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 study has applied the theoretical framework of conceptual metaphor theory to the analysis of the source and target domains of metaphors that are used in two English nineteenth century sonnets, both written by contemporaneous female poets. The quantitative and qualitative results of the textual analysis have clearly revealed that Elizabeth Barrett Browning’s sonnet 23 centres around the conceptual mapping of the journey of love and life with that of possession. In contrast, Christina Rossetti’s sonnet Remember tackles the central conceptual mapping of death as a journey in relation to its further experiential connections. In addition, the application of conceptual metaphor theory in identifying the frequencies and densities of metap
... Show MoreAbstract The means of self-determination have their peaceful and non-peaceful dimensions and are united(peaceful and non-peaceful) by international consensus adopted by international conventions and instruments. This has given it various dimensions at the applied level, especially in the light of the contemporary international developments witnessed by the world represented by a number of complete and incomplete implementation models that have nothing to do with the theory of truth Self-determination associated with the liberation of peoples from colonial domination or the liberation of oppressed nationalities
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Objectives: To assess nurses' attitude toward end of life phase. To find out relationships between nurses attitude and socio demographic data (age, gender, level of education, years of experience).
Methodology: A descriptive cross-sectional study design is carried out to assess the attitude on nurses concerning patient at the end of life phase at critical care units, from the period of (1nd November 2021) to (1th February 2022). A probability sample random sampling technique used. Then, the number of participants in Baquba Teaching Hospital and general al khalis hospital were determined by using rando
... Show MoreDespite the multiplicity of institutions contributing to the decision-making process in the United States of America, they interact to crystallize positions regarding international and strategic situations. The formulation of the national security policy depends on a number of institutions that complement each other in order to achieve an advanced security situation. Thus, the decision reflects the process of interaction of the existing regulatory institutions. This is because the essence of the national security and achieving its requirements also stems from the existence of a coherent system of shared beliefs and principles in the American society. Besides, these elements are the bases for achieving
... Show MoreThe study aimed to measure the phsycological tolerance and self-efficacy among the students of Baghdad university and knon the significant differences in psychological tolerance and self-efficacy according to the variables (Gender-Specialization)and the interaction between themas well as the study aimed to identify the strength and direction of the relationship between psychological tolerance and self-efficacy of the study sampleincluded asample of the current study(370) students from grades four ,the researcher used the measure of psychological tolerance and self-efficacy prepared by the researcher ,and the results showed that college students Generally have adegree of psychological tolerance and that there are statistically sig
... Show MoreThe research aims to diagnose the causes of the phenomenon of Marketing deception catalog, which is now deployed in the Iraqi market and related to producers and marketers, consumers, regulators and other institutions) and their impact in the areas of prejudice to the consumer protection (product and signifying specifications, price, advertising, packaging), as well as identify differences in the sample responses according to personal variables, it has been the adoption of the resolution as a tool to collect data and information through a sample survey of consumer opinions totaling 108 people in shopping centers in the province of Baghdad and in the Karkh and Rusafa, It was the use of methods selected statistical represented by the arith
... Show MoreThe purpose of this research is to highlight the relationship between the administrative investigation and the improvement of institutional performance, and the research sought to achieve a set of cognitive and applied goals. the administrative investigation is the modern trend of managing the offices of the general hginspectors and the main source to build the necessary standards to manage and invest its resources efficiently and effectively required to achieve the goals it seeks. The institutional performance is the cornerstone for the implementation of all tasks and duties carried out by institutions operating within the borders of a particular country, The significant change
... Show MoreVocational stresses and their relation with the level of ambition among the lecturers of the university In general , vocational stresses affect the attention and the process of focusing making individual busy with solving of his daily problems instead of his job. The vocational stresses , anxiety and tension are factors effecting the physical and psychological ability of the individual. This study aims to measure the vocational stresses among the lecturers of the university , to measure the level of ambition among them, to identify the statistical differences significant among them according to sex variable, to identify the differences significant in level of ambition among them according to sex variable and to identify the correlation r
... Show MoreWhat distinguishes human rights issues is their importance to the international community and their importance to democratic political regimes, because they are the axis of any political regime that seeks to achieve a successful democratic path and a stable state. So, countries that are interested in human rights try to enshrine those rights and freedoms in their constitutions and reinforce their concepts in their laws and legislations. Not to mention its involvement in international conventions and treaties concerned with human rights and freedoms, and this is what the Sultanate of Oman has worked on and confirm in the provisions of its 1996 constitution and its amendments
Christianity has rites and rituals that they should perform, and are indispensible. They say that these are sacred ordinances by Jesus Christ (PBUH) including the secret of priesthood. The origin of this secret as they claim is Christ. He puts the foundation of priesthood in Christianity. He has chosen twelve disciples and then seventeen whom he ordinated to obtain the honor of spreading the message of Christ among people. He appointed among the priests a divine message which the first fathers from the disciplesthemselves. The disciples are ones who take the secret and deliver it to the ones after them. The disciples took that sacred secret from Christ. Therefore, the secret is used when granting any religious position in the church. That s
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