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.
Abstract
The image of the soldier, as a hero who sacrifices everything to defend his
country and values, is no longer depicted in modern drama. With two World Wars
and many regional wars and civil wars, the soldier becomes a victim, not a hero.
Authors present the character of the soldier as a man who suffers a lot as he is
victimized by his own government and its politics that forces him to be in such a
position. Dramatists express their views about race, oppression and war through
their characters, such as the character of the soldier, as in the two selected plays for
this research: The Hostage by Brendan Behan and A Soldier's Play by Charles
Fuller.
The Hostage depicts, through its events, the Irish oppre
The research aims present to highlight the importance of creating construction Organizational appropriate to achieve strategic success and reduce many of the negative effects experienced by organizations has been developing his questionnaire especially so was distributed to a sample of workers in the Asia-cellular as sample included (60) responsive 0 and can embody intellectual dilemma following questions (What are the dimensions of the organizational infrastructure, and what are the justifications for carrying out the reform and development cleared the organizational structure to make it more flexible) to contribute to the achievement of the strategic requirements for success of the organization surveyed.
Find recommended a number o
AS Salman, SK Hameed…, Karbala Journal of Physical Education Sciences, 2020
Background: The association between facial types and dental arches forms has considerable implications in orthodontic diagnosis and treatment planning. The aim was to establish the maxillary and mandibular dental arches width and length in skeletal and dental class II division 1 and class III malocclusion groups, find out the most frequent dental arch form and facial type and the association between them and to check the gender differences. Materials and Methods: Frontal and lateral facial photographs and maxillary and mandibular occlussal photographs for 90 iraqi subjects with age 18-25 years old (45 males and 45 females) divided equally into three groups, the 1st group with class II division 1malocclusion (overjet more than 3mm but less t
... Show MoreThe aim of the research is to determine the impact of profit management practices on the quality of profits through the use of flexibility in determining accounting methods and practices profit information is one of the most important information that concerns current users in general and observing users in particular. Some corporations managements manipulate the results of the company's profit or loss (income statement) and financial position statement with multiple reasons, including capital market motivations to raise their share prices in the stock market and attract investors, and on the other hand the motives of funding and borrowing loans, and the use of the flexibility in accounting policies and estimates to change the in
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Research Objectives: The research aims to highlight the approach of Imam Al-Qaradawi in contemporary jurisprudence in the recent issues of the jurisprudence of minorities, and mentioning the foundations of jurisprudence of minorities, along with some of the practical applications of Imam Al-Qaradawi.
Study Methodology: The researcher applied the inductive, analytical and comparative approach by tracking the scientific material related to the subject of the study from the books of Al-Qaradawi in the first place, then by comparing the legal provisions with what had been stated in the four schools of jurisprudence.
Findings: The interest and need of Muslim minorities in non-
... Show MoreBackground: Ankylosing spondylitis is a chronic inflammatory disease that mostly involves the spine and sacroiliac joints. It is associated with a decreased quality of life. Biological medicines such as infliximab and its biosimilar are the mainstay treatments for active ankylosing spondylitis.
Objective: The study objective was to conduct a pharmacoeconomic study comparing the cost-effectiveness of the reference infliximab with its biosimilar in ankylosing spondylitis patients visiting public hospitals.
Subjects and Method: This is a two-center pharmacoeconomic study performed at two large teaching governmental hospitals in Baghdad, Iraq, which s
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The purpose of this research is to identify the youth issues in Talk Shows in the Iraqi satellite channels via monitoring a sample of episodes of the Talk Shows episodes which are concerned and analyzed the youth issues in the Iraqi satellite channels, namely, «Hala Shabab Program» at Al-Iraqia satellite Channel and «Shabab wa Banat Program» at Al-Sumaria satellite Channel by recording and re-watching them again. This research is classified as one of descriptive researches. The survey method was adopted in this study.
For this purpose, the researcher prepared an analysis form. The researcher de
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Dynamic machine foundations can be considered as a necessary component of the industrial infrastructure. Design of the dynamic equipment foundations has, however, traditionally been grounded on a rule of thumb that is inaccurate and rigid to use at the discretion of the engineers. The conventional rule of thumb, which includes minimum weight ratios and resonance avoidance criteria, has been used singularly with two poles, which can be either conservatively designed systems that are too heavy, or systems that are going to experience too much vibration and fatigue. This paper presents a novel, analytical framework for the reinterpretation of traditional design practices, using a physics-based approach, and results in a single, unified overall
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