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.
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A review of the literature on intellectual capital development was conducted using systemic criteria for the inclusion of relevant studies. The concepts behind the ideas explored in the present study were discussed in respect to the subject matter. Examining the past state of the art in the intellectual capital sector for achieving high levels of innovation performance provided a multidimensional picture of intellectual capital, innovation performance, and dynamic capabilities. The present review was designed to illustrate the correlation between intellectual capital and innovation performance, as well as the role of dynamic capabilities in moderating the relationship between these constructs. Accordingly, we presented an extensive
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In this paper, the first integrals of Darboux type of the generalized Sprott ET9 chaotic system will be studied. This study showed that the system has no polynomial, rational, analytic and Darboux first integrals for any value of . All the Darboux polynomials for this system were derived together with its exponential factors. Using the weight homogenous polynomials helped us prove the process.
The photoconductivity and its dependence on light intensity have been investigated in a-Ge20Se80 thin films as a function of temperature between (293–323)K. The result showed that the photoconductivity and photosensitivity increase with increase of annealing temperature. This behavior is interpreted in terms of the dispersive diffusion –controlled recombination of localized electrons and holes.
Fish are regarded as a crucial indicator of alterations in the aquatic environment due to their position at the apex of the food chain. Monitoring these alterations is crucial for identifying modifications in the aquatic ecosystem. The principal elements influencing fish health are temperature, pH, dissolved oxygen, salinity, pesticide contamination, microplastics, and algal presence. These elements substantially influence fish health regarding development, reproduction, respiration, oxygen stress, and the internal enzymes associated with digesting and other metabolic functions. Alterations in global environmental conditions and anthropogenic pollutants result in modifications to fish populations, their lives, and their behavior and
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Cosmetic products contain variable amounts of nutrients that support microbial growth. Most contaminants in cosmetic products include bacteria such as Staphylococcus, Pseudomonas, Klebsiella, Achromobacter and Alcaligenes. Contaminated water is a likely source of organisms found in cosmetic products. Products such as shampoo, hand and body lotion, facial cleanser, and liquid soaps were analyzed. In this study, out of 60 cosmetic products analyzed, 26.4% were found to be contaminated. Most of the contamination was from bacteria and no fungal contamination was detected. The highest level o
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Characterized the Middle East has geographic, economic, and geostrategic peculiarities, but it suffers from many problems, such as disagreement over what it means as a concept, or what it represents of a geographic extension. The question is related to the ambiguity surrounding the concept of the Middle East? The purpose of its launch? As it relates to its geostrategic, economic, and geo-cultural importance? And manifestations of this importance? And to what extent he retained his value in the strategies of the major powers? Research hypotheses:
-The multiplicity of concepts for the Middle East region, with international political and Geostrategic interests.- The geostrategic value of the Middle East has made it a focal point for
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Pragmatics looked at literary discourse as an external subject that needed an actor and based on a communicative relationship, that is, it examines literary work by focusing on the author's intent, and attempting to monitor the pilgrim and logical dimension in the text. It focuses on the practical and communicative aspect of the language, which aims to convince the recipient and his or her emotional influence.And the novel (Yamrim) starting from the title (Sos) communication, and building dialogue and pilgrims based on two different logic completely, the logic of optimism and look at things with absolute objectivity, the logic of pessimism and closure and look at things with absolute passion. These two tendencies are embodied by the char
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