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 proposal of nonlinear models is one of the most important methods in time series analysis, which has a wide potential for predicting various phenomena, including physical, engineering and economic, by studying the characteristics of random disturbances in order to arrive at accurate predictions.
In this, the autoregressive model with exogenous variable was built using a threshold as the first method, using two proposed approaches that were used to determine the best cutting point of [the predictability forward (forecasting) and the predictability in the time series (prediction), through the threshold point indicator]. B-J seasonal models are used as a second method based on the principle of the two proposed approaches in dete
... Show MoreThis article discusses how women have significant abilities to cope with the difficulties of war times. They are not the weak and vulnerable victims who are thought to be. On the contrary, they have the power to control over many-sided fronts, like participating in the battlefield as nurses or activists for peace, or even fighters, as well as through the tasks and responsibilities assigned to them to protect and support their families during wartime. The researcher will examine the impact of war upon women. Like men, women suffer during wartime. They are being injured, tortured and killed. Yet, they are able to give examples of love and courage even in the difficult times of war. Hana is one of those women who lived during wartimes,
... Show MoreOne of the main environmental problems which affect extensively the areas in the world is soil salinity. Traditional data collection methods are neither enough for considering this important environmental problem nor accurate for soil studies. Remote sensing data could overcome most of these problems. Although satellite images are commonly used for these studies, however there are still needs to find the best calibration between the data and real situations in each specified area. Landsat satellite (TM & ETM+) images have been analyzed to study soil pollution (Exacerbation of salinity in the soil without the use of abandoned agricultural for a long time) at west of Baghdad city of Iraqi country for the years 1990, 2001 & 2007. All of the th
... Show MoreThe contractual imbalance is perceived today by the majority of the doctrine as being one of the pitfalls to the execution of the contracts. As a result, most legislations grant judges the power to intervene to restore it. Granting the judge the power to complete the contract raises the question of the extent to which the judge can obtain such power. Is it an absolute authority that is not limited? If so, is it a broad discretion in which the judge operates in his conscience, or is it a power of limited scope by specific legal texts and conventions? This is what we will try to answer in this research.
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
The effects of Internet use on university’s students:The effects of Internet use on university’s students:“A Study on a Sample of Jordanian University’s students "This survey aims to identify the most important effects of Internet use on Jordanian public and private universities’ students by monitoring and analyzing a set of indicators that show the quality of the effects on specific fields such as cultural, social, psychological, moral and political effects .To achieve these goals, the study attempts to answer the following questions:1. What are the effects of Internet’s use on students?2. What is the relationship between the effects and demographic variables such as gender, age, family size an
... Show MoreTheauthor addressed politeness discourse in “Surat Ghafir”. Quran texts include many rhetorical utterances which are considered pragmatic mechanismsconcerned with finding polite discourse. examining these texts allow to determine the effectiveness degree in the discourse, and to find the effect level that leads to interaction between the speaker and the listener. Graduation is considered an effect and a mechanism of discourse escalation.
The author reached a common definition of the graduation effectiveness term, due to its importance in finding polite discourse that is constructed by lingual manifestations some of which are escalation and graduation. Escalation is a mechanism to show the level of discourse graduation, it is a mea
Molecular dynamics (MD) simulations were carried out in order to investigate the binding mode of axillaridine-A at the active site of human acetylcholinesterase (AChE) enzyme. 2.0 nanosecond of MD simulations was made for the protein and the complex to dynamically explore the active site and the behavior of the ligand at the peripheral AChE binding site. These calculations for the enzyme alone showed that the active site of AChE is located at the bottom of a deep and narrow cavity whose surface is lined with rings of aromatic residues and Tyr72 is almost perpendicular to the Trp286 ring and forms a stable - interaction. The size of the active site of the complex decreases with time due to increase the interaction. Axillaridine-A forms
... Show MoreIn this paper fractional Maxwell fluid equation has been solved. The solution is in the Mettag-Leffler form. For the corresponding solutions for ordinary Maxwell fluid are obtained as limiting case of general solutions. Finally, the effects of different parameters on the velocity and shear stress profile are analyzed through plotting the velocity and shear stress profile.