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.
Being the meeting points of the world different languages and out of a scholarly perspective, comparative literature represents a cultural leap as well as an artistic and intellectual development or a global literary movement of both prose and poetry. Such homogenous literary structure requires a systematic and coherent study of the literary output of the people different cultures and civilizations. It also represents the theoretical approach of the present study that debates a systematic comparison between Ghassan Kanafani’s All That's Left to You and William Faulkner’s. The Sound and the Fury. Within the perspective of the descriptive analysis approach, the present paper discusses th
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The study aims at analyzing the inconsistent structural and semantic aspects found in the plays of N.A Ostrovsky. The analysis, that includes all the linguistics schools of thoughts in modern Russian language, is performed chronologically to clarify all the ambiguities that the Russian language learners may face. Such difficulties lie in the use of inconsistent aspects with complete declarative sentences and adverbial clauses. Hence, it constructs a new sentence category that consists of secondary clause and its syncretism semantic.
The study illustrates the wide scope of both studying the sentence inconsistent
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This paper concerns with deriving and estimating the reliability of the multicomponent system in stress-strength model R(s,k), when the stress and strength are identical independent distribution (iid), follows two parameters Exponentiated Pareto Distribution(EPD) with the unknown shape and known scale parameters. Shrinkage estimation method including Maximum likelihood estimator (MLE), has been considered. Comparisons among the proposed estimators were made depending on simulation based on mean squared error (MSE) criteria.
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The production companies in the Iraqi industry environment facing many of the problems related to the management of inventory and control In particular in determining the quantities inventory that should be hold it. Because these companies adoption on personal experience and some simple mathematical methods which lead to the identification of inappropriate quantities of inventory.
This research aims to identify the economic quantity of production and purchase for the Pepsi can 330ml and essential components in Baghdad soft drinks Company in an environment dominated by cases of non ensure and High fluctuating as a result of fluctuating demand volumes and costs ass
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In this study, different methods were used for estimating location parameter and scale parameter for extreme value distribution, such as maximum likelihood estimation (MLE) , method of moment estimation (ME),and approximation estimators based on percentiles which is called white method in estimation, as the extreme value distribution is one of exponential distributions. Least squares estimation (OLS) was used, weighted least squares estimation (WLS), ridge regression estimation (Rig), and adjusted ridge regression estimation (ARig) were used. Two parameters for expected value to the percentile as estimation for distribution f
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يُعد التنمر ظاهرة إجتماعية قديمة موجودة في جميع المجتمعات سواء أكان المجتمع صناعيًا أم ناميًا، كما يُعد من المفاهيم الحديثة نسبيًا، وربما يرجع لحداثة الإعتراف به نوعًا من أنواع العنف فضلاعن ندرة الدراسات التي تناولته وعدم وجود معيار محدد لتحديد السلوك الذي يعد تنمرًا أم عابرًا، لقد بدأ الأهتمام بدراسة التنمر في سبعينات القرن الماضي وأصبح موضعًا يحضى بأهتمام العديد في مختلف البلدان، وفي عصرنا الحالي تطورت
... Show MoreВ статье рассматривается вопрос о связи флективных изменений с мыслительными процессами на материале русского и арабского языков, анализируются семантические, фонетические, морфологические и синтаксические основы фонограмматической когниции. Цель статьи выявление прямой связи между количественным звуковым изменением согласного состава слова и мыслительными процессами, с помощью которых человеческ
... Show MoreThe research aims at clarifying the role of green human resource management practices in achieving sustainable development. The research problem is that the health sector is less concerned with environmental aspects, specifically green human resource management practices, Which are reflected on sustainable development with their economic, environmental and social dimensions as well as reducing costs, waste minimization and recycling, And the research started from two main hypotheses to explore the correlation and influence between the variables of the research by analyzing the answers of the research sample, which included (136) employees of the Al-Imamein Al-kadhemein medical city, Data and information were collected using quest
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