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.
The aim of the research is to explain the nature of the relationship between the dimensions of the strategic recovery of the service represented by (compensation, speed of response, apology, initiative (defining the problem) and the strategic goals of the company represented in (profitability, growth, community service, employee satisfaction) in the National Insurance Company, it has been approved The questionnaire as a tool to collect data and information from the sample of (58) who are in (department manager, M. department director, division official, unit official) and the statistical program (spss) was used in calculating (arithmetic mean, standard deviation, coefficient of variation, coefficient of Correlation, t-test, varia
... Show MoreThe current research aims to verify the role of strategic intelligence as an explanatory variable in organizational success as a respondent variable in the colleges of the University of Fallujah, the research community. (Dean, Associate Dean, Section Head, Division Officer, Unit Officer), The researcher used the questionnaire as the main tool to collect data that included (50) items, in addition to using personal interviews and field observations as aids in data collection. The researcher relied on statistical programs (SPSS V.25; Excel V (16) In the treatment and analysis of data through the use of the most appropriate statistical methods (arithmetic mean, standard deviation, difference coefficient, determinatio
... Show MoreThin films of cadmium sulphoselenide (CdSSe) have been prepared by a thermal evaporation method on glass substrate, and with pressure of 4x10-5 mbar. The optical constants such as (refractive index n, dielectric constant ?i,r and Extinction coefficient ?) of the deposition films were obtained from the analysis of the experimental recorded transmittance spectral data. The optical band gap of (CdSSe) films is calculate from (?h?)2 vs. photon energy curve. CdSSe films have a direct energy gap, and the values of the energy gap were found to increase when increasing annealing temperature. The band gap of the films varies from 1.68 – 2.39 eV.
This research study focuses on fundamental questions. It deals with the content of the critical reviews through which the most important sources that undermine the renaissance of the Islamic human society can be concluded. It is the vague fetishization of the sacred between religion, politics, and ideas, which members of society live in and which raised the dust of closed-minded fanaticism that led to the return of deviant extremism. It is oppression, violence, and domination, all of which are professional tools in the manufacture of the ideology of extremism in all its forms. Here, the idea matured in giving a human, intellectual and philosophical overview that mixed the required drawing in the formulation of scientific cont
... Show MoreThe importance of social exclusion lies in the psychological problems that cause problems in social relations and mental-physical health. For this reason, the researcher set three goals for the current research: identifying the level of social exclusion among people infected with the Coronavirus. The incubation period of the virus. Social exclusion and its relationship to the duration of incubation of the disease among people infected with the Coronavirus. The result showed that the research sample does not suffer from social exclusion. The mean value for the period from
(8-14) days is the highest value followed by the period (1-7) days and the period
(14 days or more) comes at the end. There is no statistically sig
... Show MoreMany behavioral researchers pointed out the importance of relaxation techniques in the treatment of different psychological disorders where find the importance of these techniques in reducing anxiety and stress and the resulted of behaviors and habits, with the development of these techniques are being used to gain public health, whether mental health or physical or mentality, and one of these techniques is music therapy that reduces tension and anxiety and operates a state of relaxation, which is used in the treatment of patients of dental clinic.
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... Show MoreMany problems are facing the installation of piles group in laboratory testing and the errors in results of load and settlement are measured experimentally may be happened due to select inadequate method of installation of piles group. There are three main methods of installation in-flight, pre-jacking and hammering methods. In order to find the correction factor between these methods the laboratory model tests were conducted on small-scale models. The parameters studied were the methods of installation (in-flight, pre-jacking and hammering method), the number of piles and in sandy soil in loose state. The results of experimental work show that the increase in the number of piles value led to increase in load carrying ca
... Show MoreWorld statistics proved that the most of work dangerous accidents, which causes death, are occurred in the construction works. These accidents related to many causes such as loss of workers experience and ignoring rules of safety requirements, especially young workers. Due to the risk of accidents that may occur in the site of work, the idea of this study crystallized to show the relationship between the age of worker and number of injuries and accidents, to identify the causes of these injuries, and to put the appropriate solutions to avoid or reduce the risk of work injuries. Also, the research shows the main principles of safety requirements to forming a clear picture about the subject of the study. A questioner form was prepared to c
... Show MoreThis work includes two steps of synthesis, the first one is the synthesis of indole which was prepared according to literature of the reaction of phenyl hydrazine with acetaldehyde in glacial acetic acid afforded phenyl hydrazone of acetaldehyde , this product was fused with zinc chloride to give the indole.Reaction of cyclohexanone with phenyl hydrazine using the same procedure for the preparing giving 1,2,3,4-Tetrahydrocarbazole.Second step involved synthesis of a series of (17) of mannich bases derivatives of indole and 1,2,3,4-Tetrahydrocarbazle. Mannich reaction involves the condensation of aldehyde usually formaldehyde with different secondary amine and with compound containing an activated hydrogen.The reaction illustrated by the fo
... Show MoreThis research aim to recognize
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