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.
Increased interest in the subject of the image because of its great and growing link to the life of the individual and society and its impact on the overall political, economic and cultural conditions. This interest is no longer confined to the images of people or institutions, but has become beyond that to the images of countries and peoples and the impact on bilateral relations between them,
However, we find that the image of the Iraqi abroad remained vague and has not been scientifically recognized and the most that we can generalize are the features of the image of Arabs and Muslims abroad; and assume that the image of the Iraqi applies to them as the Iraqi is in the end an Arab or Muslim.
Based on this, the research
... Show MoreThe rate of electron transfer from N3 sensitized by dye to TiO2 semiconductor in variety solvent have been calculated as a function of reorientation energy effective free energy , volume of semiconductor , attenuation and lattice constant of semiconductor . A very strong dependence of the electron transfer rate constant on the reorientation and effective free energy .Results of calculation indicate that TiO2 is available to use with N3 dye .Our calculation results show that a good agreement with experimental result
Objective(s): To evaluate the family physicians' practices and to measure its impact upon the quality of family
medicine health care in Baghdad City model primary health care centers.
Methodology: A descriptive study, using the evaluation approach, has evaluated the impact of family physicians'
practices upon quality of healthcare in Baghdad's Model Primary Health Care Centers of Family Medicine. It is
carried out during 15th of May – 20th of August 2017. The study is conducted at five model primary health care
centers of family medicine from two districts; AL-Rusafa and AL-Kurkh. Sample size is calculated to be (76)
family physicians. Convenient sample of (124) patients who are attending these primary health care cen
Support Vector Machines (SVMs) are supervised learning models used to examine data sets in order to classify or predict dependent variables. SVM is typically used for classification by determining the best hyperplane between two classes. However, working with huge datasets can lead to a number of problems, including time-consuming and inefficient solutions. This research updates the SVM by employing a stochastic gradient descent method. The new approach, the extended stochastic gradient descent SVM (ESGD-SVM), was tested on two simulation datasets. The proposed method was compared with other classification approaches such as logistic regression, naive model, K Nearest Neighbors and Random Forest. The results show that the ESGD-SVM has a
... Show More There is an increase in the need for cost accounting in all organizations and from different sectors to provide detailed information to the totals of financial accounting, first and help solve problems associated with inventory and analysis, tabulation and allocation of cost elements II and do the planning process and provide the necessary oversight and help to take the right decisions such as pricing decisions that need to Information cost accounting.
And suffer most of the non-governmental organizations from the lack of a cost accounting system provides information on the cost of service in these organizations and the department research sample circle v
This study aimed to identify the extent of teachers' application of professional standards from the point of view of supervisors and detecting differences in the means of their estimates that may be attributed to the variables of the study (sex, number of years of service, educational qualification).The study adopted a descriptive approach. In order to achieve the aims of the study, a questionnaire including four areas, namely: (professional features, academic knowledge and pedagogy, teaching and learning, and professional development) was constructed.
The questionnaire was applied to a population which consisted of 60 supervisors of all school subjects in the Directorates of Education in
... Show MoreThe paper contains a theoretical analysis of the interrelation between methodology of economics used by economic researchers and the methodology of scientific research, encouraging readers to think differently about one of the most complicated & controversial subjects.
The analysis begins with the determination of propositions that were discussed and explained in the course of the argument.
1- The economic researcher, like a scientific one, goes after the procedures of physical sciences and benefits of the forms of logic.
2- Economics deals with human behavior while the natural sciences deal with the matter.
3-This similarity a
... Show MorePractically, torsion is normally combined with flexure and shear actions. Even though, the behavior of reinforced concrete continuous beams under pure torsion is investigated in this study. It was performed on four RC continuous beams under pure torsion. In order to produce torsional moment on the external supports, an eccentric load was applied at various distances from the longitudinal axis of the RC beams until failure.
Variables considered in this study are absolute vertical displacement of the external supports, torsional moment’s capacity, angle of twist and first cracks occurrences. According to experimental results; when load eccentricity increased from 30cm to 60cm, the absolute vertical displacement i
... Show MoreSoft clays are generally sediments deposited by rivers, seas, or lakes. These soils are fine-grained plastic soils with appreciable clay content and are characterized by high compressibility and low shear strength. To deal with soft soil problems there is more than one method that can be used such as soil replacement, preloading, stone column, sand drains, lime stabilization and Prefabricated Vertical Drains, PVDs. A numerical modeling of PVD with vacuum pressure was analyzed to investigate the effect of this technique on the consolidation behavior of fully and different depths of partially saturated soft soils. Laboratory experiments were also conducted by using a specially-designed large consol
... Show MoreThe problem of research is that the colleges of education in general and the College of Education in particular continue to follow traditional administrative patterns and that there is a complaint that the educational outputs do not match the aspirations of the society and its future directions. The aim of the research is to identify the reality of quality assurance standards in the college and to create a future vision for these standards to apply them. The researcher has designed a questionnaire based on the responses of the research sample which consisted of a group of university teachers to identify the quality assurance standards. The findings revealed that it is necessary to find a clear approach to apply the standards of quality i
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