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.
Hypocrisy is found in various aspects of life, whether in religion, politics, or social parts. Hence, some of the church's hypocrisy is an outcome of different ups and downs in life. Starting with the problem in the novel, some of the hypocritical pastors engaged in an immense role in affecting the folk's lives because they persuaded people that God ordered them to do so. To accomplish their personal interests, the abusive monks disguise their verbal speech, smiles, and fine clothes like mild sheep to delusional followers, leaving them with guilt, shame, and spiritual scars. The present study aims to examine the hypocrisy and heresy of the church as portrayed in Okezie Nwoka's novel entitled God of Mercy. It reflects the source of
... Show MoreThis study examines the causes of time delays and cost overruns in a selection of thirty post-disaster reconstruction projects in Iraq. Although delay factors have been studied in many countries and contexts, little data exists from countries under the conditions characterizing Iraq during the last 10-15 years. A case study approach was used, with thirty construction projects of different types and sizes selected from the Baghdad region. Project data was gathered from a survey which was used to build statistical relationships between time and cost delay ratios and delay factors in post disaster projects. The most important delay factors identified were contractor failure, redesigning of designs/plans and change orders, security is
... Show MoreThe hydraulic behavior of the flow can be changed by using large-scale geometric roughness elements in open channels. This change can help in controlling erosions and sedimentations along the mainstream of the channel. Roughness elements can be large stone or concrete blocks placed at the channel's bed to impose more resistance in the bed. The geometry of the roughness elements, numbers used, and configuration are parameters that can affect the flow's hydraulic characteristics. In this paper, velocity distribution along the flume was theoretically investigated using a series of tests of T-shape roughness elements, fixed height, arranged in three different configurations, differ in the number of lines of roughness element
... Show MoreSchools and artistic trends derive their themes from artistic styles and styles as methods followed by the artist to express his themes embodied in the values of artistic and plastic elements as symbols and signs that can be described according to the type of art school and the extent to which the artist is influenced in employing them as a goal to achieve the plastic achievement in the painting, and from those vocabulary (human beings nature Life) as encoded messages that have an appearance and an interior, the appearance of which are forms, colors, formats and distributions of space and their interior meanings and semantics embody attitudes, events and circumstances that stem from the social depth and daily life and derive their comp
... Show MoreAbstract
The researcher seeks, through different aspects of the search, to reach a set of objective concerning in content creation a clear vision about conceptual and practical dimension of relation and effects between (Leader-Member Exchange, and Organizational Commitment) to construct a framework of a pragmatic model as a solution to research problem and it questions. The theoretical problem is derived basically from the scarcity of Arab studies and researches that deal by study and analyses for such important of The two variables blend. The practical problem depends in deriving from reality of every day work in the Iraqi ministry of defense.
On this basis, a formula of research problem for pur
... Show MoreTin oxide was deposited by using vacuum thermal method on silicon wafer engraved by Computer Numerical Controlled (CNC) Machine. The inscription was engraved by diamond-made brine. Deep 0.05 mm in the form of concentric squares. Electrical results in the dark were shown high value of forward current and the high value of the detection factor from 6.42 before engraving to 10.41 after engraving. (I-V) characters in illumination with powers (50, 100, 150, 200, 250) mW/cm2 show Improved properties of the detector, Especially at power (150, 200, 250) mW/cm2. Response improved in rise time from 2.4 μs to 0.72 μs and time of inactivity improved 515.2 μs to 44.2 μs. Sensitivity angle increased at zone from 40o to 65o.
Sewer system plays an essential task in urban cities by protecting public health and the environment. The operation, maintenance, and rehabilitation of this network have to be sustainable and scientifically. For this purpose, it is crucial to support operators, decision makers and municipalities with performance evaluation procedure that is based on operational factors. In this paper, serviceability and performance indicator (PI) principles are employed to propose methodology comprising two enhanced PI curves that can be used to evaluate the individual sewers depending on operational factors such as flowing velocity and wastewater level in the sewers. To test this methodology; a case study of al-Rusafa in Baghdad city is
... Show MoreThere is no doubt that teachers are the leaders of positive changing in community where they directed the students and build their brains. In our current generation that characterized by accelerated technological development that communication changes, economic and politics, needs from the teacher an active leadership skills that match with the soul of our generation and contribute in confrontation the current challenges and the future challenges in the form that lead to create a conscious generation where they will be a basic brick for the future community where the listeners looking forward the education where they support the continuity communication of develop process, economy, scientifically and in all life fields. In our study we take
... Show MoreAn essential tool for studying the web is its ability to show how energy moves through an ecosystem. Understanding and elucidating the relationship between species variety and their placement within the inclusive trophic dynamics is also beneficial. A food web ecological model with prey and two rival predators under fear and wind flow conditions is developed in this article. The boundedness and positivity of the system’s solution are established mathematically. The stability and existence constraints of the system’s equilibria are examined. The proposed system’s persistence limitations are established. Additionally, the bifurcation analysis of every potential equilibrium is examined using the Sotomayor theorem. To describe the
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