In this issue there are a number of research papers, interesting cases and studies from the region. Al-Aseerie et al., did an observational descriptive cross-sectional study looking at the knowledge and management of ocular chemical injury among family physicians and emergency medicine physicians in Saudi Arabia. A total of 355 participants were included in this study from PHC centers and hospitals in Saudi Arabia. Data was collected using data collecting sheets and self-administered questionnaires. The data was entered and analyzed using SPSS version 23.In this study, knowledge regarding signs of severe injuring was assessed. Only 53 and 51 of emergency medicine and family medicine physicians respectively answered correctly about the most common early symptoms of chemical injury (P=0.011). However, there was a significant difference (P= 0.001) regarding to the most important sign that indicates the urgency of treatment as 52 of respondents recognized the warning sign, 28 of them were emergency medicine doctors. Regarding the practice of emergency, no significant difference was found between the respondents of the two specialties. The level of knowledge regarding ocular chemical injury showed that ER consultant (19.05%), ER specialist (19.25%), family medicine consultant (26.45%), family medicine specialist (18.75%), R1 ER (21.45%), R1 family medicine (16.65%), R2 ER (25%), R2 family medicine (15.20%), R3 ER (36.65%), R3 family medicine (25%) R4 ER (30.80%), R4 family medicine (21.05%) respectively have different level of knowledge. The highest level was R3 ER residents while the lowest level was R2 family medicine residents. While the level of practice regarding ocular chemical injury showed that ER consultant (35.70%), ER specialist (37.17%), family medicine consultant (37.27%), family medicine specialist (25.53%), R1 ER (28.58%), R1 family medicine (28.90%), R2 ER (33.98%), R2 family medicine (28.98%), R3 ER (31.10%), R3 family medicine (29.63%) R4 ER (34.63%), R4 family medicine (36.83%) respectively know the correct practice towards ocular chemical injury. The highest percentage was family consultants while the lowest percentage was family medicine specialists. The study reveals a lack of knowledge and practice in family and emergency medicine physicians regarding ophthalmic chemical injuries, suggesting the need for guidelines and training to minimize complications and improve outcomes.

Helvaci et al., looked at Low-dose aspirin plus low-dose warfarin may be the standard treatment regimen in Buerger's disease. All patients with sickle cell diseases (SCD) were included. We 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), chronic obstructive pulmonary disease (COPD) (25.2% vs 7.0%, p<0.001), cirrhosis (8.1% vs 1.8%, p<0.001), leg ulcers (19.8% vs 7.0%, p<0.001), clubbing (14.8% vs 6.6%, p<0.001), coronary heart disease (18.0% vs 13.2%, p<0.05), 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. The authors concluded that the hardened RBC-induced capillary endothelial damage initiates at birth, and terminates with leg ulcers-like atherosclerotic endpoints even at childhood in the SCD. Similarly, smoking causes a systemic inflammation on vascular endothelium terminating with an accelerated atherosclerosis-induced end-organ insufficiencies in whole body. Its atherosclerotic effect is the most obvious in COPD and Buerger's disease, probably due to the higher concentrations of toxic substances in lungs and pooling of blood in extremities. Since the already developed vascular stenoses are irreversible in Buerger's disease, low-dose aspirin plus low-dose warfarin may be the best treatment regimen to protect fingers and toes from infarctions at the moment. The regimen may even increase the leg performance by preventing recurrent ischemiaes in microcirculation of the legs.

Al Khateeb, et al., looked at Cancer in Salahadeen Governorate during (2021-2023). Cancer incidence and its burden was increasing in Asian countries,therfor its important to know the commonest cancers and its burden in Iraq. This study aimed to know the commonest cancers in Salahdeen governorate with its pattern from 2021-2023. A retrospective study was conducted in Saladeen cancer center in Salahdeen governorate. The data was collected from patients records and the cancer registration unit in the center. The data of cancer patients of the 3 years (2021-2023) were reviewed and interpreted. The incidence rate was increasing from 2021 28.7/100000 in 2021, to 50.9/100000 adult person in 2023. The total number of cases old and new cases that received chemotherapy, hormonal or immunological therapy, was 2961 case in 2021, followed by 3316 case in 2022, and 6075 case in 2023. The most common cases in 2022 was breast cancer 99 (39.6%), followed by colon cancer 26(10.4%), lung cancer 19(7.6%), and ovarian cancer 12(4.8%), as shown in figure 4. The incidence rate was breast cancer 11.3/100000, colon 3/100000, lung 2.2/100000, stomach 1.3/100000. The most common cases among female patient were breast cancer 98 (56.6%), ovarian cancer 12(6.9%), colon cancer 10(5.8%) and uterine cancer 10(5.8%). The most common cancers among male patients were colon cancer 16(20.8%), lung cancer 11(14.3%), prostate 10(13%) and stomach cancer 5(6.5%).

The cancer cases was in increasing pattern with increased burden, and the top cancers is little different from other governorates in Iraq.

Elhimadie et al., presenting a case of uncontrolled asthma which unmasked HIV. This case report highlights the diagnostic odyssey of Mr XX, 61 years old a previously healthy ex-smoker, librarian presenting with worsening asthma symptoms. Despite conventional treatments, his condition persisted, leading to a cascade of investigations that ultimately revealed HIV infection. Mr. XX asthma symptoms escalated since 2012, marked by frequent exacerbations and chest infections. Despite therapeutic adjustments, including salbutamol and seretide inhalers, his condition remained refractory. Concurrent symptoms of weight loss and recurrent green phlegm raised suspicion for underlying pathology. Multidisciplinary discussions culminated in surgical intervention for the thymoma, which led to the discovery of HIV infection. Further evaluation revealed co-infection with Pneumocystis pneumonia (PCP). Initiation of antiretroviral therapy and adjunctive treatment resulted in symptomatic improvement and disease control. The case of Mr. XX underscores the intricate interplay between respiratory symptoms and systemic illness, emphasising the necessity of a broad differential diagnosis. Through meticulous investigation and interdisciplinary management, clinicians successfully unravelled the underlying HIV infection contributing to his uncontrolled asthma. This case serves as a poignant reminder of the importance of thorough evaluation in complex clinical presentations, ultimately leading to timely diagnosis and intervention.

Alfayez et al., did a retrospective study to evaluate and interpretive the endometrial histological findings among women with uterine bleeding. This study was conducted in the Department of Obstetrics and Gynaecology at Prince Hashime /Az zarqa in Royal Medical Services RMS during the period 2018 to 2020. Purposive sampling technique have been used to select two hundred patients diagnosis with abnormal uterine bleeding underwent endometrial sampling after dilatation and curettage. A cohort study has been used to evaluate and interpretive the endometrial histological findings among women with abnormal uterine bleeding. Maximum number of cases with abnormal uterine bleeding was found in reproductive fertile age group 20 to 40 years (60.42 %) in women with parity 2-5 (90.25%). Menorrhagia was the major symptom in 76 cases and represented 35.94% and the secretory endometrium the most percentage (34.42%) of all the cases. Menorrhagia was the commonest mode of the entire age group, 50% in the group <20 years. Metrorrhagia and metropathia haemorrhagica were higher in reproductive age group rather than the age group >40 years. The authors concluded that the greatest percentage of abnormal uterine bleeding found in the group of 20-40 years in multiparous women and Menorrhagia was the commonest in all age groups.The majorities of the patients with secretory and proliferative endometrium had normal uterus size and normal form of endometrium. 50 % of all patients had cheesy endometrium and enlarged uterus in patients with atypical hyperplasia.

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