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 find out the effect of Cognitive Acceleration strategy and random excitement strategy in achievement of geography material and developing the reflective thinking for students of literary fifth class .
the researcher depended a partial control experimental design with the three groups(the competence groups of the pre & post tests), The sample is deliberately selected from first AL-Rusafah Directorate General of Education in Baghdad. AL.fardoos Interme
... Show MoreTaxes are an essential axis in the economy as the most effective and effective economic tool in any country (economy). Expanding the scope of taxation without adequate study has produced a dangerous result with a negative impact that is almost apparent, namely (tax evasion), which stands as a barrier preventing the state from reaching Therefore, the research sought to study strategic tax planning and its importance in reducing tax evasion, and the research aims from that to prove the importance of adopting strategic planning in the field of taxes according to modern and effective scientific foundations to reduce tax evasion to enhance the achievement of tax evasion. The financing objective is in addition to the other objectives,
... Show MoreIs a high degree of economic freedom an important part in the development of the economies of developing countries in the last decade of the twentieth century and the beginning of the twentieth century and the atheist. This is because a test subject (deltoid analysis of the relationship between the degree of economic freedom and foreign trade of selected developing countries for the period
( 1990 -2005) to determine the degree of economic freedom in foreign trade promotion in Singapore and Turkey. The research recommends a number of recommendations, the most important is the responsibility of the Ministry of Planning in Iraq that is providing the necessary data for the Fraser Institute, the aim of increasing cooperation
Abstract
The study aims to identify the extent to which the applied colleges at the University of Technology and Applied Sciences meet the comprehensive quality standards in light of the national education strategy for the 2040 Vision in the Sultanate of Oman. To do this, the researchers used the descriptive approach. They used a questionnaire as a tool for data collection that was applied to (237) administrators, academics, and support functions. The study found that the extent to which the applied colleges at the University of Technology and Applied Sciences meet the comprehensive quality standards in the light of the National Education Strategy 2040 in the Sultanate of Oman recorded a high range. The study als
... Show MoreMagnetic Abrasive Finishing (MAF) is an advanced finishing method, which improves the quality of surfaces and performance of the products. The finishing technology for flat surfaces by MAF method is very economical in manufacturing fields an electromagnetic inductor was designed and manufactured for flat surface finishing formed in vertical milling machine. Magnetic abrasive powder was also produced under controlled condition. There are various parameters, such as the coil current, working gap, the volume of powder portion and feed rate, that are known to have a large impact on surface quality. This paper describes how Taguchi design of experiments is applied to find out important parameters influencing the surface quality generated during
... Show MoreThere is a great operational risk to control the day-to-day management in water treatment plants, so water companies are looking for solutions to predict how the treatment processes may be improved due to the increased pressure to remain competitive. This study focused on the mathematical modeling of water treatment processes with the primary motivation to provide tools that can be used to predict the performance of the treatment to enable better control of uncertainty and risk. This research included choosing the most important variables affecting quality standards using the correlation test. According to this test, it was found that the important parameters of raw water: Total Hardn
The added value of internal audit greatly contributes to adding value to the institution, but most departments of economic units in Iraq neglected the role of internal audit and the added value that can be achieved by those institutions, since the term added value of internal audit is a relatively vague term from the premise that what cannot be measured is difficult Determine it, and perhaps descriptive standards for it is the extent of compliance with international auditing standards (IIA).
The research aims to study the procedures and results of auditing to verify that they have given an added value to the audit with a positive impact, develop its aspects and research, identify deficiencies for the audi
... Show Moreيحتل موضوع الاستهلاك اهمية كبيرة في الدراسات الاقتصادية في حالتي السلم والحرب وذلك لارتباط هذا الموضوع بالانسان والمجتمع ولكونه احد مؤشرات مستوى الرفاهية الاقتصادية والاجتماعية وتزداد اهمية ضبط حركة هذا المتغير السلوكي والكمي في زمن الحرب اكثر مما هو عليه في حالة السلم، في هذا البحث تم استخدام بيانات احصائية عن الانفاق الاستهلاكي الخاص ونصيب الفرد من الدخل القومي اضافة الى الرقم القياسي لاسعار المس
... Show MoreThe risk assessment for three pipelines belonging to the Basra Oil Company (X1, X2, X3), to develop an appropriate risk mitigation plan for each pipeline to address all high risks. Corrosion risks were assessed using a 5 * 5 matrix. Now, the risk assessment for X1 showed that the POF for internal corrosion is 5, which means that its risk is high due to salinity and the presence of CO, H2S and POF for external corrosion is 1 less than the corrosion, while for Flowline X2 the probability of internal corrosion is 4 and external is 4 because there is no Cathodic protection applied due to CO2, H2S and Flowline X3 have 8 leaks due to internal corrosion so the hazard rating was very high 5 and could be due to salinity, CO2, fluid flow rate
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Abstract has many advantages as has historically been one of the regions leading cultural centers . for centuries , it has been a center of commertial and financial operations in Iraq. it is also rich in archeological sites and natural resources, but because of its wars and implementation of urban development strategies are effective and sustainable , so contracted the secretariat of Baghdad with the company (khatib and scirntiffic) for the preparation of the comprehensive development plan for the city of Baghdad in 2030 and funded by the world bank and the fact that the plan was approved ( three stages of it ) and only one phase remains the fourth stage, which is under discussion the aim of the
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