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 surgery Keywords: Non-surgical treatment of anal fissure, fissure in ano, sphicterotomy,botulinum toxin in anal fissures, glyceryl trinitrate. Chemical sphincteratomy, pharmacological sphincteratomy.
The current study aims to identify the needs in the stories of the Brothers Grimm. The research sample consisted of (3) stories, namely: 1- The story of the Thorn Rose (Sleeping Beauty) 2- The story of Snow White 3- The story of Little Red Riding Hood. The number of pages analyzed reached (15.5) pages, and to achieve the research objectives, Murray's classification of needs was adopted, which contains (36) basic needs that are further divided into (129) sub-needs. The idea was adopted as a unit of analysis and repetition as a unit of enumeration, Reliability was extracted in two ways: 1- Agreement between the researcher and himself over time, where the agreement coefficient reached 97%. The second was agreement between the researcher and tw
... Show MoreDevelopments are carried out to enhance the performance of vertical axis wind turbines (VAWT). This paper studies the performance of the ducted wind turbine with convergent duct (DAWT). Basically, the duct technique is utilized to provide the desired wind velocity facing the turbine. Methodology was developed to estimate the decisive performance parameter and to present the effect of the convergent duct with different inlet angles. The ducted wind turbine was analyzed and simulated using MATLAB software and numerically using ANSYS-Fluent 17.2. Result of both approaches were presented and showed good closeness for the two cases of covering angles 12 and 20 respectively. Results also showed that the convergent duct with an inlet angl
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Allah Almighty has aggrandized the position of orphans and elevated their status in the society and has given the graces for those who sponsor the orphan and care for and protecting them, even those who rub their heads. The divine care is manifested in the verses of the Holy Bible and the Holy Quran. Therefore, the whole world cared for the orphan, and called for the rights of the orphans in the conferences and the channels. But all that was little effort that does not meet what the orphan need and some were only ink on paper that were not applied. All that mentioned above is necessary in dealing with the study (the rights of orphans in the Old Testament and Islam, a Comparative Study). The study was divided into a Preface and four inquirie
... Show MoreAim: The reduction in the amount of marginal bone is the most important demand for the long term success of dental implants. This prospective clinical study was aimed to investigate the marginal bone loss of early loaded SLActive implants with different dimensions and surgical approaches. Materials and methods Fifteen patients aged from 18 to 60 years were divided into 2 groups (flapped and flapless approach) that underwent delayed implant placement protocol with SLActive implants. The marginal bone level was estimated by cone-beam computed tomography during three different periods: preoperatively, 8 weeks after surgery and 24 weeks after loading of the prosthesis. Results: The mean value of marginal bone level was not significantly chan
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English has for long been one of the most widely used media of communication globally, especially in the Malaysian universities. It has been termed as a Lingua Franca because it is shared with other languages which are considered first languages by different speakers. For this reason, English as a Lingua Franca (ELF) has attracted a number of researchers to investigate its variety via other languages in various communities. The objective of this paper is therefore to establish the strategies which are employing by the international students at the National University of Malaysia/ UniversitiKebangsaan Malaysia (UKM) as an example of one of the Malaysian universities; when they e
... Show MoreAmong more than 200 different human papilloma viral genotypes, the association of low oncogenic risk-HPV genotypes have been recognized with a variety of oral, oropharyngeal, nasopharyngeal benign tumors as well as non-neoplastic polyposis and papillomas and adenoid hypertrophy. This prospective case- control study aims to determine the rate of DNA detection of HPV genotype 6/11 in nasopharyngeal adeno- tonsillar tissues from a group of patients subjected to adenoctomy for adenoid hypertrophy . A total number of nasopharyngeal adeno-tonsillar tissue specimens from pediatric patients with adenoid hypertrophy were enrolled; 40 nasopharyngeal adeno-tonsillar tissues from patients with adenoid hypertrophy, and 20 normal nasal tissue specimen
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This study examines Agence France Presse’s (AFP) media treatment of the Great Return Marches in order to identify its contents, the issues it gave attention to, its sources, attitude, techniques, objectives, the journalistic forms used in covering events and the typographic elements used to highlight them.
This descriptive study employed the survey methodology through the use of content analysis method, and the methodology of mutual relations through the use of the case study method. The data was collected by means of a content analysis form. The study was based on the Agenda Setting Theory in the analysis of the study results.
The study sample included (116) news texts from AFP collected during the period from 20/3/2018 to
Abstract
The study aimed to prepare a practical guide for procedures for auditing the strategies of municipal institutions in achieving sustainable development by adopting the idea of the audit matrix through which a classified report is prepared according to the dimensions of sustainable development, by preparing a specialized audit program for the purpose of auditing strategies for achieving sustainable development and emptying the results of the application of each of the paragraphs The program in the audit matrix that was prepared for the purpose of determining the impact of each observation and linkin
... Show MoreIn this research, some probability characteristics functions (probability density, characteristic, correlation and spectral density) are derived depending upon the smallest variance of the exact solution of supposing stochastic non-linear Fredholm integral equation of the second kind found by Adomian decomposition method (A.D.M)
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Let R be a 2-torision free prime ring and ?, ?? Aut(R). Furthermore, G: R×R?R is a symmetric generalized (?, ?)-Biderivation associated with a nonzero (?, ?)-Biderivation D. In this paper some certain identities are presented satisfying by the traces of G and D on an ideal of R which forces R to be commutative
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