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 aims at identifying the reality of alternative assessment for teachers of the first cycle of the basic education in the Sultanate of Oman with respect to the degree of teachers' use of alternative assessment strategies, level of self-efficacy for alternative assessment strategies, and attitude towards alternative assessment, and their relationship with other variables. To achieve the aims of the study, a descriptive research approach was utilized. A 5-point self-rated questionnaire was developed. It consists of three sections: Actual use of alternative assessment strategies (21 items), self-efficacy for alternative assessment strategies (21 items), and attitude towards alternative assessment (27 items). The psychometric proper
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It considers training programs is an important process contributing to provide employees with the skills required to do their jobs efficiently and effectively, so it should be concerned with and the focus of all government our organizations, and perhaps the most important reasons that I was invited to select the subject (evaluation of training programs directed toward the diagnosis of the phenomenon of financial and administrative corruption) It is the importance of those programs working in the regulatory institutions General and the Office of Inspector General of Finance and the Ministry particularly for employees because of their role in the development of their skills and their experience and their beha
... Show MoreIn this paper, a new technique is offered for solving three types of linear integral equations of the 2nd kind including Volterra-Fredholm integral equations (LVFIE) (as a general case), Volterra integral equations (LVIE) and Fredholm integral equations (LFIE) (as special cases). The new technique depends on approximating the solution to a polynomial of degree and therefore reducing the problem to a linear programming problem(LPP), which will be solved to find the approximate solution of LVFIE. Moreover, quadrature methods including trapezoidal rule (TR), Simpson 1/3 rule (SR), Boole rule (BR), and Romberg integration formula (RI) are used to approximate the integrals that exist in LVFIE. Also, a comparison between those
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ביטויי אהבה ושנאה קבלה בההגדרות שונות, לפעמים ביניהם לבין עצמם והסכימו בזמנים אחרים מהבחינה הדתית נתפסה לאהוב ביטויים ושנאה במונחים של טוב ורע, או במונחים של חלאל וחראם למעשה, הרגשות של אהבה ושנאה הם רגשות אנושיים המקושרים לאמונות של חברות אנושיות הבנויות על העמדה של דתות מכל נושא או מקרה , דבר אשר אהוב על ידי הקדושים והכמורה יהיה חלאל, וכל מה שהם שונאים יהיה חראם במילים אח
... Show MoreThis paper tackles tragedy and grief in the Hebrew poetry of the Middle Ages, as being topics which was transferred to it from Arabic poetry at that time. This came as a result of Hebrew poets quoting images from, and adopting the form and content of the Arabic poem. So, this topic was a prominent feature in the Hebrew poetry of the middle ages. The Hebrew poets focused upon this topic along three trends: poems of lamentation, whether being what are called national lamentation where poets expressed their feelings and grieves because of their remoteness and longing to their homeland, which is Palestine or the sacred land, as they claim; here, Zionist trends were apparent in many poems lamenting Zion and other cities. The other type of poe
... Show MoreMost recognition system of human facial emotions are assessed solely on accuracy, even if other performance criteria are also thought to be important in the evaluation process such as sensitivity, precision, F-measure, and G-mean. Moreover, the most common problem that must be resolved in face emotion recognition systems is the feature extraction methods, which is comparable to traditional manual feature extraction methods. This traditional method is not able to extract features efficiently. In other words, there are redundant amount of features which are considered not significant, which affect the classification performance. In this work, a new system to recognize human facial emotions from images is proposed. The HOG (Histograms of Or
... Show MorePurpose: The purpose of this study was to clarify the basic dimensions, which seeks to indestructible scenarios practices within the organization, as a final result from the use of this philosophy.
Methodology: The methodology that focuses adoption researchers to study survey of major literature that dealt with this subject in order to provide a conceptual theoretical conception of scenarios theory .
The most prominent findings: The only successful formulation of scenarios, when you reach the decision-maker's mind wa takes aim to form a correct mental models, which appear in the expansion of Perception managers, and adopted as the basis of the decisions taken. The strength l
... Show MoreThe Research Aims To Clarify The Role Of Knowledge Innovation On The Administrative Process Represented by Managing Strategic Momentum, The Research Problem Focuses on Administrative leader Interest In And Implementation Of The Innovation Element Of Knowledge In The Organization By " Managing Strategic Momentum" As Well As The Focus By Management About The Innovators And Makers Of Knowledge And Strategic Planners In The Design And Formulation Of Strategic. Research does Contribute In Solving Part Of The Organizational Problems Of Vision, Innovation And Their Impact On The Momentum Management To Determine The Extent On Which The Procedures Of The Assessed Companies And Plan To Regulate Innovation Under The Momentu
... Show MoreOne of the main techniques to achieve phase behavior calculations of reservoir fluids is the equation of state. Soave - Redlich - Kwong equation of state can then be used to predict the phase behavior of the petroleum fluids by treating it as a multi-components system of pure and pseudo-components. The use of Soave – Redlich – Kwon equation of state is popular in the calculations of petroleum engineering therefore many researchers used it to perform phase behavior analysis for reservoir fluids (Wang and Orr (2000), Ertekin and Obut (2003), Hasan (2004) and Haghtalab (2011))
This paper presents a new flash model for reservoir fluids in gas – oil se
Shmuel Yosef Agnon, a well-known Jewish writer, wrote many literary works, including poetry, story, etc. In the field of story, this writer used two areas: the first: a simple exterior, and the second: an inner full of secrets and mysteries. This area is common when Agnon is affected by his symbolic method of purpose. In his productions, we find the political and historical significance embodied in his characters, where there is almost no story without it.
Agnon and all his productions gave the character a large area, Agnon’s characters often play the center and cornerstone in those productions, where the author dealt deeply and stated the fines details of the external and internal of that ch
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