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.
The limitations of conventional cement mortar as a widely used construction material include low tensile capacity, high permeability, and susceptibility to chemical degradation. The increasing demand for durable and sustainable construction materials has led to increased attention in modifying cementitious materials through nanotechnology. This study investigates the influence of nano-silica (NS) and nano-alumina (NA) on the physical, strength-related, and durability characteristics of cement mortar to determine the optimum nanomaterial type and dosage for performance enhancement. Six mortar mixes, in addition to a reference mix, were designed and prepared by adding 1%, 1.5%, and 2% of the cement weight with NS and NA separately, an
... Show MoreIranian stories have been one of the most important aspects of Iranian society's culture and have reflected us as a mirror of all its cultural, societal and political dimensions.Among the important elements of the story can be the creation of space and the movement and the creation of characters and conflict and content and the angle of vision and landscape, language and subject. Studying the elements of the story leads to more understanding and determining the strength and skill of the author by studying the elements of his story. The story of Rustom and Suhrab is also one of the many stories in which the elements of the story are often noticed and show the skill of the great professor Al-Fardousi to benefit from these eleme
... Show MoreThis research aims to examine the effectiveness of a teaching strategy based on the cognitive model of Daniel in the development of achievement and the motivation of learning the school mathematics among the third intermediate grade students in the light of their study of "Systems of Linear Equations”. The research was conducted in the first semester (1439/1440AH), at Saeed Ibn Almosaieb Intermediate School, in Arar, Saudi Arabia. A quasi-experimental design has been used. In addition, a (pre & post) achievement test (20 Questions) and a (pre & post) scale of learning motivation to the school mathematics (25 Items) have been applied on two groups: a control group (31Students), and an experimental group (29 Students). The resear
... Show MoreResumen:
El horóscopo que es una predicción deducida de la posición de los astros del sistema solar y de los signos de Zodiaco, intenta no sólo predecir el futuro, sino también influir en el comportamiento del lector, orientándolo para que actúe adecuadamente y la invitación a actuar ante ese futuro que se aconseja mediante imperativos, perífrasis y otros recursos lingüísticos. Los horóscopos se caracterizan por su gran popularidad que existen en periódico o revista en columnas enteras dedicadas al tema, en donde se detallan la influencia que tendrá el día o el mes de cada uno de los signos correspondientes al zodíaco, siempre teniendo en cuenta la posici
... Show MoreAbstract
The research aimed to test the relationship between the size of investment allocations in the agricultural sector in Iraq and their determinants using the Ordinary Least Squares (OLS) method compared to the Error Correction Model (ECM) approach. The time series data for the period from 1990 to 2021 was utilized. The analysis showed that the estimates obtained using the ECM were more accurate and significant than those obtained using the OLS method. Johansen's test indicated the presence of a long-term equilibrium relationship between the size of investment allocations and their determinants. The results of th
... Show MoreThe research aimed to study the job satisfaction of the staff of the Federal board of supreme Audit and its relation to the effectiveness of their performance, The questionnaire was adopted as a main tool in the collection of data and information from a random sample of (54) employees of the Federal board of supreme Audit. In light of this, the data were collected and analyzed and the hypotheses were tested using the statistical program (SPSS).
The researchers reached a number of conclusions, the most important of which were: (1) the respondents' response to the variables of job satisfaction and the effectiveness of the performance were medium; (2) there was a significant relationship between job satisfaction and performance effe
... Show MoreSuzanne Collins’ novel The Hunger Games suggests a new logic of victory and set a distinguished focus on the unique personality of her heroin which brings to the mind the permanent correlation between all moral values. The Hunger Games World seems to be much more like one big bowl as it links the past, present, and the future. An Intertextual reference is interwoven in the present research as it brings Golding’s Lord of the Flies to the surface, and it highlights certain similarities between the two texts. In which Ralph, Piggy and Simon in Golding’s Lord of the Flies are the incarnations of stable moral values and hope of surviving ethics and rules in a chaotic and turmoil world. The event
... Show MoreThe websites over time have become one of the important tools for communication between individuals among themselves and between individuals and economic units, and they have emerged as one of the important intangible assets to achieve income, as they have become a competitive tool and a marketing outlet for these units and a main means of communication that it uses to exercise its various major activities and achieve potential economic benefits. Therefore, there was a need to measure and display the value of these sites in the financial statements as intangible assets. Accordingly, the purpose of the research was to determine the costs of the websites owned by the economic unit by way purchase and sites that were created i
... Show MoreDiscretionary Punishment, Public Regulation, Interest