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.
Burnishing improves fatigue strength, surface hardness and decrease surface roughness of metal because this process transforms tensile residual stresses into compressive residual stresses. Roller burnishing tool is used in the present work on low carbon steel (AISI 1008) specimens. In this work, different experiments were used to study the influence of feed parameter and speed parameter in burnishing process on fatigue strength, surface roughness and surface hardness of low carbon steel (AISI 1008) specimens. The first parameter used is feed values which were (0.6, 0.8, and 1) mm at constant speed (370) rpm, while the second parameter used is speed at values (540, 800 and 1200) rpm and at constant feed (1) mm. The results of the fatigue
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Death is undoubtedly the theme of Don DeLillo’s White Noise. Murray Siskind, a College-on-the-Hill professor who is obsessed with the exploration and reinterpretation of American popular culture, talks about the Tibetan Book of the Dead, and the German mentor of Jack Gladney has been using the Egyptian Book of the Dead, translated into German. The core episode of the story is the Airborne Toxic Event, the associate of Heinrich (Jack’s teenage son), Orestes Mercator, dreams of becoming one of the great figures in the Guinness Book by challenging and confronting death by enclosing himself in a glass pen jam-packed with poisonous snakes, and Heinrich challenges an imprisoned mass murderer in a chess game. The scholarly expertise of Jack c
... Show MorePraise be to God, Lord of the worlds, and peace and blessings be upon our master Muhammad, and upon his whole family and companions, but after: God Almighty has instituted types of acts of worship and classes of obedience that, if performed by the servant, would link him with his Creator and connect with his Lord. And for the sake of these worship, and the greatest of them: the worship of i'tikaaf, for souls need rest and recuperation from the struggle of life and its concerns, concerns and anguish, and people differ in their attitudes and interests in the means of recreation, and many people consider the outing and travel the best way in which they breathe from their toil and toil, and reclaim their strength and the advised adult He fin
... Show MoreThe concept of narration stems from the connotation of continuous communication through which narration is manifested as a message that is exchanged between the sender and the recipient, and that narration is an educational conceptual necessity, representing the philosophy of intellectual inclusion achieved in a direct speech to the mind, but it is encapsulated in a colorful frame that attracts the soul and attracts attention, and the graphic narration is a speech A visual based on the basis of interference and sequence of the event in weaving the elements in a consensual way through a continuous communication process that begins with the embodiment of an event - an important event - to the recipient, in which an intellectual employment
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In many oil fields only the BHC logs (borehole compensated sonic tool) are available to provide interval transit time (Δtp), the reciprocal of compressional wave velocity VP.
To calculate the rock elastic or inelastic properties, to detect gas-bearing formations, the shear wave velocity VS is needed. Also VS is useful in fluid identification and matrix mineral identification.
Because of the lack of wells with shear wave velocity data, so many empirical models have been developed to predict the shear wave velocity from compressional wave velocity. Some are mathematical models others used the multiple regression method and neural network technique.
In this study a number of em
... Show MoreIn this article it is proved experimentally that the photon is a particle that has mass and constant wavelength by explaining the effect of refractive index on the wavelength and the natural mass of photon. It is very difficult to measure the mass of photon, a simple and easy process was proposed in this paper to calculate the mass length of photon in vacuum (Y) and in medium (Y*), by measuring the length of laser beam in air (Lair) and in medium (Lmed). A new method was postulated to calculate refractive index by using these relations (n = Y*/Y), and (n = Lmed / Lair) which supposed a new theory of light.
Objective: The aim of this study is to identify the impact of training education program applied on
nurse-midwife practice concerning care during third stage of labor in labor room. Examine the
relationship between their knowledge regarding practices and some Demographic information’s.
Methodology: A quasi-experimental design conducted on non-probability (purposive) sample of fifty
two nurse-midwives selected during period from3
th August to 10thNovember 2011. The study is
conducted at the Ministry of Health (Baghdad health directorate in Al-Karhk and Al-Risafa sector) in
four hospitals. The questionnaire form is consisted of three parts which included demographic data,
knowledge concerning practice during third
Bac kground:
Failure is the state or condition of not meeting a desirable or intended objective, and may be viewed as the opposite of success; students always have a question "Why did I get this grade. On the contrary success leads towards new sources of earning, in fact there are a lot of interacting factors play such extrinsic and extrinsic to reach success.
Objec t i ves :
To explore internal and external factors causing students failure in medical college and to reconnoiter factors improve academic performance.
Methods: A cross-sectional study, conducted in Al Kindy College of Medicine, for the period from November 8th 2012 to May 1st 2013. Formal ethical considerations were obtained about participation and methodology. A
In this study, we attempt to provide healthcare service to the pilgrims. This study describes how a multimedia courseware can be used in making the pilgrims aware of the common diseases that are present in Saudi Arabia during the pilgrimage. The multimedia courseware will also be used in providing some information about the symptoms of these diseases, and how each of them can be treated. The multimedia courseware contains a virtual representation of a hospital, some videos of actual cases of patients, and authentic learning activities intended to enhance health competencies during the pilgrimage. An examination of the courseware was conducted so as to study the manner in which the elements of the courseware are applied in real-time learn
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The Battle of Kadesh is replete with many military arrangements that reflect the tremendous development of war preparations in the thirteenth century BC; where the expressive pictures the Egyptians left on some of the walls of their temples show the tremendous ability to organize and divide the forces and the great development that affected the war machine. Furthermore, the text accompanied these pictures reveal some news about that battle, which is considered one of the most important wars in the ancient world. Thus, the importance of the study lies in the fact that it examines one of the most important battles of the ancient Near East, the results of which had great repercussions on the region. This is because it is the most abundant B
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