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.
Arabic language the timeless language of the Qur'an ((I made it read Arabic you may understand)) (Al-Zukhruf No 3). It is a way to express his thoughts and feelings and capable of giving constant absorbed the needs of the times and meet the General requirements and interactive needs of life to achieve social and intellectual aspects.
The aim of current research to identify what teaching the contemporary trends in teaching, what the nature of knowledge and teaching methods, how do you rate the modern Arabic language teaching methods, the criteria for evaluating the effectiveness of teaching where the researcher has reached some recommendations: 1. establish the basics of environmental ed
... Show MoreThe current study aims to develop a teaching design in accordance with cluster thinking strategies and explore the effect of this teaching design on students’ achievement in science. To this end, the null hypothesis was adopted: there is no statistically significant difference at the level of (0, 05) between experimental group who adopted the teaching design in learning science and control group who follow the traditional method in learning the same subject. To test the null hypothesis, total of (74) students from Al-Alaama Hussain Mahfooth intermediate school were selected intentionally for the academic year 2016-2017. The sample divided into two equal groups when all the variables (age, prior achievement of science,
... Show MoreTaxes are an essential axis in the economy as the most effective and effective economic tool in any country (economy). Expanding the scope of taxation without adequate study has produced a dangerous result with a negative impact that is almost apparent, namely (tax evasion), which stands as a barrier preventing the state from reaching Therefore, the research sought to study strategic tax planning and its importance in reducing tax evasion, and the research aims from that to prove the importance of adopting strategic planning in the field of taxes according to modern and effective scientific foundations to reduce tax evasion to enhance the achievement of tax evasion. The financing objective is in addition to the other objectives,
... Show MoreIs a high degree of economic freedom an important part in the development of the economies of developing countries in the last decade of the twentieth century and the beginning of the twentieth century and the atheist. This is because a test subject (deltoid analysis of the relationship between the degree of economic freedom and foreign trade of selected developing countries for the period
( 1990 -2005) to determine the degree of economic freedom in foreign trade promotion in Singapore and Turkey. The research recommends a number of recommendations, the most important is the responsibility of the Ministry of Planning in Iraq that is providing the necessary data for the Fraser Institute, the aim of increasing cooperation
Abstract
The study aims to identify the extent to which the applied colleges at the University of Technology and Applied Sciences meet the comprehensive quality standards in light of the national education strategy for the 2040 Vision in the Sultanate of Oman. To do this, the researchers used the descriptive approach. They used a questionnaire as a tool for data collection that was applied to (237) administrators, academics, and support functions. The study found that the extent to which the applied colleges at the University of Technology and Applied Sciences meet the comprehensive quality standards in the light of the National Education Strategy 2040 in the Sultanate of Oman recorded a high range. The study als
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The research aims to define the theoretical framework for corporate governance and its mechanisms and shed light on corporate governance in Iraq as well as the theoretical framework for the quality of financial reports and their relationship and the role of corporate governance in activating them. A commercial bank as a sample for the research, and a survey list was prepared to show the extent to which the research sample banks are committed to applying internal governance mechanisms. imposed on them by the local environment, which leads to improving the quality of financial reports for these banks.
In this paper we prove the boundedness of the solutions and their derivatives of the second order ordinary differential equation x ?+f(x) x ?+g(x)=u(t), under certain conditions on f,g and u. Our results are generalization of those given in [1].
This study focuses on studying the effect of reinforced steel in detail, and steel reinforcement (tensile ratio, compression ratio, size, and joint angle shape) on the strength of reinforced concrete (compressive strength) Fc' and searching for the most accurate details of concrete divisions, their behavior, and corner resistance of reinforced concrete joint. The comparison of this paper with previous studies, especially in the studied properties. The conclusions of the chapter are summarized that these effects had a clear effect and a specific effect on the behavior and resistance of the reinforced concrete corner joints under the negative moments and under their influence and the resulting stress conditions. The types of defects that can
... Show MoreThis research is a comparative jurisprudential study that focuses on Imam Al-Bayhaqi’s preferred opinions in his book Al-Khilafiyat (The Disagreements), the part of Al-Rida’a (Breastfeeding). It is considered one of the most important familial topics that is concerned with organizing the social relations in Islam, strengthens the family ties and that prevents the family disintegration due to the ignorance and lack in comprehending Sharia laws (Islam law) in all aspects. The study follows the inductive and descriptive method. It aims at examining the prohibition of marriage when breastfeeding takes place at the time of woman’s conversion to Islam or during her infidelity period. It further aims at verifying the prohibition
... Show MoreThe risk assessment for three pipelines belonging to the Basra Oil Company (X1, X2, X3), to develop an appropriate risk mitigation plan for each pipeline to address all high risks. Corrosion risks were assessed using a 5 * 5 matrix. Now, the risk assessment for X1 showed that the POF for internal corrosion is 5, which means that its risk is high due to salinity and the presence of CO, H2S and POF for external corrosion is 1 less than the corrosion, while for Flowline X2 the probability of internal corrosion is 4 and external is 4 because there is no Cathodic protection applied due to CO2, H2S and Flowline X3 have 8 leaks due to internal corrosion so the hazard rating was very high 5 and could be due to salinity, CO2, fluid flow rate
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