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.
Training has an effect on employees’ performances. Accordingly, the person who is responsible for employees’ development must figure out the most effective way to train and develop employees. Central Michigan University (CMU) has recognized the importance of providing appropriate training for employees who have a duty in advising students. The reason is that these employees have a significant impact on students’ educational performances. Thus, special attention to this category of employees is needed to improve advising quality. This research attempted to explore the impact of training on academic advising at CMU. Face-to-face interviews and online surveys were used as data collection tools for this study. The study scope c
... Show More
The article considers semantic and stylistic motivations for using obsolete lexicon (historicisms) in the text of a work of art. The specifics of the functioning of this process are presented against the background of the features of the contemporary Russian literary language. Attention is focused on the fact that the layer of obsolete lexical units belongs to a number of nationally specific vocabulary, the development of which forms an understanding of the nature of the actualized language. In addition, it should be noted that the semantics of historicisms is culturally commensurate: the latter is explained by the fact that the deactuation of linguistic units is positioned as parallel to the sociocultural and political changes.
... Show More
The ground state densities of unstable proton-rich 9C, 12N and 23Al exotic nuclei are studied via the framework of the two-frequency shell model (TFSM) and the binary cluster model (BCM). In TFSM, the single particle harmonic oscillator wave functions are used with two different oscillator size parameters βc and βv, where the former is for the core (inner) orbits and the latter is for the valence (halo) orbits. In BCM, the internal densities of the clusters are described by single particle Gaussian wave functions. The long tail performance is clearly noticed in the calculated proton and matter density distributions of these nuclei. The structure of the valence proton in 9C and 12N is a pure (1p1/2) configuration while that for 23Al is
... Show MoreThe electric quadrupole moments for some nitrogen isotopes (12,14,15,16,18N) are
studied by shell model calculations with the proton-neutron formalism. Theoretical
calculations performed using the different set of effective charges due to the core
polarization effect. The effective charges in the p-shell nuclei are found to be
slightly different from those in the sd-shell nuclei. Most of the results we have
obtained are underestimated with the measured data for the isotopes considered in
this work.
The intensification of competition among all companies and at different levels has become necessary for every company need to continue to improve its performance in order to be able to face the competition and stay in the market. To achieve this, we must rely on the company's accounting information more accurate and appropriate and provided in a timely manner, for the purpose of use in planning and decision making.
So there must be information systems that help the administration to continuous development and improvement of the performance of companies in general, and this is what you need Jordanian companies, especially after the accession of Jordan to the field
... Show More
Political Discourse Analysis is an important linguistic study approach used by politicians to gain people support. The present paper sheds light on the figures of speech of emphasis in the televised debate between the two presidential elections candidates, Emmanuel Macron and Marine Le Pen and the distinctive effect they add to the political discourse to win general public support as well as the presidential elections.
The present paper provides a rudimentary definition and an analysis of the terms “discourse” and “political discourse” and traces the significant role played by politically directed televised Media and internet to support political pa
... Show More
The aim of this paper is to estimate a single reliability system (R = P, Z > W) with a strength Z subjected to a stress W in a stress-strength model that follows a power Rayleigh distribution. It proposes, generates and examines eight methods and techniques for estimating distribution parameters and reliability functions. These methods are the maximum likelihood estimation(MLE), the exact moment estimation (EMME), the percentile estimation (PE), the least-squares estimation (LSE), the weighted least squares estimation (WLSE) and three shrinkage estimation methods (sh1) (sh2) (sh3). We also use the mean square error (MSE) Bias and the mean absolute percentage error (MAPE) to compare the estimation methods. Both theoretical c
... Show More
(4)
(3)
This study ideals with the Omani legal regulations of transferring and transplanting human organs and tissues in light of the Minister of Health decree No. 179 on the year 2018. As the last update, article 27 in 2019 has prohibited conducting such operations unless permission from the Minister of Health is obtained. In the absence of a further law update until the completion of writing the research, we intend to analyze and study some of the current provisions for the transfer and transplantation of human organs and tissues, compared to the legislative trends of some related laws. To achieve this, we divided the study into three sections; the first section introduces the historical development of the legislator criminal policy in regulat
... Show MoreThis research includes the use of an artificial intelligence algorithm, which is one of the algorithms of biological systems which is the algorithm of genetic regulatory networks (GRNs), which is a dynamic system for a group of variables representing space within time. To construct this biological system, we use (ODEs) and to analyze the stationarity of the model we use Euler's method. And through the factors that affect the process of gene expression in terms of inhibition and activation of the transcription process on DNA, we will use TF transcription factors. The current research aims to use the latest methods of the artificial intelligence algorithm. To apply Gene Regulation Networks (GRNs), we used a progr
... Show More