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.
Abstract
The study aimed to prepare a practical guide for procedures for auditing the strategies of municipal institutions in achieving sustainable development by adopting the idea of the audit matrix through which a classified report is prepared according to the dimensions of sustainable development, by preparing a specialized audit program for the purpose of auditing strategies for achieving sustainable development and emptying the results of the application of each of the paragraphs The program in the audit matrix that was prepared for the purpose of determining the impact of each observation and linkin
... Show MoreThe petroleum industry, which is one of the pillars of the national economy, has the potential to generate vast wealth and employment possibilities. The transportation of petroleum products is complicated and changeable because of the hazards caused by the corrosion consequences. Hazardous chemical leaks caused by natural disasters may harm the environment, resulting in significant economic losses. It significantly threatens the aim for sustainable development. When a result, determining the likelihood of leakage and the potential for environmental harm, it becomes a top priority for decision-makers as they develop maintenance plans. This study aims to provide an in-depth understanding of the risks associated with oil and gas pipeli
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The research dealt with a topic that has been practiced and transmitted news in satellite channels in recent years a lot. That is to say the role of satellite channels in the culture of a protest. In general, this study aims to reach to know the extent of the impact of television, especially the impact of the programs that bear the contents of protest and remonstration on the public; and what can be resulted out of these programs as cognitive, emotional and behavioral effects as a result of the individual's exposure to these programs and their impact from the culture of pretense. In addition to that, the research was interested in explaining the role of Iraqi satellite channels in developing and cultivating such culture; and following up
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Let R be a 2-torision free prime ring and ?, ?? Aut(R). Furthermore, G: R×R?R is a symmetric generalized (?, ?)-Biderivation associated with a nonzero (?, ?)-Biderivation D. In this paper some certain identities are presented satisfying by the traces of G and D on an ideal of R which forces R to be commutative
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The structure of the interrogation process in cross-examinations is said to be diverse and complex in terms of question-response typology. This is because the counsel has to extract truth from an opposing party’s witness whose views are expected to advocate that party's views regarding the case. Accordingly, the study which is basically quantitative in nature aims to investigate what the examining party intends to obtain out of these questions and which of these questions are the most prevalently used. It also aims to measure the amount of cooperativity in witnesses' responses. Accordingly, three transcripts of cross-examination have been analyzed, using a pragmatically-oriented approach. The approach draws on Stenstorm (1984) and Arch
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In the present study, free convection heat and mass transfer of fluid in a square packed bed enclosure is numerically investigated. For the considered geometrical shape, the left vertical wall of enclosure was assumed to be kept at high temperature and concentration while the opposite wall was kept at low temperature and concentration with insulating both the top and bottom walls of enclosure. The Brinkman– Forchheimer extended Darcy model was used to solve the momentum equations, while the energy equations for fluid and solid phases were solved by using the local thermal non-equilibrium (LTNE) model.Computations are performed for a range of the Darcy number from 10-5 to 10-1, the porosity from 0.5 to 0.9, and buoyancy ratio from -15 t
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Let R be a commutative ring with non-zero identity element. For two fixed positive integers m and n. A right R-module M is called fully (m,n) -stable relative to ideal A of , if for each n-generated submodule of Mm and R-homomorphism . In this paper we give some characterization theorems and properties of fully (m,n) -stable modules relative to an ideal A of . which generalize the results of fully stable modules relative to an ideal A of R.
In this paper , an efficient new procedure is proposed to modify third –order iterative method obtained by Rostom and Fuad [Saeed. R. K. and Khthr. F.W. New third –order iterative method for solving nonlinear equations. J. Appl. Sci .7(2011): 916-921] , using three steps based on Newton equation , finite difference method and linear interpolation. Analysis of convergence is given to show the efficiency and the performance of the new method for solving nonlinear equations. The efficiency of the new method is demonstrated by numerical examples.
This study aims to reveal the semiotic of “March of Return” cartoon in the Palestinian journalism, topics, Symbols and semantics that were covered.
This study is descriptive. It uses the survey method. Content analysis, and methodological comparison was also used.
The researcher chose an intentional sample of Palestine and Al-Hayat Al-Jadida newspapers for one year from March 30, 2018 to March 31, 2019, through a comprehensive inventory of all cartoons of the return marches during this period, which amounted to 59 cartoons.
The study has reached the following findings:
Newspapers cartoons focused on the topics of durability of the protester
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The research deals with the concept of rationalization of consumption, which is legitimately legitimized, by indicating the permissibility of consumption and its limits in Islam, the legitimate aspects of spending and its controls, and the concept of development in the Islamic economy. The researcher followed the descriptive method by presenting the legal texts and jurisprudential opinions and linking them to contemporary economic problems.The research has reached several conclusions, the most important of which is that the goal of Islam in relation to consumption is to inform the Muslim of the amount of economic maturity, and the truth of alms is good in money and religion. It is necessary for achieving maturity that both means
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