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.
Abstract
The Paper highlights on one of the main activities in marketing management. That is the internal marketing in the commercial banks and its relationship with the quality services offered to satisfy customers needs and wishes in order to reach he ultimate objectives of those banks. Two state and five private banks in Basrah city (Iraq) were taken in a field study. The survey covered the opinions of (184) state bank employees and (158) clients . The analysis of the survey shows that there is a strong relationship between the internal marketing ( in the banks covered by the survey) and the quality of banking objective services and the private banks show greater interest and concern to the internal ma
... Show MoreShort Multi-Walled Carbon Nanotubes functionalized with OH group (MWCNTs-OH) were used to synthesize flexible MWCNTs networks. The MWCNTs suspension was synthesized using Benzoquinone (BQ) and N, N Dimethylformamide alcohol (DMF) in specific values and then deposited on filter paper by filtration from suspension (FFS) method. Polypyrrole (PPy) conductive polymer doped with metallic nanoparticles (MNPs) prepared using in-situ chemical polymerization method. To improve the properties of the MWCNTs networks, a coating layer of (PPy) conductive polymer, PPy:Ag nanoparticles, and PPy: Cu nanoparticles were applied to the network. The fabricated networks were characterized using an X-ray diffractometer (XRD), UV-Vis. spectrometer, and Ato
... Show MoreThis study aims to identify the impact of social support on breast cancer patients’ psychological rigidity using a sample in Ramallah and al-Bireh. A descriptive correlative approach was adopted to fulfill the goals of the study and a questionnaire consisted of two criteria: social support and psychological rigidity, which was adopted as a tool for data collection for the study. In order to achieve the goals of the study, the researcher selected a convenient sample that consisted of 123 female breast cancer patients in Ramallah and al-Bireh. This sample represented 50% of the original patient population. The study showed that the average estimated percentage of social support and psychological rigidity for women with breast cancer, in
... Show MoreAt the beginning of the nineties increased responsibility of the auditor to the community as the demand for auditing the environmental performance for the economic units in addition to audit the financial performance. With the aim of preserving the environment and reducing the damagse as aresult of the negative effects of the activities of these units.
The researh deal with two sides the first one identifies the theoretical framework of the concept of environmental audits, requirements, methods, types of procedures, and duties of the auditor in conducting environmental audits. It also deals with the concept of the enviro
... Show MoreThirty one samples of gum swabs were collected from patients with tooth caries (5-30 years old) from the College of Science (Biology department )- University of Baghdad- Iraq for the period from October 2018 to December 2018. , The samples were transported, after inoculation in a transport media (nutrient broth), to the laboratory of the College of Science and then cultured on mannitol salt agar and blood agar). The isolates belonging to Staphylococcus spp. were identified by biochemical tests and Vitek 2 compact system, while the more antibiotic resistant isolates were identified by using Polymerase Chain Reaction(ï´¾PCR) and sequencing of 16SrRNA . The results showed sharp UV absorption peaks at 330 - 340nm and AFM at 5
... Show MoreThis study aimed to explore self and public stigma towards mental illness and associated factors among university students from 11 Arabic‐speaking countries. This cross‐sectional study included 4241 university students recruited from Oman, Saudi Arabia, the United Arab Emirates (UAE), Syria, Sudan, Bahrain, Iraq, Jordan, Lebanon, Palestine and Egypt. The participants completed three self‐administrative online questionnaires—Demographic Proforma (age, gender, family income, etc.), Peer Mental Health Stigmatization Scale and Mental Health Knowledge Questionnaire. There was a significant difference in the average mean between the 11 countries (