This issue of the journal is rich with a number of interesting cases that are faced by primary care physicians in the Region.
Alshahrani et al., looked at patient satisfaction predictors with the primary health care services by conducting a systematic review at the Kingdom of Saudi Arabia. The three databases in the form of Google scholar, Pubmed, and Medline have been used for the article extraction. The keyword has been used to search the articles related to this work, such as the predictors of patient satisfaction. All the selected studies have been evaluated and screened with the help of PRISMA, and after the extraction of the 25 articles for systematic review, the JBI assessment has been applied to the methodologies. The overall quality satisfaction indicated that all the selected studies are suitable for the systematic review. Most studies have found the five major predictors of patient satisfaction in primary health care, which include availability and accessibility, communication-related attributes, rational conduct, and technical skills, along with personal qualities.

Almetrek, et al., followed an exploratory descriptive cross-sectional research design. The study population consisted of diabetic patients receiving insulin. The aim to investigate what factors affect patients' compliance with an insulin regimen as part of self-management in Najran Armed Forces Hospital. The study sample included 90 patients, of whom 53.3% were males. Many participants expressed poor attitudes and lacked self-management skills and the necessary health education information. The authors concluded that diabetic patients' compliance regarding self-management advice is variable. It is of utmost importance for diabetic patients to be educated and supported in all aspects of self-management to avoid diabetes complications.

Alshahrani, et al., followed a cross-sectional study during a period from December 2019 to February 2020 at the University of Bisha, College of Medicine (UBCOM), Bisha province, Saudi Arabia. The aim is to identifying the potential factors of depression among medical students is the first step towards academic excellence and future safe medical practice. Male medical students from year one to year six were involved. Of the 190 male students enrolled, 26.8% had depressive symptoms, of which 45.1% were having moderate to severe symptoms.The study concluded that medical students at UBCOM also experience depressive symptoms associated with various risk indicators. Optimizing the educational and social environment coupled with infrastructure facilities at UBCOM might promote students' mental health and well-being.

Murad et al., did a Descriptive Cross-sectional Study was done via a validated questionnaire on the general population in Western Region of Saudi Arabia. The aim in this study is to assess the parents' knowledge and awareness and practice regarding paracetamol use in children and to evaluate whether doctors and pharmacists in hospitals or pharmacies educate the parents about this medication or not. The study consisted of 502 participants, were females 52.4%, male 47.6%. This study emphasises the need for increasing caregivers' education on paracetamol use and side effects. Overall knowledge score was unsatisfactory. The study found a significant association between parents who had a university degree and their higher knowledge scores. Although most of the participants would consult their doctors before administering paracetamol, it showed no positive impact on their knowledge and practises towards antipyretics dose and side effects, which indicates a need for campaigns or educational programs on fever management.
Bin Al-Zou, et al., described the epidemiological and clinical pattern of pemphigus.
The records of 68 patients diagnosed with pemphigus were reviewed.
The total study patients were 68. They were (61.8%) females and (38.2%) males. The mean age at the onset of disease was 49.1 ± 14.4 years. Pemphigus vulgaris was the most common type (88.2%), followed by pemphigus foliaceus (10.3%). The authors concluded that pemphigus vulgaris was the most common type. Females were predominant and the patients of the age group ? 50 years and the age group > 50 years were to some extent equally. The most common site involvement was mucocutaneous. Most of the patients treated by combination of corticosteroid and azathioprine.

Hashmi et al., report a case of Middle aged 50-year man contracted severe covid 19 pneumonia. Post discharge complain of multiple joint pains and heel pain on walking. The pain was waking him up at night and regular paracetamol wasn't effective. Full thorough workup was done to exclude any possible causes and ultrasound was performed. It was concluded that he had post covid arthralgia and soft tissue swelling. He was prescribed paracetamol and amitryptiline with escalating dose and was referred to rehabilitation and exercise which showed significant improvement and he made a good recovery. The aim of this article is to explore the possible reasons behind these symptoms and the management in primary care setting.

Alsharif et al., report a case of Mutations in ZBTB20 cause Primrose syndrome in a Pediatric Patient. A seven-year-old girl complain from not speaking consistently, snoring and mouth breathing. The patient was responding to sound and there was presence of adenoid hypertrophy. Four years later, the patient presented with developmental delay, delayed speech and problem sleeping. Whole exome sequencing (WES) was done and the result showed a likely heterozygous pathogenic variant, c.11+1del, in the ZBTB20 gene. As advised, management includes educational programs, physiotherapy, speech therapy, and occupational therapy.Patients must have their growth and development followed every six months, their speech and developmental needs evaluated every six months, their behavioural issues, neurological, and musculoskeletal conditions evaluated at every visit, their brain stem evoked response audiometry evaluated annually, and their thyroid function and insulin-resistant diabetes tested annually.

Chaudhry. Et al., report on death of a child in family medicine clinic. This case study discuses the emotional impact of death of a 12-month-old child who was brought in by parents to a routine vaccination clinic. It was an expected death however parents did not disclose that to the staff and child passed away soon after arriving in health centre. This was a shock to everyone involved and witnessing the event and it left everyone distressed.

AlMarsomi1 et al., report on Smoking after a heart attack. Middle aged man suffered acute myocardial infarction while at work and angiography confirmed triple vessel disease requiring stenting followed by lifelong medication. Important to note that upon follow up his lifestyle had not significantly changed, and he continued to smoke cigarettes. Soon after he developed severe low back pain which made him bed bound for a few weeks and further medications were added however all this could not deter him from smoking. This paper aims to discuss why some patients continue to smoke after such major life events.

Ziyada et al., report on an Unusual Presentation of Acute Pancreatitis. The authors stressed that Acute pancreatitis (AP) is an inflammation of the pancreas and is one of the most common gastrointestinal causes of hospital admission in Qatar. Patients with AP usually experience severe epigastric pain, accompanied by nausea or vomiting. They present this case to highlight alternative diagnoses that should be considered in such clinical scenarios.

Asif., et al., report a case of irritable bowel syndrome. This case demonstrates that identification and linking of functional gastrointestinal symptoms helps distinguish lactose intolerance from irritable bowel syndrome. The high prevalence amongst Asian and African populations suggests that lactose intolerance should be considered early on and simple but effective interventions can lead to early diagnosis and better patient outcomes.

Hamadallah et al., report a case of Williams Syndrome (WS) in 9-year-old girl known case of Williams Syndrome (WS) who presented with chronic dry cough to the pediatric pulmonologist clinic. Th diagnosis of asthma was established based on detailed history, physical examination, and chest x-rays. She was treated with Budesonide nebulizer twice a day and Montelukast once daily. Afterwards, the patient had immediate clinical improvement. In reviewing the literature, we found that some individuals with WS had a history of asthma or wheezing. However, more research is needed to fully understand the exact relationship between the development of respiratory diseases and Williams Syndrome.

Dr Abdulrazak Abyad
Chief Editor
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