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
Leadership has now become a process for applying methods and techniques that make the Organization at the top of its competitive pyramid a greater market share. Leadership has become a focus for all leaders and managers، and leaders and managers are increasingly seeking to develop their skills and leadership skills. The research started with a clear problem of specific questions to ensure that the general objective of the research is to describe the characteristics of the leader and to clarify the dimensions of empowering the workers and to highlight the role of the leader in empowering the workers. The study examines the relation between the role of the leader in
... Show MoreAn experimental investigation of natural convection heat transfer from an isothermal horizontal,vertical and inclined heated square flat plates with and without circular hole, were carried out in two cases, perforated plates without an impermeable adiabatic hole "open core" and perforated plates with an impermeable adiabatic hole "closed core" by adiabatic plug. The experiments covered the laminar region with a range of Rayleih number of (1.11x106 ≤RaLo≤4.39x106 ), at Prandtle number (Pr=0.7). Practical experiments have been done with variable inclination angles from horizon (Ф=0o ,45o,90o,135oand 180o),facing upward (0o≤Ф<90o), and downward (90o
≤Ф<180o). The results showed that the temperature gradient increases whi
Background: Medication reconciliation can include medication reviewing and providing counseling and a list of all the medications during every transition of care. Objectives: to explore in-depth the perspectives of Iraqi physicians and pharmacists regarding the necessity of medication reconciliation at hospital discharge and identify the possible benefits and challenges that could face its implementation. Subjects and Methods: A qualitative study included semi-structured interviews with pharmacists and physicians working at a public teaching hospital in Iraq. The interviews were conducted face-to-face from February to March 2023. Thematic analysis was used to analyze the qualitative data generated from the interviews. Results: In th
... Show MoreThis article reports the first record of Aenasius arizonensis (Girault, 1915) (Hymenoptera, Encyrtidae) parasitizing the recently introduced species of cotton mealybug, Phenacoccus solenopsis Tinsly (Hemiptera, Psedococcidae) infesting Lantana camara L. (Verbeneceae) as well as other ornamental plants in Baghdad province, Iraq. A short morphological description is also presented.
The study aimed to recognize the impact of polygamy on academic achievement and self-confidence among Sattam bin Abdul Aziz University students. To achieve this goal, the researchers used the Descriptive Analytical method using The Self Confidence measurement ,that has been prepared for the purposes of this study, consists set of 29 questions, then applied to the students sample that emerges from polygamy and one- wife families, study sample consists of randomly selected 230 students registered for the year .1435-1436
The results of the study showed presence of medium statistical impact on the significance level (a 4 0.05), this proof significant statistical effect of polygamy on self-confidence among the sample of Prince Sat-tam Univ
Background. The presence of black triangles around the dental implant-supported prosthesis and the failure to construct adequate papillae around them bothers dental implantologists. Peri-implant surgical soft tissue management will improve esthetics, function, and implant survival. Aim. To compare the effects of rolled and nonrolled U-shaped flaps combined with a temporary crown in enhancing the soft tissue around dental implants. Materials and Methods. Forty patients were included in this study; all patients were operated on by the same maxillofacial surgeon at Al-Iraq specialized dental clinics from January 2019 to January 2020. Patients were divided randomly into two groups: group A: at the second stage of implant surgery, a U-sh
... Show MoreThe Arab realized that proverbs and their stories had a great literary and linguistic significance, accordingly, they collected them from their sources and wrote them down. Thus, researchers went in studying them in different directions. The aim of the present research is thus to study the stories of proverbs in the Holy Qur’an, Prophet’s hadiths, and in the sayings of Arabs. Such a study helps to show the extent of the relevance of their stories to the proverbs, their literary values, the points of convergence between them and what they highlight, and the extent of their proximity to reality. It further helps to determine the factors that contributed to the transformation of Quranic verses, Prophet’s hadiths, and some phrases of s
... Show MoreThe current research aims to study the extent to which the Independent High Electoral Commission applies to information security risk management by the international standard (ISO / IEC27005) in terms of policies, administrative and technical procedures, and techniques used in managing information security risks, based on the opinions of experts in the sector who occupy positions (General Manager The directorate, department heads and their agents, project managers, heads of divisions, and those authorized to access systems and software). The importance of the research comes by giving a clear picture of the field of information security risk management in the organization in question because of its significant role in identifying risks and s
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