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.
במחקר הזה ניתחנו מספר נאומים של שמעון פרס, אנחנו התמקדנו בהשפעה והשכנוע אצל שמעון פרס ואיך הוא יכול להעביר את המסרים של נאומיו בסגנון פרגמטי כדי להגיע ללבו של הציבור.
גם כן, התמקדנו בסגנון הפוליטי שהוא חושב כי התחום הזה צריך להיות ברור מול הציבור וגם כן מול דעת הקהל הבינלאומי מתוך השימוש במונחים בעלי השפעה ושכנוע להגיע למטרות המבוקשות.
במלים אחרות, שמעון פרס, לעתים, מתמקד בשפה מליצית ויעמוד הרב
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preparation process of performance evaluation in organizations is of extreme importance, and under development in organizations and the opening of markets and technological developments in the industry and heightened competition among industrial organizations imposed systems are built for performance give a clear picture about performance and competition, And centered research problem in answering the following questions: Is performance evaluation system is available in Wasit State Company for Textile Industries(Research sample ), This research aims to assess the performance of policies and programs in the company, according to guide performance evaluation of programs and policies prepared by the Dutch Cou
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An experimental study was performed to estimate the forced convection heat transfer performance and the pressure drop of a single layer graphene (GNPs) based DI-water nanofluid in a circular tube under a laminar flow and a uniform heat flux boundary conditions. The viscosity and thermal conductivity of nanofluid at weight concentrations of (0.1 to 1 wt%) were measured. The effects of the velocity of flow, heat flux and nanoparticle weight concentrations on the enhancement of the heat transfer are examined. The Nusselt number of the GNPs nanofluid was enhanced as the heat flux and the velocity of flow rate increased, and the maximum Nusselt number ratio (Nu nanofluid/ Nu base fluid) and thermal performance factor
... Show MoreColonialism as a movement was very popular in Europe more than two centuries before. It aimed at controlling and exploiting several countries in Africa and Asia in addition to imposing their power and control on uninhabited islands. It received adherence and criticism as well. There also appeared activists and nations who stood against it and its practices. English novels discussed this notion greatly by pointing out the bad practices of the colonizers and how the colonized received them. This paper explores two narrative fictions that tackle the different aspects of the term. While Defoe, in Robinson Crusoe (1719), shows a colonial European figure who expresses his superiority, Wells, in “The Country of the Blind” (1904), deconstructs
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... Show MoreObjective: The aims of present study to detect the effectiveness of instruction program of non-pharmacological guideline on blood pressure and laboratory test.
Methodology: A pre-experimental study was conducted in Al-Sader Teaching Hospital from 8th of September 2019 to 25th of May 2020, in order to find out the effectiveness of instruction program concerning non-pharmacological guideline on controlling essential hypertension among patients. A non- probability (purposive sample) of 50 patients with essential hypertension is selected. Those patients are already diagnosed with Essential Hypertension
... Show MoreThe research attempts to diagnose the level of the effect of human resources flexibility (employees skills flexibility, employees behaviors flexibility, and human resource practice flexibility) in the south al-rusafa directorate of a power station one of the formations and the Ministry of Electricity, and impact of a range of variables related to the performance operational, namely, (efficiency, effectiveness)recognizing the importance of the subjects studied,& because of the importance of expected results of the field under consideration,researcher selected a sample of size (121) engineers and technicians of workers in the directorate. Was my hypotheses the major search of a relationship and impact between human resources flex
... Show MoreIncreased attention to corporate governance with the increasing need for investors and other parties in the Iraqi market for securities of the information credible and confidence and greater transparency in the disclosure as well as the systems of governance lead to raise the value of the company and that by reducing the cost of capital and reduce the cost of financing, as well as that there are indications modern measurement can be adopted by the Iraqi market for securities for the purpose of evaluating the performance of listed companies and then raise their value.
The research problem is that there is no framework or structure of the legal and local rules for the application of corporate governance in Iraq obliges
... Show MoreThe research aims to test the relationship and impact of High Involvement Management as an independent variable in negotiation strategies as a response variable, at the headquarters of the Iraqi Ministry of Industry and Minerals in Baghdad Governorate, and then trying to come up with a set of recommendations that contribute to strengthening the negotiations carried out by the ministry’s leaders and based on the importance of the topic of research in public organizations and the importance of the surveyed organizations to the society. The descriptive-analytical approach was adopted in the completion of this research, and the research included a sample of (180) leaders of the Iraqi Ministry of Industry and Minerals, and data was
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