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.
Buildings begin to deteriorate gradually over time due to several factors, including environmental influences, improper use of the building, and neglected repairs for damages during the building's life span. Effective maintenance practices can minimize operational costs, extend the life of building systems and components, improve energy efficiency, and maintain property value. This paper aims to review articles related to building maintenance to identify factors affecting maintenance practices. After conducting the review, the result was that there were 33 factors affecting building maintenance categorized into six groups: management-related factors, manpower-related factors, technical-related factors, financial-
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Objectives: The aim of the study is to evaluate the information of caregivers concerned emergency care for the elderly and to identify the relationship between caregiver information and their educational level, years of service and training courses. Methodology: A quasi-experimental study was conducted in the Geriatric Care Home in Baghdad City (the governmental and private geriatric care home ) for the period from October, 14th , 2018 to March, 20th , 2019 to find the effectiveness of the instructional program on caregivers knowledge about emergency care for the elderly.. A purposive sample (non-probability) was consisting of (30) males and females caregivers, the sample was selected from geriatric care home in Baghdad city .To implemen
... Show MoreThe study aimed at identifying the strategic gaps in the actual reality of the management of public organizations investigated to determine the strategy used based on the study model. The study relied on the variable of the general organization strategy in its dimensions (the general organization strategy, the organization's political strategy and the defense strategy of the organization) The sample of the study was (General Directorate of Traffic, Civil Status Directorate and Civil Defense Directorate), formations affiliated to the Ministry of the Interior, for the importance of the activity carried out by these public organizations by providing them In order to translate the answers into a quantitative expression in the analysi
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The COVID-19 pandemic has profoundly affected the healthcare sector and the productivity of medical staff and doctors. This study employs machine learning to analyze the post-COVID-19 impact on the productivity of medical staff and doctors across various specialties. A cross-sectional study was conducted on 960 participants from different specialties between June 1, 2022, and April 5, 2023. The study collected demographic data, including age, gender, and socioeconomic status, as well as information on participants' sleeping habits and any COVID-19 complications they experienced. The findings indicate a significant decline in the productivity of medical staff and doctors, with an average reduction of 23% during the post-COVID-19 period. T
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Groupwise non-rigid image alignment is a difficult non-linear optimization problem involving many parameters and often large datasets. Previous methods have explored various metrics and optimization strategies. Good results have been previously achieved with simple metrics, requiring complex optimization, often with many unintuitive parameters that require careful tuning for each dataset. In this chapter, the problem is restructured to use a simpler, iterative optimization algorithm, with very few free parameters. The warps are refined using an iterative Levenberg-Marquardt minimization to the mean, based on updating the locations of a small number of points and incorporating a stiffness constraint. This optimization approach is eff
... Show MoreBackground: Assessment is an important part of the learning cascade in education. Students realize it as an influential motivator to direct and guide their learning. The method of assessment determines the way the students reach high levels of learning. It has been documented that one of factor affecting students’ choice of learning approach is the way how assessment is being performed. Many methods of assessment namely multiple choice questions, essay questions and others are mainly used to assess basic science knowledge in undergraduate education. Objectives: The aim of this study is to compare multiple choice questions (MCQ) and essay questions (EQ) (record the success and failure rate of multiple choice questions (MCQ) and essay quest
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