This is the last issue of this year that is rich with papers from the region. At the end of the year , I would like to thank the editorial board , the reviewers and the publishing manager in their great effort for a successful year. At the time, I would like thank you the authors for their trust in our journal and for the valuable readers that we hoped enjoyed reading our papers this year. At the end I wish all a happy holiday season and Happy New Year.

Al Qaatri et al., looked at the increased Psychological Disorders among Pediatric Population. The authors stressed that generally, the pediatric population is at a higher risk of developing psychological disorders during COVID-19 than other age groups. Educational status, developmental age, poor economic background, and existing mental health issues are among the vulnerability factors that cause the difference in psychological disorders prevalence between age groups . According to the authors, social distancing and lockdown practices have resulted in anxiety and fear, leading to long and short-term mental health and psychosocial impacts on school-age children. This literature review will focus on examining increased psychological disorders among adolescents and children during COVID-19 and the most effective practices to implement to promote early detection.

Alkubaisi et al., did a retrospective chart review (baseline audit) looking at the clinical effectiveness Department, Directorate of Clinical Affairs, Primary Health Care Corporation, Doha, Qatar. They reviewed 245 health records of children attended well-baby clinic for three months. The aim was to ensure that well-baby services provide clinical care according to children's age as per well-baby service protocol within primary health care centers, to find gaps if any and, generate action plan for further improvement. The authors concluded that impactful audits with actionable recommendation make real difference in practice and compliance. In conclusion, action plan implemented further to the baseline audit are effective in increasing the compliance in most of the areas.

Altaf et al., looked did a comparative cross-sectional study was conducted by comparing patients' demographic information, and compliance to virtual calls and physician recommendations during 2020 with the regular physical attendance clinics in 2019. Patient data was collected from the electronic medical records after randomly selecting the sample for each year from 6 main outpatient clinics. During the 4-month period of 2020 (March-June), which virtual clinics were implemented in, there was a significant decrease in the attendance compliance when compared to the same period in 2019 conventional clinics. The authors concluded that COVID-19 pandemic had significant negative impact on patient care. Although that impact was seen greatest among those with chronic conditions and oncology patients, it was an essential step towards infection control during this difficult period. However, the pandemic is an opportunity to establish a comprehensive virtual care that will ensure easy access and continuity of patient care.

El-Gamal et al., attempted to identify the major socio-demographic, and health risk factors of stunting in 2-6 years old Saudi children. They did a cross sectional study. It was a convenient sampling method, and was conducted at the outpatient clinics of two general hospitals in Jeddah city. Wasting was encountered among 3.11% of the children, while stunting was found among 22.91%, and underweight among 20.32% of the children. Stunting was more common in early years of life (b=0.015). Short stature of the mothers (b = 0.021), and decrease in her BMI (b= 0.043) were significantly associated with stunting in their children (P < .05). The authors concluded that male gender and very young age are significant risk factors of stunting. Double malnutrition was common among children with stunting. Hereditary may be an important determinant factor of stunting in children.

Al-Jadidi, et al., did a pilot study, weighted and measurable outcome of community service program in decreasing relapse, length of hospital stay and the financial sequel of relapse of the service provided. In this study , there is a statistically significant deference between number of relapse before and after enrolments to community services , the mean number of relapse decreased after enrolment to community and the decreases mean cost per admission for the patients after enrolment to the community program . Decrease in number of admissions among patient enrolled on CMHS from (M 2.68 SD 2.76) to (M 1.51 SD 2.5) with P value 0.001 .The authors concluded that CMHS in Oman is effective in decreasing relapse rate and cost.

Rashed et al., looked at the role of SGLT2 inhibitors and GLP-1analogs in cardiovascular risk reduction in type 2 diabetes. The leading cause of morbidity and mortality in patients with type-2 diabetes mellitus is cardiovascular (CV) disease, that makes it an important target in management. Sodium-glucose cotransporter 2 (SGLT-2) inhibitors and glucagon-like peptide-1 receptor agonist (GLP-1 RA) are both two new antidiabetic drug classes that showed significant reduction in major cardiovascular events (MACE). With the introduction of these drugs, comprehensive CV risk reduction has been achieved in addition to glucose control. Both drugs work in different ways, the SGLT-2 Inhibitors leads to urinary excretion of 60-90 grams of glucose and as well sodium leading to osmotic diuresis. Both the SGLT2 inhibitors and GLP-1 agonists have undergone large trials that have led to massive evidence on their cardiovascular safety and renal benefits. The decision on using which drug from both classes depends on different factors like atherosclerotic disease and chronic Kidney disease.

Almonawar, et al., looked to measure non-compliance and to identify barriers to compliance among hypertensive patients. A total of 200 hypertensive patients attending Al-Qabel Primary Health Care (PHC) Center since at least one year were included in this study. A structured data collection interview questionnaire was used. To assess non-compliance of hypertensive patients, the Hill-Bone Non-Compliance to High Blood Pressure Therapy Scale was used. Only 11% of hypertensive patients were highly compliant. The main barriers for full compliance were forgetfulness (39%) and being asymptomatic (30%). The authors concluded that non-compliance of hypertensive patients attending PHC settings in Abha is high. Main barriers against full compliance of hypertensive patients are forgetfulness, absence of symptoms, dissatisfaction with provided health care and being tired of treatment side effects. Non-compliance is significantly higher among younger, newly diagnosed, Saudi, married, smoker patients. Non-compliance is significantly higher among hypertensive patients on multiple antihypertensive medications.

Alburaidi et al., attempt to assess the level of knowledge among patients with LBP related to their disease. They did a cross-sectional study was conducted at region of Asser, Saudi Arabia and comprised patients presenting with lower back pain. In this study, they used the Arabic version of validated questionnaire called (LBP knowledge questionnaire "LKQ"). we received 183 responses from patients with LBP. Among this sample, male represented 60.7 % of the sample. The authors concluded that the level of knowledge among patients toward LBP was inadequate where most of patients had partial level of knowledge about their condition. Age, gender, martial status and monthly income had no effect on this level of knowledge. More investigations should be conducted using another design as prospective design in order to indicate the acutely reasons for this low level of knowledge among patients toward LBP.

Alasmari, et al., tried to assess proton pump inhibitors awareness level among physicians and pharmacists and its detriments in PHCCs, Aseer region, Saudi Arabia. They did an analytical cross-sectional study was applied to answer the main research question. The study targeted all physicians and pharmacists in primary healthcare centres in Abha who will be accessible during the study period from 23 May to 27 July. A total of 178 participants completed the study questionnaire. 97 (54.5%) participants were pharmacists, 45 (25.3%) were clinical pharmacists, and 36 (20.2%) were physicians. The authors concluded that the current study showed that medical staff in the primary healthcare centres had moderately low knowledge regarding PPI and its indications. The lowest awareness was mainly among physicians relative to pharmacists especially clinical pharmacists.

Harbi et al., did a cross-sectional study, a self-administered questionnaire was distributed among migraineurs attending primary healthcare centers and hospitals in Riyadh, Saudi Arabia. The survey included questions about sociodemographic data, number of attacks, and environmental factors triggering migraines in order to assess their prevalence A total of 415 participants were recruited. The most common age group was 31- 50 years old (46.5%), with females dominating the males (84.8% vs 15.2%). The prevalence of migraines that affected activities of daily living (ADL) was 80% (CI=75.7% - 84.3%). The authors concluded that Migraines are highly prevalent in our region, most specifically among women. Noise, outdoor light exposure, indoor lighting, fluorescent lights, and computer systems usage were the most triggering environmental factors of migraines. These factors dissuade patients from doing their daily activities.

Helvaci, et al., tried to understand whether or not there is a disappearance of hepatitis C virus antibodies (anti-HCV) with hydroxyurea therapy in patients with sickle cell diseases (SCD). All patients with the SCD were included, and hydroxyurea therapy was initiated for all of them. The study included 337 patients (169 females and 168 males). Hydroxyurea therapy was well-tolerated with a high majority of cases (80.1%). Mean number of painful crises per year was decreased with the therapy (10.3 versus 1.7 crises per year, p<0.000). The authors concluded that SCD are chronic inflammatory disorders with high morbidity and mortality rates, and hydroxyurea is a well-tolerated and highly effective regimen for them. While hydroxyurea therapy decreases both frequency and severity of painful crises, WBC and PLT counts, total and direct bilirubin, and LDH levels, it increases body weight, Hct value, and MCV. Although hydroxyurea therapy also decreased the anti-HCV positivity, the difference was nonsignificant probably due to the small sample size of the present study.

AlJumail, et al., looked at the satisfaction of health care workers has direct effect on the quality of care. This study aimed to assess the job satisfaction among primary health care (PHC) workers in Buraidah, Saudi Arabia. A cross sectional study was conducted among primary health care workers in Buraidah. Data was collected on socio-demographic and professional characteristics. Job satisfaction was measured using a validated 36 item Job Satisfaction Survey (JSS). A total of 230 PHC workers were included in this study. Among the nine facets of the JSS; Nature of work, Co-workers and Supervision had mean scores in satisfaction category, while, five facets were in the range of ambivalent; Pay, Promotion, Benefits, Contingent rewards and Communication. Only one facet fell under the dissatisfaction range which was Operating Conditions. None of the socio-demographic variables had significant association with job satisfaction. About two thirds of the PHC workers were not satisfied with their job. This calls for policy makers to enhance job and job conditions to increase job satisfaction and improve the quality of care at primary care level.

AlSuqair et al., attempt to measure schoolteacher's perception of epilepsy in school children in Riyadh, Saudi Arabia in 2018. They did an observational, descriptive, cross-sectional study was done and data was collected by online and manual survey from (476) teachers chosen by quota sampling technique. The data was analyzed by using SPSS. Most of the teachers had moderate and good knowledge (81%), Female had better knowledge (85%), teachers with higher educational level had better knowledge (92%) and teachers with more years of experience had better knowledge (83%). The authors concluded that the majority of the teachers had moderate and good knowledge and attitude while only few teachers had moderate and good practice. Teachers' age and years of experience are approved to be factors in acquiring knowledge. t was found that teachers' age has significant effect on their attitude and teachers with higher educational level had better attitude. Teachers' gender and educational level appeared to have a significant effect on their knowledge.

Al-Ahmari et al., attempt to evaluate non-psychiatric physicians' knowledge, attitude and practices regarding management of cases with addiction. Following a cross-sectional study, 126 non-psychiatric physicians in Aseer Region were interviewed. A study questionnaire was used for data collection. It included socio-demographic data; general attitudes and interest toward addictions, addiction psychiatry; knowledge about addictions, addictive disorders, including treatment, and practice about addictions, addictive disorders, and treatment. Age of participants ranged from 26 to 66 years (Mean±SD: 37.1±9.1 years. Most participants (81%) were males. Only 9.5% attended a training course or a conference on management of addiction, while 12.7% attended a training or a course on palliative care. The authors concluded that non-psychiatric physicians in Aseer Region have insufficient knowledge, negative attitude and poor practice about psychoactive substance use disorders. Continuing medical education and training is necessary to promote physicians' knowledge and practices related to prevention and treatment strategies for addiction diseases.

Ballaji, et al., tried to assess risk factors associated with DKA among T1DM children registered at "Heraa Diabetes Center", Makkah Al-Mokarramah City, Saudi Arabia. The authors did a
retrospective hospital-based, case-control research design was followed and included 375 diabetic patients aged less than 15 years. There was significantly more positive family history in the DKA group than the control group (78.4% and 68%, respectively, p=0.036). The mothers was the main person who injects her child. Differences between both study groups according to the person who injects the child was statistically significant (p=0.029). DKA occurred more than once in 59.2% of diabetic children, and in 46.4% of children with overactivity. The authors concluded that risk factors for DKA include positive family history of diabetes, less educated or employed mothers, but its incidence is lower among children of parents with health-related jobs. It can be triggered by over-activity. It is caused by eating much sweet, missing blood sugar monitoring, omitting the insulin dose or infection. Noncompliance is associated with higher incidence of DKA.

Ahmed, et al., explored the family physicians' perspectives of the barriers in initiating insulin for adult patients with Type 2 diabetes mellitus (T2DM) in their primary health care settings. Insulin therapy often becomes necessary when oral anti-hyperglycemic agents are not enough, no longer effective or even as an initial choice. This cross sectional study where 102 primary health care physicians (PHCPs) (58 females and 44 males) from multi PHCCs in Tabouk Health Region - Kingdom of Saudi Arabia (KSA), responded correctly to online reliable self-administered questionnaire (Cronbach alpha of 0.77344) to address their perspectives of barriers to insulin initiation for adult patients with T2DM. Despite the free of cost availability of all types of insulin, including the safest and peak less ultra-long (degludec) and long (Glargine), the availability of free of cost glucometers for all people with diabetes, the presence of a well-equipped diabetes clinic at every PHCC, the long list of guidelines and educational courses as well as an appointment system with electronic health information system (HIS), insulin inertia is a common problem among PHCPs working in Tabouk Health Region.

Dr Shasho looked at Diagnostic approach to eosinophilia in children. Blood consists of three types of cells (Erythrocyte - Leukocytes - palates), and plasma. Leukocytes divided into 2 types of granulocytes (including neutrophils, eosinophils and basophils); and agranulocytes (including lymphocytes and monocyte). Eosinophil attack and kill parasites and cancer cells, and help with allergic responses, so their role is to protect the body from bacteria and parasites. However, a dramatic blood and tissue eosinophilia is an important part of adaptive immunity to parasitic helminthic infections, whilst more detrimentally, the eosinophil is thought to make a major contribution to the inflammation underlying the pathogenesis of disorders such as asthma, allergic rhinitis and atopic dermatitis. Eosinophilia is a common finding in clinical practice and presented in broad spectrum of diseases, some of them hematologic disorders and others non - hematologic (infection disease - allergic disease - medication reaction, and autoimmune disease).

Alomary, et al., did a study to determine medical students' perceptions of ML in otorhinolaryngology, head, and neck surgery and its applications in diagnosis and management. Also, to assess medical students' awareness of current challenges facing the application of ML in medical practice in the Kingdom of Saudi Arabia (KSA). They followed a cross-sectional survey was conducted in February-May 2021 among medical students in Saudi Arabia. The participants were provided questionnaires of the survey using electronic forms. Validation of the questionnaire was done using exploratory factor analysis and confirmatory factor analysis. There were 8 validated items on Attitude and 6 items on Knowledge. A total of 538 students completed the questionnaire. The majority of the students were familiar with machine learning in general 308 (57.3%). However, only a few of the participants were familiar with machine learning applications in the field of otorhinolaryngology, head, and neck surgery 184(34.2%).

The authors concluded that medical students in the KSA demonstrated a good knowledge of ML in general, although many were not familiar with machine learning applications in the field.

Dr Abdulrazak Abyad
Chief Editor