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 research aims to get acquainted with the evaluation of the reality of the application of the curriculum axis from among the eight Iraqi academic accreditation standards in a sample of governmental and private universities and colleges in Iraq and to identify the main and secondary reasons for it as well as to provide proposed mechanisms and procedures to help reduce gaps, If the research problem is represented in the weak availability of the requirements of the curriculum axis in universities and colleges (the study sample) due to the weak documentation and successful implementation of them and interest in them is still below the level of ambition, In order to arrive at scientific facts, the researchers adopted the comparativ
... Show MoreIn light of crises, the need for efficient and flexible public administrations to make quick and decisive decisions, also institutions capable of directing the internal elements and components of them and adapting them to the requirements of rapid change due to crises and disasters, which led to scarce resources becoming scarcer and economic, political and social problems becomes more prominent. For the majority of developing countries, including Iraq, the increasing need for the importance of moving towards enhancing the efficiency of the performance of public institutions while trying to predict their future, can only be achieved. Through solid mechanisms and principles of governance that enhance the ability of institutions and make them
... Show MoreThe research has designed for studying the relationship between manufacturing strategy and its flexibility under the flexible manufacturing system with their reflection on the competitive environmental performance of the firm. To interpret and tackle the problem, a hypothesis has formulated stating that “ the competitive performance of a firm is interpreted by the manufacturing strategy and flexibility which are derived from the firm and its business strategies under the flexible manufacturing system”. Related literatures with their theoretical dissertations, which enhanced the thoughtful content, have analyzed. An illustrative case study on the flexible manufacturing system at Toyota Motors Corporation working at the g
... Show MoreThe study of surface hardness, wear resistance, adhesion strength, electrochemical corrosion resistance and thermal conductivity of coatings composed from sodium silicate was prepared using graphite micro-size particles and carbon nano particles as fillers respectively of concentration of (1-5%), for the purpose of covering and protecting the oil distillation towers. The results showed that the sodium silicate coating reinforced with carbon nano-powder has higher resistance to stitches, mechanical wear, adhesive and thermal conductivity than graphite/sodium silicate composite especially when the ratio 5% and 1%, the electrochemical corrosion test confirmed that the coating process of stainless steel 304 lead to increasin
... Show MoreBacterial toxins are considered to be virulence factors due to the fact that they interfere with the normal processes of the host cell in which they are found. The interplay between the infectious processes of bacteria and the immune system is what causes this impact. In this discussion, we are going to focus on bacterial toxins that act in the extracellular environment, especially on those that impair the activity of macrophages and neutrophils. These toxins are of particular interest since they may be found in a wide variety of bacteria. We will be concentrating our efforts, in particular, on the toxins that are generated by Gram-positive and Gram-negative bacteria. These toxins are able to interact with and have an effect on the many dif
... Show MoreThe necessary optimality conditions with Lagrange multipliers are studied and derived for a new class that includes the system of Caputo–Katugampola fractional derivatives to the optimal control problems with considering the end time free. The formula for the integral by parts has been proven for the left Caputo–Katugampola fractional derivative that contributes to the finding and deriving the necessary optimality conditions. Also, three special cases are obtained, including the study of the necessary optimality conditions when both the final time and the final state are fixed. According to convexity assumptions prove that necessary optimality conditions are sufficient optimality conditions.
... Show MoreThe moral aspect is an important one in the structure of personality , and the lack of moral aspect is responsible for what we suffering today from problems . there is no exaggeration to say that many of our current problems are moral problems , and reflects the lack of moral growth.
The goal of research is to build scale in order to detect the level of moral reasoning among junior high school students in Baghdad , The researcher followed the procedures in the construction of scientific standards in order to measur
... Show MoreAbstract The strategic performance of the United States depends on dealing with the Middle East countries and its variants on several bases and motives that enabled them to achieve American hegemony and invest its interests at the expense of the region countries. Within this performance, the administration of the United State President Donald Trump presented the Strategic Document on December 18, 2017, which focused on the principle of "America First", to determine the direction of future US strategic performance in the formulation of means of cooperation and intersections or hostility in addition to interests and threats.The future vision of the Arab region and the Middle East as a whole, this strategy is based on the fact that
... Show MoreAbstract Background: The human epidermal growth factor receptor 2(HER2) proto-oncogene is overexpressed or amplified in approximately 15%-25% of invasive breast cancers. Approximately 35% of HER2-amplified breast cancers have coamplification of the topoisomerase II-alpha (TOP2A) gene encoding an enzyme that is a major target of anthracyclines. Hence, the determination of genetic alteration (amplification or deletion) of both genes is considered as an important predictive factor that determines the response of breast cancer patients to treatment. The aims of this study are to determinate TOP2A status gene amplification in a set of Iraqi patients with breast cancer that have had an equivocal (2+) and positive HER2/neu by immunohistochemistry
... Show MoreBiological drugs have an active substance that is made by a living organism or derived from a living organism. They are one of the important therapy options used in a wide range of diseases especially life-threatening diseases. Biological therapy opens new opportunities for treating different diseases for which drug therapy is minimal, but they have considerable differences in the safety consequences in comparison with non-biological drugs. The aim of the current study was to assess the post-marketing safety profile of biological drugs used in Iraqi hospitals by the analysis of the reported adverse drug reactions regarding their severity, seriousness, preventability, expectedness, and outcome. It is a retrospective study of the individu
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