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.
Two- dimensional numerical simulations are carried out to study the elements of observing a Dirac point source and a Dirac binary system. The essential features of this simulation are demonstrated in terms of the point spread function and the modulation transfer function. Two mathematical equations have been extracted to present, firstly the relationship between the radius of optical telescope and the distance between the central frequency and cut-off frequency of the optical telescope, secondly the relationship between the radius of the optical telescope and the average frequency components of the modulation transfer function.
Soil invertebrates community an important role as part of essential food chain and responsible for the decomposition in the soil, helps soil aeration , nutrients recycling and increase agricultural production by providing the essential elements necessary for photosynthesis and energy flow in ecosystems.The aim of the present study was to investigate the soil invertebrates community in one of the date palms plantation in Aljaderia district South of Baghdad, , and their relationships with some physical and chemical properties of the soil , as Five randomly distributed replicates of soil samples were collected monthly. Invertebrates samples were sorted from the soil with two methods, direct method to isolate large invertebrates and indirec
... Show MoreThis paper aims at studying the illocutionary speech acts: direct and indirect to show the most dominant ones in a presidential speech delivered by the USA president. The speech is about the most critical health issue in the world, COVID-19 outbreak. A descriptive qualitative study was conducted by observing the first speech delivered by president Trump concerning coronavirus outbreak and surveying the illocutionary acts: directive, declarative, commissive, expressive, and representative. Searle's (1985) classification of illocutionary speech acts is adopted in the analysis.
What are the main types of the illocutionary speech acts performed by Trump in his speech?; Why does
... Show MoreBackground: Giant middle cerebral artery (MCA) aneurysms are surgically challenging lesions. Because of the complexity and variability of these aneurysms, a customized surgical technique is often needed for each case. In this article, we present a modified clip reconstruction technique of a ruptured complex giant partially thrombosed middle cerebral artery aneurysm.
Case description: The aneurysm was exposed using the pterional approach. Following proximal control, the aneurysm sac was decompressed. Then, we applied permanent clips to reconstruct the aneurysm neck. The configuration of the aneurysm mandated a tailored clipping pattern to account for resi
... Show MoreBackground : Xanthomatosis is a disease in which large tendon tumors can occur, especially in the Achilles tendon. This disease is a rare interesting orthopaedic condition.
Case Report:A case of a twenty eight year old girl patient with giant bilateral Achilles tendon xanthomas in which both tumors were resected.
There was no ulceration on the both sides. The patient was treated by total resection of the lesion and reconstruction using tendon transfer of the Peroneus brevis and Flexor hallusis longus. Postoperative treatment consisted of six weeks lower leg cast immobilization followed by partial weight bearing. After 4 months the patient was able to walk pain free without any difficultie
... Show MoreThe general trend in Iraqi banks is focused towards the application of international financial reporting standards, especially the international financial reporting standard IFRS 9 “Financial Instruments”, in addition to the directives issued on the Central Bank of Iraq’s instructions for the year 2018 regarding the development of expected credit losses models, and not to adhere to a specific method for calculating these losses and authorizing the banks’ departments to adopt the method of calculating losses that suits the nature of the bank’s activity and to be consistent in its use from time to time. The research problem revolves around the different methodologies for calculatin
... Show MoreA remarkable correlation between chaotic systems and cryptography has been established with sensitivity to initial states, unpredictability, and complex behaviors. In one development, stages of a chaotic stream cipher are applied to a discrete chaotic dynamic system for the generation of pseudorandom bits. Some of these generators are based on 1D chaotic map and others on 2D ones. In the current study, a pseudorandom bit generator (PRBG) based on a new 2D chaotic logistic map is proposed that runs side-by-side and commences from random independent initial states. The structure of the proposed model consists of the three components of a mouse input device, the proposed 2D chaotic system, and an initial permutation (IP) table. Statist
... Show MoreManipulation is a discursive concept which plays a key role in political discourse by which politicians can impose some impact on their recipients through using linguistic features, most prominent of which are personal pronouns (Van Dijk, 1995). The aim of this study is to investigate how politicians utilize the personal pronouns, namely; We and I and their possessive forms as a tool of manipulating the audience's mind based on Van Dijk's "ideological square" which shows positive-self representation and negative-other representation (Van Dijk,1998:p.69). To this end, American President Donald Trump's 2020 State of the Union speech was chosen to be the data of analysis. Only (8)
... Show MorePhotonic crystal fiber interferometers are used in many sensing applications. In this work, an in-reflection photonic crystal fiber (PCF) based on Mach-Zehnder (micro-holes collapsing) (MZ) interferometer, which exhibits high sensitivity to different volatile organic compounds (VOCs), without the needing of any permeable material. The interferometer is robust, compact, and consists of a stub photonic crystal fiber of large-mode area, photonic crystal fiber spliced to standard single mode fiber (SMF) (corning-28), this splicing occurs with optimized splice loss 0.19 dB In the splice regions the voids of the holey fiber are completely collapsed, which allows the excitation and recombination of core and cladding modes. The device reflection
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