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.
Evaluation is one of the most important elements of teaching process. The recent trends in evaluation and educational reform movements have called for using alternative evaluation, which focuses on performance evaluation. Authentic assessment is usually described as formative, in which students participate in their acquisition, in addition to the fact that students are productive and active, which is reflected in the students' achievement and skill level. The study aims to reveal the degree of knowledge and use of alternative assessment tools by primary school teachers in Gaza -Palestine. To meet the objective of the study, the researchers used the descriptive-analytical method and the questioner as a study tool. The study sample c
... Show MoreThe research aimed to study the role that the media play in shaping the public knowledge of human rights issues among the people of Kirkuk, which will be the focus of the study. The research was conducted by applying a survey panel to a random sample of the city's audience. The research dealt with the theoretical aspect of a theory that relied on the media, and the loans provided by the theory, on the basis of which the research was conducted and the research problem was determined based on a major question: What is the role that the mass media play in developing the knowledge of members of the public on human rights and the relationship between the intensity of view in that, as well as the identification of the effect of two variables G
... Show MoreThe article deals with the role of metaphors in forming the plot of L. Ulitskaya’s family chronicle “Medea and Her Children”. The author of the article describes the results of the next stage of research related to the works of Lyudmila Evgenievna Ulitskaya, a representative of modern Russian prose. The analysis of tropes and figures in the works written at the turn of the XXth – XXIth centuries is of importance for the study of the modern state of Russian language as an independent system. “Medea and Her Children” is one of the works by L. Ulitskaya (written in 1996), which, like her other works, is characterized by a unique style of narration, rich in vocabulary, lexical, semantic and stylistic diversity of the author’s word
... Show MoreThe marketing logistic chain, as an integrated system aimed to balance the achievement of its main opposite objectives which represented in the access to the best service presented to the customer with lowest possible logistic costs especially the transportation costs, where encourages the researcher to choose the second objective as a field of this study in order to reduce the transportation costs in the final link of marketing logistic chain which related to delivering of fuel oil to the customer that falls within organizational responsibilities of the company under consideration (Oil Marketing Company) and also known in a brief name by (SOMO) through two methods, the first is by functioning quantative techniques by using trans
... Show MoreThe study aimed to prepare rehabilitation exercises using some rubber ropes for people with partial rupture of the anterior cruciate ligament, to recognize their effect on the recovery of motor tides and to reduce the pain of those with partial rupture of the anterior cruciate ligament of the knee joint, and adopted the experimental method by designing the experimental and controlled groups on a sample of those with partial rupture of the anterior cruciate ligament of men (30-35) One year of those who attend the Physiotherapy Center/Rafidain University College of 12 injured were deliberately selected from their community of origin by (100%), and after determining the measuring tools and preparation of exercises applied with rubber r
... Show MoreWhereas conventional methods of teaching history do not meet the sometimes purpose has suggested some educators strategies modern help to improve the level of students in the education process through activating prior knowledge and employed in positions of current learning, and focus attention on the points and the outstanding elements of the content and practice techniques Calendar criticof ideas and meanings and mental and linguistic activities used to verify the extent of reaching understanding. &n
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This research aims to apply the Performance Focused Activity Based Costing System in the consultant office of Al-Khwarizmi College of Engineering at the University of Technology for the purpose of measuring the cost of consulting services provided by these offices in order to reduce costs and their reflection in achieving profits. For the purpose of calculating costs accurately, and to test the hypothesis of the research, the research was applied in the office of the consultant of the College of Engineering Al-Khwarizm - University of Baghdad through the financial statement
... Show MoreThe research deals with one of the urban problems facing cities, namely the existence of neglected urban spaces that need to be activated , These spaces give a negative image of the city, is not conducive to life and social interactions or the city has a one distinctive urban experience, leading to a reduction peoples' confidence in revisiting of those areas, hinder the rest of the activities in that region . Because these spaces are of the basic components of the city and give it its identity through the elements and entities that constitute it , The idea of research emerged in the reclaiming of these spaces within contemporary urban trends and the activation of flexible , short-term and inovation for that purpose with
... Show MoreReligion in its general and simplified form is defined as a set of values or moral laws, which include provisions that people should follow to organize their affairs and ratify that they are provisions sent from the divine.
The concept of religion is not limited to the narrower sense represented by the performance of the virtual rituals of worship and religious fashions, etc., but also includes all the moral and spiritual values, conduct and good dealing that reflect the true essence of religion, which boils down to a set of values – such as sincerity, honesty and dedication to work, merciful dealing and compassion, etc. All religions agree on the moral content of religion. The Prophet of Is
... Show MoreAs they are the smallest functional parts of the muscle, motor units (MUs) are considered as the basic building blocks of the neuromuscular system. Monitoring MU recruitment, de-recruitment, and firing rate (by either invasive or surface techniques) leads to the understanding of motor control strategies and of their pathological alterations. EMG signal decomposition is the process of identification and classification of individual motor unit action potentials (MUAPs) in the interference pattern detected with either intramuscular or surface electrodes. Signal processing techniques were used in EMG signal decomposition to understand fundamental and physiological issues. Many techniques have been developed to decompose intramuscularly detec
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