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.
A cost-effective and efficient detector was created to conduct thorough turbidimetric measurements by reaction of Co (II) ion with calcium ferro cyanide to form bright green particulate, using the method of continuous flow injection analysis, the use of NAG-5SX1-1D-SSP Analyzer in determining cobalt (II) ion in a test for the validity of the new design. The NAG-5SX1-1D-SSP Analyzer is composed of five irradiation sources of white snow leds having the diameter of 10 mm with one solar cell of 55 mm length, 13.5 mm width. Using a selector switch to select the optimum voltage to be used which was 2.7 VDC. Under conditions of optimization, cobalt (II) ion was determined at 0.005–20 mmol. L–1(n = 23) while linearity dynamic range 0.005–7 mm
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Hollow core photonic bandgap fibers provide a new geometry for the realization and enhancement of many nonlinear optical effects. Such fibers offer novel guidance and dispersion properties that provide an advantage over conventional fibers for various applications. Dispersion, which expresses the variation with wavelength of the guided-mode group velocity, is one of the most important properties of optical fibers. Photonic crystal fibers (PCFs) offer much larger flexibility than conventional fibers with respect to tailoring of the dispersion curve. This is partly due to the large refractive-index contrast available in the silica/air microstructures, and partly due to the possibility of making complex refractive-index structure over the fibe
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A partial temporary immunity SIR epidemic model involv nonlinear treatment rate is proposed and studied. The basic reproduction number is determined. The local and global stability of all equilibria of the model are analyzed. The conditions for occurrence of local bifurcation in the proposed epidemic model are established. Finally, numerical simulation is used to confirm our obtained analytical results and specify the control set of parameters that affect the dynamics of the model.
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In this research, the removal of cadmium (Cd) from simulated wastewater was investigated by using a fixed bed bio-electrochemical reactor. The effects of the main controlling factors on the performance of the removal process such as applied cell voltage, initial Cd concentration, pH of the catholyte, and the mesh number of the cathode were investigated. The results showed that the applied cell voltage had the main impact on the removal efficiency of cadmium where increasing the applied voltage led to higher removal efficiency. Meanwhile increasing the applied voltage was found to be given lower current efficiency and higher energy consumption. No significant effect of initial Cd concentration on the removal efficie
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Treatment of a high strength acidic industrial wastewater was attempted by activated carbon
adsorption to evaluate the feasibility of yielding effluents of reusable qualities. The experimental
methods which were employed in this investigation included batch and column studies. The
former was used to evaluate the rate and equilibrium of carbon adsorption, while the latter was
used to determine treatment efficiencies and performance characteristics. Fixed bed and expanded
bed adsorbers were constructed in the column studies. In this study, the adsorption behavior of acetic acid onto activated carbon was examined as a function of the concentration of the adsorbate, contact time and adsorbent dosage. The adsorption data was mo
: Sound forecasts are essential elements of planning, especially for dealing with seasonality, sudden changes in demand levels, strikes, large fluctuations in the economy, and price-cutting manoeuvres for competition. Forecasting can help decision maker to manage these problems by identifying which technologies are appropriate for their needs. The proposal forecasting model is utilized to extract the trend and cyclical component individually through developing the Hodrick–Prescott filter technique. Then, the fit models of these two real components are estimated to predict the future behaviour of electricity peak load. Accordingly, the optimal model obtained to fit the periodic component is estimated using spectrum analysis and Fourier mod
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يهتم هذا البحث بدراسة الأجوبة المسكتة,وهي أجوبة سريعة وحاسمة تقطع حجة الخصم وتفحمه وتغلقالحوار.وقد أرتكز البحث على منهجية تداولية تنظرإلى فاعلية الجواب المسكت في المحاورة وإنهائها من زواياإنجازية و حجاجية.وقد تكون البحث من ديباجة ممهدةوثلاثة مباحث.وسلطتالديباجةالممهدةالضوء علىمفهومالجواب المسكتوشيوعهفي كتب الأدبوالأخبارونوادر الكلاموكيف يمكن النظر لهبوصفه وحدة حوارية تنبنيمنها المحادثة؟أما المبحث ا
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The physician's commitment to medical insight is affected by several factors that vary from patient to patient in terms of the nature of the disease, the severity of the disease, the age of the patient, and the purpose of undergoing medical intervention. There are circumstances surrounding patients that require the physician to reduce the insight towards them, by concealing medical information. The physician must firmly commit to expanding the scope of his vision to a wider extent than in normal medical work. Therefore, we will discuss in this regard the cases in which medical explanation is reduced and the cases that require confirmation in the following order.