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 aim of the research is to clarify the role of service quality through its dimensions represented by (tangibility, reliability, safety, response, empathy) in tax compliance with taxpayers, i.e. performance of the duties and obligations of the taxpayer through its dimensions (registration, accounting, payment of the amount of tax), and to know For this role, a sample was taken from the taxpayers of the branches of the General Authority for Taxes spread in the governorate of Baghdad and its affiliated districts, which amount to (15) tax branches, as (215) questionnaires were distributed to know the impressions and reactions of the taxpayers regarding the level of service quality through the aforementioned dimensions. Using the statistic
... Show MoreCaryl Churchill's Top Girls (1982) reveals how women have achieved a point of strength and independence in their battle to face men's oppression throughout history. Churchill has replicated recent transitions in the 1980s and 1990s in works that depict these movements' central concerns and contradictions as they change. Similarly, her theater is a result of many problems and shifts in hegemonic modes of production during this time. This paper traces the achievements of the major character of Top Girls, Marlene, in her way of life and her handling of the struggles of other women around her. Because of this strength, Marlene is compared to the British Prime Minister, Thatcher. Therefore, this paper will shed light on the term of T
... Show MoreThe current study aimed to isolate and diagnose Candida spp yeasts that cause candidiasis with a PCR device from patients reviewed for some hospitals in Baghdad city and by 190 samples, the study recorded 123 isolates and the total percentage of infection was 64.7% .Samples were taken from different clinical cases of the vagina, blood and mouth and the Candida spp were (70.37%, 41.26%, 86.95%) respectively. Five types of yeasts were isolated and diagnosed, namely C. albicans, C. tropicalis, C. parapsilosis, C. krusei and C.glabarta. They were confirmed by PCR device and the most notable were yeast C. albicans, where 91 isolates were found, 73.98%, while the lowest infection was recorded. C.glabartawith 3 isolates, at 2.43%, significant diff
... Show Morebjective researcher through this research to Put a theoretical framework to strategic orientation the center on the market in the business and the diagnosis and interpretation of the nature of the link between relationships and influencing strategic orientation dimensions Almtmthelh organizations (Entrepreneurial Orientation, market Orientation, Interaction Orientation) and the performance of the Iraqi Private Banks The research community and the level of dimensional and through the use of scale (Balanced Scorecard) Bmnzawradtha the four, the test of this research in the Iraqi banking sector (Gulf Commercial Bank
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This research aim to overcome the problem of dimensionality by using the methods of non-linear regression, which reduces the root of the average square error (RMSE), and is called the method of projection pursuit regression (PPR), which is one of the methods for reducing dimensions that work to overcome the problem of dimensionality (curse of dimensionality), The (PPR) method is a statistical technique that deals with finding the most important projections in multi-dimensional data , and With each finding projection , the data is reduced by linear compounds overall the projection. The process repeated to produce good projections until the best projections are obtained. The main idea of the PPR is to model
... Show MoreImproving the quality of health services in the health sector is an important and necessary matter that must be taken care of and improved, and this study seeks to demonstrate the role of quality costs in improving the quality of health services and achieving a high level of quality to satisfy the beneficiaries and to provide health services of good quality, and the research concluded that the main point of service provision Good health is the costs of prevention and evaluation (costs of quality conformity) and attention to it, and that technical competition contributes greatly to the development of the level of quality, as well as the use of health and medical staff with competent expertise, and that the costs of internal failure and th
... Show MoreThe City of Ember is a very interesting novel that is although intended for young readers, have so many layers and messages that are misunderstood. In this research, both the novel and the film adaptation are studied with the intent to decode the warning messages that the novelist and the director tried to introduce to the audience. The research studies four vital messages; the first message is that history repeats itself for the novel has many allusions to the history of Jews and their painful holocaust and even goes back in history the days of Moses and the Exodus, the second message tackles the conspiracy theory that states nothing happens by accident and that everything is planned and connected hence comes the third message
... Show MoreThe city of Karbala is one of the most important holy places for visitors and pilgrims from the Islamic faith, especially through the Arabian visit, when crowds of millions gather to commemorate the martyrdom of Imam Hussein. Offering services and medical treatments during this time is very important, especially when the crowds head to their destination (the holy shrine of Imam Hussein (a.s)). In recent years, the Arba'in visit has witnessed an obvious growth in the number of participants. The biggest challenge is the health risks, and the preventive measures for both organizers and visitors. Researchers identified various challenges and factors to facilitating the Arba'in visit. The purpose of this research is to deal with the religious an
... Show MoreIn this research, the degradation of Dazomet has been studied by using thermal Fenton process and photo-Fenton processes under UV and lights sun. The optimum values of amounts of the Fenton reagents have been determined (0.07g FeSO4 .7H2O, 3.5µl H2O2) at 25 °C and at pH 7 where the degradation percentages of Dazomet were recorded high. It has been found that solar photo Fenton process was more effective in degradation of Dazomet than photo-Fenton under UV-light and thermal Fenton processes, the percentage of degradation of Dazomet by photo-Fenton under sun light are 88% and 100% at 249 nm and 281 nm respectively, while the percentages of degradation for photo-Fenton under UV-light are 87%, 96% and for thermal Fenton are 70% and 66.8% at 2
... Show MoreInvestment Bases directly and closely to an environment characterized by political, social and economic stability, and through a range of policies and institutions and economic laws that affect investor confidence and convince him directing investments to country without the other, where inter conditions and circumstances affecting the trends of capital and settle in, and political situation of the country and what is characterized of stability or disorder as well as economic conditions that are affected by what is distinguishes the country from geographic and demographic characteristics are reflected on availability of production elements and country's infrastructure.
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