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.
The Target costing is an important modern techniques strategic managerial accounting.which is been shown active adoption to changes in contemporary business environments Inaddition,they had been adopted by the units as aresult of the growth in the strategic approach in the man agement..the goal of using target costing is to build and strengthen competitive abilities of economic units thvough introducing appropriate ways to decrease cost and improving quality of product The hypothesis reflects interest in achieving the goal of the research,ie.research question,The hypothesis use target costing to assist economic units to decrease cost and in the manner that leads to competitive advantages while surviving and flourishing in current busines
... Show MoreBackground: Mental health is integrated into PHC as a strategy of WHO to fill the gap in mental health treatment. Part of this strategy needs a level of task shifting so that mental health care is provided by different level of PHC workers and not only specialists such as psychiatrists and psychologists.
Objectives: To assess the knowledge and attitudes of family doctors regarding the provision of psychological health in PHCC and if there is an association between the certificates of these family doctors and their Knowledge and attitudes to psychological health.
Subjects and Methods: A cross-sectional descriptive study with analytic elements was conducted in 8 famil
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This work presents a design for a pressure swing adsorption process (PSA) to separate oxygen from air with approximately 95% purity, suitable for different numbers of columns and arrangements. The product refill PSA process was found to perform 33% better (weight of zeolite required or productivity) than the pressure equalization process. The design is based on the adsorption equilibrium of a binary mixture of O2 and N2 for two of the most commonly used adsorbents, 5A & 13X, and extension from a single column approach. Zeolite 13X was found to perform 6% better than zeolite 5A. The most effective variables were determined to be the adsorption step time and the operational pressure. Increasing the adsorption step
... Show MoreDue to the lack of statistical researches in studying with existing (p) of Exogenous Input variables, and there contributed in time series phenomenon as a cause, yielding (q) of Output variables as a result in time series field, to form conceptual idea similar to the Classical Linear Regression that studies the relationship between dependent variable with explanatory variables. So highlight the importance of providing such research to a full analysis of this kind of phenomena important in consumer price inflation in Iraq. Were taken several variables influence and with a direct connection to the phenomenon and analyzed after treating the problem of outliers existence in the observations by (EM) approach, and expand the sample size (n=36) to
... Show MoreThe main objective of resources management is to supply and support the site operation with necessary resources in a way to achieve the required timing in handing over the work as well as to achieve the cost-realism within the budget estimated. The research aims to know the advantage of using GIS in management of resources as one of the new tools that keep pace with the evolution in various countries around the world also collect the vast amount of spatial data resources in one environment easily to handled and accessed quickly and this help to make the right decision regarding management of resources in various construction projects. The process of using GIS in the management and identification of resources is of extreme importance in t
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The research in the linguistic structures of the historians Al-Yaqoubi is considered a model of the important topics in historical studies in general, given its importance in the lives of peoples due to its connotations and meanings that summarize interpretation, clarification, and prolonged speech, as it includes life meanings with many dimensions, these structures have been used in historical incidents Important, and throughout the different ages, as it can be used to support an opinion, solve problems, prove evidence, increase wisdom, and it needs rich life experiences, and a sound language, to use it, and needs a wide absorptive capacity for the recipient, the research included linguistic structures in the achievement of science , Lingu
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Background: The objective of this study was to investigate the possibility of standardizing the Bolton ratio analysis as a diagnostic measure for both Iraqi and Egyptian orthodontic populations within three Angle' classification groups. Materials and methods: Two hundred forty pretreatment study casts (one hundred twenty of each population) were included in this study and divided into three Angle' classification groups. The mesiodistal crown diameters of all teeth were measured for computing the anterior and total Bolton ratios. Analysis of variance was performed to compare the mean ratios of Bolton analysis as a function of the Angle classification.HSD test was used to specify the classes of malocclusion that have significant differences.
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