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.
This study aimed to reveal the extent to which the values of social peace are included in the content of social and national studies textbooks of the middle stage in kingdom of Saudi Arabia. To achieve this goal, the researcher used the descriptive analytical approach. The study sample consisted of all developed social and national studies textbooks of the middle stage in kingdom of Saudi Arabia in first and second semester of student books in edition of 1439-1440. The study tool was the analysis card. The study reached the following results: 1-The content of social and national studies textbooks of the middle stage in kingdom of Saudi Arabia as a whole included (38) social peace values of total (40) values, corresponding to the inclusio
... Show MoreThis research presents a new algorithm for classification the
shadow and water bodies for high-resolution satellite images (4-
meter) of Baghdad city, have been modulated the equations of the
color space components C1-C2-C3. Have been using the color space
component C3 (blue) for discriminating the shadow, and has been
used C1 (red) to detect the water bodies (river). The new technique
was successfully tested on many images of the Google earth and
Ikonos. Experimental results show that this algorithm effective to
detect all the types of the shadows with color, and also detects the
water bodies in another color. The benefit of this new technique to
discriminate between the shadows and water in fast Matlab pro
The study presents the test results of Completely Decomposed Granite (CDG) soil tested under drained triaxial compression, direct shear and simple shear tests. Special attention was focused on the modification of the upper halve of conventional Direct Shear Test (DST) to behave as free
head in movement along with vertical strain control during shear stage by using Geotechnical Digital System (GDS). The results show that Free Direct Shear Test (FDST) has clear effect on the measured shear stress and vertical strain during the test. It has been found that shear strength
parameters measured from FDST were closer to those measured from simple shear and drained triaxial compression test. This study also provides an independent check on
This research aims to identify the effective role of self-managed teams in the quality of service performance in the directorate of Ramadi municipality. The problematic nature of our research involves this main question of the effective role of self-managed teams in the Municipality of Ramadi in improving the services of performance quality to the beneficiaries from the Directorate service. The importance of this study lies in the role played by the work teams in the organizations that excel in their field, the attendant of the changes in the leadership, administrative roles of the institutions, and teams leaders, will be achieved by the self-managed teams in improving the quality of the service provided by the institution to whi
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In the era of the digital economy, public organizations need to consolidation the capabilities of entrepreneurial alertness to reduce the risks of sudden transformations and changes, and to find effective mechanisms to discover and invest in environmental opportunities proactively, as this concern has become a knowledge gap in public sector institutions, the current research aims to identify the role of digital competence in influencing on entrepreneurial alertness in the Central Bank of Iraq (CBI), the descriptive analytical approach was used as a research method to describe and analyze the main research variables. digital competence as an explanatory variable includes three dimensions: digital infrastructure, digital integration, and d
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Here, we found an estimation of best approximation of unbounded functions which satisfied weighted Lipschitz condition with respect to convex polynomial by means of weighted Totik-Ditzian modulus of continuity
Abstract Infinitives and gerunds are non-finite verb forms which cannot be indicated by tense, number, or person. The construction of non-finite verbs is intricate because of their nature of meanings, forms, and functions. The major problem is that both infinitival and gerundial complements have identical functions and occupy identical positions in the sentences. Thus, there is a confusion in using an infinitival and gerundial forms after aspectual verbs. The selection of either one of these two forms as complements is controlled syntactically or semantically. Moreover, both forms can be used usually with similar predicate but with neat difference in meaning. In addition, there are problems with controlling the use of aspect, since aspectua
... Show MoreIn this research , we study the inverse Gompertz distribution (IG) and estimate the survival function of the distribution , and the survival function was evaluated using three methods (the Maximum likelihood, least squares, and percentiles estimators) and choosing the best method estimation ,as it was found that the best method for estimating the survival function is the squares-least method because it has the lowest IMSE and for all sample sizes
Summary:This article discusses the topic of phraseological units with the names of wild animals in the Russian and Arabic languages in the aspect of their comparative semantic and cultural analysis, since a comparative analysis of the meanings of phraseological units of the Arabic and Russian languages, detection of coincidences and differences in the compared languages, is an important method for studying linguoculturology, since phraseological units represent a reflection of culture in the language