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 Wang-Ball polynomials operational matrices of the derivatives are used in this study to solve singular perturbed second-order differential equations (SPSODEs) with boundary conditions. Using the matrix of Wang-Ball polynomials, the main singular perturbation problem is converted into linear algebraic equation systems. The coefficients of the required approximate solution are obtained from the solution of this system. The residual correction approach was also used to improve an error, and the results were compared to other reported numerical methods. Several examples are used to illustrate both the reliability and usefulness of the Wang-Ball operational matrices. The Wang Ball approach has the ability to improve the outcomes by minimi
... Show MoreIbn al-Haytham is the pioneer of optics, which is a science that had described optics circumstances. Optics or landscape science as it was known by the Arab and Muslim scientists at the time when is a science known as the conditions of sighters in their quantity and quality as the proximity and distance from the beholder , the different forms , conditions and what mediate between the beholder and the microscopes , to explain useful knowledge of what obscures the sight of the conditions of sighters and is used to measure the space Distant criminality and mirrors.
Ibn al-Haitham wrote his famous book The Book of Mirrors and studied mistakes adopted the m
... Show MoreThe aim of this essay is to use a single-index model in developing and adjusting Fama-MacBeth. Penalized smoothing spline regression technique (SIMPLS) foresaw this adjustment. Two generalized cross-validation techniques, Generalized Cross Validation Grid (GGCV) and Generalized Cross Validation Fast (FGCV), anticipated the regular value of smoothing covered under this technique. Due to the two-steps nature of the Fama-MacBeth model, this estimation generated four estimates: SIMPLS(FGCV) - SIMPLS(FGCV), SIMPLS(FGCV) - SIM PLS(GGCV), SIMPLS(GGCV) - SIMPLS(FGCV), SIM PLS(GGCV) - SIM PLS(GGCV). Three-factor Fama-French model—market risk premium, size factor, value factor, and their implication for excess stock returns and portfolio return
... Show MoreThe problem of research is that there are ways to protect and sustain environmentally important sites in Iraq. There are no documentary sources for these sites, such as the natural landscape of natural and important natural resources, which suffer from severe environmental neglect
Despite the principle of separation of powers brought by the French Revolution, which entrusted the task of drafting legislation and its amendment to the legislative authority and the task of settling disputes and settling them in the judiciary. However, since that date, the French judiciary has played a major role in the development of French civil law (In spite of all the economic and social developments that have taken place in French society throughout these years) since its promulgation until February of 2016, the date of the Legislative Decree No. 131 of the year 2016 A modification is the largest in the history of the French Civil Code (which was the judicial precedents in which a significant impact), was assisted by the French judic
... Show MoreThe researchers of the present study have conducted a genre analysis of two political debates between American presidential nominees in the 2016 and 2020 elections. The current study seeks to analyze the cognitive construction of political debates to evaluate the typical moves and strategies politicians use to express their communicative intentions and to reveal the language manifestations of those moves and strategies. To achieve the study’s aims, the researchers adopt Bhatia’s (1993) framework of cognitive construction supported by van Emeren’s (2010) pragma-dialectic framework. The study demonstrates that both presidents adhere to this genre structuring to further their political agendas. For a positive and promising image
... Show MoreThere are still areas around the world suffer from severe shortage of freshwater supplies. Desalination technologies are not widely used due to their high energy usage, cost, and environmental damaging effects. In this study, a mathematical model of single-bed adsorption desalination system using silica gel-water as working pair is developed and validated via earlier experiments. A very good match between the model predictions and the experimental results is recorded. The objective is to reveal the factors affecting the productivity of fresh water and cooling effect in the solar adsorption system. The proposed model is setup for solving within the commercially-available software (Engineering Equation Solver). It is implemented to so
... Show MoreChronic myeloid leukemia (CML), is one of the myeloproliferative disorders with a characteristic cytogenetic abnormality resulting in the BCR-ABL fusion gene. Imatinib Mesylate is an effective agent for treating patients in all stages of CML. According to the annual Iraqi cancer registry 2019, the total number of chronic myeloproliferative disorders was 338. The percentage and incidence rates were 0.94% and 0.86%, respectively, with a higher incidence rate in males than females (1.12 in males and 0.60 in females). In this registry, no details about CML, so this study aimed to estimate the number of CML patients who attended the national center of hematology from 2005 until 2020 and investigate their epidemiological and clinic-pathol
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