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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The purpose of this study is to examine the dimensions of strategic intent (SI; see Appendix 1) according to the Hamel and Prahalad model as a building for the future, relying on today’s knowledge-based and proactive strategic directions of management as long-term and deep-perspective creative directions, objective vision and rational analysis, integrative in work, survival structure and comprehensiveness in perception.
The quantitative approach was used based on research, detection and proof, as data were collected from leader
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Summary: This study aims to examine the names of four-legged animals found in Turkish translations of the Qur’an written between the 11th and 15th centuries from linguistic, etymological, and semantic perspectives. These translations, belonging to the Old Anatolian Turkish period, serve not only as religious texts but also as valuable documents reflecting the social structure, cultural values, and linguistic features of the time. Within the scope of this research, six major tafsir (exegesis) texts were systematically analyzed, and the data obtained were evaluated within historical and cultural contexts. The theoretical framework of the study is based on Lakoff and Johnson’s Conceptual Metaphor Theory and Wierzbicka’s approach to lingu
... Show MoreThe purpose of this research is to demonstrate the impact of banking compliance in combating money laundering and terrorist financing through banks. The phenomenon of money laundering and terrorist financing has received wide attention in the countries of the world and international organizations because of the negative effects this phenomenon has on the global economy as a result of exploiting developments and modern banking operations to pass Money laundering and terrorist financing operations in order to legitimize illegal funds and obliterate their criminal sources, which obliged the banking sector to increase control measures in order to reduce these operations, which conceal money laundering thr
... Show MoreType 2 diabetes mellitus(T2DM) is a metabolic disease that is associated with an increased risk for atherosclerosis by 2-4 folds than in non- diabetics. In general population, low IGF-1 has been associated with higher prevalence of cardiovascular disease and mortality .This study aims to find out the relationship between IGF-1 level and other biochemical markers such as Homeostasis Model Assessment insulin resistance(HOMAIR) and Body Mass Index(BMI) in type 2 diabetic patients . This study includes (82) patients (40 females and 42 males) with age range (40-75) years,(34) non obese diabetic patients and (48) obese diabetic patients. The non obese individuals considered
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يهدف هذا البحث الى التطرق الى صورة العربي كما يعرضها ادب اليافعين العبري في رواية " نادية " للكاتبة العبرية " كاليلا رون فيدر " . والتي تعد من الاديبات العبريات اللواتي تطرقن بصورة مباشرة الى موضوع ما خلف الجدار ، والصراع العربي – الإسرائيلي وانعكاساته على المجتمع الإسرائيلي بصورة عامة والمجتمع العربي بصورة خاصة . ينقسم هذا البحث إلى ثلاثة فصول، تطرق الفصل الأول إلى "ادب اليافعين"، و تاريخه ، مميزاته والفئ
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Abstract
This paper discusses the essence of the developmental process in auditing firms and offices at the world today. This process is focused on how to adopt the audit concepts which is based on Information and Communication Technology (ICT), including the Continuous Auditing (CA) in particular. The purpose of this paper is to design a practical model for the adoption of CA and its requirements according to the Technology Acceptance Model (TAM). This model will serve as a road map for manage the change and development in the Iraqi auditing firms and offices. The paper uses the analytical approach in reaching to the target results. We design the logical and systematic relations between the nine variable
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The thermal performance of a flat-plate solar collector (FPSC) using novel heat transfer fluids of aqueous colloidal dispersions of covalently functionalized multi-walled carbon nanotubes with β-Alanine (Ala-MWCNTs) has been studied. Multi-walled carbon nanotubes (MWCNTs) with outside diameters of (< 8 nm) and (20–30 nm) having specific surface areas (SSAs) of (500 m2/g) and (110 m2/g), respectively, were utilized. For each Ala-MWCNTs, waterbased nanofluids were synthesized using weight concentrations of 0.025%, 0.05%, 0.075%, and 0.1%. A MATLAB code was built and a test rig was designed and developed. Heat flux intensities of 600, 800, and 1000 W/m2; mass flow rates of 0.6, 1.0, and 1.4 kg/min; and inlet fluid temperatures of 30, 40, an
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The paper exposes a discourse taxonomy of language clichéd units in English and Russian, and presents some definitions of what is a cliché as being a semioticform of perceiving language and discourse. Also, it deals with language clichés as being units of structure reflecting a scheme of stereotypical situations of dialogue, whether among individuals of one culture, or in relation to cross-cultural communication. The paper proposes a taxonomy of units in language clichés in English and Russian by tackling clichés of daily use, such as professional, cultural, artistic, and scientific clichés.
Аннотация
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