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 factorial experiment (2× 3) in randomized complete block design (RCBD) with three replications was conducted to examine the effect of honeycomb selection method using three interplant distances on yield and its components of two cultivars of bean, Bronco and Strike. Interplant distances used were 75× 65 cm, 90× 78 cm, and 105× 91 cm (row× plant) represent short (high plant density), intermediate (intermediate plant density), and wide (low plant density) distance, respectively. Parameters used for selection were number of days from planting to the initiation of first flower, number of nodes formed prior to first flower, and number of main branches. Results showed significant superiority of the Bronco cultivar represented in the number
... Show MoreThe study aimed at identifying the strategic gaps in the actual reality of the management of public organizations investigated to determine the strategy used based on the study model. The study relied on the variable of the general organization strategy in its dimensions (the general organization strategy, the organization's political strategy and the defense strategy of the organization) The sample of the study was (General Directorate of Traffic, Civil Status Directorate and Civil Defense Directorate), formations affiliated to the Ministry of the Interior, for the importance of the activity carried out by these public organizations by providing them In order to translate the answers into a quantitative expression in the analysi
... Show MoreThe objective of this research is to develop a method for applying financial derivatives in the local environment to reduce the risk of foreign exchange rate fluctuations to enhance quality of accounting profits through Financial reporting to local units In accordance with international financial reporting standards, To accomplish this objective was selected a sample of Iraqi units exposed to the risk of fluctuations in foreign currency rates, As the research found:
- many companies and banks in the local environment a lot of losses due to fluctuations in foreign currency exchange rates.
- that financial derivatives in the Iraqi environment represent
Abstract:
It is essential to provide health care directly or indirectly based on laboratory tests in order of diagnosing diseases. There is an urgent need for the results of such tests to be accurate and reliable. Therefore, the International Organization for Standardization has prepared special standards for medical laboratories to prove their efficiency, presented in standards 15189: 2012. The aim of the research is to determine the possibility of the Al-alwiya Women's Hospital in meeting the requirements of the standards 15189: 2012, which includes administrative requirements consisting of fifteen items and technical requirements consisting of ten items. The research is important because laboratories shou
... Show MoreThe challenges facing today's multi-customer and this is due to the multiplicity of products and speed in launching new products so search came to reveal the reveal the of the new product classification standards through a relationship (good products, low interest products, useful products and products desired) and the customer emotionally blackmail through deportation (fear, obligation and guilt). dentified the problem of the research in several questions focused on the nature of the relationship between the variables of research, and for that outline supposedly to search it expresses the head of one hypothesis and branched out of which four hypotheses subset, but in order to ensure the validity of the ass
... Show MoreBackground: Assessment is an important part of the learning cascade in education. Students realize it as an influential motivator to direct and guide their learning. The method of assessment determines the way the students reach high levels of learning. It has been documented that one of factor affecting students’ choice of learning approach is the way how assessment is being performed. Many methods of assessment namely multiple choice questions, essay questions and others are mainly used to assess basic science knowledge in undergraduate education. Objectives: The aim of this study is to compare multiple choice questions (MCQ) and essay questions (EQ) (record the success and failure rate of multiple choice questions (MCQ) and essay quest
... Show MoreBackground: Intestinal parasitic infections including amoebiasis, blastocystosis, giardiasis, are all worldwide distribution with harmful effects, it is an important cause of morbidity and death rate in the poor countries. Objective: This study was done to collect information of the frequency of these diseases in some regions of Baghdad. Our objectives are to detect the frequency of human pathogenic parasites in some regions of Baghdad in stool samples of patients who would attend to AL-Kindy Teaching Hospital, Medical City Teaching Hospital and to determine the most common age group affected. Materials and Methods: Data were collected from Al-Kindy Teaching Hospital and Medical City Teaching Hospital, in the lab of parasitology fro
... Show MoreGroupwise non-rigid image alignment is a difficult non-linear optimization problem involving many parameters and often large datasets. Previous methods have explored various metrics and optimization strategies. Good results have been previously achieved with simple metrics, requiring complex optimization, often with many unintuitive parameters that require careful tuning for each dataset. In this chapter, the problem is restructured to use a simpler, iterative optimization algorithm, with very few free parameters. The warps are refined using an iterative Levenberg-Marquardt minimization to the mean, based on updating the locations of a small number of points and incorporating a stiffness constraint. This optimization approach is eff
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