Third International Conference on Medical Education and Medical writing, University of Karbala College of Medicine, Karbala, Iraq.

University of Karbala College of Medicine (UKCM), Iraq, conducted a three days' workshop on Medical Education and medical writing. The UKCM is now transforming to conform with the latest trends of modern education. This will help to re-shape the future of medical education and produce capable doctors. This requires a strong faculty, which is sound in teaching, training, learning improvement, research capacity building, and leadership development. The capacity building of faculty at UKCM has been initiated in collaboration with Medics International at a local and government level and includes a series of workshops and online symposia. This educational activity was conducted after a delay of three years due to COVID-19. A three -day refresher course was conducted in the first week of August, 2022. Medical writing is another important feature which has been continuously covered by UKMM since many years with the collaboration of Al-Sadiq International Virtual University (SIVU) and Imamia Medics International (IM).

Initiation of basal bolus insulin therapy.

Most practice guidelines recommend the use of longacting or pre-mixed insulin at the initiation of insulin therapy in type 2 diabetes, especially in patients not achieving glycaemic goals. Nonetheless, there are some specific indications where basal bolus insulin is the preferred regimen for insulin initiation. These include the "5S" situations - 'Severe' hyperglycaemia, 'Symptomatic' diabetes, 'Sick' diabetes (acute or chronic comorbidity), 'Special' situations (pregnancy, childhood, adolescence) and 'Secondary' diabetes (pancreatic, drug-induced, endocrine disorders). This review describes a practical approach to initiation and follow up of basal bolus insulin regimens.

Conference Report on First Certificate Course in Health Professions Educationat College of Medicine, University of Kerbala, Iraq.(September 2019).

The current status of medical education in Iraq requires complete transformation to conform to the latest trends of modern education. Presently it is compromised due to the influence of political factors, finances, weakness or fragility of planning and security. It has to be re-shaped for the future of medical education to produce good and efficient medical professionals. It is necessary to reform and revise the curriculum as accreditation in accordance with international medical universities. The initial requirement is faculty development in areas including but not limited to, curriculum development, teaching and learning improvement, research capacity building, and leadership development. The capacity building of faculty at College of Medicine, University of Kerbala (CMUCK) has been initiated in collaboration with Medics International at a local and the government level. Medics International conducted the current Course on Certificate in Health Professions Education (CHPE) programme in September, 2019 to facilitate the faculty to revise their curriculum and improve their current educational practices. Further steps will be taken to develop the faculty for Masters in Medical Education (MME), PhD, and fellowship programmes. To face the on-going challenges in the medical and health care system, continous efforts are required for faculty education. Medics International has volunteered to begin a series of Webinars through its global faculty to reach out to the Iraqi Board followed by engagement of the Arab Board covering 18 countries.

Marriage and diabetes.

This communication shares the challenges and concerns associated with marriage in persons living with diabetes. It classifies the challenges as psychosocial and biomedical, and lists counselling tips to tackle these. It dispels the various myths associated with marriage, andsuggests proactive steps to improve societal attitudes and practices.

Ramadan fasting during pregnancy: Obstetric risk stratification.

Some women may wish to fast during pregnancy or lactation, for religious or spiritual reasons. This may pose a dilemma to the obstetric care provider, who has to balance the need for maternal and foetal wellbeing with the wishes and needs of the mother. This communication describes a pragmatic, shared decision making, based on patient centred approach to this challenging clinical situation. It highlights simple clinical and investigation based clues which allow obstetric risk stratification of women in pregnancy or lactation. This clinical and laboratory based assessment allows appropriate decision making regarding fasting, while keeping foeto-maternal safety paramount.

Risk stratification of persons on premixed insulin in Ramadan.

The International Diabetes Federation (IDF), in collaboration with the Diabetes and Ramadan (DAR) International Alliance, has recently published practical guidelines on the management of diabetes and Ramadan .The risk stratification categorizes all persons wishing to fast into three groups, based upon potential risk. In spite of evidence to the contrary, all persons using premixed insulin are categorized as having high risk. In this article, we present data from randomized controlled trials, and discuss the placement of premixed insulin in the risk stratification framework.

Ramadan and diabetes: Holistic trial design.

ABSTRACT: Extensive work has been done to analyze the safety of various modern glucose-lowering drugs during Ramadan fasting. This editorial suggests the use of validated scales of religiosity/spirituality as an adjunct to pre-Ramadan counselling and risk stratification. The editors also propose a holistic trial design for future trials on glycaemic management during Ramadan. Such a design should include both spiritual and biomedical endpoints, while trying to assess correlation between religiosity/spirituality and biomedical outcomes after Ramadan fasting. Integration of validated instruments to screen and monitor spirituality will help achieve the holistic health in devout Muslims who wish to observe Ramadan.

Lipohypertrophy.

This communication focuses on lipohypertrophy (LH), which is a commonly seen, yet easily preventable insulin site reaction. LH can be detected at an early stage by regular inspection and palpation. This can prevent the excessive requirement of insulin, and the glycaemic variability that is encountered when insulin is injected into areas with LH. This article describes the etiology, clinical features and preventive measures of LH.

Diabetes and travel.

This article encapsulates pragmatic advice that is necessary to ensure safe travel for people with diabetes. Written in simple words, it empowers the primary care physician to answer questions that are frequently asked by patients planning travel. It includes discussion on insulin dose adjustment, self monitoring, foot care and sick day management.

Insulin therapy in pregnancy.

Insulin is the mainstay of pharmacotherapy in pregnancy complicated by diabetes. This review covers the various insulin regimes and preparations, explaining how to use them, and decide appropriate doses in pregnancy. It approaches insulin treatment from a patient - centred, as well as physician and obstetrician friendly viewpoint, providing pragmatic guidance for management of diabetes in pregnancy.

Gestational diabetes mellitus in South Asia: Epidemiology.

Gestational diabetes mellitus, is defined by the American Diabetes Association as "diabetes diagnosed in the second or third trimester of pregnancy that is not clearly overt diabetes". WHO has further classified the period of diagnosis as Hyperglycaemia in Pregnancy and Gestational Diabetes Mellitus. The former term is applicable in the early period of gestation and GDM is detected after 24 weeks. Irrespective of the guidelines followed, the presence of Diabetes Mellitus during pregnancy, has to be taken seriously as it is an important metabolic derangement and can prove to be harmful for the mother and dangerous for the foetus. The rising incidence of Type 2 Diabetes Mellitus in the world along with obesity, is a major contributing factor for GDM. The trend of this rise is more steep in the low and middle income countries thus proportionately increasing the risk for GDM. South Asia falls in this bracket and the responsible factors have to be identified and corrected. Management should begin from primordial prevention for which education is a key factor. Every woman should be taught the way to follow a healthy life style. Identification of the contributing factors and universal screening facilities for all pregnant women living in both rural and urban areas, should be given prime importance. On detecting Hyperglycaemia in Pregnancy or GDM, monitoring and health care facilities should be provided. This review provides some available figures of GDM in South Asia, the risk factors in this population and the steps for prevention.

Insulin in ramadan.

Many people with diabetes, both type 1 and type 2, require insulin for maintainance of glycaemic control and health. Most of these people can observe the Ramadan fast, provided appropriate dosage adjustments are made, and basic rules of safety followed. This article describes modifications and precautions that are needed while prescribing insulin during Ramadan.