In this issue there are various papers from a number of authors from the region in addition Beasley J and Pocock L provide a restrospective on the life of Dr Manzoor Butt a family doctor from Rawalpindi, Pakistan whose life's work extends far beyond the confines of his surgery and out into the community where he has initiated so many projects that provide aspects of health, safety and poverty appeasement in the local community.

Sarhan , M.D., et al, did a cross-sectional study that included 112 nocturnal enuresis patients aged between 5 to 14 years of both sexes in the Child Psychiatry Clinic at Cairo University Hospital. Social data were collected for the studied children and the parents' attitude towards the problem of nocturnal enuresis. The aim of the study is to identify the risk factors and pattern of nocturnal enuresis in the Child Psychiatry Clinic of the Center of Social and Preventive Medicine. The mean age of the patients was found to be 8.6 ± 2.6. The average number of dry nights per week was 1.8. Medicines were used by only 24% of patients. It was also observed that 47% of patients suffered from punishment. Twenty-five percent complained of constipation. Two-thirds of the patients had a positive family history. Learning problems and attention deficit disorder were present in 14 and 12%, respectively. The authors concluded that nocturnal enuresis is a common problem that is affected by many risk factors, especially constipation, parental punishment, and drinking liquids after dinner. It turns out that very few patients have learning problems.

Mass N et al., looked at the the risk factors, clinical features, and treatment outcomes of Male Breast Cancer MBC patients in Saudi Arabia. The authors followed a retrospective-cohort study using consecutive sampling, all male patients who were diagnosed with breast cancer based on the pathology results that were collected from the medical records from January 1998 to December 2017 and treated in Princess Nora Oncology Center. A descriptive statistic was used to find the minimum, maximum, and mean of age at the time of diagnosis. On the other hand, frequencies and percentages were utilized to summarize all other clinical features of the patients including the pathological type, stage at time of diagnosis, metastasis, risk factors, performance status, treatments, and relapse. The mean age of all the 15 patients was 58 +/- 16.5 SD at the time of diagnosis, whereas the maximum was 91 and the minimum was 36. The most predominant type of male breast cancer was Invasive Ductal Carcinoma IDC, which affected 14 patients out of 15 (93.3%).

Alotaibi G.N et al, used a cross-sectional study to investigate the prevalence of burnout and its associated risk factors among female medical students in Taif University. The prevalence of burnout was about 23% of 213 participants. With 27% reporting high levels of EE, 62.4% had high level of DP and a low level of PA was (8.9%). The authors concluded that Year of study, study hours, leisure time activities and exercise are factors influenced burnout among female medical students in Taif, KSA. Effective coping strategies should be considered to minimize burnout levels. Simple methods such as increased physical activity, leisure time activities and group discussion may reduce the likelihood of the development of burnout.

Basharat , V et al., did a A descriptive cross sectional survey to estimate the prevalence and correlates of IBS among teachers in Abha city. The research included 578 teachers, 55.9% of them were females and 75.6% were married. IBS was recorded among 35.5% of the teachers. IBS was more recorded among females than males. Logistic regression model included all teachers' demographic and work data among which gender, income, chronic health problems, and work load were found to be statistically significant predictors for IBS status. The authors concluded that about one third of the teachers had IBS. IBS subtype M was the most frequent especially among females with high income and high work load.

Alshehri , M.H et al., did a cross-sectional study recruited a total of 281 Saudi students of both genders at the college of medicine of IMSIU-Riyadh, from the preparatory year to the fifth year. The aim of this study is to measure the knowledge and attitude towards BLS among medical students. A total of 280 students completed the questionnaire. Males constituted the majority of participation (57.1%). The overall mean score for BLS knowledge was very poor (29.96%, SD±14.67). In addition, 40% of students had never received BLS training before. It was also noted that about 76% of students desired more BLS training and about 78% of them thought BLS training should be mandatory. The outcome indicates very poor knowledge of BLS among medical students of IMSIU, which mandates more BLS training. Despite the numerous students' failure to show acceptable knowledge on BLS training, a good attitude is observed. These findings encourage more improvement in BLS education among IMSIU students to guarantee better outcomes during emergency situations.

Asiri, A et al., did a nationwide study that included 1218 adults living in Saudi Arabia. A study questionnaire was designed for online data collection using the "Google Forms". The aim is to assess knowledge of the population in Saudi Arabia about health hazards affecting the offspring of fathers with advanced age at the time of conception. Almost half of participants were males (49.4%), age of 60.3% was 20-40 years, 22.2% were working in the health sector, while 34.4% were working in other sectors. The authors concluded that the public in Saudi Arabia mostly have poor knowledge about impact of advanced paternal age on offspring's health. Most of them feel the need to raise their awareness about offspring's health problems associated with father's ageing. It is recommended to raise their awareness regarding the fact fathers, mostly after the age of 40 years, experience decreased fertility, and constitute a high risk for congenital malformations among their offspring. Couples must be counselled on the impact of advanced paternal and maternal ages on negative pregnancy outcomes and impaired offspring health.

Mustafa A.E.M et al., did a descriptive cross-sectional survey targeting all mothers in Aseer region. The aim is to assess mother's awareness regarding weaning practices and its determinants among Mothers in Aseer reign, southern of Saudi Arabia.The survey included 803 responding mothers whose ages ranged from 20 to 55 years with mean age of 30.6 ± 10.2 years old. University level of education was recorded for 516 mothers (64.3%). Exact of 174 mothers (18.3%) reported that infant food should be breast milk only till the age of 4 months. The authors concluded that the study revealed that mothers in Aseer region had poor knowledge regarding weaning and weaning practice especially effect of delayed weaning. Their main source of information based on their personal experience. More effort should be paid to improve mother's awareness and practice regarding breast feeding and weaning.

Al Saleh, M.M et al., did a : A population based cross-sectional survey targeting general population in Aseer region, southern of Saudi Arabia. The aim was to assess knowledge, attitudes, and practices concerning self-medication with antibiotics among the public in Aseer region, Saudi Arabia. A total of 843 participants completed the study questionnaire. Exact of 796 (94.4%) of the respondent reported that Antibiotics should be purchased according to a doctor's prescription, 450 (89%) correctly said that Antibiotics have side effects, and sometimes are dangerous. The authors concluded that population in Aseer region had poor knowledge regarding antibiotic use in total. Also, participants practice was questionable and need to be improved to adhere to safe practices with antibiotic use.

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A number of papers discussed educational issue and training. AL-Shahrani, A. et al., did a descriptive cross-sectional study targeting all medical interns in all accessible hospitals. The questionnaire covered the interns' socio-demographic data, work-related data, and preferred speciality besides preferred workplace and worktime. The study included 80 medical interns of which 30 males and 50 females. As for marital status, 73.3% of the male interns were married compared to 24% of the females with statiscal significance (P=.001). the authors claims that the current study revealed that there were gender differences regarding future workplace (especially high responsibility positions) and work time specifically for those who had children especially for female interns. Besides, males showed bimodal occupational self-efficiency expectations while female interns were at moderate level. Alqahtani A.M.A. et al.,
Followed a cross-sectional design, this study out at 25 PHCCs in, Saudi Arabia. The study comprised 25 PHCCs managers and 300 PHC providers. Survey instruments included a brief sociodemographic survey questionnaire, the "Multifactor Leadership Questionnaire. The study aimed to explore the relationship between managers' leadership styles and job satisfaction among healthcare workers in primary healthcare centers (PHCCs). Only 52% of PHCC mangers attended training on leadership, 68% highly followed transformational leadership facet "idealized influence", and 64% followed "management-by-exception", while only 28% highly followed the "Laissez-faire" leadership style. About one-third of healthcare providers were satisfied, 9.3% were dissatisfied, while 51.3% were ambivalent. The authors concluded that job satisfaction is significantly less among pharmacists, those having insufficient income, or less experience in PHC. Laissez-faire leadership significantly correlates with most job satisfaction items, followed by transactional and transformational leaderships. It is necessary to improve PHC providers' job satisfaction by better application of transformational and transactional leadership styles. Ashfaq T et al., did a mixed methodology to determine the family physicians' change in knowledge due to sitting the MRCGP [INT] and its impact on their attitudes and practice in Pakistan. The study was conducted in two phases. In phase 1, 65 doctors who had passed MRCGP [INT] were interviewed and a focus group was also held to assess the FPs/GPs perceptions. In phase II, patients were interviewed regarding the practice of the FPs/GPs. A pre- tested structured questionnaire was used for data collection. In this study, Major areas of strength are patient centered approach 68%, holistic care 56%. Overall patient satisfaction was found to be 52%. Moreover, all the participants in focus group acknowledged that MRCGP has indeed brought a positive change in their knowledge and consultation skills. The authors concluded that increased patient awareness has challenged health professionals, to not only increase their knowledge base, but also to incorporate this within their everyday practice. Hence, Impact of MRCGP [INT] professional examinations such as MRCGP [INT] can be a reliable way for the FPs/GPs to keep their knowledge level updated.

Hanoof Ali alqahtani, H.A., et al., did a descriptive cross-sectional survey was conducted targeting all females in Aseer region, southern of Saudi Arabia aging 18 years up to 65 years. The aim is to assess the level of public awareness, knowledge, and attitudes towards Pap smear as a screening test for cervical cancer among Saudi women, attending major healthcare facilities in the Aseer region. The survey included 956 females whose ages ranged from 18 to 65 years old. About 64% of the females were married and 29.9% were single. The authors concluded that the study revealed that there is a great lack of knowledge regarding Pap smear as a screening method of cancer cervix among Saudi females in Aseer region. The lack of knowledge was more reported among highly educated working female. The test should be done routinely in obstetrics and gynecology departments of the hospitals for high-risk groups.

Tufail, & Saghir, reported a 34-year-old lady presented to the practice with a one-day history of vertigo, and nausea. This caused her to fall and she had hit the left side of her head. She also described a headache on the side where she had landed and had not taken any analgesia. On arrival her observations were stable, and Migraine headache was considered the most likely cause of her symptoms. During her stay at the Emergency Department, the headache worsened so a CT scan was carried out. This revealed a sinus venous thrombosis. An Magnetic resonance Venogram was recommended and showed thrombosis of the left tranverse and sigmoid sinus. Cerebral Venous Thrombosis (CVT) is an uncommon disorder. However it has higher tendencies to occur in female patients younger than 40 years of age, smokers and or those with thrombophilia. Women who are pregnant and those who are taking hormonal contraceptive therapy are at risk (Fayaz, 2012) and in this case her BMI also needs to be taken into account as a confounding factor. The case appreciates the multifactorial nature of primary care and the need to keep all hats on during a consultation. This is what sets Family Medicine aside from other disciplines; The ability to appreciate a patient as a whole story rather than chapters.

Alruwaili, S. et al., did a cross-sectional study including 112 keratoconus patients who were treated with contact lenses, subjects were from different areas of Saudi Arabia. The aim is to determine the prevalence of contact lens use as well as the attitudes toward contact lens usage and its complications among keratoconus patients. Of 112 respondents, 84.8% were treated with hard lenses, while 23.2% used soft lenses. Complications reported among 57.1%, the most common being dry eyes. The authors concluded that the results of this study highlight negative habits of contact lens use and complications experienced by users. Although the study shows good practice among keratoconus patients, health education on contact lens hygiene is recommended to improve patient behaviour and prevent severe complications. In addition, further research must be undertaken to evaluate the awareness of contact lens related complications among KC patients.

Alfayea, M.A., et al., did a cross-sectional study was conducted among a sample of general adult population aged >18 years,. To assess extent of mobile using, and its possible impact on patterns of sleep quality disturbance among general population. The study included 475 participants. Their age ranged between 18 and 60 years with a mean±SD of 28.1±8.4 years. The overall smartphone addiction scale score ranged between 37 and 161 (out of 165) with a mean±SD of 100.2±21.4. Highest scores were reported among those using smartphone in playing games (p=0.003). There was a significant negative correlation between participants' age and their smartphone addiction scale scores (r= -0.112, p=0.015). Overall, poor sleep quality, based on PSQI was observed among 93.7% of participants. The authors concluded that smartphone addiction is an evident problem among our population, particularly younger. Smartphone addiction is associated with long sleep latency, shorter sleep duration, lower sleep efficiency, higher daytime sleep dysfunction and overall poor sleep quality.
Abdulrazak Abyad
Chief Editor