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 issue of the public in the directions and theories of the theater director in the world theater, especially after the emergence of realism and the crystallization of the term direction and the definition of the role of the director in 1850 AD by the Duke Max Mengen took different paths to the Greek, Roman and even Elizabethan audience because it was here subjected to the theatrical equation from its production and presentation due to the fact that the theatrical performance is a technical artistic production, and the audience participation, watching and consumption, and here the participation of the audience was subjected to three directions: the enlightenment in the sense of arousing sense, the incitement in the se
... Show MoreThe current research aims to develop the skills of the kindergarten students in designing and implementing a theater for gauntlets made of cardboard materials. To study this, the researcher determined to build teaching plans for design and implementation skills according to (Kolb model).
The results of this research showed the effectiveness of teaching plans according to (Kolb's model) in developing skills of design and implementation (theater for gauntlets made of cardboard materials) for the students of the Kindergarten Department - the experimental group. Which had a positive effect to reach the desired results in the design and implementation of the gauntlet theater and dealing with cardboard materials
This study tests the effect of a large number of independent variables that control the growth of the total productivity, which amounted to 112 variables, gathered from what is mentioned in the specialized theoretical and applied literature. The data for these variables were taken from global reports of sound international organizations and reliable databases covering the period 1991-2016. The data of the dependent variable, the growth of the total factor productivity, were taken from the database of the world development indicators. The study covered 61 countries for which data were available. The study included three regression models to explain
... Show MoreThis study examined the effect of elements of internal marketing activities on customer satisfaction through an exploratory study of banking services in the city of Baghdad, if the research problem crystallized by asking a group of questions, the most important (is there a correlation and impact between the dimensions of internal marketing and customer satisfaction, this study aims to determine The effect of internal communication, training and internal market research on customer satisfaction, represented by the quality of service, loyalty and market share, and embodied the objective of this study to identify the level of availability of internal marketing activities and programs in the research banks, data were collected using
... Show MoreNonlinear diffraction patterns can be obtained by focusing a laser beam through a thin slice of the material. Here, we investigated experimentally the formation of the far field nonlinear diffraction patterns of cw laser beam at 532 nm passing through a quartz cuvette containing multi-wall carbon nanotubes (MWCNT's) suspended in acetone and in DI water at concentrations of 0.030.wt.%, 0.045 wt.%, 0.060 wt.%, and 0.075 wt.%. Our results show that increasing the concentration of both types of suspensions (MWCNTs in acetone and MWCNTs DI water) led to increase in the number of pattern rings which indicates an increase in their nonlinear refractive indices. Moreover, MWCNTs DI water suspension at a concentration of 0.075 wt. % was more effic
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This research aims to analyze the reality of the production process in an assembly line Cars (RUNNA) in the public company for the automotive industry / Alexandria through the use of some Lean production tools, and data were collected through permanence in the company to identify the problems of the line in order to find appropriate to adopt some Lean production tools solutions, and results showed the presence of Lead time in some stations, which is reflected on the customer's waiting time to get the car, as well as some of the problems existing in the car produced such as high temperature of the car, as the company does not take into account customer preferences,
... Show MoreStriae distensae SD or stretch mark are frequent skin lesion that cause considerable aesthetic concern. The 1064nm long pulsed Nd:YAG Laser has been used to promote an increase in dermal collagen and is known to be a Laser that has a high affinity to vascular chromphores. Also by using fractional CO2 Laser 10600nm as an effective modality in treatment of striae distensae SD. It works to stimulate fibroblast and enhance Collagen formation, which is important for newly generated skin tissue.
Objectives: This study aims to verify the efficacy of long pulsed Nd: YAG Laser (1064nm) in the treatment of immature striae distensae (SD) and the efficacy of C02 fractional Laser (10600nm) in treatment o
... Show MoreInvestigating the thermal and electrical gains and efficiencies influence the designed photovoltaic thermal hybrid collector (PVT) under different weather conditions. The designed system was manufactured by attaching a fabricated cooling system made of serpentine tubes to a single PV panel and connecting it to an automatic controlling system for measuring, monitoring, and simultaneously collecting the required data. A removable glass cover had been used to study the effects of glazed and unglazed PVT panel situations. The research was conducted in February (winter) and July (summer), and March for daily solar radiation effects on efficiencies. The results indicated that electrical and thermal gains increased by the incre
... Show MoreDiversity has become one of the required phenomena to be available within public organizations, in light of the changes taking place in the global and international environment and in various fields. Therefore, it was imperative to study the impact of this phenomenon in various institutions, especially public ones, in most developing countries, including Iraq. The current research aims to analyze the relationship between The demographic diversity and institutional effectiveness of a sample of workers in public institutions included (500) respondents. The questionnaires were distributed to them randomly. Diversity is considered an independent variable and institutional effectiveness a dependent variable. The researcher used interview tools a
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