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 study aimed to explore the school principals’ servant leadership practices for primary teachers’ perspectives in the Sultanate of Oman, furthermore to investigate the differences in those practices attributable to variables (gender, qualification, educational stage, years of experience, governorate). The study relied on the descriptive approach, by employing the survey research design using the questionnaire as a main tool for data collection, which included five dimensions of servant leadership (altruism, humility, enhancing teacher development, emotional healing, commitment to community development), Data collected from (1094) teachers in basic education schools, and they were chosen randomly. The results of the study indicated
... Show MoreMany studies and researchers have reported significant evidence that some physical properties of water can be changed as it passes through a magnetic field that can improve water use. This can have a promising potential for applications, especially in the fields of irrigation and drainage. In this research, magnetized water was used to leach salt-affected sandy loam soil. A test rig was designed and constructed to investigate the effects of magnetized water on leaching soil. The rig consists of a magnetization device that can provide variable intensity. Water was supplied from a constant head reservoir to the magnetization device then to the soils that were placed in plastic columns. Five different magnetic intensi
... Show MoreThis study dealt with the basics of financial inclusion in terms of concept, importance and objectives, The empowerment of women financially and bank ,and then the relationship between financial inclusion and women, and determine the requirements of inclusion Financial resources for women. The analytical descriptive method was used for data, which included reviewing and analyzing information and data in economic and financial literature. The study: reached a number of conclusions, the most important of which are Financial inclusion contributes to women's financial and banking support, as there is a positive relationship between financial institutions Banking and women's access to financial and banking services, thus playing a rol
... Show MoreThis study was carrid out to produce animal gelatin from chicken skin. Gelatin was prepared by the chemical method using HCl 2% and extraction at the temperature degree 70, 80, 90 c° and at the period of time 4, 6, 8 hours, calculated the yield, functional and sensory characteristics were measured at. The result also demonstrated that the produced gelatin have good functional properties in solubility, viscosity, gelling capacity, water absorpation, lipid binding, emulsification. viscosity was higher in gelatin prepared at 70 c° and period of extraction 8 hours and reached 1.0846 cp. Gelatin prepared were featured by highe gelling capacity at 1% for all extraction time periods. The produced gelatin was characterized by good sensory qual
... Show MoreThe γ- mixing ratios of γ- transitions from levels of 56Fe populated in reaction are calculated using least square fitting program for the first time in the case of pure and mixed transitions the results obtained have been compound with γ Values determined by other methods .The comparison shows that the agreement is good this confirmed the valilety of this method in calculating of values for such γ- transitions key word: γ- transition ,Multipole mixing ratios ,Least square fitting method.
This study is concerned with the derivation of differential equation of motion for the free coupled vertical – torsional and lateral vibration of opened thin-walled curved beams. The curved beam to be considered in this study is of isotropic opened thin – walled (I) section with equal top and bottom flanges. The derivation depends on Hamilton's principle which required finding the potential and kinetic energy of the curved beam section due to internal stresses and all types of movements (Vertical,Torsional and Lateral) .The effect of restrained warping displacement is also considered in this study. Three differential equations are derived for vertical, torsional and lateral movement .and approximate solutions are developed by using the
... Show MoreSince the advent of the sunrise of the immortal message, Islamic legislation has always established justice and the right guidance, and has prevented any perversion, injustice or corruption, with a divine system that called in its course the characteristics of the legislation on its general basis and its ability to develop, progressivity, and paving the way with a collective approach, accompanied by the worldly and moral punishment. When the corrupters went too far, reformers were delayed and values were missed; Mankind has been afflicted with the scourge of injustice and loss, and has lost sight of the approach that the Creator of the world has given to the people of the world, for what would guide them in their affairs sooner and later
... Show More That analytical procedures are of analytical tools important because it gives assurance to the auditor-free financial statements of the economic units replace the audit of cases offraud and errors and distortions, and thereby to increase the effectiveness of the audit process and confirm the possibility oftrust and reliance on the financial statements that Adfgaha auditor.
Inspite of identify evidence of proof necessary to enhance the auditor's opinion the results reached in the audit p
The research aims to identify the concept of green taxes and their role in reducing environmental pollution through the poll of Abnh of taxpayers and employees of the General Authority for taxes totaling 200 individual .autam adoption of the resolution as a tool head for the collection of data and information from the sample and analyzed their responses using a statistical program (spss - 10), and calculating the percentages and the arithmetic mean, standard deviation and research found to a number of conclusions, notably the lack of legislation with the challenges and the difficulty of the existence of a measure or a standard lack of planning for the application of environmental taxes that the state taxation application between the Gene
... Show MoreManagement is considered as most important resource of the society ones in modern era and an exchange
point in societies’ lives in order to achieve its goals and wishes. So far, management behinds the new
electronic society has become different in shape and nature due to the force of the nature of information
technology that shapes the relationships between the world’s individuals at the national level but it goes
beyond the international ones. The study aims at identifying the impact of the electronic management’s
components upon the improvement of the quality of nursing care in Baghdad’s hospitals. The descriptive
design, with a sample-survey approach, is used as appropriate ones for the field study of social