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.
Conflict is a common but complicated phenomenon. It has been extensively researched in many domains, including philosophy, sociology, psychology, and linguistics. Using the Critical Discourse Approach, this study examines the issue of self-society conflict in The Handmaid’s Tale. The significance of this work lies in the identification and explanation of the discursive strategies that force the ideological polarization of the positively portrayed self versus the negatively portrayed other. The purpose of this study is to answer two questions: what are the discursive strategies used in The Handmaid’s Tale to create a positive or negative representation, and how are these strategies implemented? Five extracts from The Handmaid’s
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The piled raft is a geotechnical composite construction consisting of three elements: piles, raft and soil.
In the design of piled rafts, the load shared between the piles and the raft, and the piles are used up to a
load level that can be of the same order of magnitude as the bearing capacity of a comparable single
pile or even greater. Therefore, the piled raft foundation allows reduction of settlements in a very
economic way as compared to traditional foundation concepts.
This paper presents experimental study to investigate the behavior of piled raft system in sandy
soil. A small scale “prototype” model was tested in a sand box with load applied to the system through
a compression machine. The settlement was
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Cosmetic products contain variable amounts of nutrients that support microbial growth. Most contaminants in cosmetic products include bacteria such as Staphylococcus, Pseudomonas, Klebsiella, Achromobacter and Alcaligenes. Contaminated water is a likely source of organisms found in cosmetic products. Products such as shampoo, hand and body lotion, facial cleanser, and liquid soaps were analyzed. In this study, out of 60 cosmetic products analyzed, 26.4% were found to be contaminated. Most of the contamination was from bacteria and no fungal contamination was detected. The highest level o
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يهدف البحث الى تقديم استراتيجية مقترحة لشركة نفط الشمال ، وأخذت الاستراتيجية المقترحة بنظر الاعتبار الظروف البيئية المحيطة واعتمدت في صياغتها على اسس وخطوات علمية تتسم بالشمولية والواقعية ، اذ انها غطت الانشطة الرئيسية في الشركة (نشاط الانتاج والاستكشاف , نشاط التكرير والتصفية , التصدير ونقل النفط , نشاط البحث والتطوير , النشاط المالي , تقنية المعلومات , الموارد البشرية ) وقد اعتمد نموذج (David) في التحليل البيئي
... Show MoreThe aim of advancements in technologies is to increase scientific development and get the overall human satisfaction and comfortability. One of the active research area in recent years that addresses the above mentioned issues, is the integration of radio frequency identification (RFID) technology into network-based systems. Even though, RFID is considered as a promising technology, it has some bleeding points. This paper identifies seven intertwined deficiencies, namely: remote setting, scalability, power saving, remote and concurrent tracking, reusability, automation, and continuity in work. This paper proposes the construction of a general purpose infrastructure for RFID-based applications (IRFID) to tackle these deficiencies. Finally
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This paper aims at exploring the impact of the Iraq-Iran war in the poetry of Adnan Al-Sayegh. Al-Sayegh participation in this war makes him a first hand witness to the atrocities of the trenches and fight in the first lines. This war did not only change his life and world view for good, it changes the nature of his poetry as well. As aresult, war becomes a central issue not only in the poetry Al-Sayegh wrote in the 1980s and 1990s Iraq, but also in the exile.
Key Words: War, Al-Sayegh, Poetry.
In the present paper a low cost mechanical vibration shaker of rotating unbalanced type with uniaxial shaking table was designed and constructed in an attempt to provide opportunities for experimental testing and application of vibration in experimental modal analysis, stress relief of weldments, effect of vibration on heat transfer and seismic testing of civil engineering structures. Also, it provides unexpressive solution to enhance the knowledge and technical skills of students in mechanical vibration laboratory. The shaker consists of a five main parts shaker frame, shaker table, flexible support, drive motor, and eccentricity mechanism. The experimental results show that the amplitude of the shaker is increased with increasing the f
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Some new 2,5-disubsituted-1,3,4-oxadiazole derivatives with azo group were synthesized by known reactions sequence . The structure of the synthesized compounds were confirmed by physical and spectral means .
Giving advice refers to an attempt by the speaker to express what the addressee should do in a particular situation or what is good for him/her. It is also a feature of making social relations and communications move smoothly and become stronger. The current study aims to investigate the strategies of the speech act of advice by old females and males for the younger generation in written signs. Comparison is made between old females and males regarding their pragmatic use of advice and the way they are manifested in expressing gender identity differences. The sample of the study consists of (30) written signs of advice divided equally between the two gender groups. Hinkel’s (1997) classification of the strategies for perceiving th
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The importance of evaluation depends on many institutions, whether governmental or private, including media institutions, rely on the list to evaluate the weight of things and appreciation, as well as judging things, achievements, and everything related to the institution is concerned. Because through evaluation, institutions can recognize weaknesses and strengths. It is also an effective tool for management review, through which the institution can review everything related to planning and decision-making, leadership, incentives and other administrative matters.
Therefore, this study attempts to shed light on the evaluation process, its basics and its importance in general and in the Kurdish media institutions as a model in part
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