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.
The research aims to clarify the COBIT5 framework for IT governance and to develop of a criterion based on Balanced Scorecard that contributes in measuring the performance of IT governance. To achieve these goals, the researchers adopted the deductive approach in the design of balanced scorecard to measure the IT governance at the Bank of Baghdad that was chosen because it relied heavily on IT.
The research has reached a number of conclusions, the most important of which is that the performance of IT department in the Bank of Baghdad falls within the good level that requires constant monitoring, the most committed items of Balanced Scorecard by the Bank were customer, internal operation, growth and finally the financial item; IT
... Show MoreThe current research aims at finding out how to properly and correctly manage waste and solid waste and reduce the difficulties faced by all countries. However, it is becoming increasingly acute in developed cities because their economies are growing rapidly. It is necessary to identify the modern methods used in developed countries in managing wastes. The use of modern waste management techniques is a coordinated effort by international agencies within the borders responsible for them. The problem of the study can be identified in the lack of clarity of environmental management procedures in place. The importance of the research contributes to providing greater capacity to the administrative and technical leadership in the municipality
... Show MoreThe accounting system of government is considered an important tool to follow up the financial transactions that reflect the activities of governmental units and by which the useful information for estimating governmental annual revenues and expenditures are provided through the state public budget because it is an information system that provides detailed past performance, as well as measures the efficiency of the governmental agencies performance in implementing the budget, and the of success governmental units is measured through the type of services and programs offered, their size and the possibility of achieving the objectives assigned to them. The medical evacuation program is one of the medical and curative health services provid
... Show Morethose affected by technological development risks within the scope of medical works. The unprecedented technological development the world witnesses nowadays has been providing brilliant medical service to the human being including examination, diagnosis and the treatment or follow up. However, such works hide behind potential risks threatening people's lives and such risks my be discovered within the limits of now – how and technical knowledge prevailing the time of rendering the medical service. Also this the question is raised on how to keep up between the safety of the patients and such risks are being unknown by the provider and questioning them contradicts the justices. subsequently, can the patients (affected) acquire the compensat
... Show MoreThe growth of developments in machine learning, the image processing methods along with availability of the medical imaging data are taking a big increase in the utilization of machine learning strategies in the medical area. The utilization of neural networks, mainly, in recent days, the convolutional neural networks (CNN), have powerful descriptors for computer added diagnosis systems. Even so, there are several issues when work with medical images in which many of medical images possess a low-quality noise-to-signal (NSR) ratio compared to scenes obtained with a digital camera, that generally qualified a confusingly low spatial resolution and tends to make the contrast between different tissues of body are very low and it difficult to co
... Show MoreBackground: A carefully planned clinical medical education is critical for the provision of supportive clinical educational environment. The latter will ensure effective teaching, active learning and good attitudes and performance at the bedside. The aim of this study was to evaluate clinical learning environment at AL-Diwaniyah Teaching Hospital. Materials and Methods: A descripitive cross-sectional study involved resident doctors from Internal Medicine and Surgery departments who had six months or more residency training in the respective departments. Data were collected using the Postgraduate Hospital Educational Environment Measure. Data where analyzed using the Statistical Package for Social Sciences version 21.0 and presented us
... Show MoreCloud-based Electronic Health Records (EHRs) have seen a substantial increase in usage in recent years, especially for remote patient monitoring. Researchers are interested in investigating the use of Healthcare 4.0 in smart cities. This involves using Internet of Things (IoT) devices and cloud computing to remotely access medical processes. Healthcare 4.0 focuses on the systematic gathering, merging, transmission, sharing, and retention of medical information at regular intervals. Protecting the confidential and private information of patients presents several challenges in terms of thwarting illegal intrusion by hackers. Therefore, it is essential to prioritize the protection of patient medical data that is stored, accessed, and shared on
... Show More