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.
God saw his servants with truth and light, and made him easy for them, and he commanded those who help them, including a counselor, guide and preacher, so if a Muslim sees deficiencies or defects, he must help him to reform and refine it. That it was in the hands of the prophets, God Almighty created the human being together straight, then melted on those scholars and researchers in all religions on psychological counseling and religious sychotherapy, stressing the importance of religious values in the process of understanding man in the process of psychotherapy and in controlling human behavior. A lot of research and studies have been published. I dealt with the religious approach in the process of treating mental disorders and the aim of
... Show MoreMeasurement of construction performance is essential to a clear image of the present situation. This monitoring by the management team is necessary to identify locations where performance is exceptionally excellent or poor and to identify the primary reasons so that the lessons gained may be exported to the firm and its progress strengthened. This research attempts to construct an integrated mathematical model utilizing one of the recent methodologies for dealing with the fuzzy representation of experts’ knowledge and judgment considering hesitancy called spherical fuzzy analytic hierarchy process (SFAHP) method to assess the contractor’s performance per the project performance pa
Soil wetted pattern from a subsurface drip plays great importance in the design of subsurface drip irrigation (SDI) system for delivering the required water directly to the roots of the plant. An equation to estimate the dimensions of the wetted area in soil are taking into account water uptake by roots is simulated numerically using HYDRUS (2D/3D) software. In this paper, three soil textures namely loamy sand, sandy loam, and loam soil were used with three different types of crops tomato, pepper, and cucumber, respectively, and different values of drip discharge, drip depth, and initial soil moisture content were proposed. The soil wetting patterns were obtained at every thirty minutes for a total time of irrigation equ
... Show MoreElectronic Health Record (EHR) systems are used as an efficient and effective method of exchanging patients’ health information with doctors and other key stakeholders in the health sector to obtain improved patient treatment decisions and diagnoses. As a result, questions regarding the security of sensitive user data are highlighted. To encourage people to move their sensitive health records to cloud networks, a secure authentication and access control mechanism that protects users’ data should be established. Furthermore, authentication and access control schemes are essential in the protection of health data, as numerous responsibilities exist to ensure security and privacy in a network. So, the main goal of our s
... Show MoreBackground: Congenital club foot is a complex deformity of foot .It is a collection of different abnormalities, with different etiologies. Consequently, Severity varies with difficulties in evaluating treatment strategies with outcome results. The treatment of congenital club foot remains controversial. Usually, the orthopedist's goal is to obtain anatomically and functionally normal feet in all patients. Objective: To asses short term follow up result of conservatively treated club feet in relation to the age
... Show MoreThis paper develops a fuzzy multi-objective model for solving aggregate production planning problems that contain multiple products and multiple periods in uncertain environments. We seek to minimize total production cost and total labor cost. We adopted a new method that utilizes a Zimmermans approach to determine the tolerance and aspiration levels. The actual performance of an industrial company was used to prove the feasibility of the proposed model. The proposed model shows that the method is useful, generalizable, and can be applied to APP problems with other parameters.
This research was aimed to evaluate activity of Rosemary volatile oil and Nisin A in vivo and on B. cereus isolated from some canned meat products in vitro. The results showed that the activity of Rosemary volatile oil (2000 µg/ml) and Nisin A (350 µg\ml) attained to 27 and 19 mm inhibitory zone diameter respectively in well diffusion method. The viable plate count from samples of canned meat treated with effective concentration of Rosemary volatile oil and Nisin A were examined. The samples with Rosemary volatile oil was not showed any CFU/g after 9 days of preservation while sample with Nisin A and control observed 49 and 45 CFU/g respectively. In vivo experiment on mice, two weeks after oral dose of Rosemary volatile oil (2000
... Show MoreIn this paper, we have examined the effectiveness exchange of optical vorticity via three-wave mixing (TWM) technique in a four-level quantum dot (QD) molecule by means of the electron tunneling effect. Our analytical analysis demonstrates that the TWM procedure can result in the production of a new weak signal beam that may be absorbed or amplified within the QD molecule. We have taken into account the electron tunneling as well as the relative phase of the applied lights to assess the absorption and dispersion characteristics of the newly generated light. We have discovered that the slow light propagation and signal amplification can be achieved. Our results show that the exchange o
Micro-perforated panel (MPP) absorber is increasingly gaining popularity as an alternative sound absorber in buildings compared to the well-known synthetic porous materials. A single MPP has a typical feature of a Helmholtz resonator with a high amplitude of absorption but a narrow absorption frequency bandwidth. To improve the bandwidth, a single MPP can be cascaded with another single MPP to form a double-layer MPP. This paper proposes the introduction of inhomogeneous perforation in the double-layer MPP system (DL-iMPP) to enhance the absorption bandwidth of a double-layer MPP. Mathematical models are proposed using the equivalent electrical circuit model and are validated with experiments with good agreement. It is revealed that the DL-
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