This issue of the journal is rich with papers with different topic from the region of interest to primary care. Abdulghani, et al., looked at the trend of four consultation models in four specialties at four tertiary care hospitals. Out of 263, most clinicians (n=121, 46.0 %) were found to practice a blended consultation approach while dealing with patients. The 2nd most common adopted consultation model was the Deliberative model (n= 109, 41.4%). Other consultation (Informative and Interpretive) models were the least practiced models (1.5%). The authors concluded that the blended consultation is found to be the most practiced consultation model. A clinician should adopt an attitude that is flexible and empathetic towards patients' needs and expectations. Consideration should be given to assisting physicians in adapting their roles for interpersonal styles to the preferences of various patients. This expanded role will result in improved health outcomes for diverse populations utilizing health care.

Andijani , et al., did a cross-sectional study was conducted on patients receiving chemotherapy to assess the effect of COVID-19 pandemic on gynecological cancer patients receiving chemotherapy. A total of 84 patient were identified. The most diagnosis was ovarian cancer (41.7%) followed by uterine cancer (33.3%). Of studied patients, 17.9%, 19.1%, 27.4 and 33.3% had I, II , III and IV cancer stages respectively. Patients with recurrent disease had a significantly higher percentage of patients detected with COVID-19, and all cases detected with COVID-19 died with respiratory failure. Patients who had their chemotherapy delayed had a significantly higher mean number of cycles. The authors concluded that improved communication and management programs are required to keep cancer patients and their healthcare providers connected, as well as to allow cancer patients to survive a pandemic.

Albaqami et al., a descriptive cross-sectional study that was conducted to study the impact of COVID-19 on asthmatic patients which was conducted using prepared questionnaire which was distributed online among 300 patients with asthma. In this study, we were able to collect data from 311 asthmatic patients in response to our questionnaire. Most of asthmatic patients were females (67.2%) with ratio of females: males of 2:1. The prevalence of COVID-19 in asthmatic patients was 64.3 % where third of patients needed to go to hospital because of their bad conditions, 12.6 % needed to be hospitalized in ICU and 56.4 % needed oxygen. The authors concluded that the prevalence of COVID-19 in asthmatic patients was much higher than general population especially in female patients who aged between 31-40 years old. Moreover, COVID-19 had more severe outcomes on asthmatic patients including higher prevalence of ICU admission and oxygen need. Poorer outcomes of COVID-19 were associated with poor control of asthma.

El-Gamal, et al., did a cross section study, include 2501 patients, visited the outpatient clinics at two private general hospitals in Jeddah during the years 2018 through 2019. The aim is to study gender differences of the burden of type 2 diabetes and complication risk among Saudi subjects visiting the outpatient clinics. Out of all the visits to the outpatient clinics, DM constituted 5.5%. Type 2 DM was common in those aged 40 years and above, while Type 1 DM was common in those aged 18 years and younger. The authors concluded that DM is a common chronic disorder, which imposed burden on the primary health care in Saudi Arabia. It is more common in males than females, however, the pattern of cardiovascular complications and health care management were similar in both genders.

Alhajaji, et al., did a cross-sectional study was conducted among 236 type-1 diabetics in Makkah Al-Mukarramah City. The aim is to assess magnitude of diabetic ketoacidosis (DKA) among type-1 diabetics and to identify associated risk factors. 70.8% reported past history of DKA. The main causes of DKA were "first presentation of the disease" (40.9%), and "discontinued treatment" (37%). The HbA1c among 53.6% was above 9%. Almost all cases who experienced DKA were hospitalised (98.8%). The authors concluded that most type-1 diabetics experience DKA, mainly with their first presentation of disease or due to discontinuation of treatment. DKA tends to occur more frequently among female patients, those with less educated parents or when their parents are relatives.

Arain, et al , did a comparative cross sectional study conducted on the 3rd, 4thand 5th year medical students in Taif Medical College of Taif University KSA, to determine the association of test anxiety on OSCE performance of medical students in taif medical college. A total of 518 students participated in the survey. The authors concluded that test anxiety is experienced by a large number of undergraduate medical students of Taif Medical University .anxiety has a negative effect on overall academic performance , female students were also more affected as compared to their male counterparts.

Mark Spigelman says the Covid-19 virus leads to a rapid loss of protection in many patients within 6 months. Thus the need for a 3rd injection has been found to be mandatory for continuing protection, as well as to highlight the need to monitor immune compromised patients and those with comorbidities particularly in indigenous populations where co-morbidities may be present preventing an adequate response to the initial vaccination.

Al-Amri et al., did a descriptive cross sectional study to determine the level of knowledge and awareness and the factors affecting the corneal donation. A total of 641 participants were involved. The study revealed low level of knowledge of corneal donation in Aseer Region. Approximately one quarter of the participants reported willingness to donate their cornea. Lacl of knowledge was the main barrier reported by two thirds of the particiapnts.
Khan, et al., did a parallel, two-arm, cluster randomized controlled trial. 768 mother-child pairs ('dyads') attending any of the 24-public health centers in two districts of Pakistan will be recruited, with an average of 32 participants per cluster. In intervention arm, ECD based counselling sessions will be delivered to mothers-child dyads by trained staff at public health care centers. Our primary outcome is reduction in prevalence of two or more developmental delays among children, from 38% to 23% in intervention arm. Unit of randomization will be public health care center. 24 eligible clusters recruited will be randomized into intervention and control arms, using 1:1 allocation. The authors concluded that the integrated model of child care into primary health care has the potential to provide a feasible and sustainable model for improving child developmental at scale.

Kanwal, et al., did a cross sectional study among 60 polycystic ovarian syndrome patients. The aim of current study was to appraise the relationship between women body image perception and depression in case and controls. 55% of PCOS patients with depression while 36.7% were found with depression in control group. In PCOS group 65% of patients were found with positive body image while 98.3% of patients were found with positive body image. The authors concluded that there was significant association of study group with body image perception and depression. Therefore, health of the patients with the set of symptoms is essential to be acknowledged more fully, predominantly in relation to the despair and poor body image. The outcomes of this study foster implications for clinical practice and propose that a multidisciplinary team should be involved in treatment of PCOS.

Alshareef , et al., did a retrospective chart review of growth hormone deficient (GHD) patients was done at the security force hospital in Riyadh, Saudi Arabia. The data was collected from the medical records of the patients. The aim is to examines the chances of developing growth hormone disruption and Diabetes Mellitus in patients diagnosed with Congenital Hypothyroidism at the Security Forces Hospital in Riyadh, Saudi Arabia. At the beginning of the research, 287 growth hormone-deficient (GHD) children ranging in age from 1 to 15 years old were evaluated for diabetes. The authors concluded that levothyroxine therapy has no discernible effect on blood sugar level fluctuations in males and females.

Mandoura, et al., did a descriptive cross-sectional study was conducted in the primary healthcare centers` clinics and outpatient pediatric clinics of Abha maternity and children hospital. The aim is to assess the prevalence of breastfeeding and determinants of not continuing initiated breast feeding among Saudi females. The study included 276 mothers. Majority of them (88.1%) aged between 20 and 39 years and Saudi nationals (90.2%). The authors concluded that initiation of breastfeeding was very highly practiced by mothers in Abha city, Saudi Arabia. However, its discontinuation before the recommended time is also a highly reported practice.

A number of review papers discussed important topics in practice. Dr. Abdalla, reviewed Malignant Melanoma. He stressed that Malignant melanoma is cancerous neoplasm of the melanocytes. It is the most aggressive type of skin cancer as it tends to metastasize early. Melanoma is the 5th commonest cancer in the UK. It affects adult of any age but extremely rare in children. Excessive sun exposure in childhood and early adult life is the most dominent risk factor in most cases of MM. Other risks include those with skin type 1 (always burn and never tan), People with red or blond hair, freckles, high numbers of naevi >50, and strong family Dr. Daud, looked at the clinical Efficacy and Cholesterol-Lowering Effects of Inclisiran. Inclisiran, a drug developed by Novartis, is a recent medication designed to alleviate cardiovascular disease symptoms through improving low-density lipoprotein cholesterol levels. Positive, large-scale clinical trials on the use of inclisiran demonstrate the drug's efficacy in reducing LDL cholesterol levels in patients afflicted with cardiovascular disease. However, despite the promising clinical trials on inclisiran as well as its use in the UK, the U.S. Food and Drug Administration (FDA) has yet to approve the drug as a treatment strategy for cardiovascular disease. Dr. Abdalla, reviewed Non-surgical options to treat androgenic alopecia. He stressed that Androgenic alopecia (AGA) is the commonest cause of hair loss in men and women. It isattributed to genetic and hormonal factors. A major factor identified, so far, is the effect of Dihydrotestosterone (DHT) on the scalp hair follicles. DHT is formed by the conversion of Testosterone to DHT when it is activated by the enzyme 5?? reductase which is found in type 2 receptors on the scalp hair follicles. The result of this activation is miniaturization (thinning) and shortening of the growth phase (anagen) in the hair cycle.

Abdulrazak Abyad
Chief Editor