ObjectiveThis study surveyed all Iraqi medical schools and a cross-section of Iraqi medical students regarding their institutional and student experiences of medical education amidst ongoing conflict. The objective was to better understand the current resources and challenges facing medical schools, and the impacts of conflict on the training landscape and student experience, to provide evidence for further research and policy development.SettingDeans of all Iraqi medical schools registered in the World Directory of Medical Schools were invited to participate in a survey electronically. Medical students from three Iraqi medical schools were invited to participate in a survey electronically.OutcomesPrimary: Student enrolment and graduation statistics; human resources of medical schools; dean perspectives on impact of conflict. Secondary: Medical student perspectives on quality of teaching, welfare and future career intentions.FindingsOf 24 medical schools listed in the World Directory of Medical Schools, 15 replied to an initial email sent to confirm their contact details, and 8 medical schools responded to our survey, giving a response rate from contactable medical schools of 53% and overall of 33%. Five (63%) medical schools reported medical student educational attainment being impaired or significantly impaired; 4 (50%) felt the quality of training medical schools could offer had been impaired or significantly impaired due to conflict. A total of 197 medical students responded, 62% of whom felt their safety had been threatened due to violent insecurity. The majority (56%) of medical students intended to leave Iraq after graduating.ConclusionsMedical schools are facing challenges in staff recruitment and adequate resource provision; the majority believe quality of training has suffered as a result. Medical students are experiencing added psychological stress and lower quality of teaching; the majority intend to leave Iraq after graduation.

IntroductionPatients with pulmonary arteriovenous malformations (PAVMs) usually have underlying hereditary haemorrhagic telangiectasia (HHT), when iron deficiency often develops due to recurrent nasal and gastrointestinal haemorrhage. Iron deficient PAVM/HHT patients have more ischaemic strokes and venous thromboemboli. However, recent UK data indicate that cerebral abscesse are more common in PAVM patients using intravenous iron and/or with high normal transferrin saturation index.1 Furthermore,~1 in 20 HHT patients report that iron treatments exacerbate their nosebleeds.2 The goal of this study was to evaluate clinical patterns of iron treatments in patients with PAVMs and HHT.MethodsIron, red cell and microbiology indices were evaluated as part of routine clinic assessments of patients with PAVMs and/or HHT. With ethical approval, all available patient datasets between 04/2015 and 07/2017 were recorded, categorised according to patient status, and analysed using STATA IC v13 (Statacorp, Texas).ResultsAt first assessment, 72 patients were using oral iron alone, and 21 were using intravenous iron +/-iron tablets. As noted in figure 1, intravenous iron users had lower haemoglobin concentrations than oral iron users, despite higher serum ferritin. None of the 16 selected PAVM patients evaluated had positive blood cultures in the clinic, or developed positive cultures following ex vivo iron treatments. Three of seven selected patients had low serum haptoglobin (0.32–0.36 g/L, reference range 0.5–2.4 g/L) potentially indicative of shortened intravascular red cell survival. 31 patients were commenced on oral or intravenous iron, or recommended a dose increase, but 56 were advised dose reduction. Post assessment, daily iron dosages tended to be lower (elemental iron content 14–130, median 35 mg/day) than at first assessment (elemental iron content 14–260, median 65 mg/day, p=0.08). In two patients, external clinicians advised that iron dose reduction led to at least temporary cessation of blood transfusion requirements. Reported nosebleed improvements were common, though may have also been due to intervening treatment of PAVMs.2 ConclusionsFurther study on the clinical efficacy and sequelae of iron treatments, and a more personalised approach to therapy, appears warranted in this patient group.ReferencesBoother, et al. Clin Infect Dis2017. doi:10.1093/cid/cix373Shovlin, et al. ERJ Open Res2016;2(2).00035–2016.