From the Editor

This is the last issue this year and is rich with papers from the Region covering main issues of concern in primary health care from prevention to treatment to screening. At the end of the year we wish to thank all our authors, readers and supporters and of course we cannot forget the publishing and production team working hard to meet deadlines.

A number of papers have dealt with pregnancy issues. Al-Shareef O.K et al, carried a cross-sectional study on 410 from general population in Jeddah city. The aim was to assess the awareness about complications of SCD during pregnancy. The authors found that overall Knowledge about SCD and its complications during pregnancy was moderate. So, they recommend health education programs about all aspects of SCD should be designed, implemented and evaluated among general populations. Whereas Sharef A.A et al did a Retrospective Case control study was done in Azadi teaching Hospital in Iraq looking at Vitamin D3 deficiency and early pregnancy loss. The total sample show that 186 (79.2%) were covered lady, 182(85.8%) with vit D3 deficiency, 16(7.5%) with insufficiency, and 14(6.6%) had normal level of Vit D3. The authors concluded that Vitamin D deficiency was associated with early pregnancy loss. Sufficient vitamin D is important for healthy pregnancy

Al-Ahmadi M.T et al, describe the current state of abortion training at current active centers where there is Saudi board training program for Obstetrics and Gynecology in Jeddah, Saudi Arabia. The authors concluded that from the previous results that training of abortion is variable as there are some residents who had no training and others consider such training is optional and others consider it routine in addition most of the residents performed abortion (13-17weeks) more than 50 times. Wheras Alnemari B.A et al, a cross-sectional study was conducted at the post-natal clinics of maternity hospital of king Faisal medical complex to evaluate obstetric violence in Saudi maternal healthcare settings. The authors concluded that non-dignified care was experienced by women during pregnancy as invasive procedure and medication were unnecessary used, confidentiality was breached, faced physical violence to a considerable extent and pregnant women need were neglected.

AL Blooshi et al did a cross-sectional study was conducted in 2017 using a questionnaire to measure breast cancer screening awareness. Six primary healthcare centers within 40 km of Abu Dhabi were included. Participants were 383 women aged 40-65 years. The authors concluded that primary care providers often have the first contact with women and should utilize this opportunity to spread awareness. Social media and public service campaigns can also be employed, and free mammograms could be offered to lower-income women.

A number of papers dealt with health education, Alhomood M.A et al, conducted a cross-sectional study among 385 parents of T1DM children attending the Diabetes Center in Abha City. The authors concluded that Parents' knowledge about DKA is suboptimal. They recommend that health education to T1DM patients and their guardians should be fulfilled. It must cover information related to independent management of diabetes and diabetic ketoacidosis and how to identify symptoms of DKA. Whereas Hetaimish B et al, attempted to determine the prevalence of tobacco smoking and assess the awareness of musculoskeletal effects of smoking among undergraduate medical and health science students at Makkah region, Kingdom of Saudi Arabia (KSA). The authors concluded that there is a crucial need to indorse multi-disciplinary health education events at different age groups to prevent adolescent students smoking, or support smoking cessation program.
The issue of fever and antibiotic was raised. El-Gamal F et al, looked at the causes and clinical aspects of fever in patients visiting primary healthcare. Analyses of data derived from clinical presentation of 24,816 outpatient visits revealed that 5,285 visits (21.3%) were for fever. The authors concluded that fever is a common presenting symptom among outpatient visits. Respiratory tract infections are the commonest cause of fever. Primary health care physicians should pay more effort to health educate the people about prevention and control of Fever. This information will help the MOH planners to develop programs of organized, whole-population anticipatory care. Whereas El-Gamal, F et al, attempted to explore clinical aspects and drug prescription of acute respiratory infection in primary health care. Analyses of data of 1200 outpatient visits revealed that 313 visits (26.08%) were for acute respiratory infection. Antibiotics were unnecessary prescribed to 32.8% of acute bronchitis, 32.6% of pharyngitis, and 18.2% of cases with common cold/influenza. The authors concluded that their study adds to evidence that misuse of antibiotics, characterized by antibiotic overuse is widespread in the treatment of outpatient ARIs.

A review paper from Pakistan looked at Non-Alcoholic Fatty Liver Disease Epidemic in Pakistan: Status, Challenges and way forward. The author stressed that fatty liver disease is present in the country in epidemic proportion. There is unfortunately, lack of awareness with regards to its high prevalence and serious adverse health related consequences, among patients as well as health care providers. Therefore the author stress that Unless concerted measures are taken now, we will be faced with an overwhelming disease burden that our health care delivery system with limited resources will be unable to control.

Mansour A.E et al tried to identify lifestyle diseases and associated risk behaviors among medical students, to find the association between the risk behaviors and gender of the student. Self-administered questioner was completed by all students. A total of 279 (56.0%) out of 507 medical students participated in the study of which 44.1% is male and 55.9% is female. The authors concluded that unhealthy lifestyle disease risk behavior is prevalent among medical students. There is will need to regular health education program to change in students' health behavior and students should be motivated to adapt healthy lifestyle practices.

El-Gamal, F et al, explored clinical patterns and risk factors of Acute Coronary Syndrome (ACS). A great proportion of the patients with ACS had an age range of 46 - 59 years (47.3%), and 28.2% were younger than 46 years old. Among the cases of ACS, S-T elevation myocardial infarction (STEMI) was 23.7%, non- S-T elevation myocardial infarction (NSTEMI) was 29.5% and unstable angina (UA) was 46.8%. Chest pain (82.7%), and shortness of breath (24.7%) were the most common complaints among patients with ACS. In agreement with a recent study, the present study didn't find hypercholesterolemia as a significant risk factor for ACS after allowing for possible risk factors.

In two papers the issue of urinary stone were dealt with. Qattan , M.M et al, assessed the use of extracorporeal shockwave lithotripsy (ESWL) in the management of renal stones in relation to different sizes and locations of the stone. They followed a retrospective cohort study between 2014 and 2018 carried out by obtaining data from electronic health records and patients files for all patients who had ESWL in King Abdulaziz Medical City, Jeddah. They found thatthe overall success rate of ESWL was 41.13%, out of 45 subjects who had ureteric stones, 18 (35.29%) subjects had a successful ESWL. Where as a retrospective study of all children with bladder stones seen and treated at Alsaidi private hospital in Aden. A total of 62 children were diagnosed with bladder stone and were (83.9%) males and (16.1%) females. The authors concluded that the majority of affected children were males and were from rural areas. Also, the majority were less than 6 years old. The treatment procedures were cystolitholapaxy followed by cystolithotomy.

Bifari I et al, carried a cross-sectional study using a pre-tested and validated questionnaire. The study was done in a private shopping mall at Taif city, Saudi Arabia during the month of October, 2018 after obtaining ethical clearance. We included responses of 431 participants for our analysis.. The authors concluded that the use of TEM and self medications for eye problems in Saudi Arabia is not uncommon. Even though most of the participants are aware of the harmful effects of some of the Traditional medicaments, there is a need to raise the knowledge and awareness regarding use of TEM and self medicaments for eye problems.

Thawabeh A.N et al, present a case of non-keratinizing undifferentiation nasopharyngeal cancer who had cisplatin chemotherapy. They presented a 56 years old male admitted to Al-Hada emergency department complaining of diffuse severe abdominal pain associated with nausea at the onset of the pain and constipation one day ago. In this study, thromboembolic events (TEEs) occurred within the first 100 days of starting cisplatin. TEE prophylaxis is advisable for patients receiving cisplatin-based chemotherapy.

Helvaci M.R et al tried to understand the safest upper limit of triglycerides in the plasma. The authors concluded that Plasma triglycerides may behave as acute phase reactants indicating disseminated endothelial injury and atherosclerosis. FPG, LDL, WCH, HT, DM, COPD, CHD, and CRD were all deteriorated parallel to the increased male ratio, smoking, aging, excess weight, and plasma triglycerides values. Interestingly, the greatest number of deteriorations was observed just above the plasma triglycerides value of 60 mg/dL.

Khan M et al, performed an observational cross-sectional study on 400 healthcare workers in health care facilities in Saudi Arabia. The aim of the study is do assessment of the knowledge and compliance of healthcare workers among safety precautions in health care facilities. The tool used in this study was self-administrated questionnaire divided into three sectors: (1) socio demographic, (2) knowledge about concept of standard precautions, its measures and when used, (3) Practice of standard precautions. The authors concluded that more than half of our participants had sufficient knowledge and practice regarding standard precautions.

Alkhayat, M.A et al, aimed to assess the satisfaction of patients who have undergone bariatric surgery in the city of Taif. The authors follow an online survey using a Post-Bariatric Satisfaction Questionnaire was used to collect responses from patients. The authors concluded that satisfaction from bariatric surgery was not only effective in a reduction in weight loss but also has found to affect in reducing co-morbidities which drastically improved the quality of life. Patients should be made aware of the benefits and the limitations of these types of surgeries in morbid obesity management.

Jajah, M.B et al, carried cross-sectional observational study on 347 type 2 diabetic patients who were using the drug 'metformin' for at least six months. The study aimed to assess the prevalence of vitamin B12 deficiency in patients with Type 2 diabetes mellitus (T2DM) on metformin. The prevalence of vitamin B12 deficiency among participants was 10.4%. Patients with borderline levels were about 20.2% and remaining 69.5% had normal vitamin B12 levels. The authors concluded that vitamin B12 supplementation should be prescribed for diabetic patients to prevent the occurrence of vitamin B12 deficiency complications.

Bossei A et al, conducted a cross-sectional survey to determine the prevalence of De-Quervain's tenosynovitis and its relationship to the frequency of cell phone usage among medical professionals. Participant sample size was 354 students, selected through convenience sampling. The Finkelstein test showed positive results (67%, n=238) when done on students. The authors concluded that De-Quervain's tenosynovitis is a critical cause of hand dysfunction for health care providers. Further awareness will help researchers develop an educational program for mobile texting and recommend suitable behavioral variations for avoiding this under-documented cause of tendinopathy.

Murshid S.J et al, carried an an analytic cross-sectional study of 83 post-cardiac surgery Saudi patients looking at the quality of life. The authors concluded that post-cardiac surgery Saudi patients had an accepted HRQoL months after their surgery that could deteriorate later with their advancing age. They recommend paying more attention to those with old age and /or comorbidities who will undergo cardiac surgery in order to improve their long lasting HRQoL.

A study from Ayman Abdelbaky et al, Saudi Arabia evaluated the prevalence of use of dietary supplement and hormones among male gym attendees in Taid City, and to assess participants’ knowledge and attitude towards them.

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

.........................................................................................................................