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.
Phthalimide formation of Phthalic anhydride with various amines using microwave or without a method with the difference of the catalyst used in a prepared Phthalimide, either structure general are C6H4CONRCO and used as starting materials in synthesis several compounds derivative phthalimides are an important compounds because spectrum wide biological activities including Antimicrobial activity, anticonvulsant activity, Anti-inflammatory activity,Analgesic activity, Anti- influenza activity and Thromboxane inhibitory activity
As the prices of the fuel and power had fluctuated many times in the last decade and new policies appeared and signed by most of the world countries to eliminate global warming and environmental impact on the earth surface and humanity exciting, an urgent need appeared to develop the renewable energy harnessing technologies on the short-term and long-term and one of these promising technologies are the vertical axis wind turbines, and mostly the combined types. The purpose of the present work is to combine a cavity type Savonius with straight bladed Darrieus to eliminate the poor self-starting ability for Darrieus type and low performance for Savonius type and for this purpose, a three-bladed Darrieus type with symmetric
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The way used to estimate the fuzzy reliability differs according to the nature of the information of failure time which has been dealt in this research.The information of failure times has no probable distribution to explain it , in addition it has fuzzy quality.The research includes fuzzy reliability estimation of three periods ,the first one from 1986 to 2013,the second one from 2013 to 2033 while the third one from 2033 to 2066 .Four failure time have been chosen to identify the membership function of fuzzy trapezoid represented in the pervious years after taking in consideration the estimation of most researchers, proffional geologists and the technician who is incharge of maintaining of Mosul Dam project. B
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Abstract
The research problem focuses on studying the interest of the Medical City Department of the Ministry of Health in improving the creative thinking skills of the administrative leadership through parallel & comprehensive thinking according to the of six thinking hats strategy. The research sample consisted of (170) administrative leaders in the upper & middle organizational levels, The questionnaire was used as a main tool for data collection, In addition to the observation & Interview, The research sought to answer the following questions: What is the extent to which the administrative leadership (Tpp & middle) in the organization investigated the concept of the six thinkin
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The research aims to find out the relationship between the medical and nursing staffing and its impact on the quality of provided health service in the Yarmouk Teaching Hospital, and to understand the nature of the relationship between doctors and nurses, it has been the adoption of cooperation and conflict Kmngaran independent knowledge of the relationship between doctors and nurses and the quality of health service as a variable certified by eating five dimensions (tangibility, reliability, safety, responsiveness, empathy). The research was adopted to collect data on the questionnaire prepared medical and nursing to the angel and adopted included Likert Quintet her, and distributed to doctors working in the Yarmouk hospital in
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