In this issue, there is still major interest in the Covid issue in the region and a number of papers deal with topics of importance to the health care professional, in addition to a number of interesting cases.

Alzahrani, et al., followed a cross-sectional research design, to investigate the possible adverse effects of COVID-19 vaccinations on menstrual abnormalities in women in their reproductive period. Almost half of participants (48%) reported the incidence of menstrual abnormalities after receiving COVID-19 vaccinations, manifested as changes in frequency, length or quantity of menstruation. Participants received one, two or three doses of either Pfizer-BioNTech or Oxford-AstraZeneca vaccines. Adverse effects of COVID-19 vaccines occurred mainly after the third doses of Pfizer and AstraZeneca (12.5% for both). The authors concluded that Women who receive COVID-19 vaccinations may have menstrual abnormalities. This change mainly occurs after the third dose, regardless of the brand of received vaccine. It is recommended that women be clearly informed after vaccination of the possibility of short-term menstrual abnormality and to seek proper medical advice in such conditions. Further studies are required to investigate the possible mechanisms behind these COVID-19 vaccines' adverse effects.

Atallah et al., looked at the willingness and attitudes of parents of childrens under the age of 12 about the COVID- 19 vaccine in Taif city. The goal of this study is to assess parents' attitudes towards COVID-19 vaccines, determine the prevalence of vaccine rejection among parents, and explain the reasons for vaccine rejection and the factors that influence it as there is insignificant number of studies related to our topic especially in Saudi Arabia. The authors concluded that the study showed poor acceptance of COVID-19 vaccine for children among parents. The choice of whether or not to vaccinate a child should be made by the child's parents. Individual benefits of protection against COVID-19 must be weighed against the population merits of pandemic control. Administering vaccines in children and analyzing their efficacy and advantages in terms of minimizing the risk of severe COVID-19 and subsequent consequences is a critical issue that has to be monitored on a regular basis. Whereas Aljaaly, et al., did a cross-sectional study aimed to compare dietary supplements, Prophetic medicine (PM) and herbal/plants (H/P) use among adults in Saudi Arabia before and during the COVID-19 pandemic. 1351 individuals participated in the study via an online survey shared on social media platforms between December 11th, 2021, and March 1st, 2022. The authors concluded that there was a significant increase in consumption of most dietary supplements and Prophetic medicine practices. The government should launch public awareness campaigns and employ regulations to educate about the risks and benefits of self-medicated Prophetic medicine practices and self-prescribed dietary supplements.

Aljohani, et al., reported two cases of morbidly obese patients who presented with recurrent distal catheter migration and pseudocyst formation in the subcutaneous space less than a month following VP shunt placement for the management of hydrocephalus. The authors concluded that special attention must be given when placing a VP shunt in morbidly obese patients. There are various methods to prevent tube migration in such patients, like using a longer catheter tube, tight closure of the peritoneum while placing the catheter between the fat and abdominal muscles, using a hernia patch, and using laparoscopic techniques. We advocate for using different surgical procedures in obese patients prophylactically to avoid VP shunt failure and distal tube migration in patients with associated risk factors.

Buttar & Ahmad, reported a diagnostic surprise of Hodgkin's Lymphoma in a 29-year-old long distance runner. In this case study, an uncommon presentation of classical Hodgkin's Lymphoma, involving bone, in a 29-year-old long distance female runner was reported. Patient initially presented with bony pain without classic type B symptoms and lymphadenopathy. A final diagnosis of classical Hodgkin's lymphoma stage IV was confirmed and PET scan evaluation was also done. Patient started on Escalated BEACOPP regimen and four cycles of chemotherapy were completed in 12 weeks and showed good response post treatment. Albeit, it's rare, primary osseous Hodgkin's Lymphoma should be considered in the diagnosis of bony pain. The absence of classic type B symptoms and any local lymphadenopathy in this case did make the diagnosis challenging.

Fageeh, et al., did a cross-sectional survey was conducted among medical students in clinical years in the Saudi Arabia who studied ENT module. Participating students completed an online questionnaire that included questions related to ENT module. The purpose of this study is to assess medical students' basic otolaryngology knowledge. The authors concluded that Saudi medical students have appropriate knowledge of basic otolaryngology. With a significant proportion of ENT complaints in general practice, it is critical that all graduating medical students, not just those entering ENT, are adequately trained in basic ENT to perform competently and be confident enough to manage or refer these patients.

Pandeya., et al., did a case-control study among the patients visiting the outpatient department (OPD) of BP Koirala Institute of Health Sciences, Dharan Nepal in which forty seven newly diagnosed hypertensives as cases and fifty age and sex matched healthy normotensives as controls were enrolled in the study with the prior informed consent. hs-CRP, nitric oxide (NO) and lipid profile were estimated in both the cases and controls. The authors concluded that the levels of hs-CRP which is thought to be a marker of inflammation is significantly raised in hypertensives. Moreover, majority of hypertensives are dyslipidemic suggesting hypertensives to be at an increased risk for the development of cardiovascular disease (CVD).

Dr Khan, report a case of middle age man with gastroparesis. Dyspepsia and complaints related to upper gastro intestinal disorders are very common in primary care. Different disorders can present with similar symptoms with only subtle differences. Full evaluation of such patients is essential for the optimal management of disease. This case is about a middle age man with delayed gastric emptying or gastroparesis with chief complain of nausea and bloating. Although the incidence of gastroparesis is small but many patients could be misdiagnosed due to lack of awareness amongst physician and limited investigations. Gastroparesis should be kept in mind in patients presenting with upper gastrointestinal symptoms and disease specific management should be given.

Adel M et al., did a cross sectional study that was conducted among patients with CKD who underwent kidney transplantation in the last 10 years Jeddah region, Saudi Arabia using self-reported questionnaire which was distributed online among the patients. The questionnaire included the instrument of the World Health Organization, World Health Organization Quality of Life (WHOQOL-Bref), composed of 26 questions, of these two questions assess the overall perception of QOL and general health, and the others are divided into four domains: physical, psychological, social relationships and environment. The authors concluded that patients who underwent kidney transplantation showed good QoL and physical health when compared to the literature review of patients on hemodialysis. Higher educational level, living with family, having higher income and not need for hemodialysis after the surgery were associated significantly with better QoL

Ahmad & Buttar, looked at the role of Ipratropium bromide in management of Thunderstorm asthma. Epidemic thunderstorm asthma has been reported to have occurred around twenty times over the past three decades in locations around the world. Thunderstorm asthma (TA) typically presents during an aeroallergen season in individuals, sensitized to perennial rye grass pollen (RGP) in Australia, in combination with meteorological factors such as thunderstorms and lightning activity. Short acting beta agonist (SABA) only treatment is sub-optimal therapy for prevention of asthma exacerbations. The combined treatment includes inhaled corticosteroids (ICS) and SABA but found to be contentious. So the present review focuses on suitable alternative, short acting muscarinic antagonist (SAMA), Ipratropium bromide and its efficacy on the management of allergic asthma. Salbutamol induces bronchodilation rapidly but it elicits profound cardiovascular event as the side effects. Meanwhile, ipratropium also have equivalent effect of salbutamol with low side effect profile. Ipratropium also minifies the asthmatic response to grass pollen, allergen induced bronchoconstriction. Further, it also reduces allergen induced early and late asthmatic response and also inhibits the response towards histamine inhalation. So this regard, ipratropium may be considered as suitable agent in the management of thunderstorm asthma and future trials are highly warranted.

Sako et al., Investigating the awareness of breast cancer among female pharmacy students in the Makkah region, Saudi Arabia. Previous studies have shown a recent dramatic increase in BC cases in Saudi Arabia. Therefore, the demand is high for measuring the level of awareness among young Saudi females about BC and its causes. This study is designed to assess the awareness level of female pharmacy students in the Faculty of Pharmacy, Umm Al-Qura University, Makkah region, Saudi Arabia about the general information regarding BC, as pharmacists are the health practitioners most accessible to the public. The data in this study were collected using a modified online questionnaire delivered to 217 participants in the college of pharmacy. Our results showed a sufficient awareness level among future female pharmacists, which may help in spreading their knowledge to society.

Aboalam, et al., followed a retrospective research to assess the prevalence of genetic and infectious diseases that could be identified through premarital screening in Aseer Region during 2021. The authors concluded that Sickle cell disease, and hepatitis B, are commonly identified by premarital examination in Aseer Region. Males are more frequently affected than females. Health education regarding the negative impact of consanguinity is highly needed. Vaccination against hepatitis B should be enforced. Prospective couples whose offspring is at risk of hereditary diseases should be strongly convinced to comply to marriage cancellations.

Khalil Mahmoud, et al., followed a retrospective design looking into outcome of Antenatal Renal Pelvic Dilatation. Data were collected from the medical records of infants born between 2019 and 2021, with dilated fetal renal pelvic in Armed Forces Hospital, Southern Region, Saudi Arabia.
Among patients with RPD, 43.5% had mild dilatation while 33.3% had moderate hydronephrosis and 23.2% had severe hydronephrosis. There was no significant difference in incidence of RPD between mothers of different ages (P=0.302). The authors concluded that males infants have higher risk for developing RPD, although gender is not a predictor for severity or outcomes. Among patients with RPD, most patients have good outcomes.

Dr Abdulrazak Abyad
Chief Editor
Mobile: 961-3-201901