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 surgeryKeywords: Non-surgical treatment of anal fissure, fissure in ano, sphicterotomy,botulinum toxin in anal fissures, glyceryl trinitrate. Chemical sphincteratomy, pharmacological sphincteratomy.
Study of Direct Marketing techniques and determining the scope of the suitability of each of them in the application in the Iraqi market - An analytical and explorative study for sample of views for wholesaler in Baghdad. The essential idea of the research is to go into the most important concepts which have been mentioned in the direct marketing and determining its current and most important techniques and knowing the scope of applying these techniques in Baghdad main markets (Karrada, Jamilah, shorja, Baya area, zeyouna and new Baghdad) and which of those techniques most applicable in these markets. The research took a sample of (100) wholesalers who practice the activities of selling nutritional items, auto and outs spare part
... Show MoreCompetitive advantage is a substantial strategic objective for organizations. It requires high levels in the quality of products and services provided to customers, continuous improvement of costing , care for creativity and innovative employees, and speed unique to the marketing and financial engineering, and business re-engineering processes. The situation in this area, requires actors to attract and develop human resources, including help in proper implementation of the strategic tasks that targeted by those institutions. According to the opinions and viewpoints of management scholars, the competitive advantage resource is the most important issue for organizations in the third millennium, which can be a
... Show MoreThe study aimed to reveal the extent of the first intermediate grade science curriculum focus on the national values, health, environmental, economic values, in the light of the education policy in the Kingdom of Saudi Arabia, in addition to present a proposed vision to strengthen it in the science curriculum for the first intermediate grade. The study was applied to the two books student and the two books of activity on the first-second semesters for the academic year 1441 AH. To analyze the curriculum content, the study used a verified card prepared by the researchers and a criterion for interpreting percentages. The study reached the following results: environmental values ranked first with a concentration of (43%), i.e. with an avera
... Show MoreAtenolol was used with ammonium molybdate to prove the efficiency, reliability and repeatability of the long distance chasing photometer (NAG-ADF-300-2) using continuous flow injection analysis. The method is based on reaction between atenolol and ammonium molybdate in an aqueous medium to obtain a dark brown precipitate. Optimum parameters was studied to increase the sensitivity for developed method. A linear range for calibration graph was 0.1-3.5 mmol/L for cell A and 0.3-3.5 mmol/L for cell B, and LOD 133.1680 ng/100 µL and 532.6720 ng/100 µL for cell A and cell B respectively with correlation coefficient (r) 0.9910 for cell A and 0.9901 for cell B, RSD% was lower than 1%, (n=8) for the determination of ate
... Show MoreThe flexible joint robot manipulators provide various benefits, but also present many control challenges such as nonlinearities, strong coupling, vibration, etc. This paper proposes optimal second order integral sliding mode control (OSOISMC) for a single link flexible joint manipulator to achieve robust and smooth performance. Firstly, the integral sliding mode control is designed, which consists of a linear quadratic regulator (LQR) as a nominal control, and switching control. This control guarantees the system robustness for the entire process. Then, a nonsingularterminal sliding surface is added to give a second order integral sliding mode control (SOISMC), which reduces chartering effect and gives the finite time convergence as well. S
... Show MoreThe problem of job burnout has become one of the main problems for researchers in social welfare organizations (social protection bodies) - one of the formations of the Ministry of Labor and Social Affairs. Its negative effects increased in light of the COVID-19 pandemic, and in light of the Corona pandemic, the pressures and burdens of workers varied, which resulted in high rates of anxiety, tension, and intellectual and physical exhaustion, and then negatively affected their efficiency in performing work at the individual and organizational level, especially after the increasing tasks of these Bodies in carrying out their role in achieving the general goals and objectives as beingThe general goals are that they are responsible for providi
... Show MoreConstruction projects are characterized as projects with multi phases and activities, complex, unique, and have many different parties and stakeholders. Risks could appear at one or more of the construction project stages and may affect the achievement of project objectives. Therefore, one of the key elements in the planning phase of any project is the risk management process (RMP). This study attempts to understand the terminology of risk in general, risk management, and response to risk in particular. This study is mainly a review of thirty-eight studies that have been published between 1997 and 2020 that demonstrate the importance of the crucial phase of risk response from the risk management process and its impact on
... Show MorePlagiarism is becoming more of a problem in academics. It’s made worse by the ease with which a wide range of resources can be found on the internet, as well as the ease with which they can be copied and pasted. It is academic theft since the perpetrator has ”taken” and presented the work of others as his or her own. Manual detection of plagiarism by a human being is difficult, imprecise, and time-consuming because it is difficult for anyone to compare their work to current data. Plagiarism is a big problem in higher education, and it can happen on any topic. Plagiarism detection has been studied in many scientific articles, and methods for recognition have been created utilizing the Plagiarism analysis, Authorship identification, and
... Show MoreFe, Co and Sb nanopowders were fruitfully prepared by electrical wire explosion method in Double distilled and de-ionized water (DDDW) media. The formation of iron, cobalt and antimony (FeCoSb) alloy nanopowder was monitored by X-ray diffraction. The x-ray diffraction pattern indicates that there are iron, cobalt and antimony peaks. Optical properties of this alloy nanoparticles were characterized by UV-Visible absorption spectra. The absorption peak position is shifted to the lower wavelengths when the current increases. That means the mean size of the nanoparticles controlled by changing the magnitude of the current. The surface morphological analysis is carried out by employing Scanning Electron Microscope (SEM). Particles with varies
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