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.
الحمد الله أولا واخرا وبعد .. إن الواقع الذي عايشه الناس في ظل دولة المسلمين منذ إقامة دولة الإسلام بعد بعثة الرسول الكريم (صلى الله عليه وسلم ) في المدينة ولأكثر من أربعة عشر قرنا نرى إنه عاش في كنف هذه الدولة الكبيرة من بلاد الصين شرقا وإلى وسط أوربا وجنوب فرنسا غربا العشرات من الملل و الأديان والأجناس وممن لا يدينون بالإسلام وهم كما تحفظ لهم دولة الإسلام منهم وعيشهم الرغيد فهم يمارسون شعائرهم وطقوسهم الديني
... Show MoreAccording to the prevalence of multidrug resistance bacteria, especially Pseudomonas aeruginosa, in which the essential mechanism of drug resistance is the ability to possess an efflux pump by which extrusion of antimicrobial agents usually occurs, this study aims to detect the presence of mexB multidrug efflux gene in some local isolates of this bacteria that show resistance towards three antibiotics, out of five. Sensitivity test to antibiotics was performed on all isolates by using meropenem (10μg/disc), imipenem (10μg/disc), amikacin (30 μg/disc), ciprofloxacin (5μg/disc) and ceftazidime (30 μg/disc). Conventional PCR results showed the presence of mexB gene (244bp) in four isolates out of ten (40%). In addition,25, 50μg/ml of cur
... Show MoreTerrorist crime is considered a serious act that outweighs all other crimes in terms of impact and result, because it has a wide range on societies, and it also contains a great thing of danger represented in its purpose, and here describing terrorism as a crime is a description that does not give the full right to this behavior or that it It abbreviates it and does not show its actual reality, given that terrorism contains several different crimes and the roles of its contributors, and these roles are necessary to reach the result or the end. In which each episode is complementary to the other, it is not a single act, but rather several joint and complex actions that in turn all lead to the result, and the agreement in the terrorist pro
... Show MoreMany of the signs that the global energy system indicate the start of a period of transition from total dependence on fossil energy sources, especially oil, into a new era in which alternative energy sources play an important role in meeting the growing needs of energy demand, so sought many of the developed countries through research the studies carried out to try to bring renewable energy sources and non-renewable (shale oil, oil sands, solar energy, wind energy .... etc) replace traditional fossil energy sources (oil, gas, coal) and despite the recent availability dramatically and spread throughout the the world, but they are going to dry up in the foreseeable future. So many countries, especially the developed sought to find
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The researcher has studied in his research (International Public Relations methods in building the state's image through Cyberspace)
, analytical study of the Facebook and twitter pages for British foreign office , the role was played by the International Public Relations in building the mental image of British , especially after the new media and internet have became influential role in political life . and became an important tools used by political institutions as ministries of foreign affairs in the twenty: one century .
The researcher identified the problem of this study with the following question:
(what is the role of the International Public Relations in building the mental image of state through Cyberspace)
To answer
(1)
Literary works include, for the most part, text thresholds, which are the first entry into reading them and understanding their connotations, and (literary works) vary according to text thresholds, some of which are limited to the title and on the cover page only, and others, in addition to these two thresholds, are based on the dedication threshold too, and others ...
This study takes the story of "Mamo Zain" of the poet Ahmed Al-Khani and his translator Sheikh Muhammad Ramadan Al-Bouti as the field of study, as it is a unique literary work, which included a number of textual thresholds which supported each other and cooperated with the content of the work.
The threshold of dedication in the story of "Mamo Zain" was a spee
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يهدف البحث الحالي الى استكشاف علاقات التفاعل والتاثير بين الاحتكام للمكانة والتوجه للفردية– الجماعية والدمج التنظيمي مستنداً على مزج اختلاف القيم الشخصية مع افكار نظرية الهوية الاجتماعية لبلورة نموذج البحث. وفي ضوء هذا تم صياغة عدد من الفرضيات التي توضح علاقات التفاعل ما بين ابعاد الاحتكام للمكانة والتوجه للفردية– الجماعية للتنبؤ بوجود الدمج التنظيمي. جمعت البيانات باستخدام استمارة الاستبيان ووزع
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This book includes three main chapters: 1. Functions & Their Derivatives. 2. Minimum, Maximum and Inflection points. 3. Partial Derivative. In addition to many examples and exercises for the purpose of acquiring the student's ability to think correctly in solving mathematical questions.
Compounds were prepared from In2O3 doped SnO2 with different doping ratio by mixing and sintering at 1000oC. Pulsed Laser Deposition PLD was used to deposit thin films of different doping ratio In2O3: SnO2 (0, 1, 3, 5, 7 and 9 % wt.) on glass and p-type wafer Si(111) substrates at ambient temperature under vacuum of 10-3 bar thickness of ~100nm. X-ray diffraction and atomic force microscopy were used to examine the structural type, grain size and morphology of the prepared thin films. The results show the structures of thin films was also polycrystalline, and the predominate peaks are identical with standard cards ITO. On the other side the prepared thin films declared a reduction of degree of crystallinity with the increase of doping ra
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Thsst researcher problem of delays faced by researchers are all waiting to evaluate their standards by the experts who must take their views to extract the truth Virtual important step first step in building standards whatsoever, then the difference of opinion among experts about the paragraphs Whatever the scope of their functions, leading to confusion in maintaining these paragraphs or delete? Or ignore the views and opinion of the researcher to maintain the same? Or as agreed upon with the supervisor if he was a student? Especially if the concepts of a modern new building.
Therefore, the researcher sought to try to find a solution to her problem to conduct an experiment to test building steps