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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The paper aims to build a model that supports organizational sustainability by analyzing the correlations and revealing the impact between the two main variables (entrepreneurial leadership) with its dimensions of proactive outlook, risk, and creativity (Van Zyl & Mathur-Helm, 2007), and (organizational sustainability) with its economic, environmental, and societal dimensions (Hansmann et al., 2012). As well as identifying the level of awareness and informing managers in the General Company for the Automotive and Equipment Industry, of the theoretical implications and performance, and its vital importance to society and the surrounding ecological environment, and drawing attention to that and improving performance, and indicatin
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Incorporating the LiDAR sensor in the most recent Apple devices represents a substantial development in 3D mapping technology. Meanwhile, Apple's Lidar is still a new sensor. Therefore, this article reviews the potential uses of the Apple Lidar sensor in various fields, including engineering and construction, focusing on indoor and outdoor as-built 3D mapping and cultural heritage conservation. The affordable cost and shorter observation times compared to traditional surveying and other remote sensing techniques make the Apple Lidar an attractive choice among scholars and professionals. This article highlights the need for continued research on the Apple LiDAR sensor technology while discussing its specifications and limitations. A
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Purpose To test the effect of strategic Supremacy on strategic success A case study in Thi Qar Governorate, methodology/approach – this is a mandatory entry.
a case study was used and applied to the Department managers of Government of the province of Thi Qar, Research limitations/implications – It is clear that the strategic Supremacy variable is not being used effectively to achieve strategic success.
Practical implications – use strategic supremacy positively to Support for strategic success. implementing and monitoring ignorance of them in how to use thi
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Three hundred samples of washing water of vegetables were collected from women aged ( 15- 6o) years from different area in Baghdad governorate and its suburbs include two rural area ( Jaddria in Baghdad university and Al –Wagif in Rashdia) and two urbane area (Mansoure and Escan) . The samples were examined by precipitation method and then by staining method ( Lugols –Iodine stain) . The percentage of infection of intestinal parasites 36.3% include 15.3% for urban area and 57.3% in rural area and a significant difference was found between those groups . .The results showed also increased in the prevalence of parasitic infection in group age (15 -30) year .Also the results showed only 109 sample infected with eight specie
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Laser is a powerful device that has a wide range of applications in fields ranging from materials science and manufacturing to medicine and fibre optic communications. One remarkable