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 aim of this study is to achieve the best distinguishing function of the variables which have common characteristics to distinguish between the groups in order to identify the situation of the governorates that suffer from the problem of deprivation. This allows the parties concerned and the regulatory authorities to intervene to take corrective measures. The main indicators of the deprivation index included (education, health, infrastructure, housing, protection) were based on 2010 data available in the Central Bureau of Statistics
the researchers Sought to determine the impact of the customer contact (Within a client contact there are two times, first is the total time required to create a service and within it there is contact time while the second time is the time of client contact ؛ where means a time that records the physical presence of the customer during the process of service) on operations performance by concentrate attention on the cost (labor productivity) and quality (patient ratio to the doctor) and speed (cycle time) and flexibility (the flexibility range) , as well as ruling out variable of innovation because of impossibility to measure this variable in the Specialty Center for Dental in al-alwia due to the center is lacking of mechanisms t
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The 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
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The Egyptian and Iraqi schools are one of the most important musical schools in the style of playing the oud. The influence of the style of these schools extended in the contemporary Arab world, and there were important names that emerged characterized with their style of playing. Thus, the ways of tuning the strings of oud varied between the two schools because of the difference in the ways of playing and the difference in the style of expression. The aim of the research was to identify the pluralism of the variable tunings of the strings of the contemporary Arab oud of the Egyptian and Iraqi schools, along the historical period extending from the late nineteenth and twentieth centuries to the present time. The oud has been classified i
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The 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
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In this paper waste natural material (date seed) and polymer particles(UF) were used for investigation of removal dye of the potassium permanganate. Also study effect some variables such as pH, dye concentration and adsorbent concentration on dye removal. 15 experimental runs were done using the itemized conditions designed established on the Box-Wilson design employed to optimize dye removal. The optimum conditions for the dye removal were found: (pH) 12, (dye con.) 2.38 ppm, (adsorbant con.) 0.0816 gm for date seed with 95.22% removal and for UF (pH) 12, (dye con.) 18 ppm, (adsorbant con.) 0.2235 gm with 91.43%. The value of R-square was 85.47% for Date seed and (88.77%) for UF.
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Abstract:
Objective(s): The present study aims to evaluate the effectiveness of Health educational program on nurses' knowledge toward children pneumonia at Al-Amara City hospitals..
Methods: A quasi –experimental study design two-study group (pretest-posttest 1 and posttest 2) carried out at Alzahrawy Hospital and Child and maternity hospital in Al Amara City to identify the effectiveness of the Health educational program on Nurses Knowledge toward Children pneumonia; the study was conducted between 1 of September 2019 to 1 of April 2020. A Purposive (Non-probability) sample is chosen for the present study. The size of sample is (60) nur
... Show MoreA Simple, rapid and sensitive extractive and spectrophotometric method has been described for the analysis of diphenhyldramine –HCl (DPH) in pure form and in pharmaceutical formulations. The method is based on the formation of chloroform soluble ion-pair complex with Bromophenol blue(BPB) in a phthalate buffer at pH 3.0.The extracted complex shows maximum absorbance at 410 nm. Beer's law is obeyed in the concentration range 0.2-25.0 µg.ml-1. The molar absorptivity and Sandell's sensitivity for the system being 2.416x104 L.mol-1.cm-1 and 0.012µg.cm-2, respectively. The limit of detection was found to be 0.155 µg.ml-1. The proposed me
... Show MoreThere many methods for estimation of permeability. In this Paper, permeability has been estimated by two methods. The conventional and modified methods are used to calculate flow zone indicator (FZI). The hydraulic flow unit (HU) was identified by FZI technique. This technique is effective in predicting the permeability in un-cored intervals/wells. HU is related with FZI and rock quality index (RQI). All available cores from 7 wells (Su -4, Su -5, Su -7, Su -8, Su -9, Su -12, and Su -14) were used to be database for HU classification. The plot of probability cumulative of FZI is used. The plot of core-derived probability FZI for both modified and conventional method which indicates 4 Hu (A, B, C and D) for Nahr Umr forma
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