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 aim of the research is to measure the length between the variable the efficiency of the tax examiner with its dimensions represented by (scientific questions, practical process (experience), training and development, impartiality and independence, ethics of the profession) and the approved variable discovering the artificial adaptation of profits, and the degree of arrangement of those dimensions its importance and priority, and the research problem has been identified In a main question that is there any effect of copying the images of the image examiner in discovering the adaptation, the financial statements and reports of the companies (X, Y) and the banks (A, B) were relied on in the interpretation of the results, t
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Objectives: To assess nurses' attitude toward end of life phase. To find out relationships between nurses attitude and socio demographic data (age, gender, level of education, years of experience).
Methodology: A descriptive cross-sectional study design is carried out to assess the attitude on nurses concerning patient at the end of life phase at critical care units, from the period of (1nd November 2021) to (1th February 2022). A probability sample random sampling technique used. Then, the number of participants in Baquba Teaching Hospital and general al khalis hospital were determined by using rando
... Show MoreThe purpose of this research is to highlight the relationship between the administrative investigation and the improvement of institutional performance, and the research sought to achieve a set of cognitive and applied goals. the administrative investigation is the modern trend of managing the offices of the general hginspectors and the main source to build the necessary standards to manage and invest its resources efficiently and effectively required to achieve the goals it seeks. The institutional performance is the cornerstone for the implementation of all tasks and duties carried out by institutions operating within the borders of a particular country, The significant change
... Show MoreThe aim of the research is to provide an analytical study to promote financial inclusion in Iraq by clarifying the opportunities and challenges of the economic and demographic situation in Iraq, studying the structure of the financial system and introducing non-bank financial institutions operating in Iraq, and using the descriptive approach. Analytical in the study of the phenomenon of research, the research reached a number of conclusions, the most prominent of which were:
- Iraqi society is a young society.
- The majority of the population is 70 percent. They live almost in urban areas.
- The coverage of bank branch networks is concentrated in only four provinces, leaving other provinces outside financial
In the 1970s, the world knew the long-tailed nesokia Nesokia bunnii (Khajuria, 1981) (Rodentia, Muridae) from the Mesopotamian marshes of Garden of Eden in Southern Iraq. This distinct rodent was known from only five voucher specimens collected at the confluence of Tigris and Euphrates Rivers in southern Iraq while its occurrence in Southwestern Iran had
never been reported. In the 1990s, a large extent of its natural habitat was catastrophically desiccated and the animal was last seen in the 1970s. Since then, the status of this elusive rodent was shrouded in mystery. In 2007, an extraordinary photograph of a carcass of this species came to the light from Hawizeh Marsh which was interpreted as concrete evidence of the species’ pers
Abstract The means of self-determination have their peaceful and non-peaceful dimensions and are united(peaceful and non-peaceful) by international consensus adopted by international conventions and instruments. This has given it various dimensions at the applied level, especially in the light of the contemporary international developments witnessed by the world represented by a number of complete and incomplete implementation models that have nothing to do with the theory of truth Self-determination associated with the liberation of peoples from colonial domination or the liberation of oppressed nationalities
Despite the multiplicity of institutions contributing to the decision-making process in the United States of America, they interact to crystallize positions regarding international and strategic situations. The formulation of the national security policy depends on a number of institutions that complement each other in order to achieve an advanced security situation. Thus, the decision reflects the process of interaction of the existing regulatory institutions. This is because the essence of the national security and achieving its requirements also stems from the existence of a coherent system of shared beliefs and principles in the American society. Besides, these elements are the bases for achieving
... Show MoreVocational stresses and their relation with the level of ambition among the lecturers of the university In general , vocational stresses affect the attention and the process of focusing making individual busy with solving of his daily problems instead of his job. The vocational stresses , anxiety and tension are factors effecting the physical and psychological ability of the individual. This study aims to measure the vocational stresses among the lecturers of the university , to measure the level of ambition among them, to identify the statistical differences significant among them according to sex variable, to identify the differences significant in level of ambition among them according to sex variable and to identify the correlation r
... Show MoreThe research aims to diagnose the causes of the phenomenon of Marketing deception catalog, which is now deployed in the Iraqi market and related to producers and marketers, consumers, regulators and other institutions) and their impact in the areas of prejudice to the consumer protection (product and signifying specifications, price, advertising, packaging), as well as identify differences in the sample responses according to personal variables, it has been the adoption of the resolution as a tool to collect data and information through a sample survey of consumer opinions totaling 108 people in shopping centers in the province of Baghdad and in the Karkh and Rusafa, It was the use of methods selected statistical represented by the arith
... Show MoreThe study aimed to measure the phsycological tolerance and self-efficacy among the students of Baghdad university and knon the significant differences in psychological tolerance and self-efficacy according to the variables (Gender-Specialization)and the interaction between themas well as the study aimed to identify the strength and direction of the relationship between psychological tolerance and self-efficacy of the study sampleincluded asample of the current study(370) students from grades four ,the researcher used the measure of psychological tolerance and self-efficacy prepared by the researcher ,and the results showed that college students Generally have adegree of psychological tolerance and that there are statistically sig
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