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.
Nonmissile penetrating traumatic brain injuries (pTBIs) are low-velocity injuries which can be caused by a variety of inflicting tools and represent a rare entity in children. Poor outcome has been attributed with an initial admission Glasgow Coma Scale (GCS) of <5, asymmetrical pupil size, and specific initial computed tomography scan findings including brainstem injury.
We report a case of an 11-year-old boy who presented to our ER with a GCS of 6 after being assaulted on his head by a 30 cm length metallic tent hook penetrating his forehead reaching down to the central skull bas
A remarkable correlation between chaotic systems and cryptography has been established with sensitivity to initial states, unpredictability, and complex behaviors. In one development, stages of a chaotic stream cipher are applied to a discrete chaotic dynamic system for the generation of pseudorandom bits. Some of these generators are based on 1D chaotic map and others on 2D ones. In the current study, a pseudorandom bit generator (PRBG) based on a new 2D chaotic logistic map is proposed that runs side-by-side and commences from random independent initial states. The structure of the proposed model consists of the three components of a mouse input device, the proposed 2D chaotic system, and an initial permutation (IP) table. Statist
... Show MoreThis study examines the validity of e-poetry as an acceptable literary genre. The
thematic, stylistic and esthetic features of a selected number of e-poems produced by
poetry generators are analyzed for this purpose. The e-poems are then compared with a
number of works written by Dada poets in order to establish the literary merit of the
former.
The Quiet American could be considered as one of Graham Greene’s most distinguished books; it is an epochal novel written during the phase of the cold war between the United States and the Soviet Union. The novel deals with the interference of the United States in Vietnam ten years before Vietnam’s war. The role the Americans played in arousing an inner political crisis in the country previous to her military invention. The book reflects that this action was not out of American government concern about Vietnamese people themselves but merely a political foreign affair. They wanted to stop communism from spreading widely and reducing its role in the East. This paper attempts to analyse the novel concentrating on the message Greene intend
... Show MoreWhen exercising their authority in the jurisprudence, judges are subject to a set of restrictions that they must adhere to, as they do not want their jurisprudence to be accepted and welcomed by law practitioners in general, and legal scholars in particular, and in contrast to it, the arrows of criticism and defamation will extend to that jurisprudence, and then they will have to reverse them . Perhaps the most important of those restrictions imposed on judges is their observance of justice between the parties to the lawsuit through their lack of bias for one of the parties at the expense of the other, in addition to their observance of public order and public morals, as well as their observance of the legal texts that they work under its u
... Show MoreManipulation is a discursive concept which plays a key role in political discourse by which politicians can impose some impact on their recipients through using linguistic features, most prominent of which are personal pronouns (Van Dijk, 1995). The aim of this study is to investigate how politicians utilize the personal pronouns, namely; We and I and their possessive forms as a tool of manipulating the audience's mind based on Van Dijk's "ideological square" which shows positive-self representation and negative-other representation (Van Dijk,1998:p.69). To this end, American President Donald Trump's 2020 State of the Union speech was chosen to be the data of analysis. Only (8)
... Show MoreThe general trend in Iraqi banks is focused towards the application of international financial reporting standards, especially the international financial reporting standard IFRS 9 “Financial Instruments”, in addition to the directives issued on the Central Bank of Iraq’s instructions for the year 2018 regarding the development of expected credit losses models, and not to adhere to a specific method for calculating these losses and authorizing the banks’ departments to adopt the method of calculating losses that suits the nature of the bank’s activity and to be consistent in its use from time to time. The research problem revolves around the different methodologies for calculatin
... Show MoreWith time progress importance of hiding information become more and more and all steganography applications is like computer games between hiding and extracting data, or like thieves and police men always thieve hides from police men in different ways to keep him out of prison. The sender always hides information in new way in order not to be understood by the attackers and only the authorized receiver can open the hiding message. This paper explores our proposed random method in detail, how chooses locations of pixel in randomly , how to choose a random bit to hide information in the chosen pixel, how it different from other approaches, how applying information hiding criteria on the proposed project, and attempts to test out in code, and
... Show MoreBackground : Xanthomatosis is a disease in which large tendon tumors can occur, especially in the Achilles tendon. This disease is a rare interesting orthopaedic condition.
Case Report:A case of a twenty eight year old girl patient with giant bilateral Achilles tendon xanthomas in which both tumors were resected.
There was no ulceration on the both sides. The patient was treated by total resection of the lesion and reconstruction using tendon transfer of the Peroneus brevis and Flexor hallusis longus. Postoperative treatment consisted of six weeks lower leg cast immobilization followed by partial weight bearing. After 4 months the patient was able to walk pain free without any difficultie
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