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 surgery Keywords: Non-surgical treatment of anal fissure, fissure in ano, sphicterotomy,botulinum toxin in anal fissures, glyceryl trinitrate. Chemical sphincteratomy, pharmacological sphincteratomy.
Insurance is one of effective high-impact activities in the economic and social aspects of development and that the insurance companies after the creation of stability, balance and support other sectors. The insurance of financial institutions with economic and social importance has an impact on the development and help shoulder the burden of risk and distribution. And measuring Indicators of service and cost her help in evaluating the performance and activity of insurance, and the study of sectors needed by society, institutions and individuals and development of the company. Covering all aspects of life and activity. In this study will focus on the insurance sector in the field of car accidents and so plentiful and their problems and d
... Show MoreThis book in our hands is a 'book in the science of rhymes' written by the linguistic and grammatical world 'Othman bin Jenni' 'T 392 AH', and included in it: the concept of rhyme, its characters, movements, and disadvantages, with mention of its ramifications, defining them by definition, clarification and martyrdom poetry, It is concise in size, but it is a book containing a full science in its content.
The study was divided into two parts, the first: the study, and included a study of the author and the author, I talked first about his life, such as his name and origin, and scientific status, and the words of scientists in it, and so on, and secondly: the name of the book, and his percentage, and the time of its composition, etc. I
The research discusses the public relations services, registration, and academic advising at Petra University for the years 2013-2014. Using a field study and surveying Petra University students to be informed about the services and to cover the tiny details that have to do with public relations role in the university as a specialized department interested in serving public and gaining their trust in terms of what is legal and possible to build and enhance the university reputation. And gain mutual trust between the university and its publics.
The public relations is consi
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The speech delivered by political blocs and parties and broadcasted by satellite channels, social and communication media has different ideologies and orientations: moderate speech calling for calm or one raising crises.The latter is considered very challenging due to its local and international reference., this paper aims at uncovering these challenges especially during the political crisis witnessed in Iraq. This paper sheds light on the most important crisis that spread in public opinion, broadcasted by satellite, and raised by politicians who are competing to gain authority leading to a lack of peoples, confidence in them.This matter should not be neglected at all; e |
Background: Optimal root canal retreatment was required safe and efficient removal of filling material from root canal. The aim of this in vitro study was to compare the efficacy of reciprocating and continuous motion of four retreatment systems in removal of root canal filling material. Materials and Methods: Forty distal roots of the mandibular first molars teeth were used in this study, these roots were embedded in cold clear acrylic,roots were instrumented using crown down technique and rotary ProTaper systemize Sx to size F2 ,instrumentation were done with copiousirrigation of 2.5% sodium hypochlorite and 17% buffered solution of EDTA was used as final irrigant followed by distilledwater, roots were obturated with AH26 sealer and Prota
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Takbiratul Ehram "The First Takbeer to Start Prayer" means: the words that the worshiper says to start his prayers, and refrain from anything invalidates it. the findings revealed that the four school jurists agreed that the prayer is not valid without Takbiratul Ehram "The First Takbeer to Start Prayer", and they disagreed on its description, so the majority of jurists said that it is a pillar, and some of them called it an obligatory, but Hanafi made it a condition. Likewise, the four jurists agreed that the one who articulates Takbiratul Ehram "The First Takbeer to Start Prayer" with the word: “Allahu Akbar,”; his Takbeer is correct, and they disagreed about the one who adds a word, or replaced it with another, where the m
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Nonlinear diffraction patterns can be obtained by focusing a laser beam through a thin slice of the material. Here, we investigated experimentally the formation of the far field nonlinear diffraction patterns of cw laser beam at 532 nm passing through a quartz cuvette containing multi-wall carbon nanotubes (MWCNT's) suspended in acetone and in DI water at concentrations of 0.030.wt.%, 0.045 wt.%, 0.060 wt.%, and 0.075 wt.%. Our results show that increasing the concentration of both types of suspensions (MWCNTs in acetone and MWCNTs DI water) led to increase in the number of pattern rings which indicates an increase in their nonlinear refractive indices. Moreover, MWCNTs DI water suspension at a concentration of 0.075 wt. % was more effic
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Abstract
The research aimed to prepare an audit program focusing on the activities of municipal institutions related to the environmental dimension as one of the dimensions of sustainable development, and applying the program for the purpose of preparing an oversight report related to assessing the impact of the activities of municipal institutions on the environmental reality as the main channel through which municipal institutions contribute to achieving the part related to it. Among the requirements of sustainable development, the proposed program was prepared and applied to the institutions affiliated to the Directorate of Mu
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