This is the first issue of the New Year that we hope it will be a successful year for the World in terms of peace, prosperity and elimination of poverty. This issue is rich with a large number of papers from the MENA Region and the United Kingdom.

Almazrou., et al., did a cross-sectional study. All data was collected using an online self-designed questionnaire that contained demographic data, such as the patient's age, gender and level of education. The aim was looking at the prevalence of self-medication use, and the attitude and practices toward traditional eye medicines regarding eye symptoms. The most common self-prescribed medications were anti-allergic and antibiotics. The results revealed that 148 respondents had previously used TEMs (16.4%).. The majority of respondents (86.6%) preferred medications over TEM to treat eye diseases.

Zahrani, et al., did a multicenter, cross-sectional study conducted in 386 pregnant women attending routine antenatal visits at 4 antenatal clinics from September 2019 to August 2020. The objective is to estimate the prevalence of subclinical and overt hypothyroidism in antenatal care clinics, and to evaluate the performance of targeted screening approach based on the risk stratification as recommended by the U.S. Preventive Service Task Force (USPSTF) and adopted by the American Thyroid Association (ATA). The authors concluded that the application of the targeted screening for subclinical and overt hypothyroidism using the USPSTF and ATA criteria performed poorly in the studied population. Thus, universal screening appears to be a better option.

Baba et al., did a qualitative study conducted within the boundaries of Islamabad capital territory and district Rawalpindi, Pakistan. The data was collected through in-depth and semi-structured interviews conducted with the respondents that included patients of COPD (n=8) as well as their treatment supporter(s) (n=7), recruited from the OPD wards of three hospitals (two public and one private hospital). The study shows that COPD patients not only face challenges in their physical health, but also in socio-economic and psychological domains that are equally harmful. It highlights varying notions of the respondents as to how treatment-seeking of COPD posed challenges in their lifestyles, at both, household and individual levels. Patients with COPD need high levels of input from healthcare facilities; hence, health care professionals should be trained in case management of COPD.

There are two audit and quality improvement reports in this issue. Dr. Al-shamery, did a clinical Audit Report on Adherence to Imaging Guidelines for Patients with Acute Low Back Pain in Airport Health Centre . It is observed from practice that most of the physicians did follow the guidelines while treating the patients with acute low back pain, although, sometimes they advised imaging within 6 weeks of symptoms. The Audit was conducted through a retrospective review of health records of randomly selected 66 patients with acute low back pain. Audit criteria derived from PHCC Clinical Practice Guideline for the Management of Low Back Pain in Adults . Audit findings of the total sample of 66 patients showed in 95% compliance with the recommended practice on imaging requirement for patients with acute Low Back Pain and didn't do imaging at the first visit. The author concluded that the recommendation on achieving 100% level of compliance in practice and sustain the practice. While Dr. Rahma, did a quality improvement project on documentation of pediatric observations in urgent care setting. Serious or life threatening illness in children in a primary care setting is thankfully rare. It has been reported that the prevalence of serious illness is 0.8% in primary care and 7.2% in secondary care . Early recognition and treatment of febrile children with serious infections improves prognosis, however, early detection can be difficult.There is a clear need for this quality improvement project in identifying how often each of these parameters are measured in a child presenting to an urgent care setting under the age of 5. The authors seek to identify the frequency of documentation of clinicians in each of the parameters highlighted in the NICE guideline in acutely unwell children under the age of 5.

Mougrabi, et al., attempt to assess the extent of effect of mental and physical wellbeing and social relation on the quality of life of patients with cardiovascular disease. It was a descriptive cross sectional study of all adults' Saudi patients who had cardiovascular diseases or had cardiac surgery at least for the previous 5 years, performed between February 2021 And December 2021 at different regions in Saudi Arabia. 470 participants were included in the study , 47.9% females and 52.1% males. The authors concluded that the factors that's lower the quality of life for cardiovascular patients in Saudi community is important and essential to address their needs and gives better QoL.

Sulaiman , et al., did a cross-sectional survey was conducted among patients who visited private health facilities looking at why patients go to private health care facilities? Perspectives from Qassim Saudi Arabia. Saudi government provides free health care to the population, however still a large number of people visit private health care facilities. The main reasons for choosing the private health facilities were delayed appointment in governmental hospitals and less waiting time in private hospitals. Service redesign is required to improve appointment management systems and patients' satisfaction in public sector health facilities.
Amena Ali, et al., did a cross-sectional study to assess the iron supplementation practice and influencing factors among pregnant woman in different hospitals of Taif city, Saudi Arabia.
The prevalence of iron supplements use during pregnancy among the study participants was 99.6%. There were no significant association between the age, weight and number of pregnancies (p value >0.05). The authors concluded that there is a need to encourage pregnant women to visit early for antenatal care. Iron and folic acid supplements, dietary intake preferences, diagnosis and continuous follow up of pregnant women are approaches to reduce anemia during pregnancy in Taif region. The purpose of this study was to enhance the public awareness about iron supplements during pregnancy.

Alshahrani. et al., did a descriptive cross-sectional approach was used targeting all accessible population in Southern of Saudi Arabia Data were collected from participants using an online pre-structured questionnaire. The questionnaire covered the following data: participants' socio-demographic data, participants' awareness, and participants' perception towards CKDs, preventive measures and risk. A total of 1317 participants fulfilling the inclusion criteria completed the study questionnaire. The authors concluded that the current study revealed that public awareness in Southern region of Saudi Arabia about CKD and its risk factors is low in contrast to their perception towards the disease and its associated risk. Having information from scientific sources such as books, health education campaigns or study was associated with high awareness level.

Masarit et al., did a cross-sectional study was conducted to assess knowledge of 103 family medicine residents about childhood autism. A structured self-administered web-based Healthcare Workers (KCAHW) Questionnaire was use to assess knowledge of childhood autism among participant residents. female participants. Residents' total score (Mean±SD) was 13.18±2.80 (out of 19, 69.4%). The authors concluded that Knowledge of family medicine residents regarding childhood autism is suboptimal. It is important to update the knowledge gaps of healthcare workers who have limited knowledge regarding childhood autism and to train them to be able to provide healthcare service that would ensure early diagnosis and interventions for management of autism.

Alhafithi et al., did a cross-sectional study was conducted among 249 nurses aimed at assessing the prevalence and associated factors of burnout among nurses in Yanbu General Hospital, Saudi Arabia. High burnout was found among 168 (67.5%) participants. The EE score was significantly higher among Saudis, (p=0.004), among those who worked >40 hours per week (p<0.001) and among those who had more than 8 shifts per week (p=0.001). The authors concluded that burnout was highly prevalent among nurses in this study and was associated significantly with work related factors and sources of stress in the workplace. working conditions should be improved to minimize the impact and consequences of burnout among nurses.

Fadl et al., did a cross-sectional study among undergraduate medical students in Saudi Arabia. Volunteer participants answered the questions relating to demographics and surveys containing the Rome III criteria and the Self-reported Stress questionnaire. A total of 300 participants were recruited with 63.7% of whom were females. The authors concluded that Higher prevalence of IBS was detected in undergraduate medical students in Saudi Arabia than worldwide prevalence. Female genders, higher academic grades, less exercise practicing and sleep disturbance were predictors for IBS. More screening and management of stress causes are needed to decrease medical field stressors.

Alshahrani, et al., did a cross-sectional study to assess prevalence of burnout among Emergency Department (ED) staff in Dammam City, Saudi Arabia, and to assess the potential associated factors. Most participants suffered from high level burnout for depersonalization and low personal achievement. The burnout was found among 76% of them. The authors concluded that most physicians and nurses working at emergency hospitals in Dammam City, Saudi Arabia, had burnout disorder, especially high passionate fatigue and low personal achievement.

AlOtaibi, et al, did cross-sectional survey to explores the perceptions of physicians and their attitudes toward the implementation of the electronic medical record (EMR) in general hospitals in Riyadh to identify the perceived difficulties, burdens, and usefulness of implementing electronic medical records. A total of 160 physicians filled out the questionnaire. The majority of physicians (91.3%) stated that they had heard of the EMR. Physicians rated their agreement on the usefulness of implementing the EMR positively (mean score, 3.8/5). The authors concluded that there is a necessity for formal educational programs to improve physicians' overall attitude toward the EMR.

Alzunidi et al., did an observational, descriptive, cross-sectional study. Among 162 Medical and Pharm D students. To assess the relation between sleep pattern and academic performance among Almaarefa University medical and pharmacy students in Riyadh. The authors concluded that sleep pattern and GPA had no relation. However, male students had deeper sleep than females. The percentage of female students in a shared room was higher than males. Finally, medical students had a higher percentage in sharing a room than pharmacy students. Most of the respondents are majoring in medicine, as well as females were triple the number of males, this may have affected the results.

Khmour, et al., did a cross-sectional retrospective data analysis extracted from medical records of patients with Diabetes Meletus type 2 following at PHCC, in year 2020. Qatar considered as one of highly prevalence countries in type 2 diabetes, with a prevalence of 17 % , after the start of global pandemic of COVID 19 the type of service and the access to health center had been change during the pandemic, so we wanted to know the effect of this major change in level of the glycemic control to type 2 diabetes patient followed in PHCC(primary health care corporation ) and compare it with previous studies, also we to now the relation between level of glycemic control and number of phone consultation done to each one and finally the prevalence of covid 19 in type 2 diabetic patient followed in PHCC. The authors concluded that the results showed no significant difference in level of glycemic control during the year 2020 as the mean of HbA1C not changed the mean was 7.0% and became 6.9%, with prevalence of 8.1 for positive cases of Covid in the sample

Hnish et al., did a cross-sectional study that used an anonymous paper survey. All medical residents from all programs throughout all postgraduate year levels in HMC were invited to participate in the study. The study was looking at the prevalence of Generalized Anxiety Disorder among Medical Residents in Hamad Medical Corporation in 2020. Of the 244 participants, 73 (29.9 %) reported anxiety symptoms with a GAD-7 score of 10 or more. This study highlights the prevalence of anxiety disorders among medical residents, and it was found to be high but relatively like the prevalence found in other studies internationally and locally, the level of anxiety was significantly higher among overseas residents in comparison to local residents. There was a significant number of residents who were not aware of the presence of mental health services within the institution, in addition, among those with anxiety who were aware of the mental health services but not utilizing them, there were two common reasons, the lack of time followed by confidentiality issues.

Nasir., et al., did a review on Alzheimer's Dementia. They stressed that Alzheimer's Disease (AD), identified almost a century back and is slowly progressing as a global pandemic. This disease is one of the most common causes of Dementia. In this condition, an affected individual loses their recent memories and almost all cognitive functions, and eventually, the person becomes incapable of performing even the simplest of tasks. This paper aims to review the epidemiology, clinical features, diagnostic criteria, pathophysiology, and various treatment strategies of AD dementia.

Dr. Dima reviewed Nutrition and puberty. She stressed that Nutrition plays an important role in the growth, development and puberty of children. Adequate nutrition is very important for the normal development of the child during the various stages of childhood and into puberty. Unfortunately, we note the spread of fast food and the adoption of wrong methods in feeding the child, such as making him watch TV to motivate him to eat a larger amount of food …etc. this led to the spread of obesity and overweight among children. Overweight or obese children are more likely to enter puberty early. Some evidence suggests that obesity can accelerate the onset of puberty in girls and this is a major reason why girls begin puberty at an earlier age compared to past decades while overweight or obesity may delay the onset of puberty in boys. On the other hand, Severe primary or secondary malnutrition also can delay the onset and progression of puberty.

Dr. Rahma reported a case of Erythroderma following Terbinafine therapy. A 52-year-old female patient had received oral terbinafine for onychomycosis. The patient had a family history of lupus, but no personal history. Six weeks after initiating treatment with terbinafine the patient developed cutaneous lupus which was diagnosed clinically and by histology. This report, along with previous cases described, suggests the association between terbinafine therapy and the onset or exacerbation of SLE often occurring in a patient with history of systemic lupus erythematosus or SLE.
Khmour, et al., report on a rare case of lower limb weakness. This is a 53 years old male, previously healthy, presented to primary care physician, complaint from chronic back pain, was seen multiple time with same problem, treated as Myalgia with pain killers only, after proper approach and investigation was found to have ALS Amyotrophic lateral sclerosis.

Dr Abdulrazak Abyad
Chief Editor
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