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.
The present study aims to reveal the extent of the influence of the acquired organizational immune through its dimensions (organizational vaccination, organizational learning, organizational memory, and benchmarking) in the application of knowledge management strategies in its two dimensions (codification strategy, personalization strategy) as well as clarifying that influential relationship between the study variables Because of its importance in reducing resistance to change by responding to the requirements of the environment. A set of main and sub-hypotheses emerged from the study, which was formulated in view of the hypothesis scheme of the study, and i
... Show MoreThe subject of education, and since time immemorial, gripe the attention of the religious, intellectual, political, social and economic elites. This attention not only in Iraq, but in different countries in the world. There is a close correlation between the educational level of the societies and the edginess of its rising and advancement in all fields.
In order to achieve the research objectives, the research has been divided into three sections: section I include the historical, scientific, humanitarian evolution of education, starting from the first economic revolution (The Agricultural revolution) through the second economic revolution (The Industrial Revolution) and till the Third Economi
... Show MoreBackground: Quality of life in brain tumor patients is an emerging issue and has prompted neurosurgeons to recon¬sider the need for cognitive assessment in the course of treatment. To date there has been a lack of comprehensive neuropsychological assessment performed preoperatively and in the acute postoperative period in our hospitals.Objectives: to establish the effects of tumors and their surgical treatment, from a neuropsychological perspective, on cognitive functioning in patients with cerebral Gliomas. Methods: This is a prospective study conducted in the Neurosurgical Hospital in Baghdad, Iraq, during the period from January 1999 to January 2001. Any patient admitted during the period of the study with clinical history, signs, sy
... Show MoreSatire is genre of the literary arts that has always been the source of human interest. Because it is difficult to accept direct criticism, Satire appears as a literary tool in which vices, follies, abuses and shortcomings are held up to ridicule, with the intent of shaming individuals, corporations, government, or society itself into improvement. A satirical critic usually employs irony to attain this goal. Although satire is usually meant to be humorous, its greater purpose is often profitable social criticism, using wit to draw at
... Show Moreان من اهم القضايا التي تثيرها المعرفة البشرية في تجلياتها، وتعبيراتها المفاهيمية، تكمن في مدى تأصلها وانتمائها الى البنى والتشكيلات الموضوعية (في مستوياتها التاريخية) التي تسعى لتفسيرها وادراكها ومضاهاتها. فالينبوع الذي يغرف منه الفكر مادته هو الكيان الاجتماعي المتموضع خارج الوعي والايدولوجيا.
ان قدرة الوعي على ادراك الواقع الموضوعي بخصائصه العامة يشكل الشرط الضروري لاكتساب الوعي ل
... Show MoreIn the 20th century, the concept of "sarcasm" has relatively prevailed, and in this sense, it is a method in the art of conversation that wants to keep the question about the intended meaning, that is, "saying something and suggesting its opposite."
There are other concepts that indicate that sarcasm is saying something in a way that provokes the recipient of the statement an infinite number of different interpretations, with multiple readers of different interpretations. While the philosophy of irony stands by the standards of things, exaggeration or minimization, this manipulation takes place within the enjoyment. However, it's a method to present sharp criticism in an atmosphere of criticism that differs from generation to gener
This study seeks to identify the possibility of achieving the property of faithful representation of accounting information and measure it by using the standard approach based on mathematical and statistical equations by comparing two financial periods before and after the application of (IFRS-15) Revenue from contracts with customers, during the period. (2014-2018), for the financial statements of the mixed joint stock companies listed on the Iraq Stock Exchange, which is one of the main pillars of the economic structure of the country, as a joint investment between the state and the private sector, and has importance in many aspects, including support for projects of public companies, S Absorption and employment of labor, as well as ra
... Show MoreThe current research examines the employment of indicators of stereotypes and the dimensions of organizational clarification to achieve planned organizational behaviour on a sample of employees in a number of departments of the Faculties of Engineering, University of Kufa, for a sample of (122) teaching staff. This research proposes the use of positive indicators of stereotypes for both the organization and employees and their awareness of what they want to obtain and what should be done for both parties and the removal of organizational clarity represented by the functional dimension that explores to what degree the employee's understanding of the internal strategy of the organization and the strategic dimension that searches fo
... Show More