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.
Objectives: To find out the effectiveness of education program application on nurses-midwives' knowledge toward prevention and management of postpartum hemorrhage in delivery room and some socio demographic characteristics Methodology: a quasi -experimental "test-retest"design has carried throughout the present study with the application of a pre –test and post- test for nurses-midwives' knowledge toward postpartum hemorrhage. The study was conducted in six hospitals in Baghdad: Fatima Al – Zahra for Maternity and Pediatric, Al -Elwia maternity, Baghdad Teaching, AL-Imamine Al - Kadhimin Teaching, Al-Karckh maternity and Al-Yarmouk Teaching hospital for the period from 27th May
... Show MoreThe Small Indian Mongoose
In this paper the oscillation criterion was investigated for all solutions of the third-order half linear neutral differential equations. Some necessary and sufficient conditions are established for every solution of (a(t)[(x(t)±p(t)x(?(t) ) )^'' ]^? )^'+q(t) x^? (?(t) )=0, t?t_0, to be oscillatory. Examples are given to illustrate our main results.
Abstract\
Dealing economic units at the present time with an industrial environment characterized by competitiveness and the pace of change and its strength as a result of this changing environment shall be on those who made it to adopt strategies that allow them to confront these variables and work in order to meet the market requirements of quality and price appropriate products to suit and the demand for those products and conditions to maintain
its competitive position and its development.
As a result, it became the subject of competitiveness in recent years and enjoys widespread attention at the global level. And in order to keep up
... Show MoreInvestment in high education is considered to be most important factors of production which the return an individual and social than economic returns found by searching the growing problem of unemployment, especially among youth graduates, where the unemployment rate in 2010 (50%) of these high rates have led to increased migration of scientific minds graduate recently, "to search for job opportunities outside Iraq for not hiring functions and this is in vain" clear "in the human and financial resources lead to structural imbalances in the Iraqi economy. When calculating the correlation coefficient between the graduates and the unemployment rate where it reached (0.21) emerged from the results of
... Show MoreThis work describes the effect of temperature on the phase transformation of titanium dioxide (TiO2) prepared using metal organic precursors as starting materials. X-ray diffraction (XRD) was used to investigate the structural properties of TiO2 gels calcined at different temperatures (300, 500, 700) ?C. the results showed that the samples have typical peaks of TiO2 polycrystalline brookite nanopowders after calcined at (300 ?C), which confirmed by (111), (121), (200), (012), (131), (220), (040), (231), (132) and (232) diffraction peaks. Also, XRD diffraction spectra showed the presence of crystallites of anatase with low proportion of rutile phase where calcined at (500 ?C), while rutile phase domains at (700 ?C). The crystallite size of
... Show MoreThe main object of this paper is to study the representations of monomial groups and characters technique for representations of monomial groups. We refer to monomial groups by M-groups. Moreover we investigate the relation of monomial groups and solvable groups. Many applications have been given the symbol G e.g. group of order 297 is an M-group and solvable. For any group G, the factor group G/G? (G? is the derived subgroup of G) is an M-group in particular if G = Sn, SL(4,R).
The article considers metaphors as one of the fundamental means used by L. Ulitskaya when writing the family chronicle "Medea and her Children" (1996), for the formation of images of heroines - representatives of the pronounced feminine principle in the work. Here I describe the results of the next stage of research related to the work of Lyudmila Evgenievna Ulitskaya as a representative of modern Russian prose.
The objective of drilling parameters optimization in Majnoon oilfield is to arrive for a methodology that considers the past drilling data for five directional wells at 35 degree of inclination as a baseline for new wells to be drilled. Also, to predicts drilling performance by selecting the applied drilling parameters generated the highest rate of penetration (ROP) at each section. The focal point of the optimization process is to reduce drilling time and associated cost per each well. The results of this study show that the maximum ROP could not be achieved without sufficient flow rate to cool and clean the bit in clay intervals (36" and 24") hole sections. Although the influence of combination of Weight on Bit (WOB), Round per minute
... Show MoreAvery large numbers of articles are made by powder metallurgical methods using electrolytically reduced metal powders. Iron powder is one of these powders which play an important role in this field. Its preparation by electrolytic method is economic in comparison with the traditional methods (Atomization and carbonyl processes).
An electrochemical cell consisting of two electrodes (stainless steel cathode and iron anode, 99.9%) was used to study the electrolytic preparation of iron powder with particle size less than 106µm directly as powde1y form. Ferrous sulphate electrolyte was used containing sodium chloride as a stabilizing agent. The produced powder was thoroughly washed with an acidified distilled water and absolute ethan
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