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.
Let R be a commutative ring with identity and E be a unitary left R – module .We introduce and study the concept Weak Pseudo – 2 – Absorbing submodules as generalization of weakle – 2 – Absorbing submodules , where a proper submodule A of an R – module E is called Weak Pseudo – 2 – Absorbing if 0 ≠rsx A for r, s R , x E , implies that rx A + soc ( E ) or sx A + soc (E) or rs [ A + soc ( E ) E ]. Many basic properties, char
... Show MoreLet G be a graph, each edge e of which is given a weight w(e). The shortest path problem is a path of minimum weight connecting two specified vertices a and b, and from it we have a pre-topology. Furthermore, we study the restriction and separators in pre-topology generated by the shortest path problems. Finally, we study the rate of liaison in pre-topology between two subgraphs. It is formally shown that the new distance measure is a metric
The national educational systems both in the Russian Federation and Iraq Republic have to adjust the training programs to duly prepare the pedagogical university students for the modern challenges and situations on the market of educational services. For success of the service, the education specialists have to fully mobilize their physical, mental and emotional resources and persistently advance their skills and knowledge using the relevant online education courses; practical research conferences; persistent self-education to master theoretical fundamentals of the modern physical education and sport service; and be active in trainings and competitions in their vocational individual game sports including badminton, table tennis and tennis.
... Show MoreDespite the significant increase in public spending in Iraq, it was not directed toward the important sectors that have an important role in correcting the productive structure. Rather, most of the public expenditure was going to cover the required imports, or to face shocks, whether security or health, and this caused a continuous decrease in the volume of Iraq's exports of goods and services, as the aim of the study was to review the importance of public debt and its impact on the trade balance, as well as to know the economic policies that can contribute to strengthening the trade balance, as the study proved through the (ARDL) model that there is a direct relationship between the domestic debt and the net trade balance, and an invers
... Show MoreThe purpose and goal of the research revolve around the diagnosis of intellectual capital as the logical indicator to study an effective human resource management practice and its influential role in determining the overall quality management of higher education institutions and scientific research in Baghdad.
To achieve the purpose of the research, an upgraded standard questionnaire was used to collect data and distribute it to the selected sample in a statistical manner from the study population of (5) institutions affiliated with the Ministry of Higher Education and Scientific Resear
... Show MoreBeing the meeting points of the world different languages and out of a scholarly perspective, comparative literature represents a cultural leap as well as an artistic and intellectual development or a global literary movement of both prose and poetry. Such homogenous literary structure requires a systematic and coherent study of the literary output of the people different cultures and civilizations. It also represents the theoretical approach of the present study that debates a systematic comparison between Ghassan Kanafani’s All That's Left to You and William Faulkner’s. The Sound and the Fury. Within the perspective of the descriptive analysis approach, the present paper discusses th
... Show MoreThis research aims to knowledge of the scope of applying the international specification of which is regarded to occupational health and safety management system (OHSAS 18001) second edition for year 2007 by The AL-Mammon Factory / The General Company For Vegetable Oils Industry in order to diagnosis the gap between specification requirements and reality by using the checklist made based upon the items of the specification, after translating the English copy into Arabic. The results of the research and analysis that occupational health and safety management system in comparison to the specification requirements in all of its main items, which was (%22.26) applied and documented partly, this refer to the existence of great gap (%7
... Show MoreThe study aims at analyzing the inconsistent structural and semantic aspects found in the plays of N.A Ostrovsky. The analysis, that includes all the linguistics schools of thoughts in modern Russian language, is performed chronologically to clarify all the ambiguities that the Russian language learners may face. Such difficulties lie in the use of inconsistent aspects with complete declarative sentences and adverbial clauses. Hence, it constructs a new sentence category that consists of secondary clause and its syncretism semantic.
The study illustrates the wide scope of both studying the sentence inconsistent
... Show MoreThis paper concerns with deriving and estimating the reliability of the multicomponent system in stress-strength model R(s,k), when the stress and strength are identical independent distribution (iid), follows two parameters Exponentiated Pareto Distribution(EPD) with the unknown shape and known scale parameters. Shrinkage estimation method including Maximum likelihood estimator (MLE), has been considered. Comparisons among the proposed estimators were made depending on simulation based on mean squared error (MSE) criteria.