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.
أن السياسة النقدية في العراق لم تشهد تحسناً كبيراً في دورها المطلوب
منها، وهذا يعود الى جملة من التغيرات على أدائها ودورها في التأثير على المتغيرات الأقتصادية المهمة، اذ حصلت ظروف صعبة على المستوى السياسي والأقتصادي اسهمت في أضعاف دورها في العراق. فالحروب العسكرية الثلاثة في وقت قياسي دمرت البنى التحتية للأقتصاد العراقي، وأخرت عملية التنمية الأقتصادية والبشرية لعدة عقود بسبب الأستنزاف الكبير للمو
Chapter-1
Problem of the research:
The studies and researches have noticed the aggravation of violence practice in all educational means using different and innovated styles against children in the school and house in order to upbringing by the parents or the school .
It is a training method for the person to participate in the society and prepare him to be an effective member.
The current research confines the children in age (6-12) years old representing the primary stage who face different kind of violence during the familiar or school education.
The current research aims to:
1 – The kinds of violence which happens to the children in the primary
... Show MoreTriticale is a hybrid of wheat and rye grown for use as animal feed. In Florida, due to its soft coat, triticale is highly vulnerable to Sitophilus oryzae L. (rice weevil) and there is interest in development of methods to detect early-instar larvae so that infestations can be targeted before they become economically damaging. The objective of this study was to develop prediction models of the infestation degree for triticale seed infested with rice weevils of different growth stages. Spectral signatures were tested as a method to detect rice weevils in triticale seed. Groups of seeds at 11 different levels (degrees) of infestation, 0–62%, were obtained by combining different ratios of infested and uninfested seeds. A spectrophotometer wa
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Background: Health information systems in most countries are inadequate in providing the needed management support and the current health information systems are therefore widely seen as management obstacles rather than as tools,Objectives: the current study is an attempt to assess the behavioral and organizational determinants of health information system performance in Iraq.Methods: A cross-sectional study was conducted by interviewed a total of 189 respondents selected from six Iraqi governorates. The Organizational and Behavioral Assessment Tool was used to measure the behavioral and organizational determinants of health information system performance, it is one of the PRISM package tools that are used to assess the health informatio
... Show MoreBackground: DVT is a very common problem with a very serious complications like pulmonary embolism (PE) which carries a high mortality,and many other chronic and annoying complications ( like chronic DVT, post-phlebitic syndrome, and chronic venous insufficiency) ,and it has many risk factors that affect its course, severity ,and response to treatment. Objectives: Most of those risk factors are modifiable, and a better understanding of the relationships between them can be beneficial for better assessment for liable pfatients , prevention of disease, and the effectiveness of our treatment modalities. Male to female ratio was nearly equal , so we didn’t discuss the gender among other risk factors. Type of the study:A cross- secti
The article reflects the results of the analysis of the use of metaphors as one of the main means used by Lyudmila Ulitskaya when writing the novel “Sincerely Yours Shurik” to form the image of the main hero in the novel. The main purpose of the article is to consider metaphors, which helped the author to form the image of the main character Shurik in the text space through the stages of his life path, closely related to the people around him, who is always happy to be useful (hence the title "Sincerely Yours"), among which the female images of his relatives, girlfriends and others stand out as a special layer in the narrative. And in the course of the study, the following tasks were solved: the metaphors that make up the image of the
... Show MoreObjective(s): to assess the effectiveness of educational program on nurses' knowledge concerning the side
effects of chemotherapy among children with leukemia.
Methodology: A descriptive analytic (quasi – experimental) design study was carried out at Baghdad City from
2
nd of October to 27th of June 2015. Non-probability sample of (35) male and female nurses was selected from
the Oncology Wards in Children Welfare, Child's Central and Baghdad Teaching Hospital. The study
instruments consisted of two major parts to meet the purposes of study. The first part is related to nurses'
demographic characteristics and the second part (four domains) is related to nurses' knowledge concerning the
side effects of chemothera
The Research deals with the negative phenomena which appeared in the urban scenes of the Iraqi cities after 2003, particularly trespassing the architectural design of the urban Individual houses. Many academic researchers , critics, and cultural circles, drawn attention to the impact of political and cultural variable change on such phenomena without detailed analysis . The research problem is set according to central questions : If the phenomena is the trespass , what
are the sides which are being trespassed in the division of the individual house? , If the diagnosis of the phenomena denotes perceived repetition of the cases , So what's size of this transposes on the architectural design of t
The human kidney is one of the most important organs in the human body; it performs many functions
and has a great impact on the work of the rest of the organs. Among the most important possible treatments is
dialysis, which works as an external artificial kidney, and several studies have worked to enhance the
mechanism of dialysate flow and improve the permeability of its membrane. This study introduces a new
numerical model based on previous research discussing the variations in the concentrations of sodium,
potassium, and urea in the extracellular area in the blood during hemodialysis. We simulated the differential
equations related to mass transfer diffusion and we developed the model in MATLAB Simu
Thsst researcher problem of delays faced by researchers are all waiting to evaluate their standards by the experts who must take their views to extract the truth Virtual important step first step in building standards whatsoever, then the difference of opinion among experts about the paragraphs Whatever the scope of their functions, leading to confusion in maintaining these paragraphs or delete? Or ignore the views and opinion of the researcher to maintain the same? Or as agreed upon with the supervisor if he was a student? Especially if the concepts of a modern new building.
Therefore, the researcher sought to try to find a solution to her problem to conduct an experiment to test building steps