In this issue of the journal various authors discuss important topics in primary healthcare. It included among others depression and dietary habits.

There are two papers that deal with depression issues. Alqarni et al., assessed the knowledge, attitude and practice regarding geriatric depression among primary care physicians (PCPs) in Aseer Region. This study included 330 PCPs in Aseer Region, Saudi Arabia. A self-administered questionnaire was constructed by the researchers to assess participants' knowledge, attitudes and practices about geriatric depression. Regarding geriatric depression, 30% of PCPs had poor knowledge, 94.2% had positive attitude toward management of geriatric depression, while 27% had poor practices regarding management of geriatric depression. More than one third of participants (35.8%) do not use any standard test to screen for late life depression. Only 64.2% use clinical guidelines for the diagnosis and treatment of late life depression, while 10.6% of PCPs do not request any laboratory test to identify the cause for geriatric depression. The authors concluded that PCPs knowledge regarding geriatric depression is suboptimal. Most PCPs have positive attitude toward geriatric depression, but routine screening of elderly patients is mostly not fulfilled. PCPs' CME, experience and training are the main determinants for better knowledge, positive attitude and more practice regarding diagnosis and management of geriatric depression. Therefore, PCPs should be encouraged to attend CME on mental health of elderly and to be trained on routine psychiatric screening of elderly and to use clinical guidelines for diagnosis and management of geriatric depression. Wheras, Dr. Alharbi looked at the prevalence of depression and attempted o identify its related factors among female medical students in Al-Maarefa Colleges in Riyadh. It was found that 28.9% of the medical students were depressed. 44.7% of the study population was in level 7-8, and the majority of the participants were aged between 18-21 years. GPA was found to cause stress for 85.7% of the students and so the average 18-20hr/semester put 69.3% of the students under stress. The author concluded that the prevalence of depression was relatively low among the female medical students of Al-Maarefa Colleges during 2015-2015. The findings of the study showed negative associations between depression and students' marital status, parents' and partner's support, college satisfaction, self-esteem, classmates' negativity and GPA stress. Accordingly, it cannot be generalized that all medical students have depression.

There are as well a number of papers on effect of dietary habit on health. Ali et al., assessed the effect of caffeine on sleep among medical students at King Faisal University Saudi Arabia. Study was conducted among students in collage of medicine at King Faisal University in Al-hassa in Saudi Arabia. Initially a sample size of 200 was targeted calculated A total of 206 responses were received. There were 115 (55.8%) female and 91 (44.2%) male respondents. Majority of the respondents (51.9%) belonged to age group 18-20 years. Majority of the students; 140 (68.0%); responded of not having any problem in going to sleep; while 66 (32.0%) students responded of having difficulty in going to sleep. Consuming more than 250 mg of caffeine on different aspects of sleep. The authors concluded that there was relationship between caffeine consumption and sleep. The sleep hours were decreases with people who drunk more than 250mg of caffeine. Whereas, Rehman, et al., used a cross sectional study to determine the dietary habits and physical activities in association to underlying motivating and hindering factors in undergraduate medical students at Sindh Medical College, Jinnah Sindh Medical University, Karachi. The authors concluded that medical students are future doctors and the responsibility of maintaining the health of general population at large rests on their shoulders. They should be the role models for the community in maintaining a healthy life style. The findings of this study have shown that a lot needs to be done on part of our future doctors in revisiting their lifestyle, especially with regard to their dietary patterns and physical activity. An adequate proportion of our undergraduate medical students is trying his level best to take balanced diet and engage in physical activity for maintaining good health .These students should act as enablers to help out their fellow medical students who are not so careful about their lifestyle.

Alshehri, et al., follow a case-control research design to assess health-related quality of life (HRQOL) of type 2 diabetic patients in Aseer Region, Saudi Arabia. This study included 100 adult type 2 diabetic patients and 100 healthy, age- and sex-matched subjects who attended outpatient clinics at primary healthcare centers. Diabetic patients had significantly lower SF-12 mean scores than control subjects, as regard the physical and mental components (p<0.001 for both components. The authors concluded that several risk factors can affect the HRQOL of diabetic patients including older age, female gender, level of education, employment, monthly income, marital status, and duration of diabetes.

Marouf et al., reported a case of a young pregnant female presented to the hospital with body ache and diplopia in her 30th week of pregnancy. Multiple Myeloma type IgA lambda was diagnosed. The baby delivered prematurely but healthy. Patient was treated with initially through bortezomib, cyclophosphamide, and dexamethasone (VCD) regimen along with radiation therapy and chemotherapy. The patient responds well to the treatment. This case of Multiple Myeloma in a young pregnant female presented with unexplained symptoms and was diagnosed after presented with neurological symptoms. Treatment with VCD regimen along with radiation therapy and chemotherapy showed excellent response. It highlights that multiple myeloma may be presented atypically in young patients and early diagnosis is an important. Case report is needed.to determine optimal treatment regimens for this subset of young patients.

Dr. Al-Faraj reviewed the fact that newborn hearing screening may predict autism spectrum disorder. He stressed that in the past few years, there has been growing evidence to support an underlying auditory brainstem pathology related to ASD. Improving our understanding of the underlying pathophysiology of ASD leads to the potential identification of novel biomarkers and the development of targeted interventions in the future. This literature review identifies literature articles that investigated the association between the results of the newborn hearing screening and the incident of ASD later in life. By critically analyzing these studies and their results, potential need for future hearing screening with higher intensity stimuli to allow more accurate predictions of ASD risk is indicated.

Abyad & Hammami, reviewed the use of levodopa in the management of Parkinson disease. Despite being the most effective dopaminergic treatment, there is still debate about the optimal way to use levodopa to treat Parkinson's disease (PD). Although there is a wealth of data on levodopa from clinical trials, practical guidance on how to use levodopa optimally throughout the disease is scarce. This article, which is part of a series on Parkinson disease, will discuss the use, benefits, and side effects of Levodopa.

Lohana et al., discussed the psychological impact of corona virus disease on general population in Karachi. A cross sectional study from October 2020 to January 2021 was conducted in the vicinity of Jinnah Post Graduate Medical Center in Karachi. The study was conducted on 139 visitors coming to the tertiary care hospital. The findings of this study showed a large segment of population observing lack of compliance for safety protocols against covid pandemic. The are risking threat to themselves and their families. However, the positive side of the picture shows that majority of the participants were not found to be suffering from any symptoms of psychological stress during covid pandemic . There is a need to launch proper health education programs tat impart reliable information regarding covid pandemic. The health education programs should be easily accessible, affordable and available to the general population.

Abdulrazak Abyad
Chief Editor