IRAQI JOURNAL OF MEDICAL SCIENCES

Throughout ages, skin lines had been examined by anatomists and surgeons with a great controversy about the consistency of each. None of them is considered to be the gold standard for surgical incisions. Furthermore, skin lines are not often fully understood and being misquoted over and over in literatures. Various methods had been adopted; from a simple pinch to 3D scan computerized models. Different explanations had been given for the causes of formation and variation of those lines.
Keywords: Skin lines, Langer's lines, tension lines.

Background:Research suggests that refugees are at an increased risk for poor health outcomes as compared to immigrants. However, prior studies have compared refugees and immigrants from different countries and have failed to isolate specific war-related factors.
Objective:To compare health outcomes and their determinants in refugees and immigrants from the same country of origin.
Methods:A cross-sectional study based on a convenient sample and on self-report participants were conducted at Southeast Michigan during the period September to December 2009. A validated survey was used to examine refugees (n = 75) and immigrants (n = 65) from Iraq. The survey covered socioeconomics, lifestyle, violence exposure, self-rated health, and number of medical conditions (high blood pressure, fatigue, and backache, shortness of breath, gastrointestinal disorders, skin problems, and musculoskeletal problems). Group differences and predictors of health outcomes were assessed.
Results:Refugees reported significantly more violence exposure than immigrants (p < 0.001). There were no significant differences in self-rated health or medical disorders between groups; however, violence exposure was the main predictor of health outcomes in refugees, whereas age was the main predictor in immigrants. Other predictors also varied by migratory group.
Conclusion:Even though migration status did not directly influence health outcomes, results suggest that factors associated with migration status, e.g., violence exposure and age, do impact health. Future studies need to more carefully define and control for country-specific variables.
Key Words:Health, Trauma, Violence, Emigrating, Iraq

Background:Urodynamics provide objective pathophysiological explanations for symptoms and/or dysfunction of the lower urinary tracts. It reproduce patient symptoms during the performance of the study and assist clinicians in determining the precise cause, aid in diagnostic process and follow up of patients with urinary incontinence.
Objective:To evaluate the role of urodynamic study in confirming the diagnosis of urinary incontinence in Iraqi women. Differentiate the types of urinary incontinence and assess the importance of risk factors in its development.
Methods:This study was performed in the Urology Department, Al-Sader Medical City, Holly Najaf between March 2013 and March 2014. One hundred and twenty female subjects aged 20 to 60 years were studied. They comprised 60 patients and 60 control subjects. Medical history, clinical examination and urodynamic tests were performed for them.
Result: Thirty four patients presented with stress urinary incontinence, nineteen with urge type, five with mixed type and only two patients presented with overflow urinary incontinence. The patients were complaining of cough, constipation (most of them in stress type) and presence of cystocele (most of them in stress urinary incontinence patients). In addition, there was positive history of hypertension and positive family history of urinary incontinence. The strong desire to urination and the maximum urinary bladder capacity of patients was significantly smaller than those of control subjects, specifically those patients with stress and urge urinary incontinence.
Conclusion:Age, Parity and body mass index significantly affect the prevalence of urinary incontinence in women who have given birth vaginally. Stress urinary incontinence is the most common type of UI among women regardless the small sample size in the study. Cystometric changes of urodynamic study were markedly evident in the stress urinary incontinence patients as compared to the healthy women.
Keywords:Urinary incontinence, Urodynamic study, Cystometry, Adult females.

Background:Rheumatoid arthritis is a chronic inflammatory autoimmune disease represents the most common form of chronic inflammatory joint diseases. Glycyrrhiza glabra (G. glabra) was widely known to have several pharmacological activities, which might be beneficial in preventing and treating both acute and chronic inflammatory conditions.
Objective:To study the effect of aqueous extract of G.glabra on antigen induced arthritis model in mice.
Methods:Forty-eight male Swiss albino mice were used in this study. Group 1 arthritic mice without treatment (positive control); group 2 arthritic mice treated with G. glabra aqueous extract 750 mg/kg/day; group 3 arthritic mice treated with G. glabra aqueous extract 300 mg/kg/day and group 4 negative control (non-immunized, non-treated mice). Antigen induced arthritis was induced by Methylated bovine serum albumin in Imject Alum adjuvant. The mice were given the drug orally and the treatment was started from day 1 of the induction of arthritis until day 20. At day 20 of arthritis all mice were sacrificed and serum TNF-α was measured using ELISA technique. Biopsies of the left knee joint were taken for histopathological evaluation.
Results:The results indicate that G.glabra caused inhibition of histopathological features of antigen-induced arthritis in dose dependent manner. G.glabra also caused reduction of serum TNF-α concentration in antigen-induced arthritis model in dose dependent manner.
Conclusions:Glycyrrhiza glabra can significantly inhibit antigen-induced arthritis in mice. This effect seems to be in dose dependent manner.
Key words:Rheumatoid arthritis, G. glabra, TNF-α, antigen induced arthritis.

Background:Alexis Litter (1710) may be called the father of colostomy, when he made an incision in the belly and opened the ends of closed bowel to the belly surface where it never closed and preformed the function of anus for an infant suffered from intestinal obstruction due to congenital malformation of the return, probably an imperforate anus. This operation was known as Litter's operation.
Objective:To decrease the incidence of colostomy complications through selection of proper site and type of colostomy.
Methods:Two hundred temporary colostomies made for 200 neonates, infants and children below 2 years old in Al-Kadhemiya Pediatric Hospital and Al-Imamain Al-Kadhemain Medical City over a period from September 2008 to September 2013.
Results:Imperforate anus was the most common indication for colostomy in 59% of cases and Hirschsprung's disease in 33.5%, which were done mainly in neonatal period (57%) especially for male imperforate anus without fistula. Prolapse was the most common and challenging complication following colostomy creation in 25% followed by severe skin excoriation 24% which mainly happened with loop transverse, while declining incidence in divided sigmoid and descending colostomies.
Conclusions:Divided and separated descending and sigmoid colostomies were the stoma of choice for most clinical situations requiring colostomy because of complete fecal diversion with the least complications prolapse and skin excoriation.
Keywords:Colostomy complications, prolapse, skin excoriation

Background:A spontaneous recessive mutation in the gene coding for protein kinase gamma has created a new rat strain called Albino Swiss/ Anatomy Glasgow University (AS/AGU). It characterized by disordered locomotion due to impaired dopamine release from certain areas of the brain and eventual neurodegeneration. The mutant rats also have a shorter life span.
Objective:The present study investigates Lipofuscin level as an indicator of age and calbindin D-28k level as an indicator of neuronal integrity in cerebellar Purkinje cells of the mutant AS/AGU strain in comparison to the normal AS strain.
Methods:Eighteen rats (9 AS and 9 AS/AGU) were selected to study the Lipofuscin and calbindin in relation to age and strain using multiple histological techniques including fluorescent microscopy.
Results:Fluorescent microscopical study has shown early age related Lipofuscin accumulation in the AS/AGU rats compared to the normal strain. Moreover, Calbindin D-28k showed age related increase in both strains but marginally significant decline in the AS/AGU strain.
Conclusions:Our study presents AS/AGU as an animal model of early aging in addition to its value as a model of neurodegeneration.
Keywords:Aging, Albino Swiss Rat, Calbindin D-28k, Fluorescent Microscopy, Lipofuscin.

Background:The glutathione-S-transferases (GSTs) comprise a class of enzymes that detoxify carcinogenic compounds by conjugating glutathione to facilitate their removal. Polymorphisms in glutathione S-transferase Omega 1,2 (GSTO1, GSTO2), and GSTP1 genes have been related to risk for bladder cancer.
Objective:To assess a comprehensive picture of the relationship between smoking and GSTO2 gene Asn142Asp variant (rs156697) with bladder cancer
Methods:A case control study was conducted at Chemistry and Biochemistry Department, College of Medicine and DNA Research and Training Center, Al-Nahrain University from February 2014 to September 2014. Forty one bladder cancer patients and 41 age matched apparently healthy controls were participated in this study. Genotyping of the GSTO2 Asn142Asp polymorphism was evaluated using a polymerase chain reaction fragment length polymorphism (PCR-RFLP) method. The odds ratio (OR) and 95% confidence interval (CI) were calculated as a measure of the combined effect of cigarette smoking and the GSTO2 Asn142Asp polymorphism on bladder cancer risk.
Result: It was found that subject with the GSTO2 Asp/Asp genotype have significantly increased bladder cancer risk (OR 4.92; 95% CI =1.32 - 18.30). A statistically highly significant increased the bladder cancer risk was also found in ever smoker of the GSTO2 (Asn/Asn) (OR =11.8; 95% CI=2.43 - 57.84) and (Asn/Asp +Asp/Asp) (OR =12.8; 95% CI=3.23 - 51.41) compared with never smoker Ala/Ala genotype.
Conclusion:The study suggests that smokers having GSTO2 Asn/142Asp polymorphism could play an important role as risk factor for the development with bladder cancer.
Keywords:Bladder cancer, single nucleotide polymorphism, glutathione S-transferase, GSTO2, Asn142Asp, smoking, rs156697.

Background:Aloe vera is an evergreen perennial plant widely used in modern herbal practice and is often available in proprietary herbal preparations. Evidence of efficacy is strongest for the laxative effects of Aloe vera latex; however the anthraquinones in the latex are associated with considerable risks.
Objective:To investigate the histopathological changes of kidney tissues of male mice administered low dose of whole leaf fresh Aloe vera extract.
Methods:Forty immature male Swiss Webster mice divided into two equal groups (experimental and control) (G and C respectively). The experimental group (G) was given 20 µl of Aloe vera extract orally for 21 days. While the control groups (C) were given by the same dose and route of administration with normal saline only. After six weeks (around puberty), the male were sacrificed to get their kidneys, then fixed with 10% formalin, and histological sections with a thickness of 5 microns were prepared.
Results:Histological studies of mice kidneys from groups that consume low dose fresh Aloe vera whole leaf extracts showed disrupted entire structure of kidneys including degenerative changes in most parenchymatous elements in comparison with control.
Conclusions:Using low doses of fresh Aloe vera whole leaf extract induce adverse effects on the histological features of mice kidneys and impaired their entire structure.
Key words:Aloe vera, Kidney, anthraquinones, whole leaf extract.

Background:High oxidative stress reflects the state when the production of reactive oxygen species exceeds their removal. Malondialdehyde (MDA )and Hexanoyl-Lysine Adduct (HEL) are indicators of oxidative damage of lipids caused by free radicals in blood. The high level of these biomarkers has been implicated in early pregnancy complications.
Objectives:This study aimed to investigate the correlation between serum oxidative stress biomarkers in preterm and post-term deliveries.
Methods:A case-control study was designed to recruit 90 pregnant women with 30 women delivering at term (control group), 30 women at preterm (first case group) and 30 women at post-term (second case group). All women underwent elective cesarean section. Blood samples were collected before admission to operation theatre. Women's age, body mass index, lipid profile, renal function test and random glucose were measured. Serum oxidative stress biomarkers (Malondialdehyde and Hexanoyl-Lysine Adduct) were measured as indicators of lipid peroxidation.
Results:The results showed that study groups were significantly different in serum MDA and HEL (P ≤ 0.01). Both serum MDA and HEL levels were significantly higher in preterm women group and their level steadily decreased as pregnancy progressed. Serum MDA was not significantly different between term and post-term women groups (P>0.05).
Conclusions:Oxidative stress biomarkers may be important contributors of premature birth. Low level of serum HEL may play a role in delayed onset of labor. The causal relationship between oxidative stress biomarkers and pregnancy outcome may be further investigated by longitudinal studies.
Key words:Oxidative Stress, Preterm women, Post-term women, Malondialdehyde, Hexanoyl-Lysine Adduct.

Background:Tumor necrosis factor-α elaborated soon after myocardial ischemic injury. The intracellular adhesion molecule-1 is required for polymorphonuclear emigration, the primary cause of inflammatory tissue damage due to ischemia-reperfusion.
Objective:Detect the serum level of tumor necrosis factor-α and to look for the percentage of expression of intracellular adhesion molecule-1 in atherosclerotic coronary heart disease.
Methods:Fifty patients (40 males and 10 females) were enrolled in this study with age range (42-80) years, and fifteen, age and sex matched, apparently healthy individuals. The patients group was further classified into acute and chronic cases. Blood sample was taken from each subject and divided into 2 parts. One part used for lymphocyte separation by using immunocytochmistry to detect intracellular adhesion molecule-1 and the other one for serum separation by using ELISA technique to detect tumor necrosis alpha-α.
Results:Significant difference in the concentrations of tumor necrosis factor-α was found between patients and control groups and it was elevated in acute cases compared to chronic cases. Similarly, intracellular adhesion molecule-1 was elevated in patients compared o control groups and more in acute than chronic cases.
Conclusions:TNF-α is an important marker that acts on coronary arteries which may contribute to the development of congestive heart disease. Elevation of intracellular adhesion molecule-1 level correlates well with the development of acute events in the disease.
Keywords:Atherosclerotic coronary heart disease, TNF-α, ICAM-1, ELISA, immunocytochemistry technique.

Background:The embalmed human cadavers used for teaching anatomy in the medical colleges could be preserved for a very long time, the crucial factors for acheivement of this prolonged preservation was not fully discussed.
Objectives:This is an experimental study to evaluate the veracity of using paraffin sectioning feasibility as a test for the degree of damage in the embalmed cadaveric tissue affected by recurrent and prolonged air drying in anatomy laboratories.
Methods:Routine paraffin sections were done for tissues obtained from cadaveric organs exposed to recurrent and prolonged air drying and tissues from cadaveric organs preserved most of the time in a hydrated condition.
Results:The results of this study showed unblemished paraffin sectioning of the emblamed cadaveric tissue preserved with good hydration. The cadaveric tissues exposed to reccurent air drying could not be sectioned properly, the sectioned tissues were hard and brittled.
Conlcusion:The experts dealing with the embalmed cadavers evidently necessitude maintancance of cadaveric hydration as a requisite to prolong durability of the demonstrative details in the dissected cadavers. Accordingly; the comparably more proper paraffin sectioning of the well hydrated cadaveric tissue may be considered as a sign of more durable embalmed cadaveric organs.
Keywords:cadaver, paraffin, anatomy, fixation, formalin.

Background:Operative treatment of supracondylar fractures with reduction and percutaneous pinning is so effective and safe. The great majority of displaced fractures should be treated operatively. There is little controversy that all closed Gartland type II and III fractures should have an attempt at closed reduction and pinning.
Objective:To compare the efficacy of medial and lateral entry pinning with lateral entry pinning for percutaneous fixation of displaced (Gartland type II and III) extension type supracondylar fractures of the humerus in children.
Methods:A prospective study conducted at a single centre from December 2008 to November 2011. Eighty patients who satisfied the inclusion and exclusion criteria were enrolled in the study, with 40 patients in each group. All the pinning was done according to a uniform standardized technique. The patients were re-evaluated as outpatients at three weeks, six weeks and three months after the surgery.
Results:No significant differences were found between the two groups with regard to base-line characteristics, withdrawals, complication rate and various outcome measures such as carrying angle, passive range of elbow motion, Flynn grading, Baumanns angle, change in the Baumann angle and loss of reduction grading.
Conclusions:If a uniform standardized operative technique is followed in each method, then the result of both methods will be same in terms of safety and efficacy.
Keywords:Supracondylar fractures, Humerus, Children, Percutaneous fixation

Background:Viruses are among the most common causes of opportunistic infections after transplantation. The risk for viral infection is a function of the specific virus encountered and the intensity of immune suppression used to prevent graft rejection.Epstein-Barr virus infection has also been implicated as co-factor in acute and chronic rejection syndromes.
Objective:Detection of Epstein-Barr viremia in renal transplant recipients.
Methods:Fifty seven (57) renal transplant recipients were enrolled in this study. Plasma samples were taken from all renal transplant subjects. Screening of Epstein-Barr virus was first done by serology viamono spot test, then, viral DNA of Epstein-Barr viruswas extracted from 200 µl plasma samples and Epstein-Barr virus DNA was detected and measured by Taqman quantitative real-time PCR.
Results:19/57 (33 %) of renal transplant subjects had Epstein-Barr virus viremia and the viral load ranged from 7100 to 16.165 copies/ml. Serology of all RT subjects showed negative heterophil antibody except for one patient had positive hetrophil antibody.
Conclusion:The current study showed that Epstein-Barr virus might be considered as an important cause of renal impairment and allograft loss in renaltransplant subjects. And Epstein-Barr virus seems associated with post transplantation renal impairment and/or kidney rejection. Real-time PCR is a very sensitive and specific method for the detection of Epstein-Barr viremia in renal transplant subjects.
Key words:Epstein-Barr virus, Renal transplantation, real-time PCR

Abstract:An electrical burn is a burn that results from electricity passing through the body causing rapid injury. Electrical burn differs from thermal or chemical burns in that they cause much more sub dermal damage. They can exclusively cause surface damage, but more often tissues deeper underneath the skin have been severely damaged. As a result, electrical burns are difficult to accurately diagnose, and many people underestimate the severity of their burn. In extreme cases, electrical injury can cause damage to the brain, heart, and injury to other organs like abdominal viscera and lining peritoneum causing aseptic peritonism and peritonitis.
Keywords:peritonitis, electrical shock, burn