Iraqi Provinces Research Articles

Prescription pattern of non-steroidal anti-inflammatory drugs (NSAIDs) among community patients with musculoskeletal and co-morbid conditions: A crosssectional study from an Iraqi province

Purpose: To determine the pattern of prescription of non-steroidal anti-inflammatory drugs (NSAIDs) and proton pump inhibitors (PPIs) co-prescription with NSAIDs in a sample of patients suffering from musculoskeletal disorders with and without co-morbid cardiovascular (CV) disease conditions in Baghdad Province, Iraq.Methods: A descriptive, cross-sectional study was conducted using a structured questionnaire to assess the clinical characteristics of patients that used NSAIDs alone or with PPIs for the treatment of different musculoskeletal disorders with and without co-morbid cardiovascular (CV) disease conditions.Results: A total of 102 participants were enrolled in the study. More than half of the participants had comorbid disease conditions (53.9 %), particularly hypertension (47.1 %). Nearly a quarter of the participants with CV disease conditions used non-selective NSAIDs (25.5 %). The majority of NSAIDs intake were orally administered for more than one month (79.4 %). Physicians were the major source for patient education about the risk of NSAIDs-associated complications according to 59.6 % of the participants. The majority of participants reported non-adherence to the prescribed PPIs (86.5 %). There was a statistically significant difference between the participants that used NSAIDs alone, and those with PPI co-prescription within the age group of 31 - 60 years (p < 0.0001) and for a duration of more than one month for NSAIDs administration (p < 0.0001).Conclusion: There is improper use of NSAIDs, particularly the non-selective agents, among patients with co-morbid cardiovascular disease conditions, as well as poor medication adherence and improper co-prescription of PPIs. This requires periodic revision for long-term intake of NSAIDs, while applying more care to high-risk patients regarding co-prescription of NSAIDs with PPIs.
 Keywords: Cardiovascular, Co-morbidity, Gastrointestinal complications, NSAIDs, Proton-pump inhibitors

Modelling count data with an excess of zero values applied to childhood bone tumour incidence in Iraq.

Bone tumours are rarely found in children and adolescents (0- 19 years old), but there are reports from some provinces in Iraq indicating possible increases in the incidence of childhood bone cancer. Since counts are very low and often zero, or near zero, we fitted zero-inflated Poisson, zero-inflated negative binomial, Poisson hurdle, and negative binomial hurdle regression models to investigate these changes. We used data covering the 2000-2015 period taking age, gender and province into account with the aim of identifying potential health disparities. The results indicate that the zero-inflated Poisson is the most appropriate approach. We also found that, the incidence rate ratio of bone tumours for age groups of 5-9, 10-14 and 15-19 years were 134%, 490% and 723% higher, respectively, compared to the 0-4 year olds. The incidence rate was higher by 49% higher in males compared to females. Compared to 2000-2004, the rate was higher during 2005-2009 and 2010-2015 by 23% and 50%, respectively. In addition, the provinces Al-Muthana and Al-Diwaniyah in the South were found to have a higher incidence rate than other provinces. Join point analysis showed that the age-adjusted incidence rate had a significant, increasing trend, with an average percentage change of 3.1% during 2000-2015. The study suggests that further research into childhood tumours, bone tumours in particular, is needed. Reference to the effect of environmental factors in this group of medical disorders would be of special interest.

THE CHALLENGES, RISKS, AND CONCERNS PERCEIVED BY IRAQI MEDICAL DOCTORS: A CROSS SECTIONAL STUDY

Background: The current situation of the health system in Iraq, under the difficult conditions the country has been experiencing, generates great pressures on doctors because they are in the field of confrontation between the growing needs of patients day after day and the dilapidated capabilities and government neglect of the health sector with the absence of security and stability and weak law enforcement.The imposition of state authority has led to an increase in violence in the country in general and against doctors in particular. Moreover, there are other pressures that doctors are subjected to, such as security, economic, professional, social, and psychological pressures, which have led to the emigration of a considerable number of doctors or the exposure of some of them to physical liquidation. Aim: This study was conducted to determine the challenges, risks, and concerns perceived by Iraqi medical doctors, and to explore any possibility of associations to some socio-demographic and professional characteristics of the doctors. Method: A questionnaire form was structured after reviewing several international forms relevant to exploring the participants' opinions and measuring satisfaction. The form was validated by experts and the approved version was uploaded to the Internet and sent to candidate Iraqi medical doctors through Google Forms. A link to the questionnaire survey was sent to them via doctors' WhatsApp groups. Convenience sample was used to collect data from May 30 to June 17, 2020. Results: A total of 606 medical doctors from most of the Iraqi provinces sent their responses to the questionnaire. More than 92% of them held serious concerns,such as a tribal threat. Other challenges included being infected with a serious infection, more than 3 quarters had been exposed to violence, more than half of them have been involved in problems with the administrative and/or judicial authorities, more than 35% consider the government department where they work as the party who protects them. More importantly, about 92.7% of the respondents answered that they do not feel safe/secure. The social enhancers seen by most of the respondents were having a law to protect them, owning a house or a piece of land, and/or having an Association that defends them. Conclusions: The Iraqi medical doctors face considerable physical, economical, psychological, emotional, and social challenges that affect their professional performance and their life. If the same situation remained as such it may lead to the loss of one third of the Iraqi doctors. Especially, after COVID-19 pandemic, many countries are welcoming doctors from abroad, including Iraq. If this is added to the shortage in the doctor-population proportion in Iraq, it means there will be a jeopardizing shortage. Recommendations: Several recommendations have been put to reduce pressure on the Iraqi medical doctors aiming at improving performance, effectiveness, and efficiency. Keywords: doctor challenges, violence, Iraqi doctors, risk of infection, economic impacts

Molecular& Antifungal Suceptibility Identification of Candida albicans Isolated from Samples of GIT Children with Diarrhea in Diyala Province Iraq

Diarrheal diseases in children are a major public health concern in developing countries. especially speciesof Candida, responsible for causing candidiasis infection(diarrehea), require fast and accurate identification,The correct identification of Candida species is of great importance, as it presents prognostic and therapeuticalsignificance, allowing an early and appropriate antifungical therapy. This study was conducted to investigatethe incidence of Candida albicans associated with diarrhea in childrenThis study was included isolates of Candida spp. from stool of 100 patients samples with diarrhea and100 without diarrhea evaluated in AL-Batool Teaching Hospital by phenotypic methods , antifungalsusceptibility of C. albicans and determination of the C.albicans genotypes by Nested PCR, discriminatingC. albicans from the other Candida species. The tests used for phenotypic analysis were culture in SDA andCHROMAgar™ Candida, Phenotypic tests showed green colonies in chromogenic medium, The antifungalsusceptibility results of 43 C.albicans isolates present that all of Candida isolates tested were susceptibleto Amphotericin B and fluconazole (100%), while no resistance was observed in C.albicans toCaspofunginand Micafungin.Finally, only one isolate was resistant to flucytosine . Genomic DNAs of all C. albicans isolates wereamplified by PCR to detect their genotypes using. polymerase chian reaction amplification shows fourgenotypes(A,B,Cand D).A-genotype showed 4 subtypes and most common subgenotypes(1,3,4 and 5).

Developing a theoretical model to improve the road network the a historical city in Iraq

The expansion of transport networks as a result of urban growth with low coverage and low integration leads to low transport efficiency and inaccessibility. This leads to poor connectivity in ancient urban areas of the Iraqi provinces. Identifying the Iraqi provinces with the lowest transport efficiency by performing the supply-demand ratio of the master plan for the center of Iraq's provinces (for example, the city of Karbala) is an indicator of the availability and accessibility of transport in urban areas. Solutions to meet transport needs have not focused on improving road capacity and meeting demand by improving operational efficiency even in surrounding communities. In this research theoretical model measured the degree of accessibility of the road network in the city to assess the effectiveness of transport. It has been identified that closer the coefficient of supply-demand to the zero points will provide a comfortable level of service to all road users. This theoretical model evaluates and improves the impact of changing the function of the road network and using different modes of transportation taking into account religious factors, full range of demand control, system efficiency, and infrastructure capacity clarifications.

Prevalence of chronic kidney disease and hypertension as a risk factor in Basrah province Iraq

Prevalence of chronic kidney disease and hypertension as a risk factor in Basrah province Iraq

Legal basis for the interaction between local with state authorities

The objective of the article is to analyze the legal basis for interaction between local and state authorities within the framework of the current constitution of the Republic of Iraq. At the methodological level, documentary observation was used. In recent years, after the transition to a new political regime in Iraq in 2003, many issues relating to local administrations and their interaction with state bodies have been identified and enshrined in the Constitution of the Republic of Iraq in 2005. Some of the most serious problems are the lack of a clear organization of relations between government bodies and local governments, the efficiency problems of the various authorities, as well as the lack of flexible solutions in legislation and the Constitution. The need to solve these problems is often manifested at all levels. At the same time, we find no real decisions that do not cause popular discontent in all Iraqi provinces, especially in Basra province. It is concluded that relations between regional and national authorities are mediated by the presence of bureaucracy, financial and administrative corruption administrative and political conflicts between political parties.

Assessment of heavy metals and radioactivity concentrations in Iraqi truffles

Concentrations of heavy metals in several species of desert truffles, collected from different Iraqi provinces, were determined. Samples were collected from Al-Anbar Salah ad-Den and AlMuthana provinces. The levels of Cd, Cr, Pb, Mn, Ni, and Zn were analyzed. As well as the level of radon in the truffle samples were also measured using the solid-state nuclear track detector (CR-39). The results reveal that the concentrations of the investigated elements in the Iraqi truffles were below the recommended levels and the ascending order of the measured toxic elements was NiË‚MnË‚Zn. The concentrations of the other elements (Cd, Cr and Pb) were below the detection limit of the measuring method. Radon activity levels in the study truffle samples were between (156.23 to 513.83) Bq.m-3 with mean value of (323.23) Bq.m-3. the results reveal that most measured radon activity were below the world recommended value given by ICRP except Ramadi sample. All the computed values of health risk index (HR) of all elements were within safe limits (HR<1), therefore, the consumption of the investigated truffles does not pose any health risks from the investigated heavy elements and from radiological point of view. Â

A Program for Developing Locally Food Supervision to Support Sanitary Monitoring Work

Food supervision in Iraq is the responsibility of the Ministry of Health and Environment, which conductsfood supervision to all food establishments worked in Iraq by the department of sanitary monitoring inBaghdad city as well as all directorates of health in Iraqi provinces. As a result of increasing the numberof food businesses national wide in last years, increasing the number of consumers, Iraq’s openness to theinternational market, and using the policy of random import. Due to the mentioned reasons, many problemsrelated to consumer’s health has appeared, this matter pushed the Iraqi Government to establish committees,organized seminars, and workshops related to this subject to resolve problems effected in consumer’shealth. This problem requires more effort from researchers and specialists in food supervision and sanitarymonitoring in Iraq to protect consumer’s health especially from foodborne diseases. The proposed programis the start of the way towards new food safety policy in Iraq and it will be considered as the essential baseof reorganization food control authorities in Iraq and updating national food regulations and legislations.

Psychosocial Disturbance of Hemodialysis Patients with Chronic Hepatitis B and C Virus Infection at Southern Provinces in Iraq

Psychosocial issues are an understudied yet important concern in the overall health of hemodialysis (HD)patients. Stress is a concomitant of chronic illness and its treatment, and may have meaningful influences onpsychological and medical outcomes.A descriptive study was carried out to determine Psychosocial Disturbance among hemodialysis patientswith chronic hepatitis virus infection .A non-probability of (60) hemodialysis patients with chronic hepatitisB and C virus. Reliability of the questionnaire form was determined through a pilot study while the contentvalidity of the questionnaire was determined through a panel of experts. And then the Data were collectedthrough the use of the observational tool (questionnaire), which was analyzed through the use of threestatistical approaches. They are descriptive statistical analysis (frequencies, percentage, S.D, range of scores,mean of scores and relative sufficiency; inferential statistical analysis (correlation coefficient and chi- squaretest); and analysis of variance (ANOVA) . The study indicates that the Psychosocial domain has the effectdue to hemodialysis with chronic viral hepatitis . The study indicated that the negative correlation betweenthe socio-demographic and Psychosocial, except income, socioeconomic status at the social is relations/support domain. On the basis of the results of the study, the researcher recommends to sharing the healthcover given and family members to provide psychological support for hemodialysis patients with chronicviral hepatitis accept their condition that maintain peaceful live.

Seroprevalence of HTLV-type-1 and type-2 among Blood Donors in Some Iraqi Provinces

Seroprevalence of HTLV-type-1 and type-2 among Blood Donors in Some Iraqi Provinces

Rebuilding the Ba'thist State: Party, Tribe, and Administrative Control in Authoritarian Iraq, 1991–1996

How do authoritarian states establish control in the wake of regime threatening shocks? The 1991 Uprisings—anti-regime protests across Iraqi provinces—were a turning point for Saddam Hussein and the Ba'th Party. I discuss two strategies deployed by the Ba'thist regime to reconsolidate political authority after the rebellion, both influenced by concerns about extending control to geographically-challenging locations. First, the regime collaborated with tribal intermediaries to outsource monitoring and social control of rural areas, particularly in border regions. Second, the regime expanded Ba'th Party influence in Iraq's "second cities," like Basra and Mosul, major population centers located near the border of rival states Iran and Turkey. These findings suggest weak states seek to increase their strength through investment in local political actors and in ways that are geographically differentiated across regions.

Diagnosis and control of the cucumber root rot causes using some chemical and biological agents: تشخيص ومكافحة مسببات مرض تعفن جذور نبات الخيار باستعمال بعض العوامل الكيميائية والأحيائية

This research was aimed to identify the causal agent of the root rot disease of cucumber in some provinces of Iraq, and evaluate its pathogenicity and control it using beneficial bacteria of Serratia odorifera (So) and Enterobacter cloacae (Ec) which isolated from the rhizosphere of healthy cucumber plants, and using silicon (Si) and copper (Cu). The fungus Fusarium solani was predominant, while its percentage of appearance was 80.0% with frequency of 46.2%, Isolate Bfs- 1 was most virulent which prevent germination of the cucumber's seed overall in vitro compared to the control. The bacterial isolates D6 and Q10 exhibited 100% percentage of inhibition against the pathogen in vitro. Results of bacterial isolates identification using Vitiq2 Compact System showed that they belong to S. odorifera and E. cloacae respectively. Under greenhouse conditions the quadrant treatment (So+Ec+Si+Cu) was superior in controlling the disease, while it exhibited 100% percentage of seed germination compared to the negative control (Fungus alone) which achieved 58.0% and the percentage of disease incidence and severity were 9.0%, 3.5% respectively compared to the negative control which were 90.0%, 66.5% respectively. And the quadrant treatment exhibited significant increase of plant growth criteria represented by the dry width of plant, while it achieved 2.69 gm/plant compared to negative and positive control which were 0.85, 2.16 gm/plant respectively.

Diversity and Geographical Distribution of Sand Flies Phlebotomus papatasi (Diptera: Phlebotominae) by using Geometric Morphometric Technique from two Iraqi Provinces

The variation in wing morphological features was investigated using geometric morphometric technique of the Sand Fly from two Iraqi provinces Babylon and Diyala . We distributed eleven landmarks on the wings of Sand Fly species. By using the centroid size and shape together, all species were clearly distinguished. It is clear from these results that the wing analysis is an essential method for future geometric morphometry studies to distinguish the species of Sand Flies in Iraq.

Kakais with Religious Beliefs and Rituals

Today, Kakaî communities in Iran known as Ahl-e Haqq live in Iraqi provinces especially in settlements in Mosul, Kirkuk-Dakuk, Diyale-Hanekin, Tuzhurmatı, Suleymaniye-Kelar. They undertake to hide their beliefs because of security concerns. The Kakailik synchretic Islamic religious belief is heterodox. It finds Zoroastrianism, Mitraism, Brahmanism and Hinduism, early tenets of the Kakai belief being incarnation and reincarnation. An important Kakailik place of pilgrimage is the Sultan İshak Tomb. For the Kakaî, Sultan İshak, who founded their spiritual sultanate is considered to be second in rank only to ‘Alī. The Kakaî believe in both resurrection and reincarnation. While some Kakaî claim to be Turkmen, others consider themselves to be Kurdish. Scholars such as Al-Azzawi, Edmonds, Hawramani and Moosa come to mind regarding studies on the Kakaî in Iraq.

Cure of Autistic Disorders: Mission Impossible is Possible in an Illustrated Pioneering Experience.

Background: Autistic disorders have become increasingly known as pervasive developmental disorders since the 1980s. They have been recently called autism spectrum disorder mostly by the American Psychiatric Association. They include five chronic disorders marked by early impairment in socialization, communication and behavior. There is no curative therapy or therapies for autistic disorders and they continue to be regarded as lifelong disorders. The aim of this paper is to describe our extensive experiences with treatment of autistic disorders with emphasis on the possibility of curing these disorders with a new therapeutic approach. Marked improvement or disappearance of autistic features in these disorders has not been reported with any therapy before. Materials and methods: During the period from December, 2017 to November, 2019, 116 patients with various autistic disorders were observed at the pediatric psychiatry clinic of the Teaching Hospital of Baghdad Medical City. 84 (72.4%) patients were males and 32 (28.6%) female’s patients were females. The patients’ ages ranged from two years to 16 years. The patients were from several provinces in Iraq including Baghdad, Saladdin, Najaf, Wassit, Kerbalaand Erbil in the North of Iraq). The patients were reported previously in several publications. All the patients had very poor speech development except the patients with Asperger syndrome. Most of the patients with a diagnosis other than Asperger syndrome were not saying any word and few patients were saying few words. Most patients were treated with a new therapeutic approach which included injectable cerebrolysin as the main therapeutic component. Marked improvement or disappearance of autistic features in these disorders has not been reported with any therapy before. The patients were treated with a new approach which aimed at improving the cardinal features of autistic disorders which include impairment of social interaction which is mostly manifested by poor responsiveness to their name and infrequent engagement with others manifested by poor eye contact and infrequently looking to faces. It was not possible to follow all the patients regularly nor was it possible to document details of the treatment and responses of all patients. Results: Almost all the patients treated with the new therapeutic approach experienced some improvement and lessening of the autistic features during the follow-up period. Treatment was also associated with initiation of speech and improvement of repetitive behaviors. It was possible to document complete disappearance of the main autistic features in twenty patients. It seems that the patients who achieved complete disappearance of the main autistic features will need an intensive learning especially of speech to abolish the effect of the time when they were under the effect of autistic behavior and to push them toward a possible cure of their illness. Conclusion: In this paper, we have demonstrated the possibility of cure of autistic disorders including autism and Asperger syndrome with use of individualized courses of intramuscular cerebrolysin as the main therapy for the main autistic features (Impaired social interaction and communication dominated by the lack of response to their name and poor eye contact). Understanding, a cure of autism will not immediately abolish the cumulative effect of the condition on learning, behavior and speech development before cure.

Using Multivariate Analysis to Study the Spread of Transitional Diseases in Iraq

Medical and technological development has achieved continuous successes during the last period. However, the statistics received from the World Health Organization (WHO) show the suffering that millions of people are subjected to daily as a result of their exposure to transitional diseases. The most prevalent transitional disease in the Iraqi provinces and for all age groups for both genders is water pox disease, followed by cutaneous leishmaniosis and then mumps. The most affected governorate with transitional diseases is Baghdad Governorate (Rusafa Sector), followed by Dhi Qar Governorate and Baghdad (Al Karkh Sector). The most age-groups affected with transition diseases are the categories (5-9) years for males, followed by (5-9) years for females. The highest total contribution to the first axis was for cutaneous leishmaniasis, followed by mumps, then Basil dysentery, as for the absolute contribution in the first axis, it was Dhi Qar Governorate, followed by Baghdad. There are more than 14,000,000 people who die each year because of these diseases, and most infections are concentrated in developing countries, including Iraq. Hence, this research is vital to examine the extent of transitional diseases in Iraq for different age groups, both male and female gender. The use of the multivariate method, which is the correspondence analyses, it was found through the research that Baghdad (Rusafa Sector) has a high incidence of transitional diseases and the largest age group at risk of transitional diseases is (5-9) years form male gender.

Interpolation and Statistical Analysis for Evaluation of Global Earth Gravity Models Based on GPS and Orthometric Heights in the Middle of Iraq

The regions around the world need to perform their results based on the local geoid. However, each region has different ground topography based on the amount of gravity in this region. Nowadays, the recent global Earth's gravity model of 2008 is successfully used for different purposes in geosciences research. This research presents an overview of the preliminary evaluation results of the new Earth Gravitation Model (EGM08) in the middle of Iraq. For completeness, the evaluation tests were also performed for EGM96 by examining 31 stations distributed over four Iraqi provinces. The national orthometric heights were compared with the GPS /leveling data obtained from these stations. This study illustrated that the GPS /leveling based on EGM08 data was better than that based on EGM96 data in terms of reducing the root mean square error (RMSE) of the differences between the orthometric heights and GPS/leveling data. The standard deviation (SD) values for the national orthometric heights and GPS heights were about 4 and 26cm, respectively. The results also show that there is a small difference in hight ranged (0.0013 - 0.1333 m) in Karbala, (0.0023 – 0.0062 m), in Najaf and (0.0173 – 0.0703 m), in Babylon. Due to the flat area, better results were obtained in Karbala and Najaf than Babylon. The EGM08 geoid method has shown to yield very close results to reality for various projects, thus its accuracy is acceptable.

Assessment of adherence level for neonatal hyperbilirubinemia management by various physicians in ‎Iraq: a multi-clinic study

Background: Neonatal jaundice is a physiological process that occurs normally ‎for every infant to a varying degree. In some cases, this process becomes pathological ‎and imposes an increased risk of morbidity and mortality for the infant. The aim of this study was to assess the adherence level of various physicians to different guidelines ‎of management of neonatal hyperbilirubinemia in Iraq. Methods: An observational cross-sectional study was conducted in ‎multiple outpatient clinics in various Iraqi provinces, from February ‎‎2018 to ‎February 2019. ‎The study involved 130 physicians, who were divided into emergency physicians (EPs), general practitioners (GPs), and pediatricians (PDs), and assessed their compliance to guidelines for management of neonatal hyperbilirubinemia using a questionnaire, which included providing the correct management for a test case scenario. Results: PDs had significantly longer discharge times compared to EPs and GPs. In total, ‎91.7‎% of PDs always tested the neonate for bilirubin levels ‎before discharge, while 5.5‎% of GPs and 0% of EP did so. Regarding follow-up visits, 16.7‎%, 4.8% and 45.2% of PDs, EPs and GPs, respectively, scheduled a follow-up between 49-72 hours; ‎47.6‎% and 38.1% of EPs scheduled a follow-up at ≤24 hours and 25-48 hours, respectively‎‏. In addition, 91.7% of PDs gave the correct answer for the management of the test ‎case scenario, followed by 58.9% of GPs, and 38.1% of ‎EPs‎‏.‏ About half of ‎PDs extended neonates length of stay beyond 48 ‎hours. Conclusion: GPs and EPs show lower adherence levels for the management of neonatal jaundice than PDs, which indicates that these physicians adhere well to current management guidelines from the WHO, ‎AAP, and NICE.

Assessment of adherence level for neonatal hyperbilirubinemia management by various physicians in ‎Iraq: a multi-clinic study.

Background: Neonatal jaundice is a physiological process that occurs normally ‎for every infant to a varying degree. In some cases, this process becomes pathological ‎and imposes an increased risk of morbidity and mortality for the infant. The aim of this study was to assess the adherence level of various physicians to different guidelines ‎of management of neonatal hyperbilirubinemia in Iraq. Methods: An observational cross-sectional study was conducted in ‎multiple outpatient clinics in various Iraqi provinces, from February ‎‎2018 to ‎February 2019. ‎The study involved 130 physicians, who were divided into emergency physicians (EPs), general practitioners (GPs), and pediatricians (PDs), and assessed their compliance to guidelines for management of neonatal hyperbilirubinemia using a questionnaire, which included providing the correct management for a test case scenario. Results: PDs had significantly longer discharge times compared to EPs and GPs. In total, ‎91.7‎% of PDs always tested the neonate for bilirubin levels ‎before discharge, while 5.5‎% of GPs and 0% of EP did so. Regarding follow-up visits, 16.7‎%, 4.8% and 45.2% of PDs, EPs and GPs, respectively, scheduled a follow-up between 49-72 hours; ‎47.6‎% and 38.1% of EPs scheduled a follow-up at ≤24 hours and 25-48 hours, respectively‎‏. In addition, 91.7% of PDs gave the correct answer for the management of the test ‎case scenario, followed by 58.9% of GPs, and 38.1% of ‎EPs‎‏.‏ About half of ‎PDs extended neonates length of stay beyond 48 ‎hours. Conclusion: GPs and EPs show lower adherence levels for the management of neonatal jaundice than PDs, which indicates that these physicians adhere well to current management guidelines from the WHO, ‎AAP, and NICE.