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.
Caryl Churchill's Top Girls (1982) reveals how women have achieved a point of strength and independence in their battle to face men's oppression throughout history. Churchill has replicated recent transitions in the 1980s and 1990s in works that depict these movements' central concerns and contradictions as they change. Similarly, her theater is a result of many problems and shifts in hegemonic modes of production during this time. This paper traces the achievements of the major character of Top Girls, Marlene, in her way of life and her handling of the struggles of other women around her. Because of this strength, Marlene is compared to the British Prime Minister, Thatcher. Therefore, this paper will shed light on the term of T
... Show MoreIn light of the corona pandemic, educational institutions have moved to learning and teaching via the Internet and e-learning ,and this is considered a turning point in course of higher education in Iraq in particular and education in general, which generated a great challenge for educational institutions to achieve the highest possible levels in practices and processes to reach the highest quality of their outputs from graduate students to the labor market that auditing performance by adopting e-learning standards is one of the effective tools that help the management of educational institutions by providing information on the ex
... Show MoreThe aim of the research is to clarify the role of service quality through its dimensions represented by (tangibility, reliability, safety, response, empathy) in tax compliance with taxpayers, i.e. performance of the duties and obligations of the taxpayer through its dimensions (registration, accounting, payment of the amount of tax), and to know For this role, a sample was taken from the taxpayers of the branches of the General Authority for Taxes spread in the governorate of Baghdad and its affiliated districts, which amount to (15) tax branches, as (215) questionnaires were distributed to know the impressions and reactions of the taxpayers regarding the level of service quality through the aforementioned dimensions. Using the statistic
... Show Moreالمستخلص يهدف هذا البحث الى تجاوز مشكلة البعدية من خلال طرائق الانحدار اللامعلمي والتي تعمل على تقليل جذر متوسط الخطأ التربيعي (RMSE) , أذ تم استعمال طريقة انحدار الاسقاطات المتلاحقة (PPR) ,والتي تعتبر احدى طرائق اختزال الابعاد التي تعمل على تجاوز مشكلة البعدية (curse of dimensionality) , وان طريقة (PPR) من التقنيات الاحصائية التي تهتم بأيجاد الاسقاطات الاكثر أهمية في البيانات المتعددة الابعاد , ومع ايجاد كل اسقاط
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Polymers have the ability to extract water after they have been added to the mortar or concrete mixture. They provide the absorbed water during hydration functioning as internal water source. Absorption polymers can absorb up to hundred times of their own weight of pure water.This research deals with the use of water absorption polymer balls in concrete and study the volumetric change of these mixes and compared the results with reference mix (without polymers). Samples were cured both in air and in water for the mixes to compare results which show that samples in air behave for expansion while sample in water acted for shrinkage.
The actual observations for Jupiter radio storm were taken for Hawaii station within multi years from 2001 to 2012. The Central Meridian Longitude (CMLІІІ) and Io's phase (γIo) were calculated for each year from Radio Jove program, the results of CMLІІІ for year 2006 was A=(180-300)º,B=(15-239)º, C=(60-280)º, phase was A=(182-260)º,B=(40-109)º, C=(200-260)º, which were close to the theoretical values, longitude was A=(180-300)º, B=(15-240)º, C=(60-280)º and phase was A=(180-260)º,B=(40-110)º and C=(200-260)º.
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In this study the thermal conductivity of the epoxy composites were characterized as function of volume fraction, particle size of fillers and the time of immersion(30,60,90)days in water .Composites plates were prepared by incorporating (bi-directional) (0º-90º) glass fiber and silicon carbide (SiC) particles of (0.1,0.5,1)mm as particle size at (10%,20%,30%,40%) percent volume in epoxy matrix.
The composites shows slightly increase of the thermal conductivity with increasing volume fraction, particle size and increase with increasing the days of immersion in water. The maximum thermal conductivity (0.51W/m.K) was obtained before the immersion in water at 90 days for epoxy reinforcement by bi-directional glass fiber and SiC particl
The concept of self is considered one of the important dimensions in the human personality, because feeling of self is an important characteristic in this phase from the psychological point of view.
The first source which forms the concept of self is the physical image, where the built and appearance of the body is considered among the vital matters which determine the person's image of himself/herself.
The current research aims to:
1) Identify the level of physical self concept at the kindergarten children.
2) Identify the level of psychological self concept at the kindergarten children.
3) Iden
... Show MoreThe advancement of science and technology in recent years has led to heavy and diversified production and thus market congestion in various goods and services; which led to an increase of competition among advertisers in order to meet the needs and wishes and to upgrade to the level of consumers. These upgrades have imposed an increase in the usage of the promotions, including advertising in terms of quantity and quality, to influence and persuade customers innovatively and creatively using all available mass media.
The research aims to identify the attitudes of residents of poor areas towards television advertisements for medicines, and the impact of those advertisements on them in terms of making purch
... Show MoreThis research aims to evaluate the teaching methods used by intermediate Arabic language teachers. To achieve the goal, the researcher followed the descriptive-analytical approach. The research sample was limited to Arabic language teachers at intermediate school for the academic year (2017-2018) the researcher chose a random sample included (155) teachers which form a (40%) Of the original community at Baghdad/ Rusafa1th. The researcher has developed standards of teaching methods which are (7) standards with (39) paragraphs included three alternatives. The results showed the need to pay attention to the use of various modern teaching methods. Moreover, the researcher suggested making an evaluation of the teaching methods used by Arabic
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