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.
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لخلاصة Nuclear energy is among the most important discoveries reached by the human terms contributed to the solution of many problems faced by the states. The last of these that are not only utilizing it in a peaceful area, but tended toward the military field and the nuclear weapons industry , Among these countries, we find North Korea, which has openly declared their manufacture of nuclear weapons and thus entry to the club of nuclear countries. International Atomic Energy Agency has worked to resolve the North Korea standoff but has not been able to achieve positive results, prompting the intervention of European countries in order to end the crisis. تعدُّ الطاقة النووية من بين أهم الاستكشافا
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The research aims to clarify the COBIT5 framework for IT governance and to develop of a criterion based on Balanced Scorecard that contributes in measuring the performance of IT governance. To achieve these goals, the researchers adopted the deductive approach in the design of balanced scorecard to measure the IT governance at the Bank of Baghdad that was chosen because it relied heavily on IT.
The research has reached a number of conclusions, the most important of which is that the performance of IT department in the Bank of Baghdad falls within the good level that requires constant monitoring, the most committed items of Balanced Scorecard by the Bank were customer, internal operation, growth and finally the financial item; IT
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The current research aims at finding out how to properly and correctly manage waste and solid waste and reduce the difficulties faced by all countries. However, it is becoming increasingly acute in developed cities because their economies are growing rapidly. It is necessary to identify the modern methods used in developed countries in managing wastes. The use of modern waste management techniques is a coordinated effort by international agencies within the borders responsible for them. The problem of the study can be identified in the lack of clarity of environmental management procedures in place. The importance of the research contributes to providing greater capacity to the administrative and technical leadership in the municipality
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The role of teacher of kindergarten plays an important role in the educational institution for kindergarten role in the educational institution for kindergarten and the failure of its role in the development of the mental processes of children kindergarten means failing in this institution .and hence the importance and effectiveness of the role of the student applied section kindergarten application period it is there fore necessary to be aware of the importance of learning. in preschool and good professional setting and enjoy a significant level of psychological and social systems and mental qualities and study is the urgent need to find generations hare systematic thinker's mind so stay away from memorization and trad
... Show MoreGod Almighty put in his great book secrets that do not end, and wonders that do not expire, for he is the one from which the scholars are not satisfied, and he does not create due to the multitude of response, and it is the comprehensive and inhibitory book that God conceals to the worlds, and he challenged the two heavyweights to come up with something like it.
At all times, issues arise in the Noble Qur’an that fit the needs of the people of that time and their culture, for it is an eternal book, characterized by the ability to give, extend and respond to addressing the problems of the age and its variables, when the Arabs had little luck at the time of the message’s descent from the scientific culture, and their proficienc
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Cloud-based Electronic Health Records (EHRs) have seen a substantial increase in usage in recent years, especially for remote patient monitoring. Researchers are interested in investigating the use of Healthcare 4.0 in smart cities. This involves using Internet of Things (IoT) devices and cloud computing to remotely access medical processes. Healthcare 4.0 focuses on the systematic gathering, merging, transmission, sharing, and retention of medical information at regular intervals. Protecting the confidential and private information of patients presents several challenges in terms of thwarting illegal intrusion by hackers. Therefore, it is essential to prioritize the protection of patient medical data that is stored, accessed, and shared on
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