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.
Objective: To identify causes of maternal death in Mizan Aman and Gebretsadik shawo general hospitals
Methodology: A case control study on 595 charts, 119 cases and 476 controls was conducted in Mizan
Aman & Gebretsadik shawo general hospitals. Data was analyzed by STATA 13.1. Propensity score
matching analysis was used to see causes of maternal death.
Results: Hemorrhage were the main direct causes of maternal death which accounts 47.9% (β =0.58
(95% CI (0.28,0.87)) in hospital but when projected to population based the sample (β =0.26 (95% CI
(0.22,0.31)). Followed by infection 36 (25.21%) (β = 0.50 (95% CI (0.08, 0.92)). when projected to
population based the sample PIH 7.6%) is significant cause (β = 0.16
The research aims to recognize the impact of the training program based on integrating future thinking skills and classroom interaction patterns for mathematics teachers and providing their students with creative solution skills. To achieve the goal of the research, the following hypothesis was formulated: There is no statistically significant difference at the level (0.05) between the mean scores of students of mathematics teachers whose teachers trained according to the proposed training program (the experimental group) and whose teachers were not trained according to the proposed training program (the control group) in Pre-post creative solution skills test. Research sample is consisted of (31) teachers and schools were distribut
... Show MoreThe topic of strategic intelligence is considered as important topics that acquires the attention of organizations, Because of its role in supplying the decision-making centers by strategic ideas according to the opportunities and threats facing the organization, in an effort to improve the performance of their organizations to reach the high performance organization.
A lot of organizations lack to strategy guides the strategic intelligence towards achieving high performance organization.
This research aims to determine the level of strategic intelligence that characterized the leaders of diseases and kidney transplant center in Medicine city. What is the application level of the
... Show MoreEven though in recent decades a bulk of studies have been accomplished on the use of communicative language teaching (CLT) in English as a foreign language (EFL) environments, fairly a limited numbers of studies precisely dealt with investigating the attitudes of language teachers, students and supervisors concerning the principals of CLT in the context of Iraq. Henceforth, this study was designed to delve into the attitudes of teachers, learners and supervisors about the implementation. To this end, the study was accomplished using a mixed method design. The present study was carried out in two phases: designing and using a questionnaire plus interviewing the teachers, students and supervisors (51 language learners, 41 teachers and
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The habitat type and food availability always influence the population size of many
organisms. Bird’s feeding pattern should be abstracted to complete avian community structure
data. The agronomy main research farm of Orissa University of Agriculture and Technology
is a well-managed multi-crop agro-ecosystem which provides a suitable ground for ecological
research. In a multi-crop farmland, the association of Barn Swallow Hirundo rustica Linnaeus,
1758, with the Indian mustard Brassica juncea (L.) Czernajew, 1859 crops have been
recorded for the first time while hovering only on this field. A flock of Barn swallows was
recorded in 32 field visits while flying continuously over the Indian mustard field after
flow
The research aims to identify the effect of the training program that is based on integrating futuristic thinking skills with classroom interaction patterns on mathematics teachers in order to provide their students with creative solution skills. The research sample consisted of 31teachers (15 teachers for the experimental group and 16 for the control groups). The researcher developed a measure for the academic self-efficacy consisting of (39) items. Its validity, reliability, coefficient of difficulty and discriminatory power were estimated. To analyze the findings, the researcher adopted the Mann-Whitney (U) test and the effect size, and the findings were as follows: There is a statistically significant difference at the significance leve
... Show MoreThe cost-effective carbon cross-linked Y zeolite nanocrystals composite (NYC) was prepared using an eco-friendly substrate prepared from bio-waste and organic adhesive at intermediate conditions. The green synthesis method dependent in this study assures using chemically harmless compounds to ensure homogeneous distribution of zeolite over porous carbon. The greenly prepared cross-linked composite was extensively characterized using Fourier transform infrared, nitrogen adsorption/desorption, Field emission scanning electron microscope, Dispersive analysis by X-ray, Thermogravimetric analysis, and X-ray diffraction. NYC had a surface area of 176.44 m2/g, and a pore volume of 0.0573 cm3/g. NYC had a multi-function nature, sustained at a long-
... Show MoreAbstract
This Research aims for harnessing critical and innovative thinking approaches besides innovative problem solving tools in pursuing continual quality improvement initiatives for the benefit of achieving operations results effectively in water treatment plants in Baghdad Water Authority. Case study has been used in fulfilling this research in the sadr city water treatment plant, which was chosen as a study sample as it facilitates describing and analyzing its current operational situation, collecting and analyzing its own data, in order to get its own desired improvement opportunity be done. Many statistical means and visual thinking promoting methods has been used to fulfill research task.
... Show More- coli K12 and B. subtilis 168 were investigated for their cadmium and mercury tolerance abilities. They were developed by UV mutagenesis technique to increase their tolerances either to cadmium or mercury, and their names then were designated depend on the name and concentration of metals. E. coli K12 Cd3R exhibited bioremediation amount of 6.5 mg Cd/g dry biomass cell. At the same time, its wild-type (E. coli K12 Cd3) was able to remove 5.2 mg Cd/g dry biomass cell in treatment of 17 mg Cd /L within 72 hours of incubation at 37 °C (pH=7) in vitro assays. The results show that E.coli K12 Hg 20 was able to remove 0.050 µg Hg/g dry biomass cell