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.
The path and its nodal purposes
Abstract
This study has come to indicate the doctrinal purposes of faith in this path، It was composed of an introduction and four demands، as follows:
The first requirement: the intentions of distinguishing between the ranks of people according to divine justice، as those who pass by him are different. Some of them are safe by his work، surviving from the fire، and some of them are not peace، he falls into the fire of Hell، and all of them are different in their ranks in a manner consistent with the justice of God Almighty and the works they have given themselves.
The second requirement: the purposes of divine mercy in honoring the Prophet and his nation on the path and embodying their
The current research deals with short term forecasting of demand on Blood material, and its' problem represented by increasing of forecast' errors in The National Center for Blood Transfusion because using inappropriate method of forecasting by Centers' management, represented with Naive Model. The importance of research represented by the great affect for forecasts accuracy on operational performance for health care organizations, and necessity of providing blood material with desired quantity and in suitable time. The literatures deal with subject of short term forecasting of demand with using the time series models in order to getting of accuracy results, because depending these models on data of last demand, that is being sta
... Show More This study examines the role played by the Iraqi media in promoting the values of citizenship and the dimensions of the various sectors of Iraqi society, an important segment namely university youth section.
The study intended to identify “the role of the Iraqi media organizations in promoting The sense of citizenship among young Iraqi university”, through: -
1. Identifying the most important Iraqi media, which works to promote the dimensions of citizenship and values.
2. To identify the extent of the contribution of the Iraqi media in promoting citizenship in dimensions (patriotic belonging, legal, political, economic, social, cultural).
The study provided a set of hypotheses, namely:-
The Costing Accounting is one the analytic tools which plays important role by support the management in planning& control and decisions-making ,as it became attendant necessity to establish any project whether industrial ,commercial ,service or agriculture ..etc.
The consolidated accounting system has committed the companies to have their active costing system in which the management can obtain their own data, but we found most of the economic units face problems of applying the costing system because of reasons related to the system design itself or might be related to the requirements of the application success.
... Show MoreWith the recent growth of global populations, main roads in cities have witnessed an evident increase in the number of vehicles. This has led to unprecedented challenges for authorities in managing the traffic of ambulance vehicles to provide medical services in emergency cases. Despite the high technologies associated with medical tracks and advanced traffic management systems, there is still a current delay in ambulances’ attendance in times of emergency to provide patients with vital aid. Therefore, it is indispensable to introduce a new emergency service system that enables the ambulance to reach the patient in the least congested and shortest paths. However, designing an effici
This research aims to identify the role of external environment factors on the quality of educational services, from the academic point of view, where the distribution of a questionnaire to a random sample of (100) university professors, and then analyzing a model, and test the validity of this model using structural modeling (SEM) (Structural Equation Modeling).
And then test the relationships between variables using the software of Statistical Package for Social Sciences (SPSS V.18), the research found a number of conclusions, the most important conclusion is: the external environment factors has significant impact on the quality of educational services.
This study reported the investigation of the Radio Frequency (RF) signal propagation of Global System for Mobile Communications (GSM) coverage in Emmanuel Alayande College of Education (EACOED), Oyo, Oyo State, Nigeria. The study aims at amplifying the quality of service and augment end users' sensitivity of the wireless services operation. The drive test method is adopted with estimation of coverage level and received signal strength. The Network Cell Info Lite application installed in three INFINIX GSM mobile phones was employed to take the measurement of the signal strength received from the transmitting stations of different mobile networks. The results of the study revealed that MTN has the maximum signal strength with a mean value
... Show MoreThe research presents the "theory of happiness according to Junaid al-Baghdadi" and the theory's most significant characteristics.
The reasons for happiness, include knowledge, love, and providence, and happiness itself is the return of man or spirit to the source from which it originated.
In this work, a weighted H lder function that approximates a Jacobi polynomial which solves the second order singular Sturm-Liouville equation is discussed. This is generally equivalent to the Jacobean translations and the moduli of smoothness. This paper aims to focus on improving methods of approximation and finding the upper and lower estimates for the degree of approximation in weighted H lder spaces by modifying the modulus of continuity and smoothness. Moreover, some properties for the moduli of smoothness with direct and inverse results are considered.
Flow unit and reservoir rock type identification in carbonates are difficult due to the intricacy of pore networks caused by facies changes and diagenetic processes. On the other hand, these classifications of rock type are necessary for understanding a reservoir and predicting its production performance in the face of any activity. The current study focuses on rock type and flow unit classification for the Mishrif reservoir in Iraq's southeast and the study is based on data from five wells that penetrate it. Integration of several methods was used to determine the flow unit based on well log interpretation and petrophysical properties. The flow units were identified using the Quality Index of Rock and the Indicator of Flow Zone. Th
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