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 surgeryKeywords: Non-surgical treatment of anal fissure, fissure in ano, sphicterotomy,botulinum toxin in anal fissures, glyceryl trinitrate. Chemical sphincteratomy, pharmacological sphincteratomy.
In the present paper a low cost mechanical vibration shaker of rotating unbalanced type with uniaxial shaking table was designed and constructed in an attempt to provide opportunities for experimental testing and application of vibration in experimental modal analysis, stress relief of weldments, effect of vibration on heat transfer and seismic testing of civil engineering structures. Also, it provides unexpressive solution to enhance the knowledge and technical skills of students in mechanical vibration laboratory. The shaker consists of a five main parts shaker frame, shaker table, flexible support, drive motor, and eccentricity mechanism. The experimental results show that the amplitude of the shaker is increased with increasing the f
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Giving advice refers to an attempt by the speaker to express what the addressee should do in a particular situation or what is good for him/her. It is also a feature of making social relations and communications move smoothly and become stronger. The current study aims to investigate the strategies of the speech act of advice by old females and males for the younger generation in written signs. Comparison is made between old females and males regarding their pragmatic use of advice and the way they are manifested in expressing gender identity differences. The sample of the study consists of (30) written signs of advice divided equally between the two gender groups. Hinkel’s (1997) classification of the strategies for perceiving th
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يهدف البحث الى تقديم استراتيجية مقترحة لشركة نفط الشمال ، وأخذت الاستراتيجية المقترحة بنظر الاعتبار الظروف البيئية المحيطة واعتمدت في صياغتها على اسس وخطوات علمية تتسم بالشمولية والواقعية ، اذ انها غطت الانشطة الرئيسية في الشركة (نشاط الانتاج والاستكشاف , نشاط التكرير والتصفية , التصدير ونقل النفط , نشاط البحث والتطوير , النشاط المالي , تقنية المعلومات , الموارد البشرية ) وقد اعتمد نموذج (David) في التحليل البيئي
... Show MoreCosmetic products contain variable amounts of nutrients that support microbial growth. Most contaminants in cosmetic products include bacteria such as Staphylococcus, Pseudomonas, Klebsiella, Achromobacter and Alcaligenes. Contaminated water is a likely source of organisms found in cosmetic products. Products such as shampoo, hand and body lotion, facial cleanser, and liquid soaps were analyzed. In this study, out of 60 cosmetic products analyzed, 26.4% were found to be contaminated. Most of the contamination was from bacteria and no fungal contamination was detected. The highest level o
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Objectives: Recently, there have been important advances in the clinical application of targeted hybrid near-infrared (NIR) fluorescent-radioactive tracers. ICG-99mTc-nanocolloid, for example, is already being used by some centres for sentinel lymph node biopsy in head and neck cancer. The radioactive component allows imaging at depths which would not be possible with NIR alone and, once exposed, the NIR fluorescence reporter can be imaged at very high resolution. Gamma detection is currently carried out with a separate hand-held gamma camera or with a non-imaging probe. Visualisation of NIR fluorescence during surgery requires a dedicated NIR camera, several of which are available commercially. We describe a novel hand-held hybrid NIR-gamm
... Show MoreConflict is a common but complicated phenomenon. It has been extensively researched in many domains, including philosophy, sociology, psychology, and linguistics. Using the Critical Discourse Approach, this study examines the issue of self-society conflict in The Handmaid’s Tale. The significance of this work lies in the identification and explanation of the discursive strategies that force the ideological polarization of the positively portrayed self versus the negatively portrayed other. The purpose of this study is to answer two questions: what are the discursive strategies used in The Handmaid’s Tale to create a positive or negative representation, and how are these strategies implemented? Five extracts from The Handmaid’s
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This paper aims at exploring the impact of the Iraq-Iran war in the poetry of Adnan Al-Sayegh. Al-Sayegh participation in this war makes him a first hand witness to the atrocities of the trenches and fight in the first lines. This war did not only change his life and world view for good, it changes the nature of his poetry as well. As aresult, war becomes a central issue not only in the poetry Al-Sayegh wrote in the 1980s and 1990s Iraq, but also in the exile.
Key Words: War, Al-Sayegh, Poetry.
The study evaluated the recovery performance of any home herbs group as first aid in some emergency cases. The study involved 10 items of herbs (chamomile, black pepper, cloves, cinnamon, and anise) which used in acute cases such as cold, colic, inflammation of the intestine and tonsillitis, and (hibiscus, catnip, dried lime, cress seed, and ginger) were used for chronic cases such as hypertension, cardiovascular disease, and arthritis. The results showed the herbs had healing power and efficiency in the primary remedy for the above-mentioned diseases. The side effects, the contradictions, and the overdoses of these substances were discussed. It was concluded that home herbs could be used for treatment in emergency cases until moder
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Idioms are a very important part of the English language: you are told that if you want to go far (succeed) you should pull your socks up (make a serious effort to improve your behaviour, the quality of your work, etc.) and use your grey matter (brain).1 Learning and translating idioms have always been very difficult for foreign language learners. The present paper explores some of the reasons why English idiomatic expressions are difficult to learn and translate. It is not the aim of this paper to attempt a comprehensive survey of the vast amount of material that has appeared on idioms in Adams and Kuder (1984), Alexander (1984), Dixon (1983), Kirkpatrick (2001), Langlotz (2006), McCarthy and O'Dell (2002), and Wray (2002), among others
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