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.
Abstract
The aim of the current research is to prepare an integrated learning program based on mathematics standards for the next generation of the NYS and to investigate its impact on the development of the teaching performance of middle school mathematics teachers and the future thinking skills of their students. To achieve the objectives of the research, the researcher prepared a list of mathematics standards for the next generation, which were derived from a list of standards. He also prepared a list of the teaching competencies required for middle school mathematics teachers in light of the list of standards, as well as clarified the foundations of the training program and its objectives and the mathematical
... Show MoreBackground: While two-thirds of breast cancers express hormone receptors for either estrogen (ER) and/or progesterone (PR) , genetically altered PI3K pathway was found in more than 70% of ER-positive breast cancers.An aberrant activity of cyclin-dependent kinase 1 (CDK1) in a wide variety of human cancers has selectively constituted an attractive pharmacological targets in MYC-dependent human breast cancer cells.
Aim of the study: Role of p110-beta as well as and CDK 1 in the pathogenesis of subset of breast cancers and contribution in their carcinogenesis.
Type of the study: is a retrospective study
Methods: This retr
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Job stress is considered one of the most important obstacles that may appear in the work field. In order to deal with the obstacles and challenges , the idea to deal with job stress has come to address job stress as one of the most important trends that enable organizations to face those challenges through focusing on the role of job stress and the organizational climate of the organization.
The research deals with two variables: the job stress as an independent variable, and the organizational climate as a dependent one. Each variable includes five sub-dimensions. These dimensions have been involved in an interaction to form
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The competition in the hotel sector, globalization and the development of new information have forced the sector to continuously seek new techniques and arrangements to remain competitive through hotel industry companies, including Benchmarking and the application of this method in the hotel sector. The selection of the Rashid International Hotel by the Ministry of Tourism as a leading hotel or benchmark for comparison of other hotels in Iraq, and the selection of two hotels in Baghdad for comparison, namely (Ishtar International Hotel, Baghdad International Hotel) and the choice also by the Ministry of Tourism, N is to correct the course of practice to manage the cost and diagnosis of the weakness of the strengths and weaknesses in the
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The research investigates the political effect and its directions on the architectural thoughts and its achievements and how can this political system affect all fields of life in communities including architectural urban design. The problem of the research lies in the ambiguity effects of the ideological national directions of the Nazi Party on the architecture and urban design of the city of Berlin, then determining the aims of the research to discuss the concepts of politics and architecture and their relation to the way of thinking that plays a role in the process of design that works on property and achieving the suitable urban environments for those communities. After that, the Nazi's party's thought would be studied and analyzed,
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The research aims at the possibility of measuring the technical and scale efficiency (SE) of the departments of the College of Administration and Economics at the University of Baghdad for a period lasting 8 years, from the academic year 2013-2014 to 2018-2019 using the method of Applied Data Analysis with an input and output orientation to maintain the distinguished competitive position and try to identify weaknesses in performance and address them. Nevertheless, the research problem lies in diagnosing the most acceptable specializations in the labor market and determining the reasons for students’ reluctance to enter some departments. Furthermore, the (Win4DEAp) program was used to measure technical and scale efficiency (SE) and rely on
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The Islamic architectural heritage constitutes a civilized fortune that has to be preserved and protected and work should be done to maintain its development to be more convenient for the circumstances of the age and the civilization transformations. Due to the fact that architecture represents the civilization pot and cultural identity, its originality has to be preserved and work has to be done to prevent the strange architectural invasion that changes its character and make it lose the identity and the character and detached from its roots and environment.
Decoration, in the interior design, as a concept is connected to ornamentation process of interior spaces, which is a process of adding certain items
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The research aims to identify the impact of the merger of the companies affiliated to the Ministry of Industry and Minerals on their financial profitability since the companies before the merger suffered a rise in losses and the deficit reached very high levels that affected its overall performance and even on the morale of workers as losses are increasing and solutions Efficiency is absent. The problem stems from knowing the impact of the merger on the profitability ratios of the companies. The research field was represented by the companies affiliated to the Ministry of Industry and Minerals (21) companies, while the research sample reached (6) companies after the merger (14) companies before the merger, was based on data The f
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Objective: This study aimed to assessing new suggested technique of Physical Growth Curves (PGC) charts in
children under two years old of a non-probability sample.
Methodology: A non-probability sample of size (420) children under two years selected from 12 Primary
Health Care Centers in Diyala governorate during the period from 15th Nov. 2010 to 13th Mar. 2011
according to admix of a different properties together in one chart/or growth curve chart included in at least
weight, Height, and Head circumference.
Results: the results showed different properties that can be admix together in one chart/or growth curve
chart included in at least weight, Height, and Head circumference. And to overtake the problem of the norm