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.
Shmuel Yosef Agnon, a well-known Jewish writer, wrote many literary works, including poetry, story, etc. In the field of story, this writer used two areas: the first: a simple exterior, and the second: an inner full of secrets and mysteries. This area is common when Agnon is affected by his symbolic method of purpose. In his productions, we find the political and historical significance embodied in his characters, where there is almost no story without it.
Agnon and all his productions gave the character a large area, Agnon’s characters often play the center and cornerstone in those productions, where the author dealt deeply and stated the fines details of the external and internal of that ch
... Show MoreRoughness length is one of the key variables in micrometeorological studies and environmental studies in regards to describing development of cities and urban environments. By utilizing the three dimensions ultrasonic anemometer installed at Mustansiriyah university, we determined the rate of the height of the rough elements (trees, buildings and bridges) to the surrounding area of the university for a radius of 1 km. After this, we calculated the zero-plane displacement length of eight sections and calculated the length of surface roughness. The results proved that the ranges of the variables above are ZH (9.2-13.8) m, Zd (4.3-8.1) m and Zo (0.24-0.48) m.
The aim of the research to apply TD-ABC technology to determine the idle capacity of the central oil companies (oil field east of Baghdad), as a modern cost management technology based on time-oriented activities (TD-ABC) is used by industrial companies in general and oil companies on In particular to build a sustainable Calvinist pillar and make future decisions by identifying idle energy to gain it a competitive advantage, the descriptive analytical approach has been adopted in calculating and analyzing the company’s data for 2018, and the most prominent conclusions of this research are managing idle energy and the task of applying cost technology on the basis of time-oriented activities and providing Convenient spatial infor
... Show MoreLet R be commutative Ring , and let T be unitary left .In this paper ,WAPP-quasi prime submodules are introduced as new generalization of Weakly quasi prime submodules , where proper submodule C of an R-module T is called WAPP –quasi prime submodule of T, if whenever 0≠rstϵC, for r, s ϵR , t ϵT, implies that either r tϵ C +soc or s tϵC +soc .Many examples of characterizations and basic properties are given . Furthermore several characterizations of WAPP-quasi prime submodules in the class of multiplication modules are established.
The current study seeks to evaluate teacher preparation programs in the scientific disciplines at the College of Education in Al-Aqsa University in the light of the requirements of the labor market. It further aims to reveal the significance of the differences in the sample members’ response averages of to the availability of labor market requirements in the program that prepares the teacher of scientific disciplines at the Faculty of Education in Al-Aqsa University taking into account the (gender, program) variables. The study followed the descriptive analytical approach, and so a questionnaire was distributed to a sample of scientific discipline students in the teacher preparation program adopted in Al-Aqsa University, (200) male and
... Show MoreThis study aims at identifying the reality of alternative assessment for teachers of the first cycle of the basic education in the Sultanate of Oman with respect to the degree of teachers' use of alternative assessment strategies, level of self-efficacy for alternative assessment strategies, and attitude towards alternative assessment, and their relationship with other variables. To achieve the aims of the study, a descriptive research approach was utilized. A 5-point self-rated questionnaire was developed. It consists of three sections: Actual use of alternative assessment strategies (21 items), self-efficacy for alternative assessment strategies (21 items), and attitude towards alternative assessment (27 items). The psychometric proper
... Show MoreIn this article we derive two reliability mathematical expressions of two kinds of s-out of -k stress-strength model systems; and . Both stress and strength are assumed to have an Inverse Lomax distribution with unknown shape parameters and a common known scale parameter. The increase and decrease in the real values of the two reliabilities are studied according to the increase and decrease in the distribution parameters. Two estimation methods are used to estimate the distribution parameters and the reliabilities, which are Maximum Likelihood and Regression. A comparison is made between the estimators based on a simulation study by the mean squared error criteria, which revealed that the maximum likelihood estimator works the best.
This paper tackles tragedy and grief in the Hebrew poetry of the Middle Ages, as being topics which was transferred to it from Arabic poetry at that time. This came as a result of Hebrew poets quoting images from, and adopting the form and content of the Arabic poem. So, this topic was a prominent feature in the Hebrew poetry of the middle ages. The Hebrew poets focused upon this topic along three trends: poems of lamentation, whether being what are called national lamentation where poets expressed their feelings and grieves because of their remoteness and longing to their homeland, which is Palestine or the sacred land, as they claim; here, Zionist trends were apparent in many poems lamenting Zion and other cities. The other type of poe
... Show MoreA progressive increase in the desire for environmentally friendly lubricants by users and strict government regulations for the use of these lubricants has provided an opportunity to use plant oils as biodegradable lubricants, therefore vegetable oils have been investigated to replace oil lubricants because of their maintaining the conditions of nature (environment) properties. In this paper, the influences of the blending ratio of mustard seeds oil with commercial mineral oil (SAE40) on the tribological characteristics were investigated and compared with mineral oil using the four-ball tribotester. Mustard seeds oil was blended with mineral oil at a volumetric ratio ranging from 22.5 to 90%. All experimental works were
... Show MoreThe International Court of Justice, as the main judicial organ of the United Nations in its ruling on the Barcelona Traction case, raised the concept of obligations Erga Omnes in international law, but this Latin term Erga Omnes has been used with different meanings and connotations. Through the extrapolation of the jurisprudence of the International Court of Justice, we note that it used the term In the context of its traditional meaning of expressing issues related to protest and legal interest at times, and the issue of international law enforcement at other times, it also used the same term to justify the application of the effects of some international treaties on states that are not party to it, or the application
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