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 paper addresses the new coloring in the concept of dystopian society as represented by the positive role of one of the characters vs. the passive role of the government and its mutual effect on the people of the society. In addition, it describes how all men in the dystopian society victimize and degrade the other through unlawful acts, like: stealing, rape, and fear, which are the lowest points in a moral decay. However, it offers hope by illustrating a positive sense, as exemplified by the doctor's wife out of Saramago's optimistic view that men may be descended from good women. Accordingly, the paper aims to examine the effect of the government’s role in the lives of the people who have later turned into blind in a dystopian so
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Brainstorming is one of the fundamental and necessary concepts for practicing the auditing profession, as auditing standards encouraged the implementation of brainstorming sessions to reach reasonable assurance about the validity of the evidence and information obtained by the auditor to detect fraud, as the implementation of brainstorming sessions and the practice of professional suspicion during the audit process lead to increase the quality of auditing and thus raise the financial community's confidence in the auditing profession again after it was exposed to several crises that led to the financial community losing confidence in the auditing profession.
The research aims to explain the effect of brain
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The current research aims at transforming the concept of implication from the rhetoric into the industrial design in order to have a new term (the design implication) in which the industrial designer takes all or part of another's design to imply his design in it and acknowledge that, and if he did not do so, it would be (design theft) parallel to the literary plagiarism.
In order to show the potentials of the industrial design in the production of new formulations of the industrial products forms, as the design is the carrier of language that addresses the recipients, it is possible to use the implication as a the tool of literature in the design and as a design strategy as it is one of the concepts that takes its course in e
The current study aimed to determine the relation between the lead levels in the blood traffic men and the nature of their traffic work in Baghdad governorate. Blood samples were collected from 10 traffic men and the age about from 20-39 year from Directorate of Traffic Al Rusafa/ Baghdad and 10 samples another control from traffic men too with age 30-49 year and they livedrelatively in the clear cities or contained of Very few traffic areas. The levels of lead in blood estimated by used Atomic Absorption Spectrometry.
The result stated that there is no rising of the levels of lead in blood of traffic men Lead concentration was with more a range from 14 ppm in Traffic police are not healthy They are within the permissible limits, Ap
This paper addresses the new coloring in the concept of dystopian society as represented by the positive role of one of the characters vs. the passive role of the government and its mutual effect on the people of the society. In addition, it describes how all men in the dystopian society victimize and degrade the other through unlawful acts, like: stealing, rape, and fear, which are the lowest points in a moral decay. However, it offers hope by illustrating a positive sense, as exemplified by the doctor's wife out of Saramago's optimistic view that men may be descended from good women. Accordingly, the paper aims to examine the effect of the government’s role in the lives of the people who have later turned into blind in a dystopi
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The aim of this research is to apply the concept of total value management to improve the process design of producing the toothpaste in Al Mammon factory one of the in the general company of food industry. The concept of total value management is concerning with achieve more than one values which are important for the customers as these values are related to the customers satisfaction. The research problem is that the factory did not measure the effectiveness of process design as this company has weakness in analyzing this effectiveness in synchronies with total value management. On the other side, the company did not give more attention to the cost of products and selling prices within the value cost/ profit which is one of the
... Show MoreThe research in Islamic history is considered a title for the glory of the nation and a mirror for the intellectual and mental maturity of the men of the Islamic state who played an important role in saving humanity from darkness to light and from ignorance to knowledge and to show their position in building the Islamic state, and to highlight the importance of their conquests of neighboring cities and the expansion of Islam, and for this reason they appear The importance of writing on the topic (The Battle of Dumat al-Jandal and its impact on the era of the Prophethood and the Rightly Guided Caliphate). The reason for choosing this topic was to show the status of Dumat al-Jandal and its importance in the Islamic state and its great role
... Show MoreA group of acceptance sampling to testing the products was designed when the life time of an item follows a log-logistics distribution. The minimum number of groups (k) required for a given group size and acceptance number is determined when various values of Consumer’s Risk and test termination time are specified. All the results about these sampling plan and probability of acceptance were explained with tables.
Time is an essential element of contracts، as there is an independent in many parts of each contract، but the time dimension has a significant impact on the provisions of all contracts and is not limited to a particular range of contracts، and French and Arab jurists alike have called for this dimension to be given special attention، and as a result the French legislator has introduced the term duration of the contract، to try to limit the temporal elements، to clarify their provisions and to distinguish between them in decree131/2 016، but for our Arab country it did not receive the appropriate answer. The problem of duration in contracts relates to the lack of clarity of the idea، and then to confuse the various time terms in the
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Our research was launched in the study of the sustainable conflict of globalization and the rebalancing of the great powers that have made life on the earth unstable and insecure over the past and present eras, the purpose of which is to pay attention to the waste and instability that human societies are exposed to in different proportions between abstract right and continuous deviation.
The purpose of the study is to show the loss, waste and backwardness in managing and governing societies towards private interests, away from the standards of good institutional governance.
The study’s design was based on two demands, the first on the nature and eternity of
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