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.
In their growth stages, cities become an aggregation of different urban contexts as a result of development or investment projects with other goals, which creates urban tension at several levels. Previous studies presented different approaches and methods to address specific aspects of urban stress, and thus contemporary visions and propositions varied, which required a field for research. The research, from a review of the proposals, the research problem emerged in need to study the indicators and trends of balanced urban development that address the tensions between different social, economic and urban contexts". Accordingly, the objective of the research is determined as "Building a comprehe
... Show MoreAims: The present study aims at assessing mothers’ knowledge of breastfeeding in Kirkuk governorate,
besides determining the relationship between mothers’ knowledge and some of their demographic
attributes.
Methodolgy: A descriptive study was used the assessment approach and applied on mothers in Kirkuk
governorate from January 15th 2011 to July 25th
, 2011. Non-probability sampling a convenience sample of
(72) mothers, attending pediatric general hospital in Kirkuk governorate for following up the health status
of their children, was selected for the purpose of the study. A questionnaire was developed for the
purpose of the study. It was comprised of two parts; the first part includes the mothers' demographic
This study aims at discussing how gender differences might affect communication among people. For this purpose, several TV interviews are selected and examined on the discourse level. Developing a model of analysis ,is found that certain linguistics have been used by male speakers ,whereas different aspects have been utilized my female speakers like deictic expressions and lexical items of emotion and delicacy .
The study aimed to monitor the concept of reputation in the previous literature, its relationship to mental image and identity, and to reveal recent trends in its measurement Techniques.
The study relied on a descriptive approach using library survey and comparative analysis, and the study reached following conclusions:
Despite the beginning of the first signs of reputation In the fifties of the last century, however, Defining and standardizing the concept with clear and specific dimensions began in the 1990s and the beginning of the third millennium. The concept of reputation refers to the stakeholders’ overall evaluation of organizations, which reflects their perceptions of
... Show MoreTheoretical trends have appeared Which posed the concept of biological structures in contemporary architecture concept, Spread through the emergence of architectural production that reflect and indicate the nature of the construction structures based on the ideas and principles of biological structures in biological science: Despite the emergence of many architectural proposals that tried to explain the concept in the field of architecture, but it is not dealt with in depth and not given a comprehensive definition: So there was need to search for the concept and its beginning in the biological field as a general framework down to the field of architecture for the purpose of reducing the limits of their search framework T
... Show MoreThis paper signifies the contradictory point of view in John Clare’s poetry. Clare (1794-1864) is an English romantic poetry in the nineteenth century, who writes more than ten volumes about nature. So, this study highlights the concept of Psychoanalytic theory which is ‘ambivalence’ and how through this theory can interpret any literary text on the basis of utilizing psychoanalytic methods to literary texts in order to reveal the author's inner emotions such as motives, dreams, as well as wishes. Consequently, the concept of ‘ambivalence’ has a lot in common with the human psyche and its struggles. Sometimes the reader finds the author/poet talking about something real or a notion with pleasant sentiments
... Show MoreTested effective Alttafaria some materials used for different purposes, system a bacterial mutagenesis component of three bacterial isolates belonging to different races and materials tested included drug Briaktin
In this study, a predicated formula is been proposed to find the shear strength of non-prismatic beams with or without openings. It depends on the contributions of concrete shear strength considering the beam depth variation and existing openings, shear steel reinforcements and defines the critical shear section, the effect of diagonal shear reinforcement, the effect of inclined tensile steel reinforcement, and the compression chord influence. The verification of the proposed formula has been conducted on the experimental test results of 26 non-prismatic beams with or without openings at the same loading conditions. The results reflect that the predicted formula finds the shear capacity of non-prismatic beams with openings, it is co
... Show MoreSuggestive ambiguity is a strategy of defense and maneuvering as it provides the speaker both protection and function. To put it differently, it helps the speaker to say whatever he likes and at the same time gives his opponents and friends the interpretation they desire. This is possible due to the flexibility of the linguistic expressions that the speaker uses. To be more clear, the context of situation, peoples' background and world knowledge interact with the significance of the linguistic expressions reaching an allusive situation where two interpretations, positive and negative, are available to the addressees. Such situation enables the addressers to implicate different ideas or messages, accusations, inciting violence, etc. The pres
... Show More