This is the last issue this year and we are proud of the quality of papers and the continuous interest in the journal. We are thankful for our readers that keep growing, for our authors, reviewers, editorial board and above all our editorial office and publishing manager.

Alghamdi, et al., did a cross sectional study to assess diabetes prevalence, diagnostic accuracy, and associated factors in Saudi Arabia. A representative sample will be surveyed on demographics, lifestyle, and medical history, with BMI measurements and blood glucose tests for diagnosis. Statistical analysis will identify key factors linked to diabetes. A total of 964 attendees at primary healthcare centers participated, with a mean age of 47.6 years (± 17.1) and a gender distribution of 50.4% female. Initial screenings found that 32.6% were diagnosed with diabetes, 12.9% were pre-diabetic, and 54.6% had normal glucose levels. A follow-up screening showed 36.8% diagnosed with diabetes, 12.9% pre-diabetic, and 50.3% normal. Among 312 confirmed diabetes cases, 30.1% had Type 2 diabetes and 2.3% had Type 1. Factors linked to a diabetes diagnosis included age (higher odds for those over 50), male gender, obesity (6.5 times higher odds), hypertension (3.1 times), and dyslipidemia (3.8 times). The authors concluded that there is a high prevalence of type 2 diabetes in Saudi Arabia's middle-aged and elderly population, with one-third diagnosed. Risk factors include age, obesity, and hypertension. Undiagnosed cases pose serious complications, burdening the healthcare system and requiring enhanced preventive efforts.

Soliena, et al., reviewed shoulder calcific tendonitis. Shoulder calcific tendonitis is a pathological condition characterized by the deposition of calcium hydroxyapatite crystals within the tendons of the rotator cuff. This condition manifests clinically with acute or chronic shoulder pain, restricted range of motion, and significant functional impairment. Diagnostic evaluation includes a thorough physical examination complemented by imaging modalities such as radiography, ultrasonography, and magnetic resonance imaging (MRI) to identify and assess the extent of calcific deposits. Management strategies encompass conservative treatments, including non-steroidal anti-inflammatory drugs (NSAIDs) and structured physical therapy programs, as well as interventional approaches like corticosteroid injections, ultrasound-guided lavage, extracorporeal shock wave therapy, and surgical intervention in refractory cases. Early and accurate diagnosis, coupled with an individualized treatment plan, is imperative for optimal patient outcomes and the restoration of shoulder function.

Kharel et al., did a cross-sectional study to compare the growth patterns of breast fed and formula fed babies of Duwakot. Several research studies have identified breastfeeding as a significant factor for normal infant growth and development. Childhood obesity is the major ailments seen in formula fed infants which clearly demonstrates the protective role and effect of the exclusive breastfeeding. The objective of this study was to compare the physical health among exclusive breastfed and formula fed infants. The aim of our study was to find Exclusive Breastfeeding and its impact on child's physical growth parameters among formula fed and exclusive breastfed. This was. The growth patterns of 81 exclusive breastfed babies (39 male, 42 female) and 81 formula fed babies (44 male, 37 female) were compared. The weight for age (WA), Height for age (HA), and weight for Height (WH) Z scores were calculated in 6 to 24 months babies by WHO Anthro Software Version 3.2.2. The prevalence of overweight in exclusively breastfed infant was 6.1% (> +2SD)) and formula fed infant was 17.3%. The prevalence of overweight was significantly higher among formula fed infants. The prevalence of obesity in formula fed infants was 2.5% (> +3SD)) and 1.2% in breastfed infants. The study revealed that overweight was significantly associated with formula fed but no statistically significant difference was observed in the other physical parameters like wasting, stunting and underweight. In Breastfed infants the mean Z score for WA was -0.22, WH was 0.1 and BMI was 0.06 whereas in formula fed infants the mean Z score for WA was 0.3, WH was 0.68 and BMI was 0.71. The authors concluded that the physical growth pattern of exclusive breast fed and formula fed Nepalese babies showed overweight tendency in formula fed babies as compared to breastfed babies.

Helvaci, et al., looked at whether metformin help in prevention of stroke. All patients with sickle cell diseases (SCD) were included. They studied 222 males and 212 females with similar ages (30.8 vs 30.3 years, p>0.05, respectively). Smoking (23.8% vs 6.1%, p<0.001), alcohol (4.9% vs 0.4%, p<0.001), transfused red blood cells (RBC) in their lives (48.1 vs 28.5 units, p=0.000), disseminated teeth losses (5.4% vs 1.4%, p<0.001), ileus (7.2% vs 1.4%, p<0.001), coronary heart disease (CHD) (18.0% vs 13.2%, p<0.05), cirrhosis (8.1% vs 1.8%, p<0.001), chronic obstructive pulmonary disease (25.2% vs 7.0%, p<0.001), leg ulcers (19.8% vs 7.0%, p<0.001), digital clubbing (14.8% vs 6.6%, p<0.001), chronic renal disease (9.9% vs 6.1%, p<0.05), and stroke (12.1% vs 7.5%, p<0.05) were all higher in males, significantly.The authors concluded as a prototype of systemic atherosclerosis, hardened RBC-induced capillary endothelial damage initiating at birth terminates with end-organ failures in much earlier ages in the SCD. Excess fat tissue may be much more important than smoking and alcohol for the development of atherosclerosis, and stroke and CHD are the two terminal causes of death with any underlying etiology. The efficacy of metformin in loss of appetite is well known for several years. Since metformin is a safe, cheap, orally used, and effective drug for excess weight, it should be prescribed for prevention of stroke after the age of 50 years even in normal weight individuals, since there are nearly 20 kg of excess fat tissue between the upper and lower borders of normal weight.

Dr. Elghblawi, reviewed the UK debate around Assisted dying, Dignity in Dying? Assisted dying is a conflict-ridden and debatable subject, and a broad range of interests should inform any proposed policy changes to promote autonomy and end and mitigate intense suffering by providing a 'safe and comfortable' death to patients who believe they would otherwise have to endure unbearable suffering at the end of life. Some could argue that palliative care can't do it all, especially with its inconstant availability. The British Medical Association (BMA) and some Royal Colleges have recently changed their attitude on physician-assisted suicide from 'combated' to forms of 'impartial'. For the last few years, the toll took the UK system to vote for assisted dying and wanted to legalize it. Some countries have legalized it for some time, and some British nationals fly to have it conducted. The drugs that are being prescribed and administered, are both for physician-assisted suicide (patient ingestion) and for euthanasia (physician-administered).