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.
This study aims to evaluate the performance of emergency departments according to international standards through studying the performance in some of Iraqi public hospitals, where the evaluation performance is considered one of the important topics that take a great deal of officials' attention, especially decision makers in health organizations.
The researcher has derived the research idea from the importance of work in emergency department in hospitals and to what it provides of medical services and quick and immediate nursing care that help in patients' lifesaving, and it is the mirror that reflects the real image for the hospital
... Show Morethe researchers Sought to determine the impact of the customer contact (Within a client contact there are two times, first is the total time required to create a service and within it there is contact time while the second time is the time of client contact ؛ where means a time that records the physical presence of the customer during the process of service) on operations performance by concentrate attention on the cost (labor productivity) and quality (patient ratio to the doctor) and speed (cycle time) and flexibility (the flexibility range) , as well as ruling out variable of innovation because of impossibility to measure this variable in the Specialty Center for Dental in al-alwia due to the center is lacking of mechanisms t
... Show MoreThe higher education has become an enterprise integrate system that described as knowledge society, the essential part in its electronic and virtual format in the shadow of globalization challenges with its various dimensions . Until the logical ryles aboat a strategic partnership between the Iraqi higher education establishments and their international equivalent ones Strategic windows should be invested for the purpose of enhancing the quality of higher education in a sustainable way. This forms a challenge before the international education leaders on the social, operational and establishment's level to determinte knowledge gap, observing, diagnosing and processing in the present and future, e
... Show MoreThe use analysis value chain such information in the provision as financial so information quality meet and satisfy the needs of users such information , particularly investors and lenders as the identification needs financial information and the knowledge as their behavior influenced by that information can be based on the accounting profession to focus on improving their function in order to achieve its goal that satisfying their needs and rationalize their decisions . In accounting thought discovered fertile ground for users preferences as one of the entrances theorising positive which is based on the need to include knowledge on accounting hypothesis that explain the
... Show MoreThis research aims to measure the productivity of nursing services and recognize the reality of providing such services in some public hospitals in the province of Diyala, as well as identify the most important factors affecting the productivity of nursing services, and developer measure adopted by the researcher (Kien, 2012), which includes seven factors (workforce , management team, stimulation, pressure of working hours (time), material / equipment, supervision, safety), Used the experimental method in the search, one of the private scientific research curriculum depends primarily on the scientific experiment and study of the subject, or a scientific phenomenon, which provides an opportunity to learn the facts
... Show MoreIncreasing world demand for renewable energy resources as wind energy was one of the goals behind research optimization of energy production from wind farms. Wake is one of the important phenomena in this field. This paper focuses on understanding the effect of angle of attack (α) on wake characteristics behind single horizontal axis wind turbines (HAWT). This was done by design three rotors different from each other in value of α used in the rotor design process. Values of α were (4.8˚,9.5˚,19˚). The numerical simulations were conducted using Ansys Workbench 19- Fluent code; the used turbulence model was (k-ω SST). The results showed that best value for extracted wind energy was at α=19˚, spread distance of wak
... Show MoreTransparent nano- coating was prepared by Sol-Gel method from titanium dioxide TiO2 which has the ability to self-cleaning coating used for hospitals, laboratories, and places requiring permanent sterilization. Three primary colors are selected (red, blue, and yellow) as preliminary study to the effect of these colors on the nano-coating. Three traditional oil paints color were used as base, then coated by a layer of TiO2-Sol and deposited on the paints. The optical properties of TiO2-Sol were measured; the maximum absorption wavelength at (λmax=387 nm), the refractive index (n=1.4423) and the energy band gap (Eg=3.2 eV). The structure properties found by X-ray diffraction of TiO
Abstract
Experimental work from Magnetic Abrasive Finishing (MAF) tests was carried out design parameters (amplitude, and number of cycle which are formed the shape of electromagnetic pole), and technological parameters (current, cutting speed, working gap, and finishing time) all have an influence on the mechanical properties of the surface layer in MAF process. This research has made to study the effect of design and technological parameters on the surface roughness (Ra), micro hardness (Hv) and material removal (MR) in working zone. A set of experimental tests has been planned using response surface methodology according to Taguchi matrix (36) with three levels and six factors
... Show MoreA New Spectrophotometric Methods are improved for determination Metronidazole (MTZ) and Metronidazolebenzoate (MTZB) depending on1STand 2nd derivative spectrum of the two drugs by using ethanol as a solvent. Many techniques were proportionated with concentration (peak high to base line, peak to peak and peak area). The linearity of the methodsranged between(1-25µg.ml-1) is obtained. The results were precise and accurate throw RSD% were between (0.041-0.751%) and (0.0331-0.452%), Rec% values between (97.78, 101.87%) and (98.033-102.39%) while the LOD between (0.051-0.231 µg.ml-1) and (0.074-1.04 µg.ml-1) and LOQ between (0.170-0.770µg.ml-1) and (0.074-0.313 µg.ml-1) of (MTZ) and of (MTZB) respectively. These Methods were successfully ap
... Show MoreA checklist of the wild mammals of Syria including their current status and geographical distribution is provided. Data related to 110 mammalian species were collected following a comprehensive review of available literature records, grey data, and online observations combined with photographic evidence and in situ surveys carried out between 2006 and 2023. The checklist comprises seven orders, 36 families, 73 genera (subgenera), and 110 species, and includes data on 15 globally threatened species of wild mammals. Overall, we report up-to-date information on taxonomic revisions, historical and current geographical range, as well as the conservation status recently assessed by the International Union for Conservation of Nature (IUCN)
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