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.
Microfinance Institutions (MFIs) offers small loans with easy repayment system and till now these institutions have served millions of needy people around the globe. This study highlights the hurdles influence the smooth working and growth of Microfinance institution in Egypt. The structured interviews were conducted from the top and mid-level managers of MFI's. This study revealed that interest rate, political and economic conditions, corruption, customer outreach, competition and technology are the important elements for MFI's success. It is evident that lack of use of technology and less importance drawn on customer outreach programs are the main challenges of MFI's in Egypt. This study provides a roadmap for practitioners and strategic
... Show MoreBackground: Sonographic examination is an important tool in assessment of normal and abnormal cervical lymph nodes. The aim of the study is to assess the distribution and the characteristic features of normal cervical lymph nodes in a sample of Syrian population. Materials and Methods: Fifty healthy Syrian subjects (25 men and 25 women) with an age of 20 -60years old, who had their cervical lymph nodes examined by ultrasound. Three hundred and two lymph nodes were detected. Lymph nodes were evaluated for their number, size, site, echogenic hilus, shape, as well as for the border sharpness. The subjects were categorized by age into four groups, (20 -30, 31 - 40 , 41 - 50 , 51- 60 years ). Statistical analysis of data was done using SP
... Show MoreThe objective of this article is to delve into the intricate dynamics of marriage relationships, exploring the impact of emotions such as fear, love, financial considerations and likability. In our investigation, we adopt a perspective that acknowledges the nonlinear nature of interactions among individuals. Diverging from certain prior studies, we propose that the fear element within the context of marriage is not a singular, isolated factor but rather a manifestation resulting from the amalgamation of numerous social issues. This, in turn, contributes to the emergence of strained and unsuccessful relationships. Unlike conventional approaches, we extensively examine the conditions essential for the existence of all socially signifi
... Show MoreDeontic modality expresses what is necessary or possible according to the norms of morality and laws of community. It is a cover term for those cases where modal auxiliaries used to express notions like ''obligation'', ''prohibition'' and, ''permission''. Deontic modals are basically performatives, having the ''so-be-it'' component of directives in that the speaker directs the behavior of the addressee to get things done. The present study identifies the use of deontic models in international contracts to prove that there are major pragmatic strategies employed in writing them. To achieve the aim of the study, a modified model of Danet’s (1980) and Trosborg’s (1995) in accordance to Searle (1969) is used to analyze 16 texts selected fro
... Show MorePolyaniline nanofibers (PAni-NFs) have been synthesized under various concentrations (0.12, 0.16, and 0.2 g/l) of aniline and different times (2h and 3 h) by hydrothermal method at 90°C. Was conducted with the use of X-ray diffraction (XRD), Fourier Transform Infrared spectra (FTIR), Ultraviolet-Visible (UV-VIS) absorption spectra, Thermogravimetric Analysis (TGA), and Field Emission-Scanning Electron Microscopy (FE-SEM). The X-ray diffraction patterns revealed the amorphous nature of all the produced samples. FE-SEM demonstrated that Polyaniline has a nanofiber-like structure. The observed typical peaks of PAni were (1580, 1300-1240, and 821 cm-1 ), analyzed by the chemical bonding of the formed PAni through FTIR spectroscopy. Also, tests
... Show MoreObjectives: To assess the qualifications and performance of newly graduated pharmacists and explore factors that affect their performance in public hospitals. Methods: This qualitative study included face-to-face, semi-structured interviews with hospital practitioner pharmacists. It was conducted between March and May 2023 in Kerbala province, Iraq. The participating pharmacists were selected purposefully because they had three or more years of work experience at governmental hospitals. The audio-recording interviews were transcribed. Thematic analyses were used to generate themes and subthemes from the interviews. Results: Twenty-seven hospital pharmacists participated in this study. The study found that there are several factors t
... Show MoreLanguage as a means of communication has long been the concern of many conversation analysts in their studies such as: Sacks et al. (1974), Schegloff et al. (1977), Duncan (1972), Grice (1975) and Burton (1980). Burton has attempted analyzing the first ten transitions of the play “The Dumb Waiter” for mere a presentation of her approach. This paper aims at analyzing the conversational structure of forum on the subject of literary fiction and genre fiction by applying Burton’s model (1980) of analysis to answer the question to what extent this model is applicable in analyzing the presented text. The findings of the investigation have proved the applicability of the structure of conversation formulated by Burton (1980) in her model wit
... Show MoreThe present study investigates the use of intensifiers as linguisticdevices employed by Charles Dickens in Hard Times. For ease of analysis, the data are obtained by a rigorous observation of spontaneously occurring intensifiers in the text. The study aims at exploring the pragmatic functions and aesthetic impact of using intensifiers in Hard Times.The current study is mainly descriptive analytical and is based on analyzing and interpreting the use of intensifiers in terms ofHolmes (1984) andCacchiani’smodel (2009). From the findings, the novelist overuses intensifiers to the extent that 280 intensifiers are used in the text. These intensifiers(218) are undistinguished
... Show MoreAs a result of the significance of image compression in reducing the volume of data, the requirement for this compression permanently necessary; therefore, will be transferred more quickly using the communication channels and kept in less space in memory. In this study, an efficient compression system is suggested; it depends on using transform coding (Discrete Cosine Transform or bi-orthogonal (tap-9/7) wavelet transform) and LZW compression technique. The suggested scheme was applied to color and gray models then the transform coding is applied to decompose each color and gray sub-band individually. The quantization process is performed followed by LZW coding to compress the images. The suggested system was applied on a set of seven stand
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