From the Editor

This issue is rich with papers from various countries in the region including Saudi Arabia, Qatar, Yemen, Iraq, Turkey, Lebanon and Australia. It deals with topics of interest to primary care physicians.

El-Gamal F.M et al., did a cross-sectional study, where a convenient non-probability sample was selected. The study was conducted in a cement manufacturing factory at the North of Jeddah city and at a medical college. Each subject was asked a personal questionnaire (to collect socio-demographic, and health data), an occupational questionnaire, and the MRC questionnaire on respiratory symptoms and smoking habit, and ISAAC core questionnaire on asthma and allergy. Smoking was significantly associated with chronic cough (OR=3.68; 95% CI: 0.99, 15.11' and p < 0.05), chronic phlegm production (OR=8.83; 95% CI: 2.33, 33.51, and p < 0.001), shortness of breath on exertion (OR=4.18; 95% CI: 1.49, 11.66, and p < 0.006), and eczema (OR=6.43; 95% CI: 1.33, 31.14, and p < 0.021). After allowing for age, height, weight and cement dust exposure, smoking subjects had significantly lower FEV1% compared to nonsmokers (Beta= -3.45%, p < 0.05). The authors concluded that early effects of smoking increased chronic respiratory symptoms and occurrence of eczema. FEV1% is the early affected lung function index in smokers, denoting airflow limitation. Cement exposure under the current environmental factory conditions seems to be safe.

Alshehri A et al. did a cross-sectional study to determine the practice of laboratory tests in emergency room requested by emergency physician at King Faisal Hospital, Taif, KSA. The checklist included items about demographic data, presence of chronic diseases, laboratory tests requested, and whether these tests were normal was used for data collection. CBC was requested for 97.9% of patients, LFT was requested for 82.9%. Urea/creatinine test was requested for 84.1% of the participants and electrolytes testing was requested for 88.5% of them. Vitamin D testing was requested for 42% of the participants and blood sugar testing was requested for 12.1% of them. The authors concluded that there was an overuse of laboratory tests at the ED which necessitates to choose the necessary analyses for each patient and to implement education and training of physicians on the ways to decrease unnecessary lab test ordering.

Al-Harthi A.K et al. did a cross sectional study using an electronic questionnaire which was distributed to 384 women in the reproductive age at Taif City with an age ranging from 18 to 56 years. The aim of this study was to explore the prevalence of CS, and to assess the extent of Saudi women's awareness and attitude towards the long-term and short-term complications of caesarean sections. Of the participants, 68.8% prefer normal delivery, 77.6% saw that cesarean section is more harmful than normal delivery, and 39.8% saw that cesarean section is safer for the mother and the baby. For the participants who had previous CS (38% of the sample), and 16.9% had CS for health causes and complications for the fetus. About 18% of them said that constant pain was the common complication of CS, 47.9% saw that uterine adhesion is the most common complication of a CS in the long-term, while 44.1% saw that delay and lack of breastfeeding is the most common complications of the CS on the child. The authors call for health education of all women about advantages and disadvantages of CS to enable mothers to make the proper decision.

Al Zahib Y.H et al., did a cross-sectional that included 404 Saudi adults aged 19- 65 years who attended PHC centers in Abha City. The objective is to describe the physical activity (PA) profile and its determinants among attendants of primary healthcare (PHC) centers in Abha City, Saudi Arabia. A self-administered questionnaire was designed by the researchers and was used for data collection. Most participants (80%) reported low level of PA, whereas 17.1% reported moderate PA. High level of PA was reported among only 12 participants (3%). Vigorous physical activities were practiced by only 4% of participants, whereas moderate physical activities were practiced by only 3%, and walking was practiced by 49.8%. The authors concluded that most Saudi adults attending PHC centers in Abha City have low level of PA. Males have significantly higher PA than females. There are several barriers against PA. Overcoming these barriers will contribute to improvement in PA among the Saudi population.

Younis, M.S et al., look at the quality of life of older patients attending a general hospital in Baghdad/Iraq. The number of older people is increasing worldwide due to the improvement in health care services, even in developing countries. The World Bank reported that life expectancy at birth in high-income countries was 81 years and in the low -income countries 64 years and 72years in the Arab world countries during 2018. Within the two decades of 1998-2018: life expectancy at birth in Iraq was 71.7years for females 66.5 years for males, 72.4 years for females,68.4 years for males in Iraq subsequently. Due to the global demographic changes, a heightened interest in researching the elderly's welfare through the bio-psycho-social approach using multiple tools for assessment of different dimensions of QoL using generic and specific instruments to measure health-related QoL. Like other Arab countries, religious and cultural traditions and beliefs in Iraq ensure respect and protection to the elderly. Their family members (spouse, son, or daughter) are entitled to look after them prudently. Abyad, Ashour, & Abou-Saleh (2001), stated that sending older parents to nursing homes is perceived as immoral behavior and unwelcome step, in contrast, a loving and respectful attitude toward the older people enhances their subjective and objective dimensions of QoL. The QoL of older people in Iraq warrants further study to fill the data gap and formulate a proper geriatric health care system.

Alwaedi N.M., et al., reported a case of Kocuria rhizophila is a Gram-positive microorganism infection in a new born. A 30-day old boy presented to the Maternity & Children's Hospital, Abha City, Saudi Arabia, with a history of cough and shortness of breath for two days, followed by apnea and cyanosis. On clinical examination, he was in moderate respiratory distress with compensated shock. He developed supraventricular tachycardia, which was controlled by adenosine. He was admitted to the Pediatric Intensive Care Unit (PICU). Blood culture showed positive growth with Kocuria rhizophila, sensitive to Gentamicin, Erythromycin, and Moxifloxacin. The patient developed respiratory distress and needed non-invasive respiratory support. At that time, antibiotics were upgraded with no significant improvement of clinical condition till Gentamycin was added on the second day, which led to dramatic response and the patient was shifted from PICU to the pediatric medical ward. The authors concluded that K. rhizophila can cause severe infections in pediatric patients that necessitate PICU admission. Therefore, it should be considered as a true pathogen and proper treatment should be provided to all susceptible pediatric patients.

A paper from Yemen looked at flexible intramedullary nails for treatment of femoral shaft fracture in children, Aden, Yemen. It was a retrospective study conducted in the orthopedic section at Algamhoria Teaching Hospital and 2 private hospitals in Aden. Patients numbered 37 and they were 22 [59.5%] males and 15 [40.5%] females. The mean age was 8.51 years. Motor vehicle accidents were responsible for the majority of cases (56.8%).
Mean of fracture union was 12.14 weeks, the mean time of weight bearing was 4.65 weeks, also, the mean duration of knee flexion was 2.46 weeks. The mean time of removal nails was 7.26 months. The authors concluded that flexible intramedullary nail is a great choice for the treatment of pediatric patients (6-12 years old) with closed and opened femoral shaft fracture. It can provide a rapid recovery.

Almasadi M.M et al., did a retrospective analytical cohort study to determine the pattern and frequency of hospital acquired infection (HAI) in pediatric intensive care unit (PICU) at Abha maternity and children hospital. All pediatric patients from 1 month to 12 years who had HAI in PICU were included. Out of 585 pediatric patients admitted to PICU, Abha Maternity and Children hospital throughout the study period (1 March 2017 - 28 February 2018), 42 acquired infections with 79 episodes giving a rate of 7.2%, based on number of cases and 13.5% based on number of episodes. The age of 40.5% of them ranged between one and less than 6 months. More than half of them (53.7%) have stayed more than 30 days at the hospital. The number of HAI episodes was three or above among 54.8% of cases. The authors concluded that hospital acquired infection is not very rare in PICU units. Also, mortality rate is relatively high and is related to number of hospital acquired infection.

Dr Saad & Faiqa's systematic review aimed at looking at the effects of SGLT2i in adult patients with Type 2 diabetes and chronic kidney disease. The reviewers examined renal outcomes, which were end-stage renal disease (ESRD), renal failure, doubling serum creatinine, macroalbuminuria, incident microalbuminuria, alteration in urine albumin-to-creatinine ratio (UACR), estimated glomerular filtrate rate (eGFR), dialysis, kidney transplant, or death related to renal disease. The extracted data were qualitatively synthesized.

18 studies that met the eligibility criteria were selected for review. In line with the strong evidence presented in previous meta-analyses, SGLT2i clearly demonstrated that it lowered the risk of developing ESRD, microalbuminuria, reduce the levels of eGFR and UACR compared to controls. The authors concluded that SGLT2i has positive renoprotective effects in patients with T2DM and CKD by reducing the risk of developing worsening albuminuria and decreasing the risk for ESRD compared to controls.

A paper from Iran looked at Coronavirus Environment vs Socio-Economic and Demographic Problems Followed: A Sociological Appraisal. The paper searches the cause and effect impacts of the newly-found Coronavirus. The word "Corona" is currently used by all the people (7.7 billion) over the age of at least 3. The unprecedented disease is reflecting a large number of effects, infecting and killing many people of the rich and the poor. The new phenomenon is continuing rapidly. It brings about recessions and closures in many businesses, and laying off many employees and workers, and that has created income and security problems for the families. The new environment has imprisoned families inside homes disrupting them from the normal and regular interactions. Poor economies will not easily be able to rehabilitate and reconstruct themselves. That is why a large migration wave will be quite likely to occur. Similarly, many countries will face increasing child labor and street children because of shortage of employment for the adults.

Helvaci M.R et al., tried to understand the most desired values of high density lipoproteins (HDL), low density lipoproteins (LDL), and triglycerides in the plasma. We studied 256 cases (153 females). The mean age, female ratio, body mass index (BMI), fasting plasma glucose (FPG), LDL, white coat hypertension (WCH), hypertension (HT), and diabetes mellitus (DM) were the highest in the fourth group. The authors concluded the highest mean age, female ratio, BMI, FPG, WCH, HT, and DM parallel to the highest HDL and LDL, and the highest CHD in contrast to the lowest HDL and LDL values may show initially positive but eventually negative acute phase proteins functions of HDL and LDL. Due to the lowest mean age, female ratio, BMI, FPG, WCH, DM, and CHD, the most desired values of HDL may be between 40 and 46 mg/dL. Additionally, the most desired values of LDL were in between 80 and 100 mg/dL, and the triglycerides were lower than 60 mg/dL in our previous studies.

The fourth paper on Parkinson's disease looked at the differential diagnosis and patient assessment. Early symptoms of PD are subtle and occur gradually. Patients may be tired, or experience a general malaise. We can note that we talk too softly or that they look messy and spidery in their handwriting. We may lose track of a word or thought or we may, for no obvious cause, feel irritable or discouraged. This early period can last a long time before the symptoms appear more classic and obvious. The onset of symptoms will take several years to go unnoticed. Tremor is always first detected, which usually causes the doctor's first appointment. Nevertheless, there is no tremor in up to 30 per cent of patients; this may lead to a misdiagnosis. In this review the approach to assessment and differential diagnosis of Parkinson disease are discussed.

Chief Editor:
A. Abyad
MD, MPH, AGSF, AFCHSE
Email: aabyad@cyberia.net.lb

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