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.
Abstract Infinitives and gerunds are non-finite verb forms which cannot be indicated by tense, number, or person. The construction of non-finite verbs is intricate because of their nature of meanings, forms, and functions. The major problem is that both infinitival and gerundial complements have identical functions and occupy identical positions in the sentences. Thus, there is a confusion in using an infinitival and gerundial forms after aspectual verbs. The selection of either one of these two forms as complements is controlled syntactically or semantically. Moreover, both forms can be used usually with similar predicate but with neat difference in meaning. In addition, there are problems with controlling the use of aspect, since aspectua
... Show MoreThe research aims to determine the required rate of return according to the Fama and French five-factor model, after strengthening it by adding the indebtedness factor to build the Fama and French six-factor model FF6M-DLE. The effect of the indebtedness factor on the company's profitability and the real value of the ordinary shares calculated according to the (equivalent ascertainment) model and its suitability with the company's situation, and an analysis of the fluctuation between the market value and the real value of the ordinary stocks.
The aim of this study is to get practical evidence from the Egyptian business environment The Impact of Audit Committees Effectiveness and External Audit Quality on Timeliness of annual Financial Report. Design and methodology: The study based on the content analysis technique to examine the annual reports of a sample of (30) companies listed on the Egyptian Stock Exchange (EGX100) during the period (2016-2019) with a total of (120) respondents. To test the research hypotheses, the results of the study indicate that there is a negative significant impact of audit committees on timeliness of annual financial report. Moreover, while there is a negative impact on the quality of the external audit on the timing of issuing the annual
... Show MoreThe downhole flow profiles of the wells with single production tubes and mixed flow from more than one layer can be complicated, making it challenging to obtain the average pressure of each layer independently. Production log data can be used to monitor the impacts of pressure depletion over time and to determine average pressure with the use of Selective Inflow Performance (SIP). The SIP technique provides a method of determining the steady state of inflow relationship for each individual layer. The well flows at different stabilized surface rates, and for each rate, a production log is run throughout the producing interval to record both downhole flow rates and flowing pressure. PVT data can be used to convert measured in-situ r
... Show MoreAn optoelectronic flow-through detector for active ingredients determination in pharmaceutical formulations is explained. Two consecutive compact photodetector’s devices operating according to light-emitting diodes-solar cells concept where the LEDs acting as a light source and solar cells for measuring the attenuated light of the incident light at 180˚ have been developed. The turbidimetric detector, fabricated of ten light-emitting diodes and five solar cells only, integrated with a glass flow cell has been easily adapted in flow injection analysis manifold system. For active ingredients determination, the developed detector was successfully utilized for the development and validation of an analytical method for warfarin determination
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In this work, the modified Lyapunov-Schmidt reduction is used to find a nonlinear Ritz approximation of Fredholm functional defined by the nonhomogeneous Camassa-Holm equation and Benjamin-Bona-Mahony. We introduced the modified Lyapunov-Schmidt reduction for nonhomogeneous problems when the dimension of the null space is equal to two. The nonlinear Ritz approximation for the nonhomogeneous Camassa-Holm equation has been found as a function of codimension twenty-four.
The Purpose of this Research show gap between a Normal Cost System and Resource consumption Accounting Applied in AL-Rafidin Bank.
The Research explores that, how the idle capacity can be determined under resource consumption accounting, discuss the possibility of employing these energies. Research also viewed how costs can be separated into Committee and Attribute. Resource Consumption Accounting assists managers in pricing services or products based on what these services or products use from each Source.
This Research has been proven
This research is drawn from a doctoral dissertation, studying the approach of Sheikh Abd al-Qadir al-Muhajir al-Sanandji al-Kurdi (1303 AH) on the issue of proving the existence of God Almighty.
Sheikh Abd al-Qadir al-Sanandji was one of the scholars well versed in mental sciences. He has many books, all of them in the sciences of speech and wisdom, and among his books is the book (Raising the Eyebrow in Explanation of Ithbat al-Wajib), which is still a manuscript that has not been printed.
Through this book, the researcher studied the evidence of Sheikh Abdul Qadir to prove the existence of God Almighty, and compared it with the evidence of philosophers and theologians.
At the beginning, he presented a study on the import
This research aims to identify the effective role of self-managed teams in the quality of service performance in the directorate of Ramadi municipality. The problematic nature of our research involves this main question of the effective role of self-managed teams in the Municipality of Ramadi in improving the services of performance quality to the beneficiaries from the Directorate service. The importance of this study lies in the role played by the work teams in the organizations that excel in their field, the attendant of the changes in the leadership, administrative roles of the institutions, and teams leaders, will be achieved by the self-managed teams in improving the quality of the service provided by the institution to whi
... Show MoreThe reason behind choosing this topic " internal marketing (IM) of human resource management (HRM)" is to highlight the advantages of using IM in the organization framework. The problem of the research paper lies in not paying enough attention to employees genuine needs as they interact with each other in the sake of organization prosper. This research paper can be used as indictor to expose the weaknesses that the organization encounters daily. The current research paper attempts at examining the possibility of developing philosophy of internal marketing of human resources and its most practices, empowering staff, training courses, motivations and recognitions, and within departments communication, in order to reach targeted res
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