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.
This paper is an attempt to clarify the impact of Postcolonialism, one of the most
challenging fields of study that has emerged in recent years, on representations of women in
once-colonised countries and in Western locations. It discusses the influence of cultural
differences on the status and identity of a woman who experience ‗multiculturalism‘. The
study is an analytical reading of a contemporary novel written by the Iraqi writer Betool Al-
Kudairi. The emphasis lies on the clash between two different cultures and traditions
represented by the British mother and the Iraqi father and its effect on the life and identity of
the protagonist. The main focus is on idea of ‗hybrid identity‘ and the absence of th
The current research dealt with the issue of organizational skillfulness as an entry point to reach strategic agility. The study has been tested in Iraq's mobile operators - Asia Cell, Zain Iraq and Cork Telecom. The study was applied to a sample of (93) managers distributed at various levels of management (board members, general managers, commissioners, department managers, people managers, unit managers, office managers). The survey used the questionnaire as a key tool for collecting data and information as well as personal interviews. It has sought to test a number of hypotheses related to correlation and influence relationships between the variables of the study, in order to answer the questions related to the problem of stud
... Show MoreTirzepatide is a revolutionary and promising medication with a high impact in the treatment of Obesity and T2DM with their complications. Its efficacy was proven through different trials in achieving favorable weight loss and a significant reduction in glycemic index. It also treated a large diversity of related co-morbidities, including fatty liver, cardiovascular disease, dyslipidemia, and more. Tirzepatide is well tolerated, has a good safety profile, and is highly reliable and suitable for use in a population.
In the geotechnical and terramechanical engineering applications, precise understandings are yet to be established on the off-road structures interacting with complex soil profiles. Several theoretical and experimental approaches have been used to measure the ultimate bearing capacity of the layered soil, but with a significant level of differences depending on the failure mechanisms assumed. Furthermore, local displacement fields in layered soils are not yet studied well. Here, the bearing capacity of a dense sand layer overlying loose sand beneath a rigid beam is studied under the plain-strain condition. The study employs using digital particle image velocimetry (DPIV) and finite element method (FEM) simulations. In the FEM, an experiment
... Show MoreTo assess the feasibility of using a faecal occult blood test (FOBT) kit as a screening tool for periodontal disease. Additionally, the study aimed to evaluate the test's sensitivity and specificity while exploring the influence of factors like age, sex and the number of teeth on its performance.
A prospective observational case–control study involving 150 participants divided into three groups on the basis of the basic perio
Intersectionality is a concept that focuses on social inequality towards black people and provides an analytical instruments for creating social justice issues in such a way in order to depict how social marginalization, or privilege occurs differently in various social positions. It does this by focusing on the interaction of multiple systems of oppression. Intersectionality is used to examines how the social factors; race, gender, and class can affect the people’s life especially the immigrants, black people, and refuges. This article will depicts how blacks in Canada are segregated and distinguished from white race. David Chariandy’s I’ve Been Meaning To Tell You: A Letter to My Daughter 2018 is analyzed through Kimberle Crenshaw
... Show MoreThe aim of this study is to investigate the kinetics of copper removal from aqueous solutions using an electromembrane extraction (EME) system. To achieve this, a unique electrochemical cell design was adopted comprising two glass chambers, a supported liquid membrane (SLM), a graphite anode, and a stainless-steel cathode. The SLM consisted of a polypropylene flat membrane infused with 1-octanol as a solvent and bis(2-ethylhexyl) phosphate (DEHP) as a carrier. The impact of various factors on the kinetics constant rate was outlined, including the applied voltage, initial pH of the donor phase solution, and initial copper concentration. The results demonstrated a significant influence of the applied voltage on enhancing the rate of c
... Show MoreBackground: Odontogenic tumors are a diverse group of lesions with a variety of clinical behavior and histopathologic subtypes, from hamartomatous and benign to malignant. The study aimed to examine the clinical and pathological features of odontogenic tumors in Baghdad over the last 11 years (2011–2021). Materials and Methods: The present retrospective study analyzed all formalin-fixed, paraffin-embedded tissue blocks of patients diagnosed with an odontogenic tumor that were retrieved from archives at a teaching hospital/College of Dentistry in Baghdad University, Iraq, between 2011 and 2021. The diagnosis of each case was confirmed by examining the hematoxylin and eosin stained sections by two expert pathologists. Data from pati
... Show MoreThis paper presents the implementation of a complex fractional order proportional integral derivative (CPID) and a real fractional order PID (RPID) controllers. The analysis and design of both controllers were carried out in a previous work done by the author, where the design specifications were classified into easy (case 1) and hard (case 2) design specifications. The main contribution of this paper is combining CRONE approximation and linear phase CRONE approximation to implement the CPID controller. The designed controllers-RPID and CPID-are implemented to control flowing water with low pressure circuit, which is a first order plus dead time system. Simulation results demonstrate that while the implemented RPID controller fails to stabi
... Show MoreA systematic approach is presented to achieve the stable grasping of objects through a two-finger robotic hand, in which each finger cavity was filled with granular media. The compaction of the latter, controlled by vacuum pressure, was used to adjust the structural and contact stiffness of the finger. The grasping stability was studied under the concurrent effect of an external torque and applied vacuum pressure. Stable grasping was defined as the no slippage condition between the grasped object and the two fingers. Three control schemes were adopted and applied experimentally to ensure the effectiveness of the grasping process. The results showed that stable and unstable grasping regions exist for each combination of applied torqu
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