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.
A New Perspective About Masculinity and the Issue of Identity in Ernest Hemingway's The Old Man and The Sea and Michael Ondaatje's in The Skin of a lion
The research has designed for studying the relationship between manufacturing strategy and its flexibility under the flexible manufacturing system with their reflection on the competitive environmental performance of the firm. To interpret and tackle the problem, a hypothesis has formulated stating that “ the competitive performance of a firm is interpreted by the manufacturing strategy and flexibility which are derived from the firm and its business strategies under the flexible manufacturing system”. Related literatures with their theoretical dissertations, which enhanced the thoughtful content, have analyzed. An illustrative case study on the flexible manufacturing system at Toyota Motors Corporation working at the g
... Show More
The necessary optimality conditions with Lagrange multipliers are studied and derived for a new class that includes the system of Caputo–Katugampola fractional derivatives to the optimal control problems with considering the end time free. The formula for the integral by parts has been proven for the left Caputo–Katugampola fractional derivative that contributes to the finding and deriving the necessary optimality conditions. Also, three special cases are obtained, including the study of the necessary optimality conditions when both the final time and the final state are fixed. According to convexity assumptions prove that necessary optimality conditions are sufficient optimality conditions.
... Show More
(8)
(2)
The moral aspect is an important one in the structure of personality , and the lack of moral aspect is responsible for what we suffering today from problems . there is no exaggeration to say that many of our current problems are moral problems , and reflects the lack of moral growth.
The goal of research is to build scale in order to detect the level of moral reasoning among junior high school students in Baghdad , The researcher followed the procedures in the construction of scientific standards in order to measur
... Show MoreAbstract Background: The human epidermal growth factor receptor 2(HER2) proto-oncogene is overexpressed or amplified in approximately 15%-25% of invasive breast cancers. Approximately 35% of HER2-amplified breast cancers have coamplification of the topoisomerase II-alpha (TOP2A) gene encoding an enzyme that is a major target of anthracyclines. Hence, the determination of genetic alteration (amplification or deletion) of both genes is considered as an important predictive factor that determines the response of breast cancer patients to treatment. The aims of this study are to determinate TOP2A status gene amplification in a set of Iraqi patients with breast cancer that have had an equivocal (2+) and positive HER2/neu by immunohistochemistry
... Show More
(2)
(1)
Abstract The strategic performance of the United States depends on dealing with the Middle East countries and its variants on several bases and motives that enabled them to achieve American hegemony and invest its interests at the expense of the region countries. Within this performance, the administration of the United State President Donald Trump presented the Strategic Document on December 18, 2017, which focused on the principle of "America First", to determine the direction of future US strategic performance in the formulation of means of cooperation and intersections or hostility in addition to interests and threats.The future vision of the Arab region and the Middle East as a whole, this strategy is based on the fact that
... Show More
A new laboratory study conducted on stepped spillways in order to investigate their efficiency of dissipating flow energy. All previous study on stepped spillway indicated that the flow energy dissipation decreased as increasing in discharge. Increasing in the step numbers and the spillway slope led to energy dissipation decrease. In this study, an experimental attempt to increase energy dissipation at variable discharges was performed on stepped spillway and that leads to decreasing the cost of initiating the stilling basin or may be ignoring it. Five spillways were constructed from concrete and tested to investigate and compare among them. Three were roughed by gravel with different size for each one, one of them was s
... Show MoreBackground: Multiple sclerosis is a chronic heterogeneous demyelinating axonal and inflammatory disease involving the Central Nervous System [CNS] white matter with a possibility of gray matter involvement in which the insulating covers of nerve cells in the brain and spinal cord are damaged. This damage disrupts the ability of parts of the nervous system to communicate, resulting in a wide range of signs and symptoms. Cerebral venous insufficiency theory was raised as a possible etiology for the disease at 2008 by Zamboni an Italian cardiothoracic surgeon. This theory was defeated by Multiple Sclerosis[ MS] researchers and scientists who thought that the disease is an autoimmune rather than vascular.
Obj
... Show More
In the pandemic era of COVID19, software engineering and artificial intelligence tools played a major role in monitoring, managing, and predicting the spread of the virus. According to reports released by the World Health Organization, all attempts to prevent any form of infection are highly recommended among people. One side of avoiding infection is requiring people to wear face masks. The problem is that some people do not incline to wear a face mask, and guiding them manually by police is not easy especially in a large or public area to avoid this infection. The purpose of this paper is to construct a software tool called Face Mask Detection (FMD) to detect any face that does not wear a mask in a specific
... Show More
(9)
(3)
Background: Skull secondary tumors are malignant bone tumors which are increasing in incidence.Objective: The objectives of this study were to present clinical features , asses the outcome of patients with secondary skull tumors ,characterize the MRI features, locations, and extent of secondary skull tumors to determine the frequency of the symptomatic disease.Type of the study: This is a prospective study.Methods: This is a prospective study from February 2000 to February 2008. The patients were selected from five neurosurgical centers and one oncology hospital in Baghdad/Iraq. The inclusion criteria were MRI study of the head(either as an initial radiological study or following head CT scan when secondary brain tumor is suspected , vis
... Show More