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.
Massive multiple-input multiple-output (massive-MIMO) is a promising technology for next generation wireless communications systems due to its capability to increase the data rate and meet the enormous ongoing data traffic explosion. However, in non-reciprocal channels, such as those encountered in frequency division duplex (FDD) systems, channel state information (CSI) estimation using downlink (DL) training sequence is to date very challenging issue, especially when the channel exhibits a shorter coherence time. In particular, the availability of sufficiently accurate CSI at the base transceiver station (BTS) allows an efficient precoding design in the DL transmission to be achieved, and thus, reliable communication systems can be obtaine
... Show MoreThis research discussed and analyzed the formulation of a strategy to manage tax compliance risks, as an applied research in the General commission for Taxes. The questionnaire was used as a research tool to identify the factors that stimulate or retard the research sample from being compliant. The K-means clustering method was also used to enable the classification of the research sample's views into four behaviors, some of these views pose tax-compliance risks. The research concluded that risk management is a continuous process and that all departments of the General commission for Taxes are responsible for its implementation to enable them to deal with the behavior of the taxpayer towards tax compliance. And it recommended
... Show MoreThe research study of the possibility of the application of the quality management system under the international standard ISO ISO9001: 2008 in the station project Rustumiya wastewater treatment of the Department of SEWER BAGHDAD - Baghdad MOREALITY as the first step in the right direction towards the implementation of total quality management (TQM), and the research Find the gap between the international standard and the quality system used in the organization surveyed through the use of checklists to analyze the gap, the checklist have included (191) items distributed on five basic requirements, according to the appearance in the international standard, namely, (quality management system, management responsibility, resource man
... Show MorePatients are very concerned about the lengthy nature of orthodontic treatment. It is necessary to find a non-invasive way to quicken physiologic tooth movement. This study's objective was to assess the effectiveness of low-intensity laser therapy in shortening the time and discomfort of orthodontic treatment. Experimental work: Using a split-mouth study to compare tooth movement with conventional treatment and laser-accelerated orthodontic tooth movement. A patient presenting with a class II division I malocclusion characterized by the misalignment of the upper and lower teeth as classified by Angle’s molar classification system was indicated to undergo fixed orthodontic appliance orthodontic treatment. The treatment plan involved bila
... Show MoreBackground: Young children’s oral health maintenance and outcomes are influenced by their parent’s knowledge and beliefs, which affect oral hygiene and healthy eating habits. This study aims at assessing caries risk in children aged 6 months to 6 years attending the Specialized Center of Preventive and Pediatric Dentistry Center at Al-Resafa sector in Baghdad. Materials and Methods: A cross-sectional study was conducted from 15 May – 15 June 2018, all children attended the center (80 children) were assessed by using the standard caries risk assessment tool of the American Academy of Pediatric Dentistry (AAPD). Results: The highest percentage of children was as follows: no fluoride exposure 44(55%), did not brush 46(5
... Show MoreThis research aims to test the relationship between "relational leadership as an independent variable and organizational energy as a dependent variable. The current research variables are among the recent and important variables for the development of organizations, and for the purpose of explaining the relationship and influence between the variables, a set of goals has been formulated, including providing the interested and scientific and theoretical information explaining the nature of the variables The research, and the extent to which its causes are reflected in the research sample to increase the interest of the research organization’s organization and make it more appropriate to the required performance in light of a cha
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