In this issue a number of papers dealt with common eye problems in primary care and cardiovascular issues in addition to other areas of interest to family physician.

Basheikh A., et al., Conducted a cross-sectional study among visitors of the awareness campaign about amblyopia, which took place in the Red Sea Mall, Jeddah. The authors aimed to assess the prevalence of astigmatism among the pediatric population in Jeddah, Saudi Arabia, and to assess the rate of newly detected cases (incidental astigmatism) and the associated risk factors. They examined the eyes of 347 children. The overall prevalence of astigmatism was 41.5%, whereas the prevalence of incidental astigmatism was 40.6% among 342 children without apparent astigmatism. The prevalence of incidental astigmatism was associated with a previous diagnosis of amblyopia. The authors concluded that astigmatism is highly prevalent among children in Western Saudi Arabia, with majority being undiagnosed before this screening campaign. These findings urge for further nationwide,

Almari et al., looked at the did a descriptive cross-sectional survey looking at the use of eye drops self-medication in Aseer region, Southern Saudi Arabia. A total of 209 participants completed the study questionnaire. Participants ages ranged from 18 to 65 years old with mean age of 32.9 ± 11.6 years. About persons who advised participants to use eye drops, the most reported was the person himself (34.4%; 72) followed by family and friends (29.2%), pharmacist (20.6%). The authors concluded that there is a large portion of Aseer region population practice self-medicating behavior based on their own concept or advice from friends and family most of the time, without consulting a specialized physician.

Aldhabaan W.A., et al., did a descriptive cross-sectional survey was conducted focus on all adults in Aseer region. Looking at the awareness and attitudes toward common eye diseases. A total of 1014 participants in southern region completed the survey. 23.1% of participants defined cataract as change in lens colour and 17.8% reported that it is age related disorder. Glaucoma was defined as disease that causes optic nerve damage by 22.2% of the participants while 18.6% defined the disease as condition causing diminished peri-ocular vision. In conclusion, the study revealed that overall public awareness regarding common eye diseases was very poor especially among old aged and females. The main source was family member or friend who had the disease

Basheikha, M et al., did a chart review of medical records of patients followed at King Abdul-Aziz University Hospital and diagnosed with dementia with at least one echocardiogram completed after the diagnosis of dementia. The study aimed to identify the prevalence of heart failure in patients diagnosed with dementia. A total of 200 patients met the inclusion criteria, with a mean age of 76.28 years. In 10.5% of the participants, the ejection fraction was less than 40%. The dominant type of dementia in the participants was mixed/unspecified type (78.5%). The authors concluded that the prevalence of systolic heart failure seems to be higher in patients with dementia when compared to similar age group populations reported in other studies. Multiple limitations are present in this study, and additional research is needed to further assess this possible correlation.

Farsi et al., present an excellent study on self isolation and increased burnout among physicians trainees. The authors stressed that the COVID-19 pandemic emerged in late 2019. Previous research has shown a significant prevalence of burnout among physician trainees, with concern that the pandemic will increase burnout. We aimed to assess this risk among trainees at a large academic hospital. We performed a cross-sectional study during the pandemic using a survey that included the Maslach Burnout Inventory. The response rate was 94.7%. Among trainees, 58.5% changed their living arrangements to protect family. Psychological well-being was negatively affected in 81.7% and clinical performance in 64.3%; 13.8% were at high risk of burnout. Emotional exhaustion (EE) scores were high in 50% and depersonalization (DP) scores in 28.8%; a sense of personal accomplishment was low in 41.9%. Increased risk of burnout was associated with male gender and increased exposure to suspected COVID-19 cases. Risk of high EE correlated with an increased number of children and risk of high DP with male gender. High EE and DP score correlated with increased exposure to suspected and confirmed COVID-19 patients. Trainees who self-isolated to protect family were more likely to experience high DP and burnout. Trainees in surgical specialties were more likely to feel their clinical performance was negatively affected. The results suggest that a significant percentage of trainees are at high risk of burnout during the pandemic especially those that attempted self-isolation. Training programs should incorporate methods to maintain well-being and coping, including adequate time off between shifts. Future research should evaluate other aspects of trainee well-being in relation to self-isolation and/or changed living arrangements.

AlJohani et al., reviewed the diagnostic therapeutic option of Covid-19. The global pandemic of coronavirus has resulted several manifestation of respiratory diseases. The mild common cold like illness is one of the major symptom that represents the clinical presentation of the respiratory infection. Some patients can be asymptomatic while some might have characteristic symptoms in the form of coughs, dyspnoea, and fever. Mostly it affects people aged between 30 to 79 years. major risk factors are people residing or travelling in the areas where risk of transmission is quite high, old age, and presence of comorbidities. In order to control the spreading there is four different ways quarantine the contact for at least 14 days, screening of the travellers, drive through screening centres, and temperature screening. Isolation, infection management, and the symptom management can be the most useful therapeutic approaches. Covid-19 is on a verge of constant increase and is impacting a lot of people around the globe. Currently, there is no proper treatment of covid-19 available as a result of which everyday preventive actions and vaccination are the best things that an individual can do in order to prevent the flow of covid-19.

Alsabi et al., conducted a cross sectional study included 260 female students at the King Khalid University. The aim is to know the impact of acne among female university students on their quality of life. They used a self-administered questionnaire. Prevalence of acne among participant students was 87%. Its severity among 48% of participants was mild, 39.6% was moderate, while 12.3% had severe acne. The authors concluded that
Prevalence of facial acne is very high among students and significantly affects their QOL. During management of acne patients, health care professionals should consider its psychosocial aspect.

Hassan, A.A., et al., did a cross-sectional study was conducted at primary healthcare centers, to assess the levels of knowledge and practice regarding foot care among recently diagnosed diabetic patients. The study included 250 recently diagnosed diabetic patients. Generally, 66% of patients had poor knowledge regarding diabetic foot, whereas only 13.6% of them had good knowledge. Good foot care practice was observed among 52% of patients. Less than half of patients (45.2%) received health educational brochures about foot care. The authors concluded that most recently diagnosed diabetic patients in Muhayil City, Aseer Region, KSA have inadequate knowledge and poor practices regarding foot care. Intensive health education regarding diabetic foot care is highly recommended.

Alshahrani,et al., did a cross-sectional study conducted among male secondary school students in Abha City, to examine the relationship between obesity and negative emotional states among male secondary school students. The standardized Arabic version of Depression Anxiety Stress Scale (DASS-21) was used by the researchers. Three hundred and ninety eight students participated in the study. There were statistically significant associations between obesity and symptoms of depression, anxiety and stress (p<0.001 for all). The authors concluded that the burden of overweight and obesity are high among the male secondary school students. Overweight and obesity are associated with symptoms of depression, anxiety and stress. Therefore, there should be emphasis on implementing interventions to raise awareness about maintaining normal body mass index among the school students and thereby reducing the risk of mental disorders.

Javed et al., did a multi-institutional prospective cross-sectional study at Oncology department, JPMC and Atomic Energy Medical Centre, Karachi to determine the frequency of Esophageal Carcinoma and to identify factors responsible for late stage diagnosis of this malignancy. A frequency of 3.83% of esophageal cancer was recorded. Squamous cell carcinoma as the most common (80.6%) subtype, moderately differentiated grade in 67.7% & lower 1/3rd involvement was noted in 53.8% cases. The authors concluded that Esophageal carcinoma is a common malignancy with squamous cell carcinoma as the most common subtype. Initial diagnosis of most of the patients was made in late stage. Important contributing factors of late diagnosis were unawareness of patients, delayed initial diagnostic workup, poor socioeconomic status and late referrals to oncologists by General Physicians. No significant association was observed between ethnicity and grading or staging of tumor.

Alqahtani, et al ., did a descriptive cross-sectional survey using a a self-administered questionnaire looking at the perception of food allergy among mothers. Descriptive and inferential statistics were obtained. Out of 980 mothers, 49% were suffering from food allergy, while 28.6% of their children were suffering from food allergy. Shellfish was the most common cause of food allergy (38%). The management of FA in children is improving through the acquisition of new knowledge in diagnosis and treatment. Education of physicians and food-allergic patients about FA and its treatment is becoming recognized as an unmet need

Shaheen et al., look at quality improvement project on minor head injury. The authors stressed that future management, follow up and final outcome of the injury depends on initial consultation and its clear and effective documentation. Quality of documentation after the introduction of the template was compared against the quality of previous documentation before the introduction of the template. Using NICE guidance on head injury (Jan 2014), 9 salient points in history and 8 in examination were chosen to be audited and given a tabulated form. Retrospectively, 15 medical notes were retrieved using ''System One'' (the electronic system for recording medical notes in UK). All notes were studied and audited against the chosen salient points in history and examination. Quality of notes was analysed collectively as well as individually. After 12 months, again a sample of 15 notes was collected randomly, in retrospective manner and again the clinicians' grades were kept indiscrete. Data analysed again and a remarkable improvement was demonstrated. Suggestions were made to further improve the documentation in other important areas of the clinical practice as well

Yousuf & Mansouri attempt to define the best practice guidelines for primary prevention of cardio-vascular diseases in middle age individuals as well as the elderly. The authors reviewed RCT, clinical trials and systematic review studies published in English language from 2003-2018; in middle age individuals as well as the elderly. The total numbers of study search were 2020 studies. The authors concluded that Statin is beneficial for primary prevention of cardiovascular disease in middle age individuals as well as the elderly, who had dyslipidemia or diabetic aged 40-75years, or 10-years CVD risk =>7.5% according to AHA/ACC, or =>10% in accordance with the guidelines for both NICE and USPSTF, there is no definite evidence for non-statin therapy benefit for primary prevention of CVD but it can be used in hypercholesterolemia patients or high CVD risk patients who do not tolerate statins or not responded to the maximum dose of statins. No evidence for aspirin benefit in primary prevention of CVD in diabetics. Immediate blood pressure control is important in the primary prevention of CVD in hypertensive patients with high cardiovascular risk.
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Almusa et al., did a correlational cross-sectional to assess prevalence of internet addiction with its association with insomnia and scholastic achievement among secondary school females in Abha city, Saudi Arabia. Self-administered questionnaire sheets were distributed to students in their classes. the study included 3 female students whose ages ranged from 15 to 22 years old with mean age of 16.9 ± 1.1 years. Regrading father education, 214 students' fathers were university graduated (61.5%) and 108 (31%) had secondary level of education. Regarding frequency of using social internet, 85.3% of the students reported usual use. The authors concluded that more internet addiction was a significant problem among secondary school female students affected their scholastic achievement and their life due to high stress.

Alshahrani1, et al., conducted cross-sectional study was conducted at primary healthcare centers
to identify difficulties and barriers facing primary health care physicians in rural areas of Aseer Region, Saudi Arabia. Female physicians constituted 43.3% of respondents, age of 58.2% was 30-35 years, 54.5% were married, Only 34.3% had opportunities for on-the-job continuing medical education, 33.6% were satisfied with medical equipment and resources, and 50% were dissatisfied with their salary. Participants were less satisfied regarding several social factors, such as internet connectivity, isolation from family and relatives; received support from rural people, difficult schooling for children, but were not satisfied regarding PHCC infrastructure, their residential facilities, or earning more money. The authors concluded that serving within the rural healthcare system provides young physicians with an opportunity to build up their experience and to increase their confidence as physicians. However, important difficulties that they face are mainly social and financial. Hence, creating a health policy to safeguard the serving physicians' career and providing facilities to promote personal and social well-being needs to be considered.

Dr Patel A, conducted a cross-sectional study on a stratified proportional allocation sample, to estimate the proportion of households consuming iodized salt in the Aseer region, southwestern Saudi Arabia, and assess salt iodization's adequacy.The study included 3038 samples of table salt. Insufficient iodized table salt samples (less than 15 ppm based on the WHO/UNICEF ICCIDD classification) were observed in 22.3% (95% CI: 20.8% - 23.8%) of the samples. The study showed that the use of insufficient iodized salt in the region is still common. The accessibility of iodized salt can be achieved through iodized salt's marketing and sales. Authorities in the Aseer region should play an influential role in forbidding non-iodized salt in the local markets in the Aseer region.

Almoutaz H., reported a case on treatment of hepatitis C. A 22-year-old male with long standing, active Crohn's disease on Adalimumab had presented with increasing levels of his transaminases. A full workup was conducted and the patient was found to have hepatitis C (HCV) based on a positive HCV antibody, polymerase chain reaction (PCR) and genotyping. He was started on a regimen of Glecaprevir/Pibrentasvir with excellent response defined by complete normalization of his transaminitis and an undetectable PCR at the end of 8 weeks of treatment and achieved sustained viral response at 12 weeks of treatment. This is the first case reporting the use of a combination of Glecaprevir/Pibrentasvir and Adalimumab in a patient with HCV and Crohn's disease.
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Abdulrazak Abyad
Chief Editor