This issue is rich with papers from the Region that address areas of interest to primary care including Covid 19 epidemic and other variable problems that impact the life of our patients.

Kahlout et al., looked at the prevalence of Atopic Dermatitis and its associated factors among 4-12-month-old Infants attending primary health care corporation in Qatar.

Atopic Dermatitis, or Eczema, is one of the most common skin inflammation disorders worldwide. The disease has high prevalence rate, socioeconomic costs, and lacks the availability of curative and preventative measures. The authors investigated the effects of several risk factors on the development of AD in 4-12-month-old infants attending PHCC centers across Qatar. Multiple factors, previously thought to influence the occurrence of AD, were proven to have no association with the disorder's occurrence. Those factors include the duration of pregnancy, the type of delivery, breastfeeding, artificial milk feeding, and weaning age. Moreover, we found genetics to play a significant role in determining a child's predisposition to developing AD in their first year of life (p<0.05). By ruling out those factors, we can move forward to determine other key factors that may play a role in causing AD in young children in Qatar and worldwide

Al-Amri, et al., conducted a cross sectional study among 201 students of King Khalid University, in Abha city. The participants chosen were students from all levels of the medical faculty,. Each individual was asked to complete a questionnaire consisting of demographic features, education level, history of past refractive errors, family history of astigmatism, academic achievement problems and final GPA. Astigmatism was observed in 78 students (45.8 percent) out of total students. There was a strong link between the past of parents and the occurrence of astigmatism (p= 0.001). The authors concluded that among almost half of the included students, astigmatism was documented, particularly those with a positive family background of astigmatism and who had impaired visual acuity for both far and close objects themselves. Students with astigmatism showed difficulties completing graph-based assessments or using microscopes, but there was no impact on the students' final GPA.

Nayaz, et al., investigated the correlations between Islamic religiosity and resistance to intellectual temptation, as well as identifying the differences between high and low level of Islamic religiosity in resisting intellectual temptation, and to examine whether Islamic religiosity can predict resistance to intellectual temptation among youth sample in the Kingdom of Saudi Arabia . The results showed a statistically significant positive correlation between Islamic religiosity and resistance to intellectual temptation, as well as differences between high and low level of Islamic religiosity in resisting intellectual temptation in favor of high level of Islamic religiosity, the results also revealed the possibility of predicting resistance to intellectual temptation through Islamic religiosity. These results emphasized the importance of increasing Islamic religiosity among youth in order to protect them from intellectual temptations.

Kahlout et al., did a cross-sectional descriptive study design without any staff identifiers data for all PHCC staff attending primary health care and their information. The study aims to find out the prevalence of COVID - 19 among PHCC staff during the period of March to end of September 2020 and to correlate between the place of work and position of the staff. Total 5062 staff were included, 1541 cases 30.4 % were males, 3521 case 69.6% were females. The authors concluded that although PHCC also adopted a staff protection policy which included the waiver of attendance registration, the use of (masks, gloves, PPE), hand hygiene, isolation rooms for swabbing and the proper management of medical waste resulted from dealing with COVID -19 patients. The prevalence of Covid 19 infection among PHCC staff during the period from march first till 30 September found to be 9.7 % , but neither the position at work or comorbidities were found to be statistically significant with COVID 19 infection . Pharmacist were the most exposed medical staff category to COVID19 infection due to direct contact to all patient visiting PHCC, while dentist are second because they are dealing with open mouth patients , non-medical staff cashier and billing staff were the highest category because the deal with all visitors and exposed to probably infected material ( credit cards , currency ) in addition to lack of awareness , training .

Al-Kuwari, et al., conducted a retrospective data analysis was conducted for all the COVID-19 swabbing activities, the services utilization volume, and utilization of the alternative services (teleconsultations and medication home delivery) across the primary health care centers. Primary health care allocated testing sites for COVID-19 resulted in conducting 194,381 tests and detected 25,173 confirmed cases with a positivity rate of 12.9 %. The overall PHCC services utilization declined with an overall reduction of 50% in April 2020. Family medicine clinics represented 41.9% of the cancelled appointed. The author concluded that to decrease the risk of infection to the patients and health care workers, Primary health care in Qatar cancelled the appointments for some high-risk population. However, virtual remote services managed to make up for the in-person utilization volume and reflected acceptance in patients' behaviours. Primary health care continued in detecting positive COVID-19 cases among its targeted communities.

Dr Alqahtani, Followed a retrospective hospital-based research design, the data of 101 patients registered at the Homecare Department in the Armed Forces Hospitals of Southern Region (AFHSR), in Khamis Mushayt City, Aseer Region, Saudi Arabia, who were infected with COVID-19 were reviewed. Most homecare patients were elderly, Almost half of patients (47.5%) were admitted to the hospital. Almost three-fourths of homecare patients (72.3%) were hypertensive, 69.3% were diabetic and 36.6% had chronic kidney disease. Heart diseases included ischemic heart disease (16.8%), congestive heart failure (11.9%) and atrial fibrillation (10.9%). The authors concluded that most homecare patients infected with COVID-19 have associated comorbidity, mainly in the form of chronic diseases, such as hypertension, diabetes, chronic kidney, heart and neurological diseases. Case fatality rate due to COVID-19 among homecare patients is high, mainly due to their old age and associated morbidity.

Zaza & Agha looked at the diagnostic approach to lymphadenopathy in children
In most cases, a careful history and physical examination will identify a readily diagnosable cause of the lymphadenopathy, such as upper respiratory tract infection, pharyngitis, periodontal disease, conjunctivitis, lymphadenitis, tinea, insect bites, recent immunization, cat-scratch disease or dermatitis, and no further assessment is necessary. In general, lymph nodes greater than 1 cm in diameter are considered to be abnormal.

Supraclavicular nodes are the most worrisome for malignancy. A three- to four-week period of observation is prudent in patients with localized nodes and a benign clinical picture.
Generalized adenopathy should always prompt further clinical investigation.
When a node biopsy is indicated, excisional biopsy of the most abnormal node will best enable the pathologist to determine a diagnosis.

Fallatah et al., reported a 46-year-old gentleman presented to our hospital with necrotizing pancreatitis complicated by a pseudocyst a month prior to presentation. During hospitalization, the patient had a sudden decrease in his level of consciousness accompanied by a reduction in hemoglobin levels. Hemorrhagic pancreatitis with bleeding from three major vessels was diagnosed by computed tomography angiography. The bleeding was controlled with angiographic embolization. We present here the radiological findings and interventional techniques used to control life- threatening hemorrhagic pancreatitis. The authors concluded that hemorrhagic pancreatitis is a life-threatening emergency for which treatment with angiographic embolization should be commenced as soon as possible. Prompt diagnosis, team collaboration, and nonsurgical interventions could be lifesaving.

Idris, et al., utilized the Arabic version of Depression Anxiety Stress Scales (DASS-21) test to measure the anxiety, depression and stress among caregivers of patients with cancer. A total of 128 participants participated in the study. According to DASS 21, the results revealed that the overall prevalence of depression, anxiety, and stress in this study was found to be 57%, 52%, and 50%, respectively. The research concluded that voluntary care givers of patients with cancer were found to experience high levels of depression, anxiety and stress.

Alzahrani et al., followed a cross-sectional design to assess patients' comprehension of discharge instructions and to explore associated factors. A questionnaire was designed by researchers for data collection. It consisted of personal data and statements related to assessment of the patients' comprehension of discharge instructions. The authors concluded that about one-third of patients have poor comprehension regarding their discharge instructions. Verbal methods for discharge instructions is preferred by about half of patients, while 41% prefer both verbal and written methods. Patients' poor comprehension is significantly associated with patients' illiteracy, older age (>50 years), and social isolation.

Agha et al., looked at the effects of digital technology usage on children's development and health. They stressed that globalization has changed our lives in multiples ways, but the most important change in our lives, is due to our way of communication. Mobile phones have almost become an essential part of our daily lives. Smart phones were invented for the use of adult people, especially probably for people who are working an cement in the field of information and technology brings about the birth or students of higher level for their better achievements in academics. But now a day's Excessive use of mobile (smart) phone among young learners smart phones are serving the medium of learning to young children/learners. Leads to multiple learning difficulties and behavior disorders, emotional, moral and social development disorders of young children. It has eventually affected the academic performance of young children. The positive and negative effects of the mobile gadgets are affecting the overall development of young children. Educators and psychologist pointed out those using digital devices in the preschooler have negative effect as well, which is mainly linked to using those devices without any time bound.

Shehata et al., did a descriptive cross-sectional survey in different colleges at King Khalid University, Abha Saudi Arabia, to estimate the prevalence and correlates of obesity among children in Aseer region A total of nine colleges were included. After having permission from the college authority, self-administered questionnaires were distributed to a total of 500 students, with explanations about the questionnaire by the principal investigator. The study included 445 students who completed the study questionnaire. The authors concluded that
nearly half of the university students were overweight or obese with overweight more prevalent. Obesity was more recorded among male, old, aged students who frequently had family history of obesity. Improving the children lifestyle and dietary habits is mandatory to work against weight gain.

Dr Samer looked at the Relationship between autoimmune thyroid dysfunction and diabetes mellitus type 1 in pediatric population. Type 1 diabetes (T1D) and autoimmune thyroid diseases (AITD) frequently occur together within families and in the same individual in most parts of the world, type 1 diabetes is the most prevalent chronic disease in the population under 18 years of age although there are no reliable data available from many countries. Using internet search, a comprehensive literature review was done and words such as diabetes mellitus, autoimmune thyroid, hypothyroidism, hyperthyroidism, thyroid antibodies, and thyroid problems were searched The references of the relevant articles on this subject were also searched for further information. Analyses of results of various studies from various parts of the world were considered and their prevalence was noted to access the correlation between thyroid dysfunction and diabetes mellitus. Subclinical hypothyroidism is seen as the commonest thyroid problem among female type 1diabetes. The authors concluded that there is a strong relationship between thyroid dysfunction and Type 1 diabetes mellitus.
kanwal & Alemadi did a literature search was performed using Cochrane advanced search using "liraglutide", non-diabetic, weight loss, obese, and glucagon-like peptide-1 receptor agonist in different combinations. All randomized control trials, relevant to the inclusion criteria were selected for review writing. Nine randomized controlled trials of all doses of liraglutide for weight management in non-diabetic, obese individuals were identified. The authors concluded that all doses of liraglutide are effective in weight loss in non-diabetic, obese individuals; particularly dose 3.0 is the most effective one. Generally, liraglutide is safe for most study participants with minor gastrointestinal adverse events. The only concern is its associated serious adverse events; although, experienced by very few.

Dr Haidarah, described the characteristics of the patients and to evaluate the total knee replacement related to sex, age, weight, outcome and complications. He followed a retrospective study of all patients who undergone knee replacement surgery at Al-Naqib Private Hospital, Aden, over the period from January 2016 to December 2018. The authors concluded that TKR in management of OA still the most effective management modility with very promising future in medical advancement here in aden , TKA Post operative outcome is complex subject with too many factors effect on the result of TKR longstanding outcome expectation , and the preoperative physical state of patient still the leading factor in post operative expectation of ROM, in general early diagnosis and operation, control the comorbidity, weight reduction, improve lifestyle, pain control, and physiotherapy can make big positive difference in the outcome,

Wagokh et al., the authors stressed that there are many factors that may predispose to dissatisfaction in those patients. We studied whether patient's psychological status, implant type or BMI had predicted poor outcome after TKA at the JRMS. They performed their study on 189 TKA in 158 patients to assess the effect of the above-mentioned factors and their relation to the patient's satisfaction at 1 year after surgery. Two surgeons independently applied the Likert's satisfaction Score system, however, all surgeries were performed by one surgeon. Outcomes generally included postoperative pain, dissatisfaction, or loss of function of the patients. The authors found that a poor preoperative psychological status of a patient, higher BMI, greater than 40, might affect the post-operative satisfaction of a TKA. We also came to the conclusion of a satisfaction rate of 81% of all the TKA patients at the JRMS with the preoperative psychological factor being the most significant factor affecting the rate of post TKA satisfaction based on the used questionnaire with no significant effect of implant type.

Abdulrazak Abyad
Chief Editor