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.
The place in which the person lives and his geographical and social environment have a great impact on building his personality, belief and culture, Islam has alerted the importance of the Muslim to make sure to choose the appropriate place in which he resides and dwells in that it is compatible with his religion and belief in order to ensure communication with Islamic knowledge in a way that enhances his belief Arabization occurs when a person makes himself an Arab by living the life of the Bedouins, and creates the morals of the Bedouins from the inhabitants of the Badia with its harshness, cruelty, ignorance and lack of understanding in religion and far from the sources of knowledge of Islamic knowledge. Blasphemy and polytheism, and
... Show Morethe traumatic memory of their ancestors. The novel navigates sites of trauma, memory, and blues music while resisting the bourgeoisie-capitalist relationships that permeated not only white society but also African American communities. Jones’s novel presents the plight of an African American woman, Ursa, caught between the memory of her enslaved foremothers and her life in an emancipated world. The physical and spiritual exploitation of African American women who bear witness to the history of slavery in Corregidora materializes black women’s individuality. This article is framed by trauma studies as well as the Marxists’ concepts of commodification, accumulation, and production. Ursa, one of the Corregidora women, represents
... Show MoreDue to restrictions and limitations on agricultural water worldwide, one of the most effective ways to conserve water in this sector is to reduce the water losses and improve irrigation uniformity. Nowadays, the low-pressure sprinkler has been widely used to replace the high-pressure impact sprinklers in lateral move sprinkler irrigation systems due to its low operating cost and high efficiency. However, the hazard of surface runoff represents the biggest obstacle for low-pressure sprinkler systems. Most researchers have used the pulsing technique to apply variable-rate irrigation to match the crop water needs within a normal application rate that does not produce runoff. This research introduces a variable pulsed irrigation algorit
... Show More A representative sample of a thousand volunteer university students was screened for evidence of thalassemia minor.Complete blood counts using automated blood cell analysers and blood smears were examined. Patients having anemia, abnormal red cell indices or morphological features of thalassemia minor like hypochromia, microcytosis, target cells erythrocytosis and family history of thalassemia were then investigated for determination of HbA2 & HbF levels. Estimation of hemoglobin A2 was performed by micro-column chromatography while HbF was done using alkali denaturation. Seventy seven out of the thousand samples tested positive for thalassemia minor. They all showed a hemoglobin A
The research study and analysis of the integration of marketing communications and their impact on the marketing performance of a number of telecom companies, as included in the research problem to know the role of marketing communications community in achieving sales and market share, profitability and customer satisfaction. The importance of research begins to be the right choice for the elements of marketing communications, lead to savings in time, effort and money and create a more idea about the effectiveness of the application of the concept of integration. The research to determine the role of marketing communications in promoting the integration of the marketing performance of companies in the field of sales and marke
... Show MoreThe features of the actor's performance in the ritual theater are of great importance and chief in theatrical work since the first emergence of the theater, as the features of the performance were embodied in all Iraqi theatrical performances, but they took personal privacy in some ritual performances because of their differences and similarities between the ritual theatrical performance and the ritual show Al-Khalis, who wanted the researcher to know the similarities and differences in the features of the ritual performance and in the theatrical performance, despite the many transformations that occurred in the theater and affected the features of the performance, but it remained an important and attractive link between the recipient, t
... Show MoreThis study aims to assess the effect of adding twisted fins in a triple-tube heat exchanger used for latent heat storage compared with using straight fins and no fins. In the proposed heat exchanger, phase change material (PCM) is placed between the middle annulus while hot water is passed in the inner tube and outer annulus in a counter-current direction, as a superior method to melt the PCM and store the thermal energy. The behavior of the system was assessed regarding the liquid fraction and temperature distributions as well as charging time and energy storage rate. The results indicate the advantages of adding twisted fins compared with those of using straight fins. The effect of several twisted fins was also studied to discover
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The research aims to identify the factors that affect the quality of the product by using the Failure Mode and Effect Analysis (FMEA) tool and to suggest measures to reduce the deviations or defects in the production process. I used the case study approach to reach its goals, and the air filter product line was chosen in the air filters factory of Al-Zawraa General Company. The research sample was due to the emergence of many defects of different impact and the continuing demand for the product. I collected data and information from the factory records for two years (2018-2019) and used a scheme Pareto Fishbone Diagram as well as an FMEA tool to analyze data and generate results.
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