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 surgery Keywords: 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 paper presents an annotated checklist of the Salticidae of Armenia. This study was carried out in 2019-2020 in order to provide an inventory of the Salticidae fauna. Thirteen species are reported for the Armenian fauna for the first time: Afraflacilla epiblemoides (Chyzer, 1891); Aelurillus v-insignitus (Clerck, 1757); Asianellus festivus (C. L. Koch, 1834); Heliophanus dubius C. L. Koch, 1835; Heliophanus kochii Simon, 1868; Heliophanus tribulosus Simon, 1868; Heliophanus curvidens (O. Pickard-Cambridge, 1872); Macaroeris nidicolens (Walckenaer, 1802); Pellenes diagonalis (Simon, 1868); Pellenes geniculatus (Simon, 1868); Pellenes seriatus (Thorell, 1875); Pellenes tripunctatus (Walckenaer, 1802) and Phlegra fasciata (Hahn, 1826).
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Background: Osteoporosis is a skeletal defect manifested by a reduction of bone strength as a result of reduced bone mass to the extent that there is a higher risk of fracture even on minor trauma. Hysterectomy in a premenopausal woman is a well known cause of ovarian failure resulting in an increased risk of osteoporosis.
Objective : To clarify bisphosphonate's preventive effect on osteopenia and osteoporosis in premenopausal women after hysterectomy.
Type of the study: Cross –sectional study.
Method: 84 premenopausal females post hysterectomy aged between 40 – 50 years, were enrolled in this randomized controlled double blinded trail a
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he study aims to build a model that revolves around the main question of the role of strategic agility (SA) in enhancing organizational excellence (OE). For the purpose of achieving OE and to determine the extent of interest and knowledge of managers at the Midwest Refineries Company (MRC) on the theoretical and practical implications, and on the performance foundations of these two vital variables with the aim of continuous improvement. A questionnaire was used and distributed to a random sample of 54 managers in this important energy production company. The study followed the descriptive analytical approach to answer the questions raised. The study model and dimensions were built according to reference models, most notably the models (Al-
... Show MoreBackground: Myasthenia gravis is an autoimmune disease of the neuromuscular junction that results in fluctuating muscle weakness as well as significant fatigue. Disease exacerbation is a critical condition, and the predisposing factors for it need to be identified to improve preventive measures.
Objectives: Our study aims to determine the predisposing factors for myasthenia gravis exacerbations in a group of Iraqi patients.
Subjects and Methods: A total number of 30 myasthenia gravis patients were admitted to the hospital with an exacerbation of their symptoms, determined as the development of functional disability, dysphagia, or respiratory fai
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Addressed the problem of the research is marked: (Performing processors for the time between Impressionism and superrealism) the concept of time and how to submit artwork. The search came in four sections: general framework for research and identified the research problem and the need for him. With an indication of the importance of his presence. Then determine the research objectives of (detection processors performing to the concept of time in works of art in each of Impressionism and superrealism. And a comparison between them to reveal similarities and differences), followed by the establishment of boundaries Find three (objectivity, the temporal and spatial) were then determine the terms related to the title. Then provide the theore
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A concept of indoor solar illumination is described and simulated. The solar illumination system is composed of a tracking primary reflector, a selective secondary reflector, a visible light guide and a scattering solid glass tube fixture. Each part of the solar illumination system is optically suited and compatible with other parts to realize high efficiency. The simulation is conducted for Baghdad city for a library hall. Two major days over a year are chosen to investigate the illumination system for acceptable visible light level for reading hall. The two days are: summer solstice day and winter solstice day at 8:00 AM and 12:00 PM for each. Research results showed that the design of the solar system is achieved on the base of minimu
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Recently, numerous the generalizations of Hurwitz-Lerch zeta functions are investigated and introduced. In this paper, by using the extended generalized Hurwitz-Lerch zeta function, a new Salagean’s differential operator is studied. Based on this new operator, a new geometric class and yielded coefficient bounds, growth and distortion result, radii of convexity, star-likeness, close-to-convexity, as well as extreme points are discussed.
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Cohesion is well known as the study of the relationships, whether grammatical and/or lexical, between the different elements of a particular text by the use of what are commonly called 'cohesive devices'. These devices bring connectivity and bind a text together. Besides, the nature and the amount of such cohesive devices usually affect the understanding of that text in the sense of making it easier to comprehend. The present study is intendedto examine the use of grammatical cohesive devicesin relation to narrative techniques. The story of Joseph from the Holy Quran has been selected to be examined by using Halliday and Hasan's Model of Cohesion (1976, 1989). The aim of the study is to comparatively examine to what extent the type
... Show MoreThe majority of Iraqi translator-student have problems at two main levels: the conceptual level and the productive level. From different perspectives, such problems are either related to ‘language’ or to ‘cognition’. This binary view is an indication to the implicit and interchangeable relationship between language and cognition. The relationship between cognition language and translator starts with the first language and its effect on the Iraqi translators. Identifying the effect is the aim of the present study. It is hypothesized that Iraqi students are negatively influenced by the problems and weaknesses of first language schema. This reflects the major claim and later concludes that first language instruction in the Iraq
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