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.
In order to understand the effect of (length of pile / diameter of pile) ratio on the load carrying capacity and settlement reduction behavior of piled raft resting on loose sand, laboratory model tests were conducted on small-scale models. The parameters studied were the effect of pile length and the number of piles. The load settlement behavior obtained from the tests has been validated by using 3-D finite element in ABAQUS program, was adopted to understand the load carrying response of piled raft and settlement reduction. The results of experimental work show that the increase in (Lp/dp) ratio led to increase in load carrying capacity by piled raft from (19.75 to 29.35%), (14.18 to 28.87%) and (0 to 16.49%) , the maximum load carried
... Show MoreThe research aims to identify the level of educational supervisors' practices of their supervisory duties according to the requirements of comprehensive quality from the viewpoint of teachers in Oman. Moreover, identify the differences between the responses of the sample about these practices, which are attributed to gender, and years of experience. Thus, a questionnaire was administered to teachers, consisting of (48) items distributed on (5) main fields related to the educational supervisor's practices. The sample consisted of (220) teachers who were randomly chosen from the schools in Dhofar region. Data were analyzed using means, standard divisions, T-test, and One Way ANOVA. The research concluded that the level of educational super
... Show More There is an increase in the need for cost accounting in all organizations and from different sectors to provide detailed information to the totals of financial accounting, first and help solve problems associated with inventory and analysis, tabulation and allocation of cost elements II and do the planning process and provide the necessary oversight and help to take the right decisions such as pricing decisions that need to Information cost accounting.
And suffer most of the non-governmental organizations from the lack of a cost accounting system provides information on the cost of service in these organizations and the department research sample circle v
Stream of Consciousness technique has a great impact on writing literary texts in the modern age. This technique was broadly used in the late of nineteen century as a result of thedecay of plot, especially in novel writing. Novelists began to use stream of consciousness technique as a new phenomenon, because it goes deeper into the human mind and soul through involving it in writing. Modern novel has changed after Victorian age from the traditional novel that considers themes of religion, culture, social matters, etc. to be a group of irregular events and thoughts interrogate or reveal the inner feeling of readers.
This study simplifies stream of consciousness technique through clarifying the three levels of conscious
... Show MoreIndicators of government debt is of extreme importanse in economic activity through knowledge of the economic impact of government debt, if the phenomenon is accepted or prepared to dangerous stage by stage, and there fore it can Through these indicators to measure the degree of indebtedness in relation to the economic activity of the Government on the one hand, the governments ability to repay the other hand.
Due to this it inferred that the degree of indebtedness in Iraq specificratio has exceed 60% during the period 1990 – 2002 ntejh lack of political and economic stability of the government, which led to the governments inability to repay the ma
... Show MoreThis research sheds light on the morphological structure of nouns and verbs in the novel "ASTONISHMENT" by the novelist Aharon Applefield by analysing selected models from the novel in a morphological analysis in order to identify the most important morphological features of this structure according to a statistical analytical approach.
The morphological structure is the main pillar of the linguistic structure of the literary text. Morphology is the science that studies the word, by which its structure and original letters are known, and the change that has occurred to it. The aesthetics of the fictional text is reflected in this structure, through which the writer conveys his ideas and narrations to the reader. The research
... Show MoreThe integration of arti cial intelligence (AI), whether through devices or software, has become a critical tool in analyzing and evaluating technical performance. AI signi cantly contributes to enhancing athletic performance by enabling accurate data analysis and supporting educators in developing effective training programs and interactive curricula. This study addresses a noticeable gap in the literature regarding the attitudes and inclinations of educators toward AI in physical education and sport sciences—a gap often attributed to limited awareness and lack of access to moderntechnologies.Theprimaryaimofthestudyistoexaminethetendenciesandperceptionsoffemaleinstructorsin physical education and sport sciences toward the use of AI
... Show MoreThin films of pure polycarbonate (PC) with anthracene doping PC films for different doping ratios (10, 20, 30, 40, 50 and 60 ml) were prepared by using a casting method. The influence of anthracene doping ratio on photo-fries rearrangement of polycarbonate was systematic investigated. Furthermore, pure PC and anthracene doping PC films were irradiated via UV light at a wavelength (254 nm) for different periods (5, 240, 288, and 360 hrs). The photo-fries rearrangement occurring in pure PC and anthracene doping PC films were monitored using UV and FTIR spectroscopies. The photo-fries rearrangement leads to scission the carbonate linkage and formation phenylsalicylate and dihydroxybenzophenes. The result of the UV spectrum confirms disappea
... Show MoreThe aim of this study was to provide an overall assessment to the efficiency of the Iraq stocks exchanges (ISE) through specifying well –known models .First, Fama's efficient market hypothesis as a contrary concept to the random walk hypothesis, was performed and it has been found that ISE follows the random process, so the price of the shares can't be predicated on the basis of past information. Second,we use a multifactor model, which so named multiple regression, to explore the link between ISE and the main economic indicators. our empirical analysis finds that every weak associations exists between major ISE measures and main economic indicators.