This is the third issue this year and includes a number of papers from the region including review papers, case report, and original research papers.

Mansour et al., reviewed the conflict between humans did not stop throughout the ages, and humans have used everything in nature to serve this conflict since the first ages of history, during the First World War the world witnessed the actual use of chemical weapons, and a nuclear weapons during World War II By the United States of America against Japan, which greatly developed a biological warfare program before and during World War II, and a lot of information regarding this program was withheld by an agreement between Japan and the USA after Japan's defeat in the war. Finally, the countries of the world succeeded in signing a Biological Warfare Convention (BWC) in 1972, and the Ninth Review Conference will be held for this convention during 2021 to discuss its articles and try to develop its mechanisms to prevent the development and use of biological weapons in the conflict between nations.

Helvaci et al., looked at Pulmonary hypertension and chronic obstructive pulmonary disease in sickle cell diseases. All patients with sickle cell diseases (SCD) were included. The study included 434 patients (212 females) with similar mean ages in males and females (30.8 versus 30.3 years, p>0.05, respectively). The authors concluded that SCD are severe inflammatory processes on vascular endothelium, particularly at the capillary level since the capillary system is the main distributor of hardened red blood cells (RBC) into tissues. Although smoking, alcohol, disseminated teeth losses, ileus, cirrhosis, leg ulcers, digital clubbing, CHD, CRD, stroke, and COPD-like atherosclerotic events were higher in males, PHT and DVT and/or varices and/or telangiectasias were similar in both genders. Similarly, although the male gender alone is a risk factor for the systemic atherosclerosis, the similar prevalences of PHT in both genders also support its nonatherosclerotic nature. In another definition, COPD may have an atherosclerotic whereas PHT a hardened RBC-induced chronic thromboembolic background in the SCD.

Bukhari, et al., did a cross-sectional study to assess the prevalence of depression and anxiety among patients with breast cancer and risk factors associated with it. This cross-sectional study enrolled 74 patients diagnosed with breast cancer. From the 74 patients with breast cancer, 36% of the women were found to have depression and 24% were found to have anxiety and the prevalence of having both depression and anxiety was 23.0%. This study showed that the prevalence of depression and anxiety was similar to previously conducted studies; it also showed no associations between the risk factors studied and anxiety or depression in patients with breast cancer.

Alkubaisi et al., did a retrospective chart review (baseline audit) was conducted on 245 health records of children attended well-baby clinic for three. The aim is to ensure that well-baby services provide clinical care according to children's age as per well-baby service protocol within primary health care centers, to find gaps if any and, generate action plan for further improvement. Performance for criterion on relevant clinical history taking (feeding and bowel history) has slightly increased from the baseline for each of the following age groups: from 71% to 82% at 4 months, 77% to 80% at 18 months and, 76% to 81% at 30 months, however, a declination shown at 2 months 88% to 80%. Assessment of developmental milestones at 2, 18 and 30 months of age increases by 5% (76% to 81%), 13% (70% to 83%) and 19% (50% to 69%) respectively and, at 4 months performance remain the same 69%. The authors concluded that impactful audits with actionable recommendation make real difference in practice and compliance. In conclusion, action plan implemented further to the baseline audit are effective in increasing the compliance in most of the areas.

Helvaci, et al., looked at positive and negative acute phase reactants in sickle cell diseases. The studies looked at consecutive patients with the SCD and controls were studied. The study included 193 patients (98 females) and 132 controls (67 females). Although the body weight and body mass index (BMI) were retarded in the SCD (58.9 versus 71.1 kg and 21.5 versus 26.8 kg/m2, respectively, p<0.000 for both), the body heights were similar in both groups (164.8 versus 162.8 cm, p>0.05). Parallel to the retarded body weight and BMI, fasting plasma glucose (FPG) (93.4 versus 102.4 mg/dL, p=0.025), low density lipoproteins (LDL) (70.4 versus 98.1 mg/dL, p<0.000), high density lipoproteins (HDL) (24.2 versus 35.8 mg/dL, p<0.000), and systolic (117.6 versus 127.9 mmHg, p=0.001) and diastolic blood pressures (BP) (77.3 versus 86.0 mmHg, p<0.000) were all retarded in the SCD. The authors concluded that body weight, BMI, FPG, LDL, HDL, systolic and diastolic BP, and Hct may be some negative whereas TB, LDH, WBC and PLT counts, and MCV may be some positive APR in the body.

Alrobiaee et al., did a cross-sectional survey was conducted among women seeking Antenatal care (ANC) at PHCCs in Unaizah city, during 2021. The aim of this study is to assess women's expectations and satisfaction with the quality of ANC provided at primary health care centers (PHCCs) in Unaizah city, Qassim region, Saudi Arabia. A total of 204 women participated in the survey; 54.5% were 30 years or less in age and 50.5% had university or higher degree. The majority of women were satisfied regarding overall information received (n=189, 92.7%), care received from physicians (n=201, 98.5%) and general quality of the health care provided (n=189, 92.7%). The authors concluded that the overall satisfaction with the quality of ANC was high. However, few aspects of services need improvement including waiting time and the instructions about danger signs and seeking emergency care. Regular satisfaction surveys should be carried out to identify problem areas and to improve the quality of services.

Karrar, et al., reviewed cystic fibrosis. The authors stressed that Cystic Fibrosis consider one of the most common autosomal recessive diseases that are associated with a decrease in the length of age in a Caucasian population. also, it's considered as one of the most common life-shortening diseases in the white population in the United States. Cystic fibrosis affects around 30,000 people in the United States and more than 80,000 people worldwide. The incidence rate of this disease is 1 out of 3,500 births per year in the whites' population in the United States. While the incidence rate of the person becoming a carrier is 1:25 in the Caucasian population, and also the incidence of the disease is 1:2,500. The main cause for this disease is the mutation in Fibrosis Transmembrane Conductance Regulator (CFTR) gene. This disease considers a life-threatening genetic disease that causes a buildup of thick, viscous mucus secretions in organ systems. Cystic Fibrosis consider a multiple system disease, but in most cases, the disease gets worsen and mortality increase because of respiratory manifestation such as bronchiectasis. Also, Pancreatic damage in children followed by severe wasting, malabsorption, and mortality is one of the recorded observations in children. This article aims to provide a brief introduction, the clinical picture of the disease, Etiology, Pathophysiology, Epidemiology, Nutrition, Prevention, and good practice management advice.

Abdulla Saleh, et al., did a retrospective descriptive study, in which we reviewed the medical records of all patients with vitiligo attending two private clinics in Aden during the period January 2019 to December 2020. The objective of the study was to evaluate the different clinical features of vitiligo diseases and to assess the comorbidity disorders in Aden. The majority (49.7%) patients were aged ? 20 years old and the positive family history of vitiligo was found in 28.6%. Vulgaris is the predominant vitiligo type (57.8%) followed by acrofacial type (13.0%).
Extremities involvements were higher in females and males (17.4%) and (9.9%), respectively. Face with extremities involvement and trunk with extremities involvement in female patients seem to be similar with (9.9). The patient concluded that Vitiligo disease more common in females and the most common form was vitiligo vulgaris. Third of patients had positive family history of vitiligo and the most site involvements were extremities.

Dr Ebtisam, reports a case of early-onset CTCL, localized and unilateral . the patient is
a 39-year-old man attended with itchy single red skin lesion on his left leg that was unresponsive to topical steroids for the past two-weeks. Apart from that, he had no other complaint. He was fit and well. Examination showed a unilateral localized red slightly-scaly, non-blanchable skin plaque on his lower left leg. Other skin parts were not affected. Physical examination was otherwise unremarkable without any detectable lymphadenopathies. The histology report concluded that the immunohistochemical profile is consistent with T-cell proliferation and the picture suggests cutaneous T-cell lymphoma.

Dr Abdulrazak Abyad
Chief Editor
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