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.
This paper discusses the Sums of Squares of “m” consecutive Woodall Numbers. These discussions are made from the definition of Woodall numbers. Also learn the comparability of Woodall numbers and other special numbers. An attempt to communicate the formula for the sums of squares of ‘m’ Woodall numbers and its matrix form are discussed. Further, this study expresses some more correlations between Woodall numbers and other special numbers.
Many tools and techniques have been recently adopted to develop construction materials that are less harmful and friendlier to the environment. New products can be achieved through the recycling of waste material. Thus, this study aims to use recycled glass bottles as sustainable materials.
Our challenge is to use nano glass powder by the addition or replacement of the weight of the cement for producing concrete with enhanced strength.
A nano recycled glass p
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The research aims to apply one of the techniques of management accounting, which is the technique of the quality function deployment on the men's leather shoe product Model (79043) in the General Company for Textile and Leather Industries by determining the basic requirements of the customer and then designing the characteristics and specifications of the product according to the preferences of the customer in order to respond to the customer's voice in agreement With the characteristics and technical characteristics of the product, taking into account the products of the competing companies to achieve the maximum customer satisfaction, the highest quality and the lowest costs. Hence, the importance of research has emerged, which indicat
... Show MoreObjectives: The study aims to assess the QOL for parents of a child with autism Methodology: A descriptive study was conducted on parents of autistic child in Baghdad city. A purposive (non-probability) sample of (156) parents, (78) mothers and (78) fathers of (78) autistic children who are clients and receive care in the private specialization centers for autism were selected to participated in the current study. The study used a self- administrative questionnaire for data collection. Results: The findings indicated that both parents (mothers and fathers) were participated in this study, and they comprised
This study research to Showing The impact of the integration process on the quality of Insurance service and analyze the impact financially to determine whether there is any impact on the quality of the insurance service, in addition to identifying the obstacles that impede the merger between the insurance companies, insurance and the appropriate proposals for its' application and benefit from the benefits achieved.
The importance of The study lies in the fact that it is an important and vital spotlight that is becoming increasingly important in the world to confront the various difficulties and crises that have occurred recently in light of the liberalization of international trade, globalization a
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In this work, we first construct Hermite wavelets on the interval [0,1) with it’s product, Operational matrix of integration 2^k M×2^k M is derived, and used it for solving nonlinear Variational problems with reduced it to a system of algebric equations and aid of direct method. Finally, some examples are given to illustrate the efficiency and performance of presented method.
China's economic policy and its huge capabilities operate according to an expansion strategy, especially in investing foreign projects, as the past ten years have witnessed a major development in the elements of comprehensive strength, especially in the economic field, in 2014 China launched the largest initiative in the world, represented by the Belt and Road Project (BRI), which links nearly 70 countries, through this project, a very important region has emerged, which is (the port of cadres) in Pakistan, as China has headed towards that region and given the highest importance that is in its interest in the first place regardless of the great Pakistani interest, This is consistent with its future aspirations, especially after breaking
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This is a descriptive study that used the survey method, it’s aimed to identify the topics and frameworks of diplomatic and political issues covered by the news of the website of the Iraqi Ministry of Foreign Affairs, through the content analysis method applied on a sample selected in a systematic random manner for news published in the year 2021. The sample included (191) news equivalent to (20%) of the total study population of (942). The study reached some results, the most important of which were as follows: The political issue, in its general sense, grabbed the most prominent attention among the various issues and events focused on by Iraqi diplomacy: "international cooperation", "bilateral cooperation", and then "regional politic
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As long as Islamic banks cannot operate in an environment that deals with traditional banking instruments based on the interest rate (bank interest) that is prohibited by Article No. (6) of the Islamic Banking Law No. (43) of 2015 which stipulates that (do not deal in any activity that carries Interest (neither taking nor giving)). Therefore it seeks to provide an alternative strategic solution within the framework of the provisions and rules of Islamic Sharia, on the basis of participating in profit and loss to avoid the method of interest taking and giving, to find investment methods to provide new financial products, such as Islamic certificates of deposit and investment funds according to the method Murabaha, speculation (Mudar
... Show MoreThe upbringing of Yehuda Amichai and the conditions he lived in had a great influence on his deep sense of pain, which made him think of death and suicide. Especially after the Nazis came to power in Germany, and his emigration with his family. Amichai searched for love throughout his life, and his failure was one of the most important factors affecting his psyche, which is A deep influence that made him live in harsh and painful pains that broke him, and prevented her from achieving his ambitions in life.Dramatic texts are characterized by repetition in writing and presentation. It is a textual discourse that has two advantages, first, that it can be read as a literary text like all other literary texts, and second, that it can be consider
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