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.
Abstract:
The internal control is the tool through which it is possible to verify and ensure the implementation of tasks in accordance with the established plans and programs and to evaluate the level of performance that is implemented within the different companies.
A guarantee from the supplier with the absence of a specialized technical committee that follows up the stages of implementing the contract and disbursing all amounts of financial dues to the supplier before completing the implementation of the contract and overlooking the non-implementation of some clauses of the contract by the committee in charge of
... Show MoreThis research aimed at identifying the factors that affecting in the recruitment of a teaching staff for the Massive Open Online Courses (MOOCs) in university teaching at the University of Khartoum. The descriptive method was followed. The questionnaire was used as a tool for data collection,, which was distributed directly to a sample of (181) respondent of the teaching staff members of the senate at University of Khartoum from those who were attend at the senate meeting No. (409) which was held on 22 August 2016 Of (272). The researcher followed for the distribution the chance method, where each questionnaire was distributed to each of a teaching staff from different faculties at the University of Khartoum, according to his willingness
... Show MoreThe aim of this study is to identify the effect of enabling the effectiveness of the work of the audit committees in private commercial banks and to identify the extent of awareness of the importance of empowerment in the work of these committees, especially as it is known that these committees, especially the inspection committees that go to private banks and from various sources including committees of the Central Bank of Iraq Committees of the Securities Commission and finally committees of the external audit offices, through an analysis of the determinants of empowerment in the performance of the most important work of the audit committees, namely: supervising the process of preparing reports, supervising the system of intern
... Show MoreBackground This study aimed to evaluate the efficacy of once-daily liraglutide as an add-on to oral antidiabetics (OADs) on glycemic control and body weight in obese patients with inadequately controlled type 2 diabetes (T2D). Methods A total of 27 obese T2D patients who received 7 months (0.6 mg/day for the first month, 1.2 mg/day for 3 months, and 1.8 mg/day for 3 months) of liraglutide treatment as an add-on to OADs were included. Data on body weight (kg), fasting plasma glucose (FPG, mg/dL), postprandial glucose (PPG, mg/dL), and HbA1c (%), were recorded. Results Liraglutide doses of 1.2 mg/day and 1.8 mg/day were associated with significant decreases in body weight (by 8.0% and 11.9%, respectively, p < 0.01 for each) and HbA1c (by 20.0
... Show MoreThis research Sheds highlights the procedural protections that must be enjoyed by the consumer in the face of the product, which is the protection of no less dangerous than the substantive protection of our obligations and duties delivered by the legislature upon the product of consumer interest, what is the benefit of the right if the access road to him complicated, so know The consumer has a right to the face of the product, but leaves the claim, either to ignorance For access to this right either to the difficulty of connecting to him.
That this research modest attempt we tried through which to focus on the way to the consumer behavior of arrived right, as we tried to highlight the weaknesses and the complexity of the procedure to
This research deals with the relationship between television advertising and buying random cosmetics, where we find that TV ads influence on the purchasing behavior of women, has conducted research in the field on a sample of women in the University of Baghdad, was a random sample taken from 150 different women in the age and social levels educational and cultural students and employees and teachers in order to sample representative be for the research community, and designed a questionnaire for this purpose form as a tool to collect data and information search and analyzed they answered the sample surveyed using a statistical program (spss) to extract percentages And correlation coefficients and testing square Kay , The study found Of w
... Show MoreThe university press is an essential pillar in building an academic community to achieve its objectives in the service of society. Since the university press is a means of university media, which is issued by the departments or units of media in Iraqi universities as academic governmental-institutions, so it highlights the activities of the university and link them to its internal society in the first place as the university press is a mirror of the university and its voice is sincerely expressed. This research comes to know the extent of interest of the university press in various student issues.
In order to identify the problem of the research, the method of content analysis was adopted within the survey method
... Show MoreThe UV−VIS absorption spectroscopy technique was used to study the formation of a new complex of charge transfer (CT) between bioactive organic molecules as (Nystatin) containing both a π-electrons from a conjugated system and lone-pair of electrons (amine) with Tetrachloro-1,4 benzoquinone (TCBQ) as a π-acceptor in which the transferred electron goes into its vacant anti-bonding molecular orbitals. The Tyrian purple-colored complex formed was quantitatively measured at 544 nm. This complex shows obeying Beer's law within the concentration range of (10-90) μg.ml-1The stoichiometry of the formed complex between the (Nys.) and (TCBQ) was found 1:2 as evaluated by continuous variation (Job's method) and mole ratio method The value of mola
... Show MoreBackground: Survey of the occlusion in population groups usually include in their objections the academic assessment of occlusal feature, the planning resources for public health treatment programmers, the comparison of different population and the screening of groups for orthodontic treatment. Likewise a thorough investigation of the occurrence of malocclusions among school–students would be of major importance in the planning of orthodontic treatment in the public dental health services. For this purpose it is necessary to have detailed information on the prevalence of individual malocclusion among boys and girls at different ages distributed regionally, and moreover, an analysis of the need for orthodontic treatment in the different sc
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