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 effects of solar radiation pressure at several satellite (near Earth orbit satellite, low Earth orbit satellite, medium Earth orbit satellite and high Earth orbit satellite ) have been investigated. Computer simulation of the equation of motion with perturbations using step-by-step integration (Cowell's method) designed by matlab a 7.4 where using Jacobian matrix method to increase the accuracy of result.
Abstract
This study aims to identify the degree to which the first cycle teachers use different feedback patterns in the e-learning system in addition to the differences in the degree of use according to specialization, teaching experience, and in-service training in the field of classroom assessment, as well as the interaction between them. The study sample consisted of (350) female teachers of the first cycle in government schools in Muscat Governorate for the academic year 2020/2021. The study used a questionnaire that contained four different patterns of feedback, which are reinforcement, informative, corrective, and interpretive feedback. The psychometric properties of the que
... Show MoreGlorify and Praise be to God, and prayers and peace be upon the Messenger of God, his family, companions, and those who are loyal to him.
The subject derives its significance from two important sources , the first one lies in the Sunnah of the Prophet, while the other is the family source , which enrich this subject with great importance.
As for the objective of the topic, it shows to the reader the prophetic bases that mitigate and ease the burden of the husband in a way that secures the marital happiness, so that the Muslim woman takes it as a path for her in life and a slogan that illuminates the darkness of the path and makes her to overcom
... Show MoreThe objective of drilling parameters optimization in Majnoon oilfield is to arrive for a methodology that considers the past drilling data for five directional wells at 35 degree of inclination as a baseline for new wells to be drilled. Also, to predicts drilling performance by selecting the applied drilling parameters generated the highest rate of penetration (ROP) at each section. The focal point of the optimization process is to reduce drilling time and associated cost per each well. The results of this study show that the maximum ROP could not be achieved without sufficient flow rate to cool and clean the bit in clay intervals (36" and 24") hole sections. Although the influence of combination of Weight on Bit (WOB), Round per minute
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The current research aims to train students to take benefit of their studies to analyze and taste the artistic works as one of the most important components of the academic structure for students specializing in visual arts; then to activate this during training them the methods of teaching. Consequently, the capabilities of mind maps were employed as a tool that would be through freeing each student to analyze a model of artistic work and think about his analytical principles according to what he knows. Then, a start-up with a new stage revolves around the possibility of transforming this analysis into a teaching style by thinking about how the student would do. The same person who undertook the technical analysis should offer this work
... Show MoreInvestigation of the adsorption of Chromium (VI) on Fe3O4 is carried out using batch scale experiments according to statistical design using a software program minitab17 (Box-Behnken design). Experiments were carried out as per Box-Behnken design with four input parameters such as pH (2-8), initial concentration (50–150mg/L), adsorbent dosage (0.05–0.3 g) and time of adsorption (10–60min). The better conditions were showed at pH: 2; contact time: 60 min; chromium concentration: 50 mg/L and magnetite dosage: 0.3 g for maximum Chromium (VI) removal of (98.95%) with an error of 1.08%. The three models (Freundlich, Langmuir, and Temkin) were fitted to experimental data, Langmuir isotherm has bette
... Show MoreThe researcher focused on the importance of the physical abilities of the tennis game, as this game is one of the games that are characterized by its specificity in performance as this game is characterized by continuous movement and dealing with different elements, so this game requires the development of muscle strength, which plays an important role in Performance skills in the game of tennis. There are several methods to develop strength, including flat hierarchical technique, which is one of the most common forms of training in the development of muscle strength. As for the research problem, the researcher found a method that has an effect on the development of force. Therefore, the researcher tried to diversify a
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Investment in high education is considered to be most important factors of production which the return an individual and social than economic returns found by searching the growing problem of unemployment, especially among youth graduates, where the unemployment rate in 2010 (50%) of these high rates have led to increased migration of scientific minds graduate recently, "to search for job opportunities outside Iraq for not hiring functions and this is in vain" clear "in the human and financial resources lead to structural imbalances in the Iraqi economy. When calculating the correlation coefficient between the graduates and the unemployment rate where it reached (0.21) emerged from the results of
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Box-Wilson experimental design method was employed to optimized lead ions removal efficiency by bulk liquid membrane (BLM) method. The optimization procedure was primarily based on four impartial relevant parameters: pH of feed phase (4-6), pH of stripping phase (9-11), carrier concentration TBP (5-10) %, and initial metal concentration (60-120 ppm). maximum recovery efficiency of lead ions is 83.852% was virtually done following thirty one-of-a-kind experimental runs, as exact through 24-Central Composite Design (CCD). The best values for the aforementioned four parameters, corresponding to the most restoration efficiency were: 5, 10, 7.5% (v/v), and 90 mg/l, respectively. The obtained experimental data had been
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Background: The prevalence of both obesity & diabetes are increasing all over the world & more in women. They have a negative impact not only on morbidity & mortality but also on quality of life.
Objectives: To assess the HRQoL with a specific comparison between obese & normal weight among wo
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