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.
In the light of what is witnessing in the advertising arena of new ways and methods in delivering advertising message to consumers by finding new outlets to communicate with them especially through social networking sites, which became the first choice of advertising companies in order to spread its goods and services. These companies now are relying gradually on celebrities to appear with their products and goods to drive the audience's attention towards them. The thesis aims to find out the attitudes of young people towards the the advertisements that show famous celebrities on social networking sites. The researcher used survey method which aims to record, analyze and interpret the phenomenon after collecting the necessa
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The present work investigates the effect of magneto – hydrodynamic (MHD) laminar natural convection flow on a vertical cylinder in presence of heat generation and radiation. The governing equations which used are Continuity, Momentum and Energy equations. These equations are transformed to dimensionless equations using Vorticity-Stream Function method and the resulting nonlinear system
of partial differential equations are then solved numerically using finite difference approximation. A thermal boundary condition of a constant wall temperature is considered. A computer program (Fortran 90) was built to calculate the rate of heat transfer in terms of local Nusselt number, total mean Nusselt number, velocity distribution as well as te
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The key objective of the study is to understand the best processes that are currently used in managing talent in Australian higher education (AHE) and design a quantitative measurement of talent management processes (TMPs) for the higher education (HE) sector.
The three qualitative multi-method studies that are commonly used in empirical studies, namely, brainstorming, focus group discussions and semi-structured individual interviews were considered. Twenty
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Wireless sensor applications are susceptible to energy constraints. Most of the energy is consumed in communication between wireless nodes. Clustering and data aggregation are the two widely used strategies for reducing energy usage and increasing the lifetime of wireless sensor networks. In target tracking applications, large amount of redundant data is produced regularly. Hence, deployment of effective data aggregation schemes is vital to eliminate data redundancy. This work aims to conduct a comparative study of various research approaches that employ clustering techniques for efficiently aggregating data in target tracking applications as selection of an appropriate clustering algorithm may reflect positive results in the data aggregati
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In this paper the variable structure control theory is utilized to derive a discontinuous controller to the magnetic levitation system. The magnetic levitation system model is considered uncertain, which subjected to the uncertainty in system parameters, also it is open-loop unstable and strongly nonlinear. The proposed variable structure control to magnetic levitation system is proved, and the area of attraction is determined. Additionally, the chattering, which induced due to the discontinuity in control law, is attenuated by using a non-smooth approximate. With this approximation the resulted controller is a continuous variable structure controller with a determined steady state error according to the selected control
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