This issue is rich with papers from the region and with COVID 19 epidemic still raising research interest in the area.

In two papers medical students were used as research subject. Alyahya et al., did a cross-sectional questionnaire based study. The aim of this study is to assess the desired future medical specialties and what are the motivational and influential factors for such decision. It was found that the most commonly indicated perceived specialty was pediatrics (8.3%), followed by internal medicine (8%), orthopedic (6.6%) and general surgery (6.6%). The most commonly mentioned source of advice regarding specialty was family (38.4%), followed by practicing doctors (33.5%) and friends (18.4%). The authors concluded that College of medicine in King Faisal University needs to engage the practicing doctors with students for a better guidance and mentorship. The extra-curricular mentorship programs need to be implemented from the first year of college, so students have a wider range of exposure towards different specialties. While Ilyas, et al ., cross-sectional study was conducted from August 2019 - September 2019 in Jinnah Sindh Medical University (JSMU), Karachi, Pakistan, according to non-probability purposive sampling. This study aimed to explore FC's prevalence and associated lifestyle factors among undergraduate medical students at Jinnah Sindh Medical University, Karachi, Pakistan. A total of 365 medical students were included in this study. The authors concluded that the prevalence rate, FC is a widespread issue among medical students. Low fibre diet, low water intake, stool with-holding, and less frequent defecation are the most apparent risk factors among the constipated subjects.

Ali et al., aims to analyze the image reject rate for radiographs at PHCC and determine the reasons for rejection. The data was retrospectively collected from January 2020 to December 2020 to include all rejected images. The reject rate per each reason, anatomical area and health centers were analyzed. The reject rate in PHCC radiology department is within the accepted limits of quality control and assurance studies. However, it is highly important to carry on quality improvement projects with proper training and education based on utilization of regular reject analysis and feedback tool.

Alamri et al., did a descriptive cross-sectional approach was used targeting all adults in Aseer region. The aim to assess adults' awareness, attitude, and practice regarding testicular cancer (TC) and testicular self-examination (TSE) in Aseer region, Saudi Arabia. The survey included 809 male participants who completed the questionnaire. Participants ages ranged from 18 to 55 years old with mean age of 26.9 12.7 years. Majority of participants (73.1%; 591) were single while 23.7% were married. Exact of 591 (73.1%) participants heard about cancer tests and 651 (80.5%) know it affects men. The authors concluded that male adult's awareness about TC and TSE are inadequate and the proportion who is performing is below the average. Also, Male adults' attitude towards TSE and its importance was not promising.

Dr. AlQaatri did a study aimed to determine how shared information databases and common spreadsheets can be used in disaster management communication in the primary health care command center (PHCCs) in Qatar to respond appropriately to any kind of disaster. The research established that current communication frameworks between PHCCs and emergency command centers are weak. The sharing of resources and capacity information is not done well and regularly from the PHCCs to the emergency command center. Consequently, live shared spreadsheets would ensure the PHCCs distribute capacity information with the command center. The Spreadsheets would also act as a backup in case the phone communication links were broken. The tools should improve communication between the two levels, including disaster preparedness and response. They should solve the current problems of communication breaks between the PHCCs and command centers related to emergency and disaster planning.

Dr. Al-Otaibi, did a retrospective study of patients is 20 patients underwent total hip procedure with 6 month flow up divided in two groups, to see the effect of other musculoskeletal changes on outcome. To compare the effects of disease manifestation other than that on the replaced hip on out come of hip replacement in sickle cell anaemia patients. The authors concluded that catego rizing all sickle cell hip avascular necrosis in one group is un fair for patients and surgeons. Patients with multiple sites of disease manifestation must be considered difficult primary hip and handled with care, while some patients with Isolated hip involvement have comparable results to hip replacement in other conditions.

The issue of COVID epidemic received attention from three authors. Alrubaysh. et al., conducted a cross-sectional study using an online questionnaire on adults over the age of 18 living in Saudi Arabia from January to February 2021. This study aims to assess the lifestyle changes that are considered risk factors of cardiovascular diseases (CVD) among the Saudi population during the COVID-19 lockdown. The authors concluded that dietary and exercise habits among the Saudi population have changed significantly during the COVID-19 pandemic which subsequently resulted in an increase in CVD symptoms. Dr. Alshaiby did a descriptive prospective study conducted in Aden to delineate the different development patterns of olfactory disorders in covid-19 patients. Seventy ENT patients underwent covid-19 testing by real-time PCR in the Center of Covid-19 at Algamhoria Hospital during 1June to 31 August 2020. Comorbid conditions were diabetes mellitus in (11.4%) patients and hypertension in (7.1%). Anosmia found in (85.7%) and hyposmia in (14.3%) patients. The situation of a significantly higher proportion of patients with anosmia followed by hyposmia supports the need for ENT health care for patients with Covid-19 diseases. Whereas Dr. A.Alqaatri, looked at COVID 19 Mass Vaccination. While the COVID-19 pandemic has adversely affected global economies and healthcare systems, mass vaccination presents a permanent way to transition out of it. However, accessibility of the vaccines and vaccine hesitancy provide significant challenges to mass vaccination programs. Nevertheless, the WHO-approved vaccines, including Pfizer, AstraZeneca, Janssen, and Moderna, have helped reduce the global infection curve, severe cases, and mortality associated with the disease. Consequently, governments and non-governmental organizations globally should raise awareness among the public about the benefits of taking COVID-19 vaccines. The vaccines should also be made widely available, particularly to the underdeveloped and developing nations, through the manufacturing of generic forms of COVID-19 vaccines that are relatively affordable.

Dr. Alharthi, carried a study in the outpatient clinic of Primary Health Centers (PHC) across Bisha Governorate in Saudi Arabia. The study objective was to determine the knowledge and management practices of primary care physicians on the management of asymptomatic hyperuricemia (AH). The mean age of the respondents was 41.3 years, with a standard deviation of 8.6. All the respondents work in public health facilities. The authors concluded that in the primary care setting studied, a high proportion of the physicians have adequate Knowledge about AH, but less than half of them put this Knowledge into practice. Good practices of AH management was determined by years of experience and revising the literature. Emphasis should be made on the practices of the physicians for proper service delivery.

Ghazanfar, & Zafrani presented a case of degeneration of a fibroid. Haemorrhagic degeneration occurring in a young 23 year old nulliparous women with a small fibroid. Uterine fibroids are the most common solid tumours found in the uterus. Prevalence varies significantly and research shows that women with African ancestry have a greater risk for these. Though the majority of cases are asymptomatic and therefore require conservative or no treatment, in some cases, fibroids can be troublesome and undergo complications that have a significant impact on patients lives. These include degeneration of fibroids, often a misdiagnosis best detected on an Magnetic Resonance Imagining scan.

Al Zahib , et al., A cross-sectional study was conducted among 385 type-1 diabetics in Abha City, Saudi Arabia. The aim to assess prevalence of ketoacidosis and to identify risk factors associated with it among patients with type-1 diabetes mellitus (T1DM) in Abha City, Saudi Arabia.Our study included 228 males (59.2%), 44.2% were diabetic for more than 5 years, 48.3% had positive family history of diabetes, while 70.9% reported past history of DKA. Last recorded HbA1c levels for 53.5% were >9%. The authors concluded that most T1DM patients experience DKA, mainly with their first presentation of disease or due to discontinuation of treatment. DKA tends to occur more frequently among patients with poor glycemic control, those with less educated or unemployed parents, and those with positive family history of diabetes.

Saleh, et al., did a retrospective study of all patients who presented with alopecia areata and seen in our two private dermatology clinics in Aden. The aim of the study was to describe the demographic and clinical characteristics of alopecia areata and to determine the associated diseases among patients. The total patients were 264 (females 61.7% and males 38.3%). The mean age of patients was 18 years. The relation between age means of gender showed statistically highly significant (p = 0.000). This study highlights the importance of further studies in this field.

Dr. GhazanfarDiscussed Why are SGLT2 inhibitors a good choice in the management of Type 2 Diabetes Mellitus? Sodium- glucose co-transporter 2 inhibitors (SGLT2) are the most recent addition to the oral management of type 2 diabetes mellitus. This chronic progressive disease is linked to cardiovascular and renal disease causing millions of deaths each year worldwide. As oral treatment options have expanded over the years, this has made the management of diabetes mellitus more tailored to individuals taking into account their co-existing comorbidities and therefore slightly more challenging. Several benefits have been reported from SGLT including their ability to improve plasma glucose levels, lower blood pressure, weight loss and more importantly their cardiovascular and renal beneficial outcomes making them one of the popular choices for add on to monotherapy in current guidelines.

Ahmed et al., looked at Pituitary dysfunction following a traumatic brain injury (TBI) at the disk of General Practitioner. Traumatic brain injuries are among the serious causes that affect the health of many people around the world. There are many causes for traumatic brain injuries such as road traffic accidents, work-related accidents, sports activities, falls, and assaults. The injuries could cause transient or permeant pituitary dysfunction which affects a lot of body activities and may decrease significantly the quality of life of such victims. Diagnosis of pituitary dysfunction associated with brain injuries constitutes a real challenge for physicians. This review aims to discuss the current knowledge about this condition and simplify current recommendations to the busy general practitioner at his/her clinic.

Abdulrazak Abyad
Chief Editor