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Clinical presentation and electrocardiographic features of Brugada syndrome in Iraq


The Medical Journal of Basrah University, 2021, Volume 39, Issue 2, Pages 111-119
DOI: 10.33762/mjbu.2021.130674.1080

Background: Brugada syndrome is a clinical entity composed of twelve leads electrocardiographic changes of coved or saddle shaped ST-segment elevation in V1 and V2 with serious ventricular arrhythmias which may cause sudden cardiac death.
Objectives: The objectives of this study is to highlight the clinical presentation and the types of ECG changes of Brugada syndrome cases seen in Iraq and to orient physicians about this fatal condition.
Patients and Methods: Patients presented with symptoms of palpitation, dizzy attacks or syncope and diagnosed as Brugada syndrome were included in this case series study. The diagnosis of Brugada syndrome based mainly on the typical coved or saddle shaped or variant ST-Segment elevation in electrocardiographic leads V1, V2.
Results: Eighteen patients were included in this case series study. All are males. Age ranged from 15-45 Y. The presenting symptoms were palpitation in 12 patients, syncope in 8, dizzy spells and pre syncope in 14 and chest pain seen in 2. The arrhythmic events were clinically documented in 10. Monomorphic VT seen in 4, VF in 2, atrial fibrillation in 2 and atrial flutter in 2. Induced VF by EP study seen in 2. Type I Brugada ECG pattern was seen in 6 patients, type II in 4 and three of type III. Five showed a variant type of the syndrome. Family history of sudden cardiac death was seen in 8 patients while in 10 it was negative. ICD was implanted in 6 patients. In 12 patients (67%) the diagnosis of Brugada syndrome was missed during the provisional medical contacts.
Conclusion: Brugada syndrome is not uncommon in Iraq but needs a high diagnostic suspicion through appreciating the symptomologies and electrocardiographic features of this fatal syndrome to plan management to prevent sudden cardiac death.
Key words: Brugada syndrome, Iraq

Overview of Iraqi experience in management of acute promyelocytic leukemia

Waseem Al-Tameemi; Zahra’a S. Shakir

The Medical Journal of Basrah University, 2021, Volume 39, Issue 1, Pages 21-30
DOI: 10.33762/mjbu.2021.129847.1068

Background & Objectives
In Iraq, leukemia is the 4th most common cancer, Acute promyelocytic leukemia contributes to 2.83%, and 3.18% of leukemia in Iraqi males and females respectively. This study is to review of acute promyelocytic leukemia patients presentation and management outcome in Iraq
Patients and Method
A hospital based case series study was conducted over a period of 15 months in different hematology centers. A total of 58 acute promyelocytic leukemia patients were enrolled in this study (53 newly diagnosed and 5 relapsed cases). Diagnosis based on of morphology with or without cytogenetic study.
The mean age was 33.1±13.8 years, with slight female predominance. Most cases presented at winter season (39.7%). Sanz severity scoring classification as; (25.9%) low risk, (53.4%) intermediate risk, and (20.6%) high risk disease. Induction protocol consist of chemotherapy plus ATRA in (58%) while (36.2%) received only ATRA plus ATO. At the end of induction, 86.2% of patients have complete remission, while only 13.8% have failure of induction due to death. Induction mortality was higher in those who have received chemotherapy based regimens. At relapse, a second complete remission has been achieved in 4 out of 5 cases (80%).

There is a predilection of acute promyelocytic leukemia to young age group and winter season presentation. The choice of non-chemotherapy regimens, especially for the low and intermediate risk group, showed no drawback in complete remission rate. Disease outcome in Iraq has improved over several years due to increasing experience with using different regimen

The Epidemiological Pattern of COVID-19 Epidemic, During the Initial Phase in Thi-Qar Governorate, Iraq: A Case Series Study

Muslim Dhahr Musa

The Medical Journal of Basrah University, 2020, Volume 38, Issue 2, Pages 25-36
DOI: 10.33762/mjbu.2020.128230.1033

Background/ Aims: Understanding the epidemiological features and transmission dynamic during the initial phase of the COVID-19 epidemic provide valuable information for control and mitigation of the outbreak. Thus, this study focused on a cohort who represent early cases in Thi-Qar governorate for describing the early epidemiological features during the initial phase of the COVID-19 outbreak.
Subject & Methods: This case series study was conducted in AL-Hussien Teaching Hospital, Thi-Qar governorate, from 27, February to 8, May 2020. Patient's data were obtained from official records of the Public Health Department of ThiQar Health Directory. A descriptive and analytical statistic were used by the aid of SPSS, also household secondary attack rate was estimated.
Results: The median age was 37 years (IQR:31,20-51), females were 57.2% and males were 42.8%. According to age groups, as a higher infection rate (30.61% %) was found in the age group (14-26), while only (4%) found old age groups(66-78,79-91). Only six patients(12.25%) had comorbidities. Clinically, majority(79.6%) of cases were mild and (18.4%) moderate while only (4%) were severe. The age and comorbidities had an effect on the severity of symptoms. Family transmission(80.43%) was the predominant dynamic of disease transmission. Three index cases in this cohort fulfill the criteria of super-spreader as collectively transmitted the disease to 79.6% individuals, the household secondary attack rates were 22%, 24%, and 17% respectively.
Conclusion: Family transmission was the predominant dynamic of transmission which was the result of the presence of a super-spreader event in the early infected patients in the governorate.