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 concept of -closedness, a kind of covering property for topological spaces, has already been studied with meticulous care from different angles and via different approaches. In this paper, we continue the said investigation in terms of a different concept viz. grills. The deliberations in the article include certain characterizations and a few necessary conditions for the -closedness of a space, the latter conditions are also shown to be equivalent to -closedness in a - almost regular space. All these and the associated discussions and results are done with grills as the prime supporting tool.
This research aims to test the effect of strategic cohesion with its dimensions (organizational excitement, organizational casting, organizational synergy) as an independent variable on administrative excellence as a dependent variable in the Ministry of Planning, and through surveying several employees (general managers, heads of departments, and units managers). As a research community, and based on the importance of the research topic in the aforementioned research community. The researchers have adopted the descriptive-analytical using the questionnaire as the main data collection. 155 questionnaires were distributed, yet,114 of them were retrieved and 110 were used for final statistical analysis. The researchers used the relev
... Show MoreThe internationalization of the Libyan crisis and its accompanying militarization of the conflict have played a vital role in hindering to reach a comprehensive political settlement solution in Libya. The increasing international greediness in the Libyan energy resources and the geopolitical importance of the Libyan State led to the involvement of many international and regional powers in this crisis and transformed the Libyan crisis into “proxy war”. Moreover, the Turkish direct military intervention in the Libyan crisis is considered as one of the main constraints facing the international and regional efforts to settle the Libyan crisis as a result of the Turkish insistence on its military existence in Libya to preserve i
... Show MoreANN modeling is used here to predict missing monthly precipitation data in one station of the eight weather stations network in Sulaimani Governorate. Eight models were developed, one for each station as for prediction. The accuracy of prediction obtain is excellent with correlation coefficients between the predicted and the measured values of monthly precipitation ranged from (90% to 97.2%). The eight ANN models are found after many trials for each station and those with the highest correlation coefficient were selected. All the ANN models are found to have a hyperbolic tangent and identity activation functions for the hidden and output layers respectively, with learning rate of (0.4) and momentum term of (0.9), but with different data
... Show MoreThe flow in a manifolds considered as an advanced problem in hydraulic engineering applications. The objectives of this study are to determine; the uniformity qn/q1 (ratio of the discharge at last outlet, qn to the discharge at first outlet, q1) and total head losses of the flow along straight and rectangular loop manifolds with different flow conditions. The straight pipes were with 18 m and 19 m long and with of 25.4 mm (1.0 in) in diameter each. While, the rectangular close loop configuration was with length of 19 m and with diameter of 25.4 mm (1.0 in) also. Constant head in the supply tank was used and the head is 2.10 m. It is found that outlets spacing and manifold configuration are the main factors aff
... Show MoreABSTRACT This paper has a three-pronged objective: offering a unitary set of semantic distinctive features to the analysis of nominal “hatred synonyms” in the lexicon of both English and Standard Arabic (SA), applying it procedurally to test its scope of functionality crosslinguistically, and singling out the closest noun synonymous equivalents among the membership of the two sets in this particular lexical semantic field in both languages. The componential analysis and the matching procedures carried have been functional in identifying ten totally matching equivalents (i.e. at 55.6%), and eight partially matching ones (i.e. at %44.4%). This result shows that while total matching equivalences do exist in the translation of certain Eng
... Show MoreThe higher education has become an enterprise integrate system that described as knowledge society, the essential part in its electronic and virtual format in the shadow of globalization challenges with its various dimensions . Until the logical ryles aboat a strategic partnership between the Iraqi higher education establishments and their international equivalent ones Strategic windows should be invested for the purpose of enhancing the quality of higher education in a sustainable way. This forms a challenge before the international education leaders on the social, operational and establishment's level to determinte knowledge gap, observing, diagnosing and processing in the present and future, e
... Show MoreIncreasing world demand for renewable energy resources as wind energy was one of the goals behind research optimization of energy production from wind farms. Wake is one of the important phenomena in this field. This paper focuses on understanding the effect of angle of attack (α) on wake characteristics behind single horizontal axis wind turbines (HAWT). This was done by design three rotors different from each other in value of α used in the rotor design process. Values of α were (4.8˚,9.5˚,19˚). The numerical simulations were conducted using Ansys Workbench 19- Fluent code; the used turbulence model was (k-ω SST). The results showed that best value for extracted wind energy was at α=19˚, spread distance of wak
... Show MoreThe use analysis value chain such information in the provision as financial so information quality meet and satisfy the needs of users such information , particularly investors and lenders as the identification needs financial information and the knowledge as their behavior influenced by that information can be based on the accounting profession to focus on improving their function in order to achieve its goal that satisfying their needs and rationalize their decisions . In accounting thought discovered fertile ground for users preferences as one of the entrances theorising positive which is based on the need to include knowledge on accounting hypothesis that explain the
... Show MoreThe biggest problem of structural materials for fusion reactor is the damage caused by the fusion product neutrons to the structural material. If this problem is overcomed, an important milestone will be left behind in fusion energy. One of the important problems of the structural material is that nuclei forming the structural material interacting with fusion neutrons are transmuted to stable or radioactive nuclei via (n, x) (x; alpha, proton, gamma etc.) reactions. In particular, the concentration of helium gas in the structural material increases through deuteron- tritium (D-T) and (n, α) reactions, and this increase significantly changes the microstructure and the properties of the structural materials. T
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