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:
Musa son of Yaqoob son of Izra, the Spanish poet, linguist, and philosopher, was born in Granada. He has many poems representing types of poetry. Also, he had important books, such as "the Poetry of Israel" and "Contemplative Research". He is knowledgeable in both Hebrew and Arabic, because most of his books were written in Arabic and the then translated to Hebrew. It seemed that he was influenced by Arab poets, specifically Abo Firas, and borrowed many issues, such as comparison, repetition, exaggeration, etc. and included them in his poetry.
All know that Arabic literature clearly influenced Hebrew literature in the Spanish era. Ara
... Show MoreThis research sheds light on one of the important and vital topics for the banking sectors (technical requirements for the application of economic intelligence) namely by (Hardware, equipment, communication networks, software, databases). And the dimensions of the strategic success of the banks represented by(Customer satisfaction, customer trust, quality of service, growth) In the three Iraqi private banks, namely(Assyria International Investment, Mansour Investment, International Development Investment and Finance). Its implementation is an urgent necessity in order to improve the quality of its banking services to win the satisfaction of its customers and their confidence and then grow to achieve stra
... Show MoreThe research aims to determine the strength of the relationship between time management and work pressure and administrative leadership, where he was taken a sample of (47) of the administrative leadership at the Higher Institute of security and administrative development in the Ministry of Interior was used questionnaire as a key tool in collecting data and information and analyzed the answers to the sample surveyed by using Statistical program (spss) in the arithmetic mean of the calculation and test (t) and the correlation coefficient, the research found the most important results: the existence of significant moral positive relationship between both time management and work pressure and administrative leadership, the leadership of th
... Show MoreIraq has seen many changes at the social, economic and political levels. This led to cause many shifts in the structure of its society and imposed great challenges reflected in the behavior and awareness of that society in general and youth in particular.
Those changes made the Iraqi society undergoing the transformation of value and culture aspects formed a political awareness that caused cultural and political diversity within the family and society. A greater openness to the outside world caused by the communication revolution, as the world has witnessed during the past two decades, has helped in making that change. Iraq had its share of media and political openness, which were included after the US occupation in 2003. As a re
... Show MoreThis study aims to know the degree of importance and the availability of the enhancing specifications of the educational process, and the way its objectives are achieved. Such a step involves using educational techniques, laying the selection foundations, knowing the methods of their employment and tracking the obstacles that limit this employment in teaching Arabic to non-native speakers. To achieve these objectives, the study followed a descriptive approach, and collected the necessary data through an integrated questionnaire prepared for the purpose of describing the phenomenon or topic. This approach was adopted, as it is characterized by being comprehensive, focuses on collecting data related and necessary to the topic under study.
... Show MoreThe aim of the research is to measure the relationship and effect of the application of total production maintenance TPM in the operational strategy, as it is considered one of the most important strategies for the process of restoring production losses because of inefficient equipment. Competitive edge in the global market by upgrading the operational strategies of OS in the application of TPM in those institutions that apply both H-OS-oriented and P-OS-oriented strategies where the strategy has been identified as a critical success factor. The aim of this study is to attempt to consider the application of comprehensive productive maintenance in industrial establishments
Background: The aim of this in vitro study was to evaluate and compare the microleakage between Vertise Flow T M composite material and other conventional (Filtek Z250, riva light cure and SDR) composite materials when restoring CII mesial box only cavity at gingival margin through die penetration test Materials and methods: Forty maxillary first premolars were prepared with class II box design only cavities. Samples were divided into four groups of ten teeth according to material used: group I (FiltekZ250 only). Group II (SDR+FiltekZ250). Group III (Vertise Flow +FiltekZ250). Group IV (Riva light cure+ FiltekZ250). After 24 hrs. immersion in 2% in methylene blue, samples were sectioned and micro leakage was estimated. Results: None of the
... Show MoreThe research topic (The Impact of the Compulsory Reserve on the Banks Credit-an applied research on a sample of Iraqi banks), was chosen on basis of the Iraqi private Banks attempts to increase their credit activities in hope to gain more profits.This coincided with the CBI aim to back the private banking market.It is thus apparent why the CBI issued its regulation to those banks to increase their capitals up to IDB250. On the other hand,the CBI acted as an obstacle in the way of increasing the private banks of their capitals,that is by implementing the quantitive monetary tool so called the compulsory reserve.This is why we intended to overlook at this contradictional problome
... Show MoreIn the age of information and communication revolution, education as one of life aspects has influenced with that revolution by integrating technology in education, which have become as an important learning tools of the whole educational process . Technology, when used appropriately, can help make science classroom a site of active learning and critical thinking, furthering student inquiry and connections with different materials. It is necessary to develop human rights education programs and materials for discretionary and extracurricular activities as it provide them with the skills and tools so that they are empowered to take action to realize their rights. Human rights education is a critical means of instilling the knowledge، skil
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