Tawfik A M Khoja et al., looked at Primary Health Care in Pandemics: discussing the major barriers, challenges and opportunities. They stressed that COVID-19 has become a major global public health threat. It started from Wuhan the province of China in December 2019 and has spread in every country of the globe with over 100 million people currently infected and over three million deaths as of May 2021. Nearly a year on, with much town and cities are in lockdown and with all public health measures to minimize transmission of the virus SARS-COV-2 and the scientific achievements with many vaccines development at a record time, the transmission in the second wave is still strong with new variants of the virus that are emerging. The pandemic has caused a serious impact on the economic, social, political, and cultural dynamics of people, globally. The majority of people with mild and moderate symptoms of COVID-19 seek primary care (PC) service as the entry point for getting medical intervention, reducing flow to hospital care. Currently, primary care settings are facing major challenges including lack of funds, poor infrastructure in some countries, shortage of health care workers and equipment. Most, if not all primary care centers are not designed to separate people with the virus. The pandemic so far shows that strengthening primary care as the first point of contact with the health system is vital. The health systems of the future cannot be resilient without strong primary care for all, capable of meeting population health needs and aspiration for good health and well-being.

Almadhi et al., did a cross-sectional study aimed at IMSIU medical students in Riyadh. A questionnaire was distributed in April 2021 through WhatsApp to randomly selected medical students from all years except preparatory-year students. They collected 301 responses. 41.9% reported not starting any clinical rotations, and 38.5% indicated finishing some clinical rotations. Of the total students surveyed, 49.5% indicated that the COVID-19 pandemic influenced their choice of specialty; 48.6% felt that they had discovered new interests, which affected their consideration. In comparison, 40.5 % believed that COVID -19 had limited their ability to explore their considered specialty. The authors concluded that most of the students did not complete their clinical rotations or electives. Moreover, we found that the COVID-19 pandemic influenced students' perceptions about their specialty choices after graduation. Most of the students surveyed said their intentions had changed from pursuing specialties that required direct contact with patients to those that did not.

Alamri et al., assessed public willingness and preparedness with their attitude to receive COVID-19 vaccine in Saudi Arabia. They did a descriptive cross-sectional study was conducted targeting all available population in Saudi Arabia. The study included 2227 participants whose ages ranged from 18 to 62 years old with mean age of 31.7 ± 11.3 years old. In conclusion, the study revealed that acceptance of the COVID-19 vaccine in Saudi Arabia somewhat good but not sufficient to have the recommended herd immunity. It is affected by the effectiveness of the vaccine, safety of the vaccine, being taken by others, and history of getting infection or experienced death due to covid-19.

Dr. Basheikh, M.A., did a a descriptive, cross-sectional study conducted from March 2018 to October 2019. He was looking at burnout and depression symptoms are extremely common among internal medicine physicians including program directors There are more than 60 training centers offering internal medicine programs all around the Kingdom of Saudi Arabia. This study was approved by the Quality Committee, which follows the Scientific Council for Internal Medicine at Saudi Commission of Health Specialties. All participants were informed about the study objectives and confidentiality of survey responses, and they provided informed consents. Among 40 program directors who participated in this survey, (85%) were stressed out. Moreover, 27.5% expressed lack of support from the hospital's administration, 23.1% claimed that the department head interfered with the training process, 30% were frustrated with their uncooperative colleagues, and 82.5% denied receiving any financial benefit other than training allowance. Finally, 95% were satisfied with their performance as program directors. The authors concluded that Similar to other physician groups, program directors experience burnout. Nevertheless, more studies should be conducted to better understand stress and its possible causes. Further, such investigations can help identify the reasons behind the lack of support, in addition to protection of program director's encouragement.

AL Shehri et al., did a cross sectional study, data was collected from the purposely constructed questionnaire, the questionnaire was composed of demographical and questions related to the tracheostomy, ethical approval was obtained, consent from the respondents was taken , questionnaire was anonymous, questionnaire was constructed from the panel of experts including subject specialist , researchers and language specialist. Out of total 70 patients 33% have no pain while 26% have mild pain , 20% moderate pain , 11 and 10 % have severe pain controlled by narcotics and medication respectively.29% have not noticed any change in their appearances. The authors concluded that tracheotomy may be successfully conducted in this group of patients and that it provides significant practical and psychological benefits over other options.

Aljuaid , et al., assessed the level of awareness regarding first-aid management and control of epistaxis among teachers inside schools in Taif region, Saudi Arabia. The study revealed that teachers have fair knowledge about epistaxis control. Most of them were aware of changing the head position, Aalmost (80.1%) of the teachers will try to stop bleeding by applying pressure on the nose and about one third of them will do it on the lower part of the nose,17% of the teachers reported that they will use other methods where most of them reported that they will Seek health care or call the emergency. The authors concluded that Sixty-three percent of the teachers have fair knowledge regarding the control of epistaxis, especially those who have previous experience about it. However, more attention should be paid to improve the awareness regarding epistaxis management in the area through health training and educational sessions.

Dr. Nazish Jaffar et al., looked at barriers to premarital thalassemia screening and to observe the current thalassemia practices in Asian countries. This study was conducted on six countries of Asia based on economic status according to World Bank criteria. In Saudi Arabia, major obstacles for premarital thalassemia screening included planned weddings (43%), fear of social disgrace (21%), pressure from family (17%), and religious factors (14%). While in Oman, 4% of the people feared positive results and also considered it as an insult. Amongst Iranian population, financial burden on couples, disease phobia, fear of positive results, difficulty in accessibility, tribal variances and sociodemographic factors were frequent hindrances to screening program. Religious factors, financial constraint and lack of awareness cause reluctance in Pakistan and Bangladesh. Moreover, in Sri Lanka, factors like cancellation of marriage and sociocultural norms were identified as negative outcome of the screening. The authors concluded that, a negative attitude and reluctant response to premarital thalassemia screening was observed in people belonging to all the countries included. Major contributing factors were religious misconceptions, social stigma, varying ethnicities, low financial status and poor accessibility to screening programs.

Majrashi et al., assessed prevalence of immunization against seasonal flu and to explore the knowledge related to influenza virus and flu immunization among elderly population in Abha sector. A descriptive cross-sectional approach was used targeting all accessible elderly population in Aseer region, Southern of Saudi Arabia. A total of 386 elderly aged 60-89 years old with mean age of 72.3 ± 5.8 years completed the study questionnaire. Totally, 56.2% of the elderly had good awareness regarding seasonal influenza. About 91% of the participants heard about it, 73.8% reported that it is safe, 60.9% know that influenza vaccine can prevent serious complication for elderly, and 50.8% know that influenza vaccine promotes immunity against the virus. The study revealed that one third of the elderly received the seasonal influenza vaccine regularly during the last years and nearly two thirds of them received it last year. Higher coverage rate was higher among highly educated male elderly with sufficient income and at rural residence and those who were asthmatic and previously hospitalized dur to flu.

Al Ghamdi, et al., attempt to measure the magnitude of the problem of diabetic foot in the special area of Albaha in Saudi Arabia. They included 53 patients presented to the diabetic foot center in Al Baha, Saudi Arabia over 1 year. The included patients were assessed by meticulous clinical examination including eye examination and foot assessment for ulcer, neuropathy, skin manifestations like abscesses, and foot deformities. Investigations included fasting blood glucose, hemoglobin A1C (HbA1C), lipid profile, and Doppler Ultrasonography of the lower limbs. Interestingly, diabetic foot ulcers were found to be significantly higher (p 0.038) in patients aged <66 years (24 (88.9%)) in comparison to those aged >66 years (20 (76.9%). In conclusion; diabetic foot ulcers and complications are a major health problem contributing to devastating morbidities up-to amputations. Poor glycemic control is a major contributing factor for diabetic foot problems. Good glycemic control, diabetic foot meticulous care, and early interventions are recommended health practice strategies.

Malibari , et al., applied a validated questionnaire of six parts was distributed online to include all diabetes patients in Saudi Arabia. After applying the criteria, 400 diabetes responses were included. The aims of this study were:1) to assess the awareness of diabetes and its systemic and oral complications among adults with diabetes in Saudi Arabia, 2) to evaluate their behaviors toward maintaining proper oral hygiene and factors associated with adequate oral health knowledge, and 3) to identify what recommendations and improvements are needed in diabetic clinics in KSA. The authors concluded that their study revealed comparatively better results of awareness than previous studies reported in Saudi Arabia, however not to the desired standard. Therefore, both dentists and all healthcare providers should be encouraged to take the responsibility to promote proper oral hygiene practices among their diabetic patients in order to reduce the risk of having periodontal diseases. Further research is required to identify obstacles preventing those patients from having regular dentist visits.

Al-Muhannadi, et al., assessed the prevalence and co-occurrence of major depression disorder and generalized anxiety disorder in adolescent in Qatar. They followed a cross-sectional study. An online questionnaire including Demographic data, PHQ-9 and GAD-7 will be sent to parents or legal guardians to take online consent, then to be filled by their children in the age of 12-18 years old. Chi-square test will be used to test the significance of association between variables. The significant level for all statistical analysis was set at 0.05. According to previous local study in Qatar we expect the prevalence of both disorders in this age group to be around 30% if not more and as per worldwide studies result 25-50% of depressed patient have anxiety also and 10-15% who have anxiety found to have depression as comorbidity, so we expect to have co-occurrences in this range.

Al-Karbi, et al., did a meta-analysis of randomized controlled trials (RCT) to evaluate the efficacy of curcumin on inflammatory pain in different disorders, in comparison to placebo and traditional pain treatments (NSAIDs and glucosamine plus chondroitin). In the all the 15 studies included 1475 subjects involved. Curcumin was found to be superior in controlling pain against placebo. Moreover, curcumin demonstrated a superior effect in controlling osteoarthritic pain when compared to Glucosamine and Chondroitin combination. However, Curcumin was found to be similarly effective to NSAIDs in controlling pain. The authors concluded that curcumin was found superior in pain relief against placebo and combination of glucosamine and chondroitin, in addition, it demonstrated equal efficacy in relieving osteoarthritic pain, when compared to NSAIDs.

Ibrahim et al., explored the relationship between the SES and the parental feeding practices will identify target groups who may benefit of interventions aimed at modifying unhelpful parental feeding practices. They followed a cross-sectional study done over 1 year. Participants were recruited from Clinical Nutrition Clinics at AbouElrish children hospital, Cairo University. A total of 712 eligible parent of children aged 3-5 years were asked to fill El-Gilany socio-economic status (SES) scale and the Arabic version of the child feeding practices questionnaire (CFPQ), then the individual domains and the total scores were calculated. The most common feeding practice adopted by the parents was encourage balance and variety (Mean ± SD 17.63 ± 2.88) while the least used feeding practice was emotional regulation (Mean ± SD 5.26 ± 3.36). There was statistical significance between the three levels of social classes and the following feeding practices: child control (P=0.002), encourage balance and variety (P= 0.004), restriction for weight (P= 0.005) and teaching nutrition (P <0.001). The authors concluded that The parental feeding practices are changing according to the SES. These practices can be promoted to improve dietary choices and prevent nutritional problems in children.

ALjohani , et al., aimed to assess knowledge of standard precautions (SPs) and infection control by healthcare workers (HCWs) at the primary healthcare level in Buraidah City, Qassim Region, Saudi Arabia. A cross section study enrolled HCWs (doctors, nurses, lab workers) from 20 primary healthcare (PHC) centers in Buraidah. Two-hundred participants were selected randomly to participate in this study. the study finding revealed inadequate of knowledge and a substandard adherence of SPs among the study participants. This is highlighted the necessity of the provision of a comprehensive training program to ensure the compliance to the infection control measures by the HCWs.

Alfaifi, et al., did a a cross-sectional study to assess prevalence, determinants and impact of migraine on health-related quality of life (HRQOL) among healthcare workers in Abha primary healthcare centers. The present study was conducted on 212 healthcare workers at primary healthcare centers belonging to the Ministry of Health 51.9% were males and 38.2% were residents. The mean±SD of MIDAS score was 12±10.6, and the mean±SD score of HRQOL was 54.9±7.4. the authors concluded that Prevalence of migraine varies according to several factors. The attacks of migraine affected grades of migraine disability and health-related quality of life of healthcare workers.

Bahhary, et al., did a cross-sectional study to assess the level of awareness regarding diabetic peripheral neuropathy (DPN) and its risk factors among diabetics in Muhayil City, Aseer Region, Saudi Arabia. This study included 367 diabetic patients. Regarding participants' awareness grades about diabetes and its risk factors, 4.1%, 18.5%, and 77.4% had excellent, acceptable, and poor awareness levels, respectively. The authors concluded that Type 2 diabetic patients in Muhayil City have poor awareness about DPN and its risk factors. However, prevalence of DPN among them is relatively low.

Abdulrazak Abyad
Chief Editor