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

This is a very rich issue with a number of research papers and reviews from the region in addition to a review on virology and MERS.

A multi-country cross-sectional study was conducted in six countries of EMR attempt to identify the current practices and perceptions of family physicians regarding health promotion, disease prevention including periodic screening and health checks in Eastern Mediterranean Region.
Family Physicians who were currently practicing in different countries of EMR were invited to participate in the study. A pre-tested structured questionnaire was used for data collection. Data was entered and analyzed on SPSS 19 and logistic regression analysis was performed. A total of 100 physicians' data was included in the final analysis. Approximately 53% of Family physicians always recommend periodic screening and health checks to their patients. The authors concluded that periodic screening and health check is an important strategy to prevent disease and maintain health. It is an underutilized practice and a great need exists for its implementation in family practice.

A prospective interventional study carried out on 120 participants paper from Egypt evaluated the effect of Dietary Approaches to Stop Hypertension (DASH) diet on normotensive individuals; pre-hypertension and hypertensive grade 1 patients as well as to identify time needed for DASH to reduce BP in pre-hypertension and hypertensive grade 1 patients. Participants were equally distributed in three groups; normotensive, pre-hypertensive hypertensive grade 1 participants (40 in each group). The authors found significant reductions in systolic and diastolic BP among pre-hypertension by (8.1, and 16.4 mmHg respectively with P < 0.001) and hypertensive participants by (5.8, and 7.4 mmHg respectively with P < 0.001) were observed. Reduction was greater in the first 8 weeks and reached a plateau after 12 weeks. BP decrease in normotensive group was insignificant. The authors concluded that adherence to DASH diet has rapid and statistically significant improvement in systolic and diastolic blood pressure in hypertensive grade 1 and pre-hypertensive participants. Hence, DASH diet was found effective as a first line intervention of elevated blood pressure.

A paper from Suez Canal University identifies the magnitude and the burden of TB stigma on patient and effect of TB stigma on treatment adherence. A total of 53 patients consented to participate. There was an immense stigma observed among urban residence (57.7 %), current smokers (60.0 %) and those had two or less rooms in their house (66.7 %) and this was found to have statistically significant difference (P<0.05).The majority of patients (67.9%) take treatment regularly. The authors concluded that TB stigma has been raised as a potential barrier to home and work-based direct observational therapy (DOT). Perceived TB stigma had no effect on treatment regularity. Health education programs should be conducted to reduce TB stigma and improve patients compliance.

A paper from Iraq is concerned with estimation of some biophysical parameters in fertile and infertile patients. The results of this study in shows that, there are significantly decreases in the viscosity and relative viscosity between fertile and infertile patients seminal fluid, and(density and kinematic viscosity) no significantly differences between fertile and infertile patients at range of P<0.05. The project concluded by demonstration of the changes of viscosity of semen. Where displayed and explained changing in relative viscosity and kinematic viscosity. Their effects on the physiology of human body, moreover to the disadvantage of increasing and decreasing of semen density with the locality of people.

A cross sectional study from Cairo University in which 100 adult diabetic patients were interviewed and the visual acuity, retinopathy status, and presence of other ocular diseases were assessed. The objectives of this study were to assess the awareness of diabetic patients about the screening for diabetic retinopathy and to detect the presence of different stages of retinopathy among a sample of patients attending the Diabetic clinic. It was found that there is general awareness of diabetic retinopathy among the majority of the study participants; however there is little awareness as regards the importance of screening. The main barrier for performing fundus examination was lack of awareness of its importance. The authors concluded that awareness creation is crucial for decreasing diabetic eye complications.

A cross sectional analytic study, a sample of 100 asthmatic patients was selected from patients attending Al Bateen Family Medicine clinic in Abu Dhabi Each patient responded to a structured questionnaire assessing his/her knowledge about asthma aetiology, pathophysiology, symptoms, treatment and triggering factors; and evaluating his/her attitude and behaviour regarding asthma diagnosis, inhalers, anti-inflammatory drugs and non-medical methods of treatment , and assessment of their inhaler skills. The main sources of information about asthma were health workers (56%) and Newspapers and magazines (18%). 70% believed that asthma can be life threatening, asthma was believed to be initiated by infections in 86% of patients and weather changes by 49%. The reasons of acute exacerbations were Perfumes (87%) and upper respiratory tract infection (86%). The authors concluded that Asthmatic patients in Bateen Clinic have false beliefs and poor inhaler skills about asthma management. Most of them use inhalers for treatment of asthma attacks and less than half do not use preventers regularly when prescribed. Most of patients believe that preventer therapy lead to its addiction, most of them are lacking inhaler skills especially coordination actuation with inhalation, most patients avoid exercise to avoid acute exacerbations. Patients' ideas, concerns and fears regarding asthma management should be explored during consultation; inhaler skills should be reviewed also in each visit.

A review by our publisher looks at Virology vigilance - an update on MERS and viral mutation and epidemiology for family doctors. She stressed Viruses have been with mankind and the animal kingdom since recorded history and their aetiology is still not fully known. Throughout history the influenza viruses particularly, have been the greatest everyday concern to man and Dengue viruses also take large numbers of lives in endemic areas. While there are viruses specific to humans and particular animal species, the problematic viruses have become those that have spread from animals to humans due to mutation. Some of these mutations have then gone on to human to human transmission. Even given better global communications has there been an actual increase in virus mutation and spread? In this past 100 years dramatic new viruses such as HIV, and Ebola, have emerged and spread rapidly among humans and have caused global concern; new strains of corona viruses such as SARS and MERS have been shown to spread rapidly and dramatically into new populations. We are yet to quantify if viruses spreading into new host populations may have an advantage and therefore greater impact on human health in geographical areas other than those in which the viruses originated. It remains an ongoing problem and ongoing work for doctors, technicians and public health personnel, as well as global health organisations. Family doctors who are usually the first contacted and who live in the patient's local environment where the outbreak may have originated, particularly need to be alert not just for evidence and symptoms of existing strains but for pockets of new viral strains/mutations.