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 research addresses a problem manifested in a main question: what is the role of the digital media in marketing the artistic products? in order to determine the role played by the digital media in the disclosure and promotion of the artistic product, its price and places of distribution, as the basic elements of the marketing mixture.
This is a descriptive research in which the researcher used the survey method to check the opinions of a sample chosen according to the (proportion) method from the research community represented by instructors and students of the college of Fine Arts- University of Dayala.
... Show MoreRecently, there has been an increasing advancement in the communications technology, and due to the increment in using the cellphone applications in the diverse aspects of life, it became possible to automate home appliances, which is the desired goal from residences worldwide, since that provides lots of comfort by knowing that their appliances are working in their highest effi ciency whenever it is required without their knowledge, and it also allows them to control the devices when they are away from home, including turning them on or off whenever required. The design and implementation of this system is carried out by using the Global System of Mobile communications (GSM) technique to control the home appliances – In this work, an ele
... Show MoreThe basic objective of the research is to study the quality of the water flow service in the Directorate of Karbala sewage and how to improve it after identifying the deviations of the processes and the final product and then providing the possible solutions in addressing the causes of the deviations and the associated quality gaps. A number of quality tools were used and applied to all data Stations with areas and activities related to the drainage of rainwater, as the research community determines the stations of lifting rainwater in the Directorate of the streams of Karbala holy, and the station was chosen Western station to apply the non-random sampling method intended after meeting a number of. It is one of the largest and m
... Show MoreThe objective of an Optimal Power Flow (OPF) algorithm is to find steady state operation point which minimizes generation cost, loss etc. while maintaining an acceptable system performance in terms of limits on generators real and reactive powers, line flow limits etc. The OPF solution includes an objective function. A common objective function concerns the active power generation cost. A Linear programming method is proposed to solve the OPF problem. The Linear Programming (LP) approach transforms the nonlinear optimization problem into an iterative algorithm that in each iteration solves a linear optimization problem resulting from linearization both the objective function and constrains. A computer program, written in MATLAB environme
... Show MoreThis study presented an endeavour to integrate the value chain activities with the Balanced Scorecard for a comprehensive evaluation of an organization’s strategic performance. It also demonstrated the connection and the integration of the activities of the value chain with the Balanced Scorecard. The financial measurement was linked with non-financial measurement by integrating these techniques to achieve an appropriate performance that supports all aspects of the organizational performance. Consequently, the research problem in this study emerged, which is due to the concentration of many organizations on the measurement of financial performance. Notably, the latter caused the decline of some organizations from the competitive market. T
... Show MoreThe consumption of fresh fruits has increased nowadays due to the lifestyle of the consumers. Maintaining the quality and nutritional value of cut fruits during storage is difficult compared to whole fruits. Deterioration of internal and external quality usually occurs in freshly harvested fruits. It is necessary to use different techniques to maintain the quality and increase the shelf life of the freshly cut product. This research studied the effect of treating apple slices with cold plasma once and with filtered water again on quality characteristics (hardness, moisture content, sugar content, carbohydrate content, and color) after being stored for five days. The best treatment was determined using two different pressures of the plasma j
... Show MoreThe tests that measure special strength defined by speed contributes a great deal in evaluating the players' weaknesses and strengths so as to aid coaches judge their players according to scientific and objective measurements. The problem of the study lies in answering the following question : is there a test that measures legs' vertical strength defined by speed especially for youth basketball players? The aim of the research was to construct and standardize a test for measuring legs' vertical strength defined by speed in youth basketball. The subjects of the study were 74 youth basketball players from Baghdad. The researchers concluded that the test measures leg's vertical strength defined by speed for youth basketball players as well as
... Show MoreObjectives: The study aims to evaluate patients’ performance toward insulin injection after training program to
identify the variation in skill of patients in insulin injection technique with regard to some variable (i.e.
educational level and duration of insulin injection.
Methodology: A quasi experimental study has been conducted on diabetic patients.
An observational checklist had been prepared which consisted of 4 main areas with 37 sub-items, which are
syringe preparation for injection, insulin drawing; skin preparation for injection and insulin injection. Each of the
sub-items has 2 options yes or no. One score for positive answer and zero for no.
The sample of the study consisted of (n =30) males and females
The Planning and Resource Development Department of the Iraqi Ministry of Health is very interested in improving medical care, health education, and village training programs. Accordingly, and through the available capabilities of the ministry, itdesires to allocate seven health centers to four villages in Baghdad, Iraq therefore the ministry needs to determine the number of health centers allocated to each of these villages which achieves the greatest degree of the overall effectiveness of the seven health centers in a fuzzy environment. The objective of this study is to use a fuzzy dynamic programming(DP) method to determine the optimal allocation of these centers, which allows the greatest overall effectiveness of these health centers
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