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 surgery Keywords: Non-surgical treatment of anal fissure, fissure in ano, sphicterotomy,botulinum toxin in anal fissures, glyceryl trinitrate. Chemical sphincteratomy, pharmacological sphincteratomy.
In this research, the removal of cadmium (Cd) from simulated wastewater was investigated by using a fixed bed bio-electrochemical reactor. The effects of the main controlling factors on the performance of the removal process such as applied cell voltage, initial Cd concentration, pH of the catholyte, and the mesh number of the cathode were investigated. The results showed that the applied cell voltage had the main impact on the removal efficiency of cadmium where increasing the applied voltage led to higher removal efficiency. Meanwhile increasing the applied voltage was found to be given lower current efficiency and higher energy consumption. No significant effect of initial Cd concentration on the removal efficie
... Show MoreThis research attempts to shed light on a topic that is considered one of the most important topics of HRMs management, which is the Employee centric approach by examining its philosophy and understanding . To achieve the goal, the research relied on the philosophical analytical method, which is one of the approaches used in theoretical studies. The research reached a set of conclusions, the most important of which are the theoretical studies that addressed this entry in the English language and the lack of it in the Arabic language, according to the researcher's knowledge. The research reached a set of recommendations, the most important of which was that this approach needs more research, analysis and study at the practical and th
... Show MoreThe research aims to identify the role of strategic improvisation as an independent variable with its dimensions (Building the Solution, Intuition, Adaptation, and Spontaneity) and the Entrepreneurial Orientation as a dependent variable with its dimensions (Identifying Opportunities, Creativity, Adopting risk, and Vision). This research has been applied in the Rafidain Bank and its branches (Sunk, People, Al-Firdaws, and Alawiya); it used the questionnaire as a basic tool for collecting information. The sample was intentionality, which included all the heads of departments in the bank’s branches, which amounted to (33) workers, and data on the questionnaire paragraphs of 28 were processed using the SPSS V.23 and AMOS V.23). The most impor
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In a world of limited space, the owners are always surrounded by others next to them, and, consequently, there is hardly any activity which the owner may exercise on his land which would not affect the other owners. If he builds a building, that building may block the sun's rays or the air from the buildings next to it and owned by other people. And if he runs a business, the lands adjacent to that business may be overburdened with the accompanying noise or traffic. If oil is prospected in a land, the neighboring lands may be deprived of oil or their owners may be exposed to toxic fumes. Hence the importance of researching the intention of harming others, as it is one of the most important forms of abuse in the use of the right (especially
... Show MoreDeixes belong to the field of both semantics and pragmatics as they lie in the edge of these two fields. Pragmatically, they are concerned with the relationship between the structure of a language and the contexts. The present work aims at analyzing the use of deixes using Levinson’s (1983) and Yule's (1996) concept of deixes, where the latter maintained that the referents of the deixes cannot be realized apart from the context where they are used. He added that the contextual information of certain utterances involves information about the participants (the speaker and the addressee), the time and the place. Consequently, a qualitative- descriptive approach has been adopted to meet the objective of the study which reads, “exam
... Show MoreType 2 diabetes mellitus which abbreviate as T2DM is a complex endocrine and metabolic disorder arisingfrom genetic and environmental factors interaction which in turn induce various degrees of insulin functionalalteration on peripheral tissues. Globally, T2DM has develop into a public health problem. Therefore, Thestudy included (75) patients(37 female and 38 males) suffering from T2DM who visit al-kadhimiya teachinghospital with age range 20-80 years and (70) as healthy controls with age range 20-70 years. All studiedgroups were evaluated CMV IgG by ELISA,B. urea, S. Creatinine, cholesterol and triglyceride the resultsshowed that B.urea, S.creatinine and serum cholesterol showed a non-significant differences between studiedgroup,
... Show MoreThe Log-Logistic distribution is one of the important statistical distributions as it can be applied in many fields and biological experiments and other experiments, and its importance comes from the importance of determining the survival function of those experiments. The research will be summarized in making a comparison between the method of maximum likelihood and the method of least squares and the method of weighted least squares to estimate the parameters and survival function of the log-logistic distribution using the comparison criteria MSE, MAPE, IMSE, and this research was applied to real data for breast cancer patients. The results showed that the method of Maximum likelihood best in the case of estimating the paramete
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