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.
The basic solution to overcome difficult issues related to huge size of digital images is to recruited image compression techniques to reduce images size for efficient storage and fast transmission. In this paper, a new scheme of pixel base technique is proposed for grayscale image compression that implicitly utilize hybrid techniques of spatial modelling base technique of minimum residual along with transformed technique of Discrete Wavelet Transform (DWT) that also impels mixed between lossless and lossy techniques to ensure highly performance in terms of compression ratio and quality. The proposed technique has been applied on a set of standard test images and the results obtained are significantly encourage compared with Joint P
... Show More
(1)
The traditional centralized network management approach presents severe efficiency and scalability limitations in large scale networks. The process of data collection and analysis typically involves huge transfers of management data to the manager which cause considerable network throughput and bottlenecks at the manager side. All these problems processed using the Agent technology as a solution to distribute the management functionality over the network elements. The proposed system consists of the server agent that is working together with clients agents to monitor the logging (off, on) of the clients computers and which user is working on it. file system watcher mechanism is used to indicate any change in files. The results were presente
... Show More
The present research aimed to test the imagination of children, and may build sample consisted of (400) a baby and child, selected by random way of four Directorates (first Resafe, second Resafe ,first alkarkh , second alkarkh), in order to achieve the objective of research the tow researchers have a test of imagination and extract the virtual and honesty plants distinguish paragraphs and paragraphs and difficulty factor became the test consists of (32), statistical methods were used (Pearson correlation coefficient, coefficient of difficult passages, highlight paragraphs, correlation equation, an equation wrong Standard) the tow researchers have a number of recommendations and proposals.
Debate is a teaching strategy in nursing education that enhances students' critical thinking. Although debate can be an effective teaching strategy, it is not without limitations. This article discusses the advantages and disadvantages of debate as a teaching strategy in nursing. Also, evaluating debates and choosing topics are highlighted.
(4)
(3)
It is axiomatic that languages mirror the world view of their users. Manipulating honorific forms among people inevitably reflects this truth . Honorifics are conventionalized forms or expressions manifested in all the world's languages and are used to express the social status of the participants in the verbal interaction and to convey indications like politeness and respect . English is no exception. However the question is what exactly creates these forms and their meanings. Although honorifics have been extensively researched from a grammatical and semantic angle , yet they haven’t received that significant attention i
... Show MoreThe current research is concerned with studying the decisive answers which are considered quick and conclusive. These answers can effectively interrupt the opponent's argument and close the dialogue.This research is concentrated on deliberative methodology focusing on the decisive answer's activity and ending them through several completing and argument sides. This research consists of an introduction and three parts, the current introduction is focused the light on the concept of decisive answers and its uses in literature and the scarce of speech, and how to consider it with one dialogue description,that dialogue constitute by ? The first part is concerned with those answers through the deliberative methodology and classifying decisive
... Show MoreIn This paper, we introduce the associated graphs of commutative KU-algebra. Firstly, we define the KU-graph which is determined by all the elements of commutative KU-algebra as vertices. Secondly, the graph of equivalence classes of commutative KU-algebra is studied and several examples are presented. Also, by using the definition of graph folding, we prove that the graph of equivalence classes and the graph folding of commutative KU-algebra are the same, where the graph is complete bipartite graph.
In this research, we highlight the most important research related to the mixed ligand complexes of the drug trimethoprim (TMP), and for the past 7 years where this drug has been used as a chelating ligand and gives stability to the complexes with ions of metal elements where these complexes, prepared and diagnosed, and for some research the bacterial activity was studied against different types of bacteria.
The current study aimed to review previous scholarly efforts to understand the concept of sustainable development, its practices, and its significance for public institutions. The study focuses on the dimensions of sustainable development—environmental, social, and economic—within public institutions. Sustainable development allows these institutions to balance environmental protection, economic growth, and social justice, ensuring the prosperity of both current and future generations. Furthermore, sustainable development is crucial for maintaining organizational performance. The review bridges knowledge gaps related to sustainable development and utilizes an analytical approach, surveying previous studies on the topic. The sele
... Show More