient (r) 0.9910 for cell A and 0.9901 for cell B, RSD% was lower than 1%, (n=8) for the determination of ate
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Morphologies of ceramic hollow fiber membranes prepared by a combined phase-inversion and sintering method were studied. The organic binder spinning solution containing suspended Al₂O₃ powders was spun to a hollow fiber precursor, which was then sintered at elevated temperatures( 300 ˚C, 1400 ˚C, 25 ˚C) in order to obtain the Al₂O₃ hollow fiber membranes. The spinning solution consisted of polyether sulfone (PES), N-methyl-2-pyrrolidone (NMP), which were used as polymer binder, solvent, respectively. The prepared Al₂O₃ hollow fiber membranes were characterized by a scanning electron microscope (SEM). It is believed that finger-like void formation in asymmetric ceramic membranes is initiated by hydrodynamically unstable vis
... Show MoreZainab M. Al-Bahrani Department of Oral Diagnosis, College of Dentistry, University of Baghdad, Baghdad, Iraq.Corresponding author: Zainab M. Al-Bahra...
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