The Medical Journal of Basrah University

By 2024, all international medical graduates (IMGs) intending to apply for certification or gain verification of their primary medical qualification (PMQ) by the Educational Commission for Foreign Medical Graduates (ECFMG) will require that their medical school has been appropriately accredited. The World Federation for Medical Education (WFME) Recognition Program is the only one accepted by the ECFMG for the recognition of medical school accrediting agencies. This applies to anyone intending to work or study in the United States, United Kingdom and an increasing number of countries adopting such approach. The process of accreditation of Iraqi medical colleges started in 2007 but to date there is no internationally recognized body in Iraq to accredit those colleges. This means by the 2024, graduates from Iraqi medical colleges may not be able to work and study in many parts of the world. Urgent action is required as we detailed in this article. ministry of higher education, universities, medical colleges need to collaborate with the National Council to get it recognized by the WFME and save the future of thousands of doctors who will graduate in the forthcoming years starting with 2024 and on.

Background: Hepatitis c virus (HCV) is global health problem it has many extrahepatic manifestations including hematologic, lymphoproliferative, endocrine, and renal diseases. The most common and important endocrine disorder are thyroid abnormalities.The aim of this study: Is to investigate the correlation between HCV infection and thyroid function abnormalities and the factors that may affect it.Patients and methods: This were a case-control study with 51 patients (27 males) were HCV positive who were attending Faiha Gastroenterology and Hepatology center and 49 HCV negative persons (34 males) from health workers and patients’ relatives represent control group. They were sent for thyroid function test in form of Thyroid stimulating hormone (TSH), free tetraiodothyronine (FT4), total triiodothyronine (T3), anti-thyroid peroxidase antibody, thyroglobulin, and anti-thyroglobulin.Results: thyroid function abnormalities were found in eighteen patients (35.3%) of HCV positive group ,and nine (18.4%)in control group but the difference was not significant (p = 0.057), also there was no difference in thyroid antibodies prevalence between the two groups (p ˃ 0.05).The distribution of thyroid abnormalities in HCV patients was as follows: Four patients (7.8%) have hypothyroidism, Four (7.8%) have subclinical hypothyroidism, and Ten (19.7%) have weird thyroid function, while in control group: Four (8.2%) have subclinical hypothyroidism, Five(10.2%) have weird thyroid function and none have hyperthyroidism in both groups. Abnormal thyroid function was more in women with age group 30-40 years and was statistically significant. Conclusion: Thyroid abnormalities are more in HCV positive patients where hypothyroidism is the most frequent, they are more in women, and more in 30-40 years old. With the majority of hypothyroidism has autoimmune origin.

Background: The severity and mortality by COVID-19 vary among countries. This may be related to the underlying immunity. Response to the vaccine effect is immunologically related to several factors like vaccination, infestation with parasites and nutrition. Socioeconomic status is an important factor in health problems. Objectives: The purpose of the study is to understand the effect of the BCG scar size and the socioeconomic status as indicators of underlying immunity on the severity and mortality of COVID-19 patients. Method: A comparative study of PCR-confirmed COVID-19 patients were done in Basrah, Teaching Hospital. The patients were divided into two groups: Severe and mild to moderate cases. All confirmed cases during April and May 2020 in Basrah Teaching Hospital were included. The BCG scar size and socioeconomic status were studied and related to the severity and mortality of COVID-19 cases. Results: Patients who had small BCG scar size and high socioeconomic status were significantly associated with higher severity and mortality due to COVID-19 infection.Conclusion: BCG scar size and socioeconomic class can be used as good indicators for immune response against infection and the extent of their severity and mortality.

Background: The coronavirus was first recognised in December 2019 in Wuhan, China as an outbreak of an unidentified health storm. Although the main presenting complaints are respiratory complaints, many patients are presented with multisystem and extrapulmonary manifestations. Objective: This study aims to assess the extrapulmonary manifestations of COVID-19. Methods: A cross-sectional observation study was conducted in Basrah teaching hospital, which is a specialised and tertiary centre for COVID-19 management, for a 5-month duration and involving 507 patients with confirmed COVID-19 infection.Results and Conclusions: The extrapulmonary manifestation was reported in 347 patients (68%), and the clinical manifestations analysis of the enrolled patients showed that most of the neurological manifestations were headaches. Myocardial infarction is the most common cardiovascular manifestation. Moreover, gastrointestinal manifestations showed that nausea and vomiting, followed by abdominal pain and diarrhea, are frequently reported symptoms. Additionally, stroke, new atrial fibrillation, conjunctivitis, macular skin rash, urticaria, acute kidney injury, fatigue, joint pain, deep venous thrombosis, diabetic ketoacidosis, and hyperglycemia were observed also at lower percentages.

Introduction: Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are chronic inflammatory conditions that damage joints and impair patient’s physical fitness. Despite sharing many drugs in their treatment guidelines, they have many differences in their pathogenicity. It is generally understood that a mismatch between pro-and anti-inflammatory cytokine activity promotes autoimmune and chronic inflammation. However, it is still unclear how cytokines are arranged within such complex signaling pathways, and hence which cytokine would be the better target for the evolution of treatments.Methods: This cross-sectional study included 71 patients, 45 with RA, and 26 with AS. According to the type of the treatments, RA patients were divided into three groups (1,2,3), and AS patients were divided into 2 groups (4,5) Data collection was made by clinical examination and specially designed questionnaire form. Five to seven milliliters of blood were collected, centrifuged and the serum was stored at -24 C till the time of assay. Serum TNFa, CXCL13, and ICAM1 were determined by the ELISA. CRP is measured by the photometric method, and ESR by the Wintrobe method. Data were analyzed statistically utilizing the SPSS program (version 26).Results: Eighty-two percent of patients with RA were females, and (18%) were males, their mean age was (51.84 ± 10.74) years and their mean weight was (73.28 ± 13.17) Kg. Regarding AS, (4%) of the patients were females and (96%) were males, with a mean age was (41.88 ± 10.95) years and mean weight was (78.67 + 13.4) Kg. Serum inflammatory parameters except ICAM1 were significantly higher in patients with RA than in those with AS, regardless of the treatment type.Conclusion: TNFa is significantly correlated with DAS-CRP, ASDAS in patients with RA and AS but its level is significantly higher in patients with RA. Serum CXCL13 correlates with disease activity in patients with RA and could be used as a target for the evolution of new treatments while it has a minor role in patients with AS.

Background: Postdate pregnancy is pregnancy last longer than estimated date of confinement which is known as due date. Postdate pregnancy can be considered as high-risk factor from the point of increasing maternal & neonatal morbidity & mortality. Aim: to identify whether the pregnancy beyond the expected date of delivery has negative effects on the health of mother & neonate.Study design: This is a prospective case-control study done from (1st Jan. 2020-1st Jan.2021). It includes (600) pregnant women admitted with spontaneous labor or for induction of labor. They were divided into (350) pregnant women as control with gestational age (37 weeks completed -40 weeks) & (250) pregnant women as cases with gestational age (beyond 40 weeks - 42 weeks completed). Estimation of the gestational age based on the last menstrual period & early first trimester ultrasound.Results: Those with postdate pregnancy were mainly of young age group (62.4%) & multiparous (55.6%). Induction of labor done in (46.4%). Cesarean section rate was (22.4%) mainly for fetal distress (66%). Postpartum hemorrhage consequent to uterine atony was the main maternal complication (16.4%). The newborns had favorable outcome with Apgar score (i. e ≥7) in (77.6%). They were macrosomic (19.2%). Male gender was the predominant sex (68.4%). Meconium-stained liquor affect (23.2%); (12.4%) had meconium aspiration syndrome & (18.8%) admitted to intensive care unit.Conclusion: Postdate pregnancy negatively affect both maternal & neonatal health by increasing postpartum hemorrhage & cesarean section rate as well as neonatal macrosomia, meconium staining & aspiration.

Background: The World Health Organization (WHO) declared COVID-19 an international public health emergency on January 30th and demanded coordinated action from all countries to contain its rapid spread, and a pandemic on March 11th due to its continued spread across countries and continents. During a pandemic, the information gap can have negative consequences by increasing stress and instability. Furthermore, unfavorable attitudes and practices, as well as other misconceptions and beliefs, can intensify the disaster's devastating effects. Aims: 1. To determine the knowledge, attitude and practices of people in Basrah about COVID-19 pandemic. 2. To know the main source of peoples, information. Method: This study is a cross-sectional study conducted on a sample of persons selected throughout the period from 25th April to 1st August 2021. The study involved 402 individuals who attended primary health care centers in Basah city center.Results: In this study, 25.6% of the participants aged 30-39 years and 34.6% of them had secondary school education, 51.7% were females. Majority of the study sample (71.6%) were married. More than half (62.4%) showed self or family history of COVID-19. Half of the participants in this study had moderate level of knowledge, social media was the source of information for 54.2% of the participants, 67.4% of the participants didn’t know the correct symptoms of COVID-19 disease, and also 82% didn’t know the incubation period, while 90.8% know the mode of transmission. Highest percentage (40.5%) had poor attitude, and 59%had poor practice level.Conclusions: The highest percentage of the participants had moderate knowledge, poor attitude and poor practices. Social media is the main source of information about COVID-19 among the studied sample. Recommendation: This study recommends enhancing awareness of people about the importance of control and preventive measures against COVID-19 virus in decreasing the prevalence of the disease.

Background: COVID-19 pandemic has made vaccination more of a necessity than a choice as it continues to spread. The need to combat vaccine hesitancy is more relevant now than ever, given the availability of effective and safe vaccines. Aims: To assess the acceptance rate of COVID-19 vaccines in Iraq, and to identify the reasons for hesitancy. Methods: A cross-sectional online survey of 1100 Iraqi citizens was conducted in October 2021. Sociodemographics, willingness to get COVID-19 vaccine and a list of reasons for refusal or hesitancy were collected. These factors were compared across basic demographics. Results: The acceptance rate for COVID-19 vaccine was 46.1%. Females, older adults and those with higher education had higher acceptance rates for COVID-19 vaccine. The most common concern about the COVID-19 vaccine involved fear about side effects (24.6%). Conclusion: To achieve effective immunizations, it is vital to develop strategies that encourage vaccinations and ensure optimal coverage.