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.
Cloud point extraction is a simple, safe, and environmentally friendly technique for preparing many different kinds of samples. In this review, we discussed the CPE method and how to apply it to our environmental sample data. We also spoke about the benefits, problems, and likely developments in CPE. This process received a great deal of attention during preconcentration and extraction. It was used as a disconnection and follow-up improvement system before the natural mixtures (nutrients, polybrominated biphenyl ethers, pesticides, polycyclic sweet-smelling hydrocarbons, polychlorinated compounds, and fragrant amines) and inorganic mixtures were examined and many metals like (silver, lead, cadmium, mercury, and so on). We also find
... Show Moreهدفت هذه الدراسة إلى تحليل نتائج الاختبار الوطني الموحد الذي تطبقه وزارة التربية والتعليم الفلسطينية في مادة الرياضيات لطلبة الصف الثامن الأساسي في المدارس الحكومية في محافظة طولكرم، وذلك لمعرفة مستوى الطلبة على هذا الاختبار في ضوء متغيرات الجنس والمنطقة التعليمية ونوع المدرسة، ومعرفة علاقة التحصيل على هذا الاختبار بتحصيل الطلبة المدرسي والمعدل العام. ولتحقيق ذلك تم تحليل درجات (3218) طالباً وطالبة؛ وهم ي
... Show MoreThe research aims to identify the level of educational supervisors' practices of their supervisory duties according to the requirements of comprehensive quality from the viewpoint of teachers in Oman. Moreover, identify the differences between the responses of the sample about these practices, which are attributed to gender, and years of experience. Thus, a questionnaire was administered to teachers, consisting of (48) items distributed on (5) main fields related to the educational supervisor's practices. The sample consisted of (220) teachers who were randomly chosen from the schools in Dhofar region. Data were analyzed using means, standard divisions, T-test, and One Way ANOVA. The research concluded that the level of educational super
... Show MoreImplementation of Warm Mix Asphalt concrete (WMA) is getting global acceptance due to the restrictions for protecting the environment and the requirements to reduce fuel consumption. In this investigation, two WMA mixtures have been prepared in the laboratory using medium curing cutback (MC-30) and Cationic emulsion asphalt. Hot Mix Asphalt (HMA) was also prepared for comparison. The cylinder specimens (63.5mm) in height and (101.6mm) in diameter were constructed from the mixtures and subjected to indirect tensile strength test to determine the Tensile Strength Ratio (TSR). The cylinder specimens of (101.6mm) in height and (101.6mm) in diameter were also constructed from those mixtures and subjected to static compressive
... Show MoreSome structures such as tall buildings, offshore platforms, and bridge bents are subjected to lateral loads of considerable magnitude due to wind and wave actions, ship impacts, or high-speed vehicles. Significant torsional forces can be transferred to the foundation piles by virtue of eccentric lateral loading. The testing program of this study includes one group consists of 3 piles, four percentages of allowable vertical load were used (0%, 25%, 50%, and 100%) with two L/D ratios 20 and 30, vertical allowable load 110 N for L/D = 20 and 156 N for L/D = 30. The results obtained indicate that the torsional capacity for pile group increases with increasing the percentage of allowable vertical load, when the percentage of allowable vertica
... Show MoreSoft clays are generally sediments deposited by rivers, seas, or lakes. These soils are fine-grained plastic soils with appreciable clay content and are characterized by high compressibility and low shear strength. To deal with soft soil problems there is more than one method that can be used such as soil replacement, preloading, stone column, sand drains, lime stabilization and Prefabricated Vertical Drains, PVDs. A numerical modeling of PVD with vacuum pressure was analyzed to investigate the effect of this technique on the consolidation behavior of fully and different depths of partially saturated soft soils. Laboratory experiments were also conducted by using a specially-designed large consol
... Show Morethe contemporary Arab scholars deal with semiotics as an approach that helps them understand the texts, its meaning, and its structural functionalism . that’s why every now and then we find some
studies and researches using semiotics as an approach in study and comparatives, some of them even used the semiotic approach in analyzing old and new texts, while others think that semiotic holds and important place in critical approaches .
even though some of them considers semiotic just a trend of fashion this really didn’t lessen the value of semiotic as a scientific and procedural approach in literary and media studies as well as in analyzing literary and journalistic texts. for this reason it is considered as an important approa
In this study, a 3 mm thickness 7075-T6 aluminium alloy sheet was used in the friction stir welding process. Using the design of experiment to reduce the number of experiments and to obtain the optimum friction stir welding parameters by utilizing Taguchi technique based on the ultimate tensile test results. Orthogonal array of L9 (33) was used based on three numbers of the parameters and three levels for each parameter, where shoulder-workpiece interference depth (0.20, 0.25, and 0.3) mm, pin geometry (cylindrical thread flat end, cylindrical thread with 3 flat round end, cylindrical thread round end), and thread pitch (0.8, 1, and 1.2) mm) this technique executed by Minitab 17 software. The results showed th
... Show MoreAbstract:
The research aims to monitor the image of the man in the group (The Cart and the Rain) by the storyteller (Badiaa Amin); With the aim of highlighting an aspect of feminist writing, especially with regard to the relationship of women to men, and determining the form adopted by the storyteller in drawing the features of men.
The research used the descriptive-analytical method in the space of its textual formation, which aims to stand on the text and deconstruct its narrative significance. To provide a comprehensive picture of it.
Three images of the man appeared in the group's stories, represented by (the authoritarian, the negative, and the positive), and the image of the authoritarian ma
... Show MoreObjective(s): To evaluate the family physicians' practices and to measure its impact upon the quality of family
medicine health care in Baghdad City model primary health care centers.
Methodology: A descriptive study, using the evaluation approach, has evaluated the impact of family physicians'
practices upon quality of healthcare in Baghdad's Model Primary Health Care Centers of Family Medicine. It is
carried out during 15th of May – 20th of August 2017. The study is conducted at five model primary health care
centers of family medicine from two districts; AL-Rusafa and AL-Kurkh. Sample size is calculated to be (76)
family physicians. Convenient sample of (124) patients who are attending these primary health care cen