In this issue a number of papers from the region and an opinion section that addresses the atrocity of the various wars in the Region and Ukrainian.

Tabain et al., presented a case on Diagnosis of Colorectal Carcinoma in the Younger Population Amidst Mental Health Challenges. This case report goes through the journey of a 42 year old female patient getting diagnosed with colorectal carcinoma. They stressed that
Bowel cancer is a common type of cancer in both men and women - it is the 4th most common cancer in the UK, with over 42,000 people diagnosed every year. About 1 in 20 people will get it during their lifetime. Most people diagnosed with Colorectal cancer are over the age of 60. The diagnosis of Colorectal cancer is being made in the younger populations more frequently, and this case is an example of it. The chief complaint in this case has been a history of having intermittent loose stools for around 9 months on the background of always having a 'sensitive stomach'. Sometimes there has been mucus present. At times, there has been a feeling of being constipated. There has also been cramping abdominal pain which is relieved by opening your bowels and an on and off feeling of bloating. There has not been any weight loss, nor any blood in the stool and no meleana present throughout. No opening of bowels at night disturbing sleep. There has also not been any upper gastrointestinal symptoms throughout. No foreign travel prior. No patterns related to food. The symptoms did seem to follow a pattern of getting worse when there was undue stress/anxiety. There has been a past medical history of anxiety and more recently in the last few months of Irritable Bowel Syndrome (IBS). There is no significant family history apart from a cousin who has been diagnosed with Crohn's Disease. The patient was taking Sertraline for anxiety, and was also trialled on Mebeverine for a month for her IBS symptoms, to no success.

Dr Elghblawi, discussed Inflammoscopy and Stethoscopic of inflammatory skin lesions. The term Inflammoscopy merely implies trichoscopic distinctive features of inflammatory skin conditions; the commonest ones along with some rare ones, to demonstrate the usefulness, and to ease our understanding and help conclude, if possible, in aiding and supporting the diagnosis when it is equivocal. Previously, dermoscopy, an optical device that is used to detect skin malignancy, but promptly, it is also used to analyse inflammatory skin disorders as a supportive tool in various non-neoplastic dermatoses such as inflammatory, infiltrative, and infectious diseases, however; it doesn't follow a standardised approach. It is non-invasive, easy to apply, and allows visualization of the epidermis, dermo-epidermal junction, and papillary dermis, in vivo magnification of the skin which cannot be seen with the naked eye. Dermoscopy employs a ×10 to ×100 microscopic visualisation with a light source to magnify the structures under the skin's surface. There are three kinds of dermoscopy: namely, conventional nonpolarized dermoscopy, nonpolarized contact dermoscopy, and polarized contact dermoscopy. Many dermoscopic structures have a high degree of correspondence with pathognomonic histopathologic features. It's considered the dermatologist's stethoscope as it's an economic tool, yet data on the skill of colour is still limited and is a challenge. Histology is the cutting edge to learn about the underlying issues, but that needs a biopsy. Thus, applying trichoscopy features with the clinical findings can be sufficient to establish the right diagnosis without the need for a biopsy. Nonetheless, dermoscopy requires special training and experience.

Helvaci, et al., looked at Metformin in the treatment of chronic obstructive pulmonary disease even in cases with normal weight. All patients with the SCD were studied. They included 222 males and 212 females with similar mean ages (30.8 vs 30.3 years, p>0.05, respectively). Smoking (23.8% vs 6.1%, p<0.001), alcohol (4.9% vs 0.4%, p<0.001), transfused RBC in their lives (48.1 vs 28.5 units, p=0.000), disseminated teeth losses (5.4% vs 1.4%, p<0.001), ileus (7.2% vs 1.4%, p<0.001), chronic obstructive pulmonary disease (COPD) (25.2% vs 7.0%, p<0.001), cirrhosis (8.1% vs 1.8%, p<0.001), leg ulcers (19.8% vs 7.0%, p<0.001), digital clubbing (14.8% vs 6.6%, p<0.001), coronary heart disease (18.0% vs 13.2%, p<0.05), chronic renal disease (9.9% vs 6.1%, p<0.05), and stroke (12.1% vs 7.5%, p<0.05) were all higher in males, significantly. SCD are prototypes of an accelerated atherosclerotic process all over the body. On the other hand, the role of excess fat tissue on the systemic atherosclerosis, the efficacy of metformin in loss of appetite, and atherosclerotic background of COPD are obvious in the literature. Since metformin is a safe, cheap, oral, long term used, and effective drug for the treatment of excess weight, it should be prescribed in COPD even in patients with the normal weight to minimise the adverse effects of excess fat tissue on the lungs since there are approximately 20 kg of excess fat tissue between the upper and lower borders of the normal weight in adults.

Helvaci*, et al., looked at Metformin in the treatment of cirrhosis. All patients with the SCD were included. They studied 222 males and 212 females with similar mean ages (30.8 vs 30.3 years, p>0.05, respectively). Smoking (23.8% vs 6.1%, p<0.001), alcohol (4.9% vs 0.4%, p<0.001), transfused RBC in their lives (48.1 vs 28.5 units, p=0.000), disseminated teeth losses (5.4% vs 1.4%, p<0.001), ileus (7.2% vs 1.4%, p<0.001), cirrhosis (8.1% vs 1.8%, p<0.001), chronic obstructive pulmonary disease (25.2% vs 7.0%, p<0.001), leg ulcers (19.8% vs 7.0%, p<0.001), digital clubbing (14.8% vs 6.6%, p<0.001), coronary heart disease (18.0% vs 13.2%, p<0.05), chronic renal disease (9.9% vs 6.1%, p<0.05), and stroke (12.1% vs 7.5%, p<0.05) were all higher in males. SCD terminate with an accelerated atherosclerotic process in whole body, and cirrhosis may just be one of the several consequences of systemic atherosclerosis. Excess fat tissue may be much more important than alcohol and smoking for the development of cirrhosis all over the world at the moment. The efficacy of metformin in loss of appetite is well known in the literature. Since metformin is a safe, cheap, orally used, and effective drug for the treatment of excess weight, it should be advised in cirrhosis even in patients with the normal weight since there are approximately 20 kg of excess fat tissue even between the upper and lower borders of normal weight in adults.