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.
Psychosocial Alienation is a modern concept that arises from the capitalist and materialistic conceptions of individuals. The evergrowing competitive nature of domestic societies crystallised the concept in its modern form. The intensity of the rapid changes in the urbanised societies prevents the individuals from exploring their inner selves. Thus, a new generation is created with an alienation crisis which is reflected inward towards the self and outwards toward society. Alan Ayckbourn (1939), A British playwright, presents Alienated characters inspired by his life on and off stage. He explores their Alienation and their path toward recovery and self-realization. A Brief History of Women (2017) Ayckbourn explores the depth of the individu
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The researchers of the present study have conducted a genre analysis of two political debates between American presidential nominees in the 2016 and 2020 elections. The current study seeks to analyze the cognitive construction of political debates to evaluate the typical moves and strategies politicians use to express their communicative intentions and to reveal the language manifestations of those moves and strategies. To achieve the study’s aims, the researchers adopt Bhatia’s (1993) framework of cognitive construction supported by van Emeren’s (2010) pragma-dialectic framework. The study demonstrates that both presidents adhere to this genre structuring to further their political agendas. For a positive and promising image
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Bee keping projects is one of the most important agricltural investment projects because it generate profit in a short period . In addition to the multiplicity of products and other benefits . Research aimed at study the feasibility of two projects one hand in the origin of the Al – Mashrok since 2006 , kicking off with ten hives , and the scond proposal , kicking of 100 hives using the criteria of the world bank . Results showed that the bee keeping projects is economically feasible, whether small or large .. Even when the analysis of the sensitivity of the project to changes which may occur in the price of output and resources by reducing costs and increasing revenues by 10% it remains economically viable .
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This paper deals with defining Burr-XII, and how to obtain its p.d.f., and CDF, since this distribution is one of failure distribution which is compound distribution from two failure models which are Gamma model and weibull model. Some equipment may have many important parts and the probability distributions representing which may be of different types, so found that Burr by its different compound formulas is the best model to be studied, and estimated its parameter to compute the mean time to failure rate. Here Burr-XII rather than other models is consider because it is used to model a wide variety of phenomena including crop prices, household income, option market price distributions, risk and travel time. It has two shape-parame
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يعد هذا النص أحد النصوص المسمارية المصادرة التي بحوزة المتحف العراقي، ويحمل الرقم المتحفي (235869)، قياساته )12،7x 6x 2،5سم). يتضمن مدخولات كميات من الشعير،أرخ النص الى عصر أور الثالثة (2012-2004 ق.م) و يعود الى السنة الثالثة من حكم الملك أبي-سين (2028-2004 ق.م)،أن الشخصية الرئيسة في هذا النص هو)با-اَ-كا مسمن الماشية( من مدينة أري-ساكرك، ومقارنته مع النصوص المسمارية المنشورة التي تعود الى أرشيفه يبلغ عددها (196) نصاً تضمنت نشاطاته م
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