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 coefficient of performance of a window type Air-Conditioner system can be improved if a reduction in the work of compressor can be achieved by a suitable technique. The present study investigates the effect of dispersing a low concentration of TiO2 nanoparticles in the mineral oil based lubricant, as well as on the overall performance of a window type Air-Conditioner system using R22 as the working fluid. An enhancement in the COP of the refrigeration system has been observed and the existence of an optimum volume fraction noticed, with low concentrations of nanoparticles suspended in the mineral oil. Results showed that the average compressor work reduced by 13.3%, which ultimately resulted in an increase of 11.99% in the COP due to
... Show MoreThere is no access to basic sanitation for half the world's population, leading to Socioeconomic issues, such as scarcity of drinking water and the spread of diseases. In this way, it is of vital importance to develop water management technologies relevant to the target population. In addition, in the separation form of water treatment, the compound often used as a coagulant in water treatment is aluminum sulfate, which provides good results for raw water turbidity and color removal. Studies show, however, that its deposition in the human body, even Alzheimer's disease, can cause serious harm to health and disease development. The study aims to improve the coagulation/flocculation stage related to the amount of flakes, i
... Show MoreThe poultry industry is developing continuously and rapidly, this development takes several trends in the poultry industry, such as searching for new alternatives feed additives. The research focused on finding new alternatives feed additives, among these alternatives is Synoptic, which used to maximize the benefit of the two important compounds (probiotics and prebiotics) as these two compounds are considered one of the most alternatives feed additives, which have been used a lot in poultry feeding to maximize the value of these compounds, they were combined into one compound called synbiotic. Several studies confirm that the synbiotic effect on the intestine morphology, which, the ratio villus height and villus: crypt ratio in the
... Show MoreThis review article concentrates the light about aetiology and treatment of the periimplantitis.
The deficiency in the nurse staff in the health organizations consider an important problem that must be studied and solved basically , not only because it affect on the health organization and it's strategic goals , but also it affect the human being and it's health which can't be substituted with anything or delayed in it's treatment ,This research aims to necessary for health organizations to strategically help in maintaining the nurse staff and to keep that in it's strategic orientation and it's mission , moreover , the health organizations must study the reality of the nurse in the health organizations and know the causes beyond leaving the nurse staff the nurse job , and then remove
... Show MoreThis paper proposes a new method to tune a fractional order PID controller. This method utilizes both the analytic and numeric approach to determine the controller parameters. The control design specifications that must be achieved by the control system are gain crossover frequency, phase margin, and peak magnitude at the resonant frequency, where the latter is a new design specification suggested by this paper. These specifications results in three equations in five unknown variables. Assuming that certain relations exist between two variables and discretizing one of them, a performance index can be evaluated and the optimal controller parameters that minimize this performance index are selected. As a case study, a third order linear time
... Show MoreFallacies are incorrect reasoning that make an argument seem less logically credible and easier to be identified as unsound. They are widespread; individuals commit them while engaging in various activities, including at work, at home, while creating advertisements, and in the media. This study aims to investigate the rhetorical strategies accompanied with producing the fallacious arguments selected from the American Film “12 Angry Men (1957)”. The study adopts Damer’s (2009) model for the identification of fallacy. As for rhetorical analysis, the study adopts Aristotle’s triangle of rhetoric and McGuigan’s (2007) taxonomy of rhetorical devices. The results uncover that the most violated criteria are relevance, acceptabili
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