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.
Our research was launched in the study of the sustainable conflict of globalization and the rebalancing of the great powers that have made life on the earth unstable and insecure over the past and present eras, the purpose of which is to pay attention to the waste and instability that human societies are exposed to in different proportions between abstract right and continuous deviation.
The purpose of the study is to show the loss, waste and backwardness in managing and governing societies towards private interests, away from the standards of good institutional governance.
The study’s design was based on two demands, the first on the nature and eternity of
... Show MoreThe aim of this research is to apply the concept of total value management to improve the process design of producing the toothpaste in Al Mammon factory one of the in the general company of food industry. The concept of total value management is concerning with achieve more than one values which are important for the customers as these values are related to the customers satisfaction. The research problem is that the factory did not measure the effectiveness of process design as this company has weakness in analyzing this effectiveness in synchronies with total value management. On the other side, the company did not give more attention to the cost of products and selling prices within the value cost/ profit which is one of the
... Show MoreThe research in Islamic history is considered a title for the glory of the nation and a mirror for the intellectual and mental maturity of the men of the Islamic state who played an important role in saving humanity from darkness to light and from ignorance to knowledge and to show their position in building the Islamic state, and to highlight the importance of their conquests of neighboring cities and the expansion of Islam, and for this reason they appear The importance of writing on the topic (The Battle of Dumat al-Jandal and its impact on the era of the Prophethood and the Rightly Guided Caliphate). The reason for choosing this topic was to show the status of Dumat al-Jandal and its importance in the Islamic state and its great role
... Show MoreBaghdad and the other Iraqis provinces have witnessed many of celebrations which have the significant effect on the souls of Arabic and Islamic people in general , and Iraqi people, especially the birthday and death of two al-kadhimen Imams(peace upon them) and others .From here the researcher begin to study the visiting of imam kadhimen (peace upon him) on 25 Rajab the commemoration of his sacrifice, simply because have implications of religious, ideological and cultural sectors which represents in finding the greatest flow of visitors .the problem of research appeared due to the clear difference in number of visitors during one day, beside the significant increase in number of visitors throu
... Show MoreThe study aims to reveal the degree of application of the alternative evaluation strategy in social studies in public education in the Kingdom of Saudi Arabia. It also aims to identify the opinions of experts on how to implement this. The study adopted the mixed methodology, which represented in the descriptive-analytical method, and qualitative methods through the grounded theory. The study used two tools namely: a questionnaire for assessments of social studies teachers and semi-structured interview questions. The results of the study showed a medium degree of appreciation for the application of alternative evaluation strategies by social studies teachers in general education with an average of (2.28). The results also showed that ther
... Show MoreIn parallel with the shell model using the harmonic oscillator's single-particle wave functions, the Hartree-Fock approximation was also used to calculate the neutron skin thickness, the mirror charge radii, and the differences in proton radii for 13O-13B and 13N-13C mirror nuclei. The calculations were done for both mirror nuclei in the psdpn model space. Depending on the type of potential used, the calculated values of skin thickness are affected. The symmetry energy and the symmetry energy's slope at nuclear saturation density were also determined, and the ratio of the density to the saturation density of nuclear matter and the symmetry energy has a nearly linear correlation. The mirror ener
... Show MoreA group of acceptance sampling to testing the products was designed when the life time of an item follows a log-logistics distribution. The minimum number of groups (k) required for a given group size and acceptance number is determined when various values of Consumer’s Risk and test termination time are specified. All the results about these sampling plan and probability of acceptance were explained with tables.
يعتقد البعض ان مفهوم العلم يعني الآلات والاجهزة العلمية (تقنيات التعليم) وهي لا تختلف عن مفهوم تكنولوجيا المعلومات , ويعد هذا الاعتقاد خاطئ , لان العلم هو بناء المعرفة العلمية المنظمة والتي يتم التوصل اليها عن طريق البحث العلمي , اما تكنولوجيا المعلومات فهي "التطبيقات العملية للمعرفة العلمية في مختلف المجالات ذات الفائدة المباشرة بحياة الانسان, او هي النواحي التطبيقية للعلم وما يرتبط بها من آلات واجهزة".
The purpose of this study is to investigate the effect of credit risk indicators on the Arab Gulf countries' banks Profitability over the period of 2015 to 2017. The banking credit risk was calculated using non-performing loans ratio affecting banks profitability indicators like net income and by using fixed effect and random effect model analyses, the study found that increasing in non-performing loans ratio will decrease the net income in gulf banks, the study also found that personal loans represent the largest share of loans granted in gulf banks. Also, the study recommends the importance of developing the capabilities of credit departments in commercial banks in dealing with bad loans, and studying the financial statem
... Show MoreThe main aim of this paper is to explain the effect of the aggregation accounting information on the financial, investment, and operational, managerial decision-making and the evaluation of the financial statements after aggregate. The problem of this study is represented in administrative decision-making that takes place under differentiated accounting systems operating within a governmental economic unit that seeks at the same time to achieve a unified vision and goals for the organization. This study was conducted at the College of Administration and Economics /University of Baghdad, and it represents a sample from a community of governmental economic units that apply differentiated accounting systems. The study method is repr
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