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.
هدفت هذه الدراسة إلى تحليل نتائج الاختبار الوطني الموحد الذي تطبقه وزارة التربية والتعليم الفلسطينية في مادة الرياضيات لطلبة الصف الثامن الأساسي في المدارس الحكومية في محافظة طولكرم، وذلك لمعرفة مستوى الطلبة على هذا الاختبار في ضوء متغيرات الجنس والمنطقة التعليمية ونوع المدرسة، ومعرفة علاقة التحصيل على هذا الاختبار بتحصيل الطلبة المدرسي والمعدل العام. ولتحقيق ذلك تم تحليل درجات (3218) طالباً وطالبة؛ وهم ي
... Show MoreMalaysia has been supported by one of the high-speed fiber internet connections called TM UniFi. TM UniFi is very familiar to be used as a medium to apply Small Office Home Office (SOHO) concept due to the COVID-19 pandemic. Most of the communication vendors offer varieties of network services to fulfill customers' needs and satisfaction during the pandemic. Quality of Services is queried by most users by the fact of increased on users from time to time. Therefore, it is crucial to know the network performance contrary to the number of devices connected to the TM UniFi network. The main objective of this research is to analyze TM UniFi performance with the impact of multiple device connections or users' services. The study was conducted
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يهدف البحث الحالي إلى اختبار العلاقة بين نوعية حياة العمل والإبداع التنظيمي في ديوان وزارة التخطيط ، ولبلوغ الهدف المذكور وبناء على معطيات البحث الاستطلاعي للباحث بني ألانموذج الفرضي للبحث الذي ضم المتغير المستقل والمعتمد، واعتماداً على حركية الأنموذج صيغت فرضيتان، ولاختبار صحة الفرضيات وجمع المعلومات من عينة البحث البالغة (100) مدير يمثلون مرك
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The article examines metaphors as one of the fundamental means used by D. Rubina when writing the novel “Parsley Syndrome” to form images of dolls as equal heroes of the work. The author of the article continues research related to the work of Dina Ilinichna Rubina, a representative of modern Russian prose.
Objective(s): To evaluate the family physicians' practices and to measure its impact upon the quality of family
medicine health care in Baghdad City model primary health care centers.
Methodology: A descriptive study, using the evaluation approach, has evaluated the impact of family physicians'
practices upon quality of healthcare in Baghdad's Model Primary Health Care Centers of Family Medicine. It is
carried out during 15th of May – 20th of August 2017. The study is conducted at five model primary health care
centers of family medicine from two districts; AL-Rusafa and AL-Kurkh. Sample size is calculated to be (76)
family physicians. Convenient sample of (124) patients who are attending these primary health care cen
Soft clays are generally sediments deposited by rivers, seas, or lakes. These soils are fine-grained plastic soils with appreciable clay content and are characterized by high compressibility and low shear strength. To deal with soft soil problems there is more than one method that can be used such as soil replacement, preloading, stone column, sand drains, lime stabilization and Prefabricated Vertical Drains, PVDs. A numerical modeling of PVD with vacuum pressure was analyzed to investigate the effect of this technique on the consolidation behavior of fully and different depths of partially saturated soft soils. Laboratory experiments were also conducted by using a specially-designed large consol
... Show MoreTo decrease the dependency of producing high octane number gasoline on the catalytic processes in petroleum refineries and to increase the gasoline pool, the effect of adding a suggested formula of composite blending octane number enhancer to motor gasoline composed of a mixture of oxygenated materials (ethanol and ether) and aromatic materials (toluene and xylene) was investigated by design of experiments made by Mini Tab 15 statistical software. The original gasoline before addition of the octane number blending enhancer has a value of (79) research octane number (RON). The design of experiments which study the optimum volumetric percentages of the four variables, ethanol, toluene, and ether and xylene materials leads
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The problem of generated waste as a result of the implementation of construction projects, has been aggravated recently because of construction activity experienced by the world, especially Iraq, which is going through a period of reconstruction, where construction waste represents (20-40%) of the total generated waste and has a negative effect on the environment and economic side of the project. In addition, the rate of consumpted amounts of natural resources are estimated to be about 40% in the construction industry, so it became necessary to reduce waste and to be manage well. This study aims to identify the key factors affecting waste management through the various phases of the project, and this is accom
... Show MoreThe size and the concentration of the gold nanoparticles (GNPs)
synthesized in double distilled deionized water (DDDW) have been
found to be affected by the laser energy and the number of pulses.
The absorption spectra of the nanoparticles DDDW, and the
surface plasmon resonance (SPR) peaks were measured, and found to
be located between (509 and 524)nm using the UV- Vis
spectrophotometer. SPR calculations, images of transmission
electron microscope, and dynamic light scattering (DLS) method
were used to determine the size of GNPs, which found to be ranged
between (3.5 and 27) nm. The concentrations of GNPs in colloidal
solutions found to be ranged between (37 and 142) ppm, and
measured by atomic absorptio
(1)
Abstract:
The research aims to monitor the image of the man in the group (The Cart and the Rain) by the storyteller (Badiaa Amin); With the aim of highlighting an aspect of feminist writing, especially with regard to the relationship of women to men, and determining the form adopted by the storyteller in drawing the features of men.
The research used the descriptive-analytical method in the space of its textual formation, which aims to stand on the text and deconstruct its narrative significance. To provide a comprehensive picture of it.
Three images of the man appeared in the group's stories, represented by (the authoritarian, the negative, and the positive), and the image of the authoritarian ma
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