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.
This research aims to knowledge the extent of the application of Tuz General Hospital to the concept of tacit knowledge dimensions (mental models, intuition, experience, skill) and methods of acquiring knowledge dimensions (training, job rotation, work teams) and the measurement and analysis of the link and the kind of impact between the methods of acquiring knowledge and tacit knowledge of the Angels nursing in the researched hospital, and was the questionnaire primary means of collecting information adopted by the researcher that, the research sample of (90) individuals, including the Angels nursing, has been using the statistical program spss for the purpose of conducting statistical treatments, and through the diagnosis and m
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The technology of subsurface soil water retention (SWRT) uses a polyethylene trough that is fixed under the root zone of the plant. It is a modern technology to increase the values of water use efficiency, plant productivity and saving irrigation water by applying as little irrigation water as possible. This study work aims at improving the crop yield and water use efficiency of a cucumber plant with less applied irrigation water by installing membrane trough below the soil surface. The field experiment was conducted in the Hawr Rajab District of Baghdad Governorate in Winter 2018 for testing various trickle irrigation systems. Two agricultural treatment plots were utilized in a greenhouse for the comparison. Plot T1 has used a subsurface t
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Gas adsorption phenomenon on solid surface has been used as a mean in separation and purification of gas mixture depending on the difference in tendencies of each component in the gas mixture to be adsorbed on the solid surface according to its behaviour. This work concerns to study the possibilities to separate the gas mixture using adsorption-desorption phenomenon on activated carbon. The experimental results exhibit good separation factor at temperature of -40 .
The TV has the ability to combine sound and picture, which makes it of a direct impact on the recipient as it is a rich communicative tool with various artistic forms that display through this small screen programs and films, so that the TV has become superior over many other means of communication.
This research is concerned with the technical and artistic ability in the production of programs owned by the TV as a means of attraction of educated children aged between 5-12 years old, which makes it an educational supplement for the school that helps them in providing knowledge, acquiring skills and being informed about the different sciences through educational programs. It is known that the child at this stage enjoys when wa
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Crime has become a phenomenon associated with human socialization. Wherever human groups are found, a crime, which differs from one society to another, is found. It is one of the most dangerous social issues that undermines the solidarity of a given society. This is because it establishes a takeoff from community's norms, values, customs and traditions, and thus turns into a danger to the lives of people, groups and society that threatens its strength and security. The paper focuses on the crimes that violate the social law, like child rape, incest and electronic extortion, which are increasing in size, increasing as a result their repercussions on the human society. The study seeks several objectives, including: examining the natu
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In this study, a proposed process for the utilization of hydrogen sulphide separated with other gases from omani natural gas for the production of sulphuric acid by wet sulphuric acid process (WSA) was studied. The processwas simulated at an acid gas feed flow of 5000 m3/hr using Aspen ONE- V7.1-HYSYS software. A sensitivity analysis was conducted to determine the optimum conditions for the operation of plant. This included primarily the threepacked bed reactors connected in series for the production of sulphur trioxidewhich represented the bottleneck of the process. The optimum feed temperature and catalyst bed volume for each reactor were estimated and then used in the simulation of the whole process for tw
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The current study aimed to identify the quality of health services provided by the Omani health sector through the comparison between public and private hospitals in Dhofar Governorate, Oman. A questionnaire has been developed to collect data from 360 patients who received health services in one public Hospital (Sultan Qaboos) and three private Hospitals (Badr Al-Sama, Lifeline, and Al-Hakeeim). The data were analyzed using independent samples T-Test and One Way ANOVA. The results of the study showed that the quality levels of health services offered in private hospitals were better than public hospitals. The study results also reveled that there are significant differences between public hospitals and private hos
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Abstract
The research stems from the problem that focuses on a number of questions. They are as follows: What is the extent of interest in the topic of efficiency by the banks and their role in raising the efficiency of the banking business and its development? Is the banking efficiency used in Iraqi banks clear and specific for the Iraqi banking sector? How the banking sector efficiency is measured and what are the approaches adopted in determining the banking inputs and outputs? What is the level of efficiency in the research sample of the banks and what are the causes of its decline or rise in private banks individually and in the Iraqi banking sector in general?
The re
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The political struggle being waged by Muslims today is one of the most important issues that have preoccupied the Arab and international media, and the failures that have afflicted Muslims in our contemporary world have negatively affected the younger generations and led them, and with the influence of anti-Islam media, to rely on accusing Islam as a religion with all the negative in Islamic and Arab society . So secularism took its role in spreading these concepts by deviating from its course from the concept of science to the concept of (the religion).
From here the calls for reform rose to return the Muslims to the incubator of Islam, so people turned around them, but they turned into competing Islamic polit