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.
Stubbornness is of the nature of the mean, we do not see it in the character of a person whose heart God filled with faith, wisdom and knowledge. And stubbornness does not fall into it except hearts that are arrogant, envious and objectionable, hearts that do not admit mistakes, and are not satisfied with the truth. Rather, you see humiliation,humiliation and shortcomings in returning to Him. He loves corruption * Except in humiliation, humiliation and shortcomings, the stubborn fall, even if they are proud when it is said to him, "Beware of God", pride takes him for sin, so his count is Hell, and his misery.
traces of stubbornness :key wor
... Show MoreIn the name of of Allah the Merciful
Research Summary
This rule is one of the common rules between the sciences of the principles of jurisprudence and the jurisprudence rules. It is originally a fundamental rule because it relates to one of the topics of the science of the principles of jurisprudence, which is ijtihad. The ruling on reversing his ijtihad is permissible or not (1), and for this reason Ibn Al-Subki titled it in his book Al-Ishbah wa Al-Nazaer by saying: “What invalidates the judge’s judgment and what does not invalidate it.” ([2]).
The importance of this rule comes from the need for it by the judge, the mufti and the imitator, for the judge needs it to know the matters in which the ruling base
... Show MoreIn this work ,medical zinc oxide was produced from zinc scraps instead of traditional method which used for medical applications such as skin diseases, Iraq is importing around 50 ton/year for samarra plant the producted powder has apartical size less than 5 micron and the purity was more than 99.98%,also apilot plant of yield capacitiy 15 kg/8hours wsa designed and manufactured .
There were two types of plows used widely in agricultural fields in the country. The first plow was moldboard plow, while the second one was chisel plow. There were large numbers of Iraqi farmers that used chisel plow for such farming practices. Researchers found that moldboard plows gave the highest rate of carbon dioxide emission. They observed that that with chisel plows they got the lowest carbon dioxide emission. Chisel plow saved energy as compared to moldboard plow and the cost of using the chisel plows was less than the moldboard plows. Chisel plow decreased carbon dioxide emissions from the soil and improve soil properties. The benefits of using chisel plows were more than using moldboard plows.
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Background : Polycystic ovary syndrome (PCOS) is the most common cause of infertility in reproductive-age women , it is an important harbinger of metabolic disorders. It has been reported that hyperamylasemia can be used as marker of ovarian cancer patients . The current study was conducted to evaluate amylase activity and to estimate the correlation of this enzyme with insulin and insulin resistance in PCOS patients. Methods: This study was conducted on forty five patients with PCOS in comparison to twenty five women as control. Fasting blood sample was taken from each subject and analyzed for amylase activity , FSH,LH, Insulin , proteins, and blood sugar , meanwhile insulin resistance was determined by HOMA-IR index. Results: The result
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Bedside clinical teaching is a fundamental part of the medical education that offers invaluable opportunities for the students to build and improve their clinical and communication skills. However, there is a growing concern about the increasing refusal of patients to participate in clinical sessions, especially in certain settings where there are sensitive cultural traditions and decreased trust in institutions.
This paper discusses patient refusal duri
