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.
Chapter-1
Problem of the research:
The studies and researches have noticed the aggravation of violence practice in all educational means using different and innovated styles against children in the school and house in order to upbringing by the parents or the school .
It is a training method for the person to participate in the society and prepare him to be an effective member.
The current research confines the children in age (6-12) years old representing the primary stage who face different kind of violence during the familiar or school education.
The current research aims to:
1 – The kinds of violence which happens to the children in the primary
... Show MoreThis study aims to identify the level of application of blue ocean leadership activities in public organizations and to build a conceptual and cognitive framework around this concept. The study adopted a descriptive-analytical approach, and the research sample consisted of (95) individuals from the senior management working at the center of the Iraqi Ministry of Communications (director general, department manager, section head). The data analysis technique used is structural equation modeling (SEM) and the Statistical Package for the Social Sciences (SPSS). The results indicate that the senior management in the Ministry of Communications is working to adopt the blue ocean leadership style through its activities, but not to the leve
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In Iraq, water shortages and drought, especially during the hot summer months, necessitates that municipal authorities adopt water reuse projects like reusing treated domestic wastewater for crop irrigation. This work gives the conceptual and basic design elements for the necessary steps of filtration, UV irradiation and chlorination to make such a wastewater fit for agricultural use. A typical rural community of 50,000 people is considered as an example case for which functionality and relative simplicity of the proposed designs are prime factors. The objectives are 1) to show what is required and 2) that the presented information may be utilized to embark on the following phases of detailed design and execution of such projects.
Triticale is a hybrid of wheat and rye grown for use as animal feed. In Florida, due to its soft coat, triticale is highly vulnerable to Sitophilus oryzae L. (rice weevil) and there is interest in development of methods to detect early-instar larvae so that infestations can be targeted before they become economically damaging. The objective of this study was to develop prediction models of the infestation degree for triticale seed infested with rice weevils of different growth stages. Spectral signatures were tested as a method to detect rice weevils in triticale seed. Groups of seeds at 11 different levels (degrees) of infestation, 0–62%, were obtained by combining different ratios of infested and uninfested seeds. A spectrophotometer wa
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The current research aims to evaluate the level of inclusive leadership within the General Secretariat for the Council of Ministers, and its role in achieving integration in work through the need to improve relationships between different administrative levels, facilitate participation, expression of opinions, and belonging to the organization. In order to achieve the research objective, the descriptive analytical statistical method was chosen using the SPSS V.25 programs, with various statistical methods and measures, including mean, standard deviation, variance coefficient, relative importance, and simple regression, through a questionnaire tool for data collection. The research community included the leadership in the sample of resear
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This book includes four main chapters: 1. Indefinite Integral. 2. Methods of Integration. 3. Definite Integral. 4. Multiple Integral. In addition to many examples and exercises for the purpose of acquiring the student's ability to think correctly in solving mathematical questions.
Background: DVT is a very common problem with a very serious complications like pulmonary embolism (PE) which carries a high mortality,and many other chronic and annoying complications ( like chronic DVT, post-phlebitic syndrome, and chronic venous insufficiency) ,and it has many risk factors that affect its course, severity ,and response to treatment. Objectives: Most of those risk factors are modifiable, and a better understanding of the relationships between them can be beneficial for better assessment for liable pfatients , prevention of disease, and the effectiveness of our treatment modalities. Male to female ratio was nearly equal , so we didn’t discuss the gender among other risk factors. Type of the study:A cross- secti
The present study has three objectives: 1) to investigate the prevalence of complex nominals in economic discourse represented via the selected business news texts, 2) to shed some light on the most common translation errors made by second year students in the Department of Translation in rendering complex nominals into Arabic, and 3) to detect the possible causes behind such translation errors and suggest some translation tips which might sound helpful to the students of translation to find the most suitable translation equivalent. The present study is based on an empirical survey in which a selective analysis of someeconomic texts represented in business news texts is made. A corpus of 159 complex nominals was selected from seven busin
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Literary works include, for the most part, text thresholds, which are the first entry into reading them and understanding their connotations, and (literary works) vary according to text thresholds, some of which are limited to the title and on the cover page only, and others, in addition to these two thresholds, are based on the dedication threshold too, and others ...
This study takes the story of "Mamo Zain" of the poet Ahmed Al-Khani and his translator Sheikh Muhammad Ramadan Al-Bouti as the field of study, as it is a unique literary work, which included a number of textual thresholds which supported each other and cooperated with the content of the work.
The threshold of dedication in the story of "Mamo Zain" was a spee
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