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From
the Editor
In this issue we have papers from Germany,
UK, Qatar, Yemen, Saudi Arabia, Turkey, Lebanon,
Australia, Jordan, and Pakistan. We also feature
a new section on the Covid 19 pandemic.
The world has been plagued by way of the pandemic
of COVID-19. It has spread rapidly in a speedy
time affecting around 210 countries and causing
much death that is increasing daily or through
the hour. Thus, it needed an efficient health
system that acts swiftly to limits it spread
and complication. The region is not far away
from the problem. Over the past six months there
were growing interest in the issue of Corona
Virus epidemic that is affecting the whole area.
We are starting in in this issue a special section
on COVID-19 for opinion and papers from the
Region. In the past issues a paper from Pakistan
looked at the grim looking trajectory for the
COVID 19 in Pakistan. A second paper attempted
to quantitatively analyze the impact of type
of contact and duration of contact with infectivity
of novel corona virus. A Sociological Appraisal
of the corona virus came from Iran as well.
In this issue we have four papers on Corona
epidemic. Aseel, M et al., looked at Family
Medicine Residents Mentoring During Covid-19
Pandemic and Beyond. With the Covid-19 pandemic,
it was expected that residents will be working
under pressures that may lead to mental health
and other challenges as we are dealing with
a virus that we still know less about it. The
authors stressed that a structured mentoring
program did help supporting residents accommodate
faster during the difficult time of Covid-19
especially during the early time. More frequent
meetings between mentors and mentees are to
continue for the first few months after the
pandemic to ensure that the residents are ready
to continue learning and for better achievements.
Moussa R et al; looked at the implications of
COVID -19 pandemic on Family medicine Residency
training program & and ACGME requirements
at Qatar. The authors stressed that Disasters
like Covid -19 pandemic can turn in to opportunities
for sustainable development. They stressed the
following elements that family medicine residents
can learn during the epidemic including leadership
role and responsibility during the crisis, Covid
-19 implications on ACGME-I Requirements and
Residents Rotations and safety. The authors
concluded that Crisis could be an opportunity
for continuous development in the presence of
adequate mentoring and leadership.
Sumathipala, S discussed the Trust and psychological
safety in a virtual healthcare team. The author
stressed that as the face of healthcare delivery
has changed with the COVID 19 pandemic, virtual
interactions between clinicians and their patients
have increased. He indicated that Trust in virtual
teams is positively associated with job satisfaction
and improved working relationships. He concluded
that with developments in technology and the
impact of disease, working patterns in healthcare
continue to change. Interacting remotely, not
just with a patient but also with colleagues,
is becoming more common, such that clinicians
are now likely to be part of virtual teams.
Alnaser F.A., looked at the Role of Family Doctors
and Primary Health Care in COVID-19 Pandemic.
He stressed that The Primary Health Care (PHC)
is the first level of contact between the patients
and the health system. Family doctors (FDs)
are considered the gatekeepers in the fight
against any outbreaks or illnesses. They, by
the nature of their work, are very close to
the patients and their families. Therefore,
they have a greater chance for knowing about
their patients' ailments and any new changes
in their health conditions.
Abdalla H et al., did a cross-sectional study
with a sample size of 350 on type 2 diabetes
people aged 30 - 65 years at West Bay Health
Centre in Qatar. The authors were looking at
the Prevalence of Diabetes Distress among People
with Type 2 Diabetes at Primary Health Care
in Qatar. Overall prevalence of diabetes distress
was 40.3% and expected to range between 35.2%
and 45.5% with 95% confidence. Participants
with high distress constituted 15.1%. The authors
concluded that their study is the first of its
kind in Qatar. The significant high prevalence
highlights the importance of regular screening
of diabetes distress, especially for those at
high risk. Alfaqeeh A.S et al., looked at Risk
factors and complications of cataract disease
in type two diabetic patients in Taif city.
They did a retrospective study was done where
medical records of 110 diabetic patients were
reviewed. About half of the participants (49.1%)
were exposed to the sun, and 65.5% reported
exposure to radiations. About 45% of the participants
(45.5%) reported that they had a family history
of cataract, of them 77,6% reported that those
having cataract were of the 1st degree relatives.
The authors concluded that long duration of
DM, no commitment to medication, radiation exposure
and aging were risk factors of cataract in diabetic
patients. Diabetic patients should be continuously
evaluated by an ophthalmologist.
Mathkhor A.J et al., investigated the prevalence
of fibromyalgia and allied symptoms in patients
with psoriasis. Seventy patients with psoriasis
(40male and 30 female) and 70 age and sex matched
controls were enrolled in the study.
A total of 37 (52.9%) patients with psoriasis
were found to have widespread pain. A total
of 21 patients met the criteria of FMS. The
authors concluded that
FMS and allied symptoms are more prevalent in
patients with psoriasis than in the general
population. Women with psoriasis are more frequently
affected by FMS than are men. Awareness of this
comorbidity is an essential part in the treatment
of psoriasis. Because of the strong association
between disease severity and FMS, proper treatment
that reduces skin involvement and disease severity
may be associated with the alleviation of FMS
and its allied symptoms.
Raza & Ahmed, reviewed irritable bowel
syndrome. The authors stressed that Irritable
Bowel Syndrome (IBS) is a highly prevalent gastrointestinal
disorder affecting over 10% of the global population.
It is a condition managed mostly in primary
care but can often result in referral to secondary
care. There is no test for diagnosing IBS and
it is largely a diagnosis of exclusion. The
pathogenesis of IBS is understood to be multifactorial
therefore the treatments options are diverse,
seeking to address the IBS patient using a holistic
approach. In this review, they put a spotlight
on IBS and in particular focus on the pathophysiology
of IBS and how this understanding shapes how
we manage IBS based on the current medical guidelines.
Asif, H et al., attempted to Identify the factors
responsible for students self-medicating with
antibiotics in medical students at Sindh Medical
College, Jinnah Sindh Medical University, Karachi.
They followed a cross sectional study was conducted
on a sample size of 359 students. The percentage
of self-medication among students of Sindh Medical
College, Jinnah Sindh Medical University, Karachi
is 52.1%. Age groups were (16-18 = 14.5%, 19-21
= 58.2% and 22-24 = 27.3%). The authors concluded
that students of Sindh Medical College, Jinnah
Sindh Medical University, were found to self-medicate
themselves with antibiotics. However, knowledge
about drug resistance is required at individual
level in-order to refrain from doing so. In
consideration of these results, adequate measures
should be taken to educate students regarding
the hazardous side effects of antibiotics.
Helvaci M.R et al., tried to understand whether
or not there is a higher prevalence of rheumatic
heart disease (RHD) in the sickle cell diseases
(SCDs). All patients with the SCDs and controls
were studied. The study included 428 patients
with the SCDs (208 females) and 2855 controls
(1620 females). The authors concluded that SCDs
induce severe and chronic inflammatory processes
on vascular endothelium all over the body, and
terminate with end-organ insufficiencies in
early years of life. Beside that SCDs cause
a moderate to severe immunosuppression by several
mechanisms that may be the cause of higher prevalence
of RHD in them.
Javed H et al., attempted to determine the
perceptions of millennials of twenty first century
regarding position of women in Pakistani society
in Karachi. They followed a cross-sectional
study on a sample of 330 participants from various
universities of Karachi. The authors concluded
that the youth of Pakistan is well aware of
the social stigmas around them. Even our targeted
audience that comprised of people living in
urban areas has grown up seeing women mistreated
for bearing daughters, but our study shows that
this generation has realized the fault of their
ancestors and there is hope that these young
adults would bring a positive change in the
future.
Hatroom A.A.S, did a a retrospective study
involving 120 medical files of adult patients
with undescended testes. He describes the pattern
of clinical presentation, the ultrasound and
intra-operatively findings, and the outcome
of Cryptorchidism in Adults. Sixty-eight (56.7%)
were presented to the hospital complaining of
empty scrotum. Other 33(27.5%) were complaining
of infertility. The best result of treatment
of cryptorchidism is preferably in the childhood
age, therefore careful physical examination
of the baby at birth, regular follow-up of the
infant and advice for early corrective surgery
in cases of persistent undescended testis will
go a long way in reducing the morbidity due
to cryptorchidism.
Ahmed & Ali Raza reviewed thyroid disease
in pregnancy. They stressed that Thyroid dysfunction
in the form of hypo and hyperthyroidism are
some of the most common endocrine conditions
encountered in primary care. The hormone deficiency
or excess can be easily diagnosed and managed
yet potentially fatal in severe cases if left
untreated. The authors stressed that guidelines
around the world advocate various approaches
to decision making about testing pregnant women
for thyroid disease. There is increasing debate
about whether thyroid screening should be made
universal. In this article we look at the current
guidelines and latest evidence and opinion in
this important area.
Sumathipala, S., reviewed Glucose- 6-phosphate
dehydrogenase deficiency. He stressed that G6PD
deficiency is the most common enzyme disorder
affecting red blood cells. It is inherited in
an X linked recessive manner and there are over
400 variants identified. The disorder is normally
asymptomatic but common presentations include
neonatal jaundice and acute hemolysis. Treatment
depends on the nature of the symptoms, co-existing
conditions, and the degree of hemolysis. Identification
of G6PD deficiency can begin with screening
tests but definitive tests are required to diagnose
the condition. Once diagnosed, people with G6PD
deficiency need to avoid any agent that can
provoke oxidative stress upon the red blood
cell and seek medical attention if symptoms
develop suggesting hemolysis.
Barg and Kadori, reported a rare case report
of 17-year-old male patient from Pakistan with
moth-eaten alopecia involving scalp hair and
eyebrows. Alopecia syphilitic (AS) is an uncommon
presentation and has been reported in up to
7% of cases with syphilis. This case report
discusses the presentation and management of
a 17-year-old male patient from Pakistan who
presented with patchy hair loss on the scalp
and eyebrow.
Ayyash F.F et al., reported H Syndrome case.
H Syndrome is one of the rarest diseases in
the world, it is an autosomal recessive (AR)
disorder that occurs due to mutations in the
solute carrier family 29. H Syndrome is characterized
by cutaneous hyperpigmentation, hearing loss,
hypertrichosis, hypothyroidism, hepatomegaly,
flexion contracture of the fingers and toes,
short stature, hypertriglyceridemia, diabetes
mellitus type one, and hypogonadism.
It was named H syndrome considering the fact
most of the clinical features start with the
letter "H."
Chief Editor:
A. Abyad
MD, MPH, AGSF, AFCHSE
Email: aabyad@cyberia.net.lb
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