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 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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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
Four hundred and fifty urine samples were collected from patients suffering from urinary tract infection from the General Azadi hospital in Kurkuk province ,during the period of october 2007 till march 2008 . Results of bacteriological culture revealed that (168) out of (450) studied samples (37.3%) gave positive culture using blood agar and macConkey agar ; different species of bacterial isolates were detected using morphological and biochemical tests ,from these isolates the highest percentage of the isolates were from Escherichia coli when it was (100) isolates out of (190) isolate (52.63%) . one hundred isolates were distributed between (77) from females and (23) from
... Show MoreBackground: The access cavity is a critical stage in root canal therapy and it may influence the subsequent steps of the treatment. The new minimally invasive endodontic access cavity preparation concept aims to preserve sound tooth structure by conserving as much intact dentine as possible including the pulp chamber's roof, to keep the teeth from fracturing during and after endodontic treatment. While there is great interest in such access opening designs in numerous publications, still there is a lack of scientific evidence to support the application of such modern access cavity designs in clinical practice. This review aims to critically examine the literature on minimal access cavity preparations, explain the effect of minimally inva
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The aim of this study is to get practical evidence from the Egyptian business environment The Impact of Audit Committees Effectiveness and External Audit Quality on Timeliness of annual Financial Report. Design and methodology: The study based on the content analysis technique to examine the annual reports of a sample of (30) companies listed on the Egyptian Stock Exchange (EGX100) during the period (2016-2019) with a total of (120) respondents. To test the research hypotheses, the results of the study indicate that there is a negative significant impact of audit committees on timeliness of annual financial report. Moreover, while there is a negative impact on the quality of the external audit on the timing of issuing the annual
... Show MoreOur aim in this paper is to introduce the notation of nearly primary-2-absorbing submodule as generalization of 2-absorbing submodule where a proper submodule of an -module is called nearly primary-2-absorbing submodule if whenever , for , , , implies that either or or . We got many basic, properties, examples and characterizations of this concept. Furthermore, characterizations of nearly primary-2-absorbing submodules in some classes of modules were inserted. Moreover, the behavior of nearly primary-2-absorbing submodule under -epimorphism was studied.
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The downhole flow profiles of the wells with single production tubes and mixed flow from more than one layer can be complicated, making it challenging to obtain the average pressure of each layer independently. Production log data can be used to monitor the impacts of pressure depletion over time and to determine average pressure with the use of Selective Inflow Performance (SIP). The SIP technique provides a method of determining the steady state of inflow relationship for each individual layer. The well flows at different stabilized surface rates, and for each rate, a production log is run throughout the producing interval to record both downhole flow rates and flowing pressure. PVT data can be used to convert measured in-situ r
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Many studies have recommended implying the skills and strategies of creative thinking, critical thinking, and reflective thinking in EFLT curriculum to overcome EFL teaching-learning process difficulties. It is really necessary to make EFL teachers aware of the importance of cultural thinking and have a high perception of its forces. Culture of thinking consists of eight cultural forces in every learning situation; it helps to shape the group's cultural dynamic. These forces are expectations, language, time, modeling, opportunities, routines, interactions, and environment. This study aims to investigate EFL student-teachers’ perceptions of cultural thinking. The participants are selected randomly from the fourth-stage students at
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