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 this paper we proposed a new method for selecting a smoothing parameter in kernel estimator to estimate a nonparametric regression function in the presence of missing values. The proposed method is based on work on the golden ratio and Surah AL-E-Imran in the Qur'an. Simulation experiments were conducted to study a small sample behavior. The results proved the superiority the proposed on the competition method for selecting smoothing parameter.
The main subject of this poem is a chance meeting between Baudelaire and unknown beautiful lady. Her presence represents the far-fetched, magnificent beauty. This beauty forms an aspect of idealism that takes its real existence and disappears immediately.
This emotional poem deals with the continuous despair that dates back to the Romantic age where it was a key topic; the passing woman embodies destiny. All this comes from constant experience and mad love through the poet’s view to a woman paving the way toward the unknown. Baudelaire, however, noticed this unknown through a passer-by that reflected the real and magical image of this unk
... Show MoreObjective: To determine the effectiveness of a dietary educational program upon the hypertensive client’s
information.
Methodology: The sample of the study consists of (60) hypertensive clients who attended Al Anbar Health Office –Al
Andalus Health Center during the period of the study from the14th of March 2010 to the 30th of September 2010. The
sample is divided into two groups; study group (30) hypertensive clients who received dietary educational program
and control group (30) hypertensive clients who received a routine care from the center. Three major instruments
were used; these instruments included (1) knowledge test which was applied on both groups pretest and eight weeks
post-test (2) questions to know
Hepatitis, an inflammation of the liver, has a number of infectious and non-infectious causes. Two of the viruses that cause hepatitis (hepatitis A and E) can be transmitted through water and food; hygiene is therefore important in their control. First, to assess the importance of HAV and HEV as a possible diagnosis for clinically diagnosed patients with acute viral hepatitis. Second, to assess the prevalence of hepatitis A and E in all provinces of Iraq and study its association with age, gender. This study consisted of two groups: The first group consisted of 2975 patients with a clinical diagnosis of acute viral hepatitis. The second group consisted of a total of 9610 persons, which were recruited by surveying a nationally representative
... Show MoreCrime is considered as an unlawful activity of all kinds and it is punished by law. Crimes have an impact on a society's quality of life and economic development. With a large rise in crime globally, there is a necessity to analyze crime data to bring down the rate of crime. This encourages the police and people to occupy the required measures and more effectively restricting the crimes. The purpose of this research is to develop predictive models that can aid in crime pattern analysis and thus support the Boston department's crime prevention efforts. The geographical location factor has been adopted in our model, and this is due to its being an influential factor in several situations, whether it is traveling to a specific area or livin
... Show MoreTrickle irrigation is one of the most conservative irrigation techniques since it implies supplying water directly on the soil through emitters. Emitters dissipate energy of water at the end of the trickle irrigation system and provide water at emission points. The area wetted by an emitter depends upon the discharge of emitter, soil texture, initial soil water content, and soil permeability. The objectives of this research were to predict water distribution profiles through different soils for different conditions and quantify the distribution profiles in terms of main characteristics of soil and emitter. The wetting patterns were simulated at the end of each hour for a total time of application of 12 hrs, emitter disch
... Show MoreThe research aims to present a proposed strategy for the North Oil Company, and the proposed strategy took into account the surrounding environmental conditions and adopted in its formulation on the basis and scientific steps that are comprehensive and realistic, as it covered the main activities of the company (production and exploration activities, refining and refining activities, export and transport of oil, research and development activity, financial activity, information technology, human resources) and the (David) model has been adopted in the environmental analysis of the factors that have been diagnosed according to a
... Show MoreThe effect of compound machine on wheat/ AlNoor cultivar was studied based on some technical indicators. were tested under three speeds ( 2.541, 3.433 and 4.091km.hr-1) and three tillage depths (14, 16 and 18cm). The experiments were conducted in a factorial experiment under complete randomized design with three replications. The results showed that the 2.541km.hr-1 practical speed was significantly better than other two speed in all studied conditions. Except for the FC, which achieved the best results with the third speed 4.091 km.hr-1. mechanical parameters, plant growth parameters and yield and growth parameters. The 1