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 literary review addresses the status of the most famous Israeli writer, Amos Oz, through the analysis of relevant articles that highlight various aspects of his literary and political orientations, reflecting his ideological and social background. Oz's literature encompasses a mix of political orientations that many critics view as extreme, while others see them as moderate stances indicative of the author's awareness. And these are what strengthened his literary status in modern Hebrew literature.These trends emphasized the contribution of Oz's works to shaping Israeli cultural consciousness and reflect the challenges facing identity in multiple contexts. He was an advocate for equality between Palestinians and Israelis and
... Show MoreBackground: Disc battery ingestion is a common
serious problem in Iraq. It increase in the last years
because of the increase in number of electronic toys
that uses these batteries. These batteries contains
many types of irritant chemicals that increases the
risk of it's ingestion.
Methods:We reviewed the medical records of
children aged between 1year and 7 years
old admitted to Surgical Specialty Hospital/Baghdad
Medical City due to disc battery ingestion from
January 2007 through December 2010). The diagnosis
of disc battery ingestion was based upon history,
clinical symptoms, and results of imaging studies.
The clinical data reviewed included sex, age, clinical
manifestation and duration of sy
Low cost Co-Precipitation method was used for Preparation of novel nickel oxide (NiO) nano particle thin films with Simple, with two different PH values 6, 12 and its effect on structural and optical properties as an active optical filter. Experimental results of structural properties X-ray diffraction (XRD) showed that both Nickel oxide nanoparticles with (PH=6 and 12) have polycrystalline structure smaller average particle size about 8.5 nm for PH=6 in comparison with PH=12. Morphological studies using Scanning electron microscopy (SEM) and atomic force microscope (AFM) show uniform nano rod distribution for PH=6 with smaller average diameter, average roughness as compared with NiO with
... Show MoreThe present paper discusses morphological and syntactic structures of time in Russian language. The morphological and syntactic structures are considered part component of time category in Russian language.
The morphological categories of time are formed through a various types of expressions .Tenses generally express time relative to the moment of speaking. In some contexts, however, their meaning may be relativized to a point in the past ,present or future which is established in the discourse .Some languages have different verb forms or constructions and that are opposed in meaning not in syntactic category. Hence, the present study traces and compares the syntacti
... Show MoreThe aim of this investigation is to present the idea of SAH – ideal , closed SAH – ideal and closed SAH – ideal with respect to an element , and s- of BH – algebra .
We detail and show theorems which regulate the relationship between these ideas and provide some examples in BH – algebra .
The researcher has studied in his research (International Public Relations methods in building the state's image through Cyberspace)
, analytical study of the Facebook and twitter pages for British foreign office , the role was played by the International Public Relations in building the mental image of British , especially after the new media and internet have became influential role in political life . and became an important tools used by political institutions as ministries of foreign affairs in the twenty: one century .
The researcher identified the problem of this study with the following question:
(what is the role of the International Public Relations in building the mental image of state through Cyberspace)
To answer
This book includes four main chapters: 1. Indefinite Integral. 2. Methods of Integration. 3. Definite Integral. 4. Multiple Integral. In addition to many examples and exercises for the purpose of acquiring the student's ability to think correctly in solving mathematical questions.
This study aims to identify the level of application of blue ocean leadership activities in public organizations and to build a conceptual and cognitive framework around this concept. The study adopted a descriptive-analytical approach, and the research sample consisted of (95) individuals from the senior management working at the center of the Iraqi Ministry of Communications (director general, department manager, section head). The data analysis technique used is structural equation modeling (SEM) and the Statistical Package for the Social Sciences (SPSS). The results indicate that the senior management in the Ministry of Communications is working to adopt the blue ocean leadership style through its activities, but not to the leve
... Show MoreAbstract: Background: Drug toxicity and chemotherapeutic side effects negatively impact the quality of life of breast cancer patients. Objectives: to evaluate the efficacy of pharmaceutical Interventions (PI) on quality of life (QOL)Among chemotherapy intake breast cancer women. Method: A pre-post interventional study was carried out at the chemotherapy ward of Alhabobi Hospital in Alnasiriyah City. Eligible patients received comprehensive pharmaceutical care and a self-compiled Breast Cancer Patients Medication Knowledge Guide pamphlet. Each patient received two sessions, the first at baseline and the second after 7, 14, or 21 days depending on the next taking dose of chemotherapy. Each session lasted for approximately 15-30 minutes. Par
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