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.
The current study aimed to identify key consumer rights and the nature of the work of organizations and traders in the Algerian market through the opinions of the study sample. To prove the hypotheses the researcher depended on the data obtained by the questionnaire prepared for this purpose. She distributed 384 questionnaires out of which only 300 were returned.
The data were analyzed using several statistical techniques such as the Statistical Package for Social Studies system, in addition to percentages, frequencies, and standard deviation.
And a number of conclusions and recommendations were presented. The most important results are:
- There is a strong correlation between safety and compensation rights.
- There is a st
The global globalization the world is experiencing has enabled international actors—states, international governmental and non-governmental organizations, such as liberation movements, international social movements, and even terrorist organizations—to use cyber power to achieve their goals. Therefore, this study discusses the impact of information power on the domestic environment of the United States.
The main objective of the audit process is to enable the auditor to express his neutral technical opinion as to whether the financial statements have been prepared in accordance with the financial reporting framework and fairly express the financial position, the result of the activity and the cash flows. A wrong opinion works to burden the beneficiary parties with great damages, and then the presence of any error or bias from the auditor when applying the rules of professional ethics (such as violating professional confidentiality and conflict of interest and moving away from impartiality and objectivity) negatively affects the performance of his
... Show MoreThe current research seeks to Analyze third intermediate chemistry book following sustainable development standards for academic year (2016-2017). To do this, a list of sustainable development standards that should be included in chemistry book was designed based on the previous studies. The first version of the list consisted of (50) sub-case divided into three standards (social, economic, and environmental) which was exposed to group of experts in teaching chemistry and teaching methods. The list has modified to (43) sub-case. The researcher followed the implicit and explicit meaning in his analysis: one for recording and repetition and the other for frequency. The result showed that third intermediate chemistry book has achieved (20)
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Today, the Islamic nation is going through a phase that is one of the most dangerous that it has never experienced before. This phase was characterized by the following:
The nation is divided into states and its weakness in most of its doctrinal, political, social, economic and moral aspects.
Enemies targeting the nation's faith and capabilities, and the emergence of loyalty to the enemies of the nation from some groups of society, spreading misconceptions in the Muslim community.
Spreading the spirit of rebellion in all segments of society and striving to stir up the people against the rulers and put pressure on the rulers.
All these manifestations and others require the nation's wise men
... Show MoreThe principle in the language is that each word has one meaning. This is because the purpose of language development is for understanding, understanding, and communication between people. The language is sounds with which each people expresses their Arabic language did not stop at this point, but rather needed another next stage or to convey additional features or characteristics that would qualify it. To be the language of the Qur’an and revelation, and capable of carrying this heavy burden.
The study aimed to identify the psychological counseling skills and the strength of the ego in the educational counselors, and to identify the relationship of statistical significance between the psychological counseling skills and the strength of the ego in the educational counselors, and to identify the differences of statistical significance in the relationship between psychological counseling skills and the strength of the ego in the guides according to the gender variable(male, Females), the number of sample (100) guides, including (50) males and (50) females from the area of Atifiya and Qadissiya and Ameriya in the Directorate of Education Karkh / 1, the researcher adopted a scale of psychological counseling skills prepared b
... Show MoreScientific development has occupied a prominent place in the field of diagnosis, far from traditional procedures. Scientific progress and the development of cities have imposed diseases that have spread due to this development, perhaps the most prominent of which is diabetes for accurate diagnosis without examining blood samples and using image analysis by comparing two images of the affected person for no less than a period. Less than ten years ago they used artificial intelligence programs to analyze and prove the validity of this study by collecting samples of infected people and healthy people using one of the Python program libraries, which is (Open-CV) specialized in measuring changes to the human face, through which we can infer the
... Show MoreThe trade war, of course, leads to a sharp tension in international relations because the economy is the lifeblood of the states. In the world of trade and economy, countries began to lean towards cooperation. Economic relations after World War II were more liberal, trade barriers were removed and global trade became more flexible and smooth
To investigate the research objectives, the researchers put the following hypothesis:
There was no statistically significant difference at the level of (0.05) between the average score of the students of the experimental group who studied the language of rhetoric according to model of learning method, and the average score of the students of the control group who studied the same article in the traditional way acquiring rhetorical concept. The researchers relied on the experimental design with the partial setting of the post-test, which depends on the experimental group that is taught using the model of the learning method, and the control group taught using the traditional method.
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