This issue is rich with papers from the region and worldwide. Al Zahrani et al., did an observational cross-sectional study in the west part of Saudi Arabia. The study's population include all patients of sleeve gastrectomy from the Western Region of Saudi Arabia.

The instrument used was an electronic questionnaire, which included questions about knowledge of sleeve gastrectomy indications and complications. The questionnaire was sent to 451 patients who underwent sleeve gastrectomy, and about 444 patients gave consent to participate. According to the findings of our study, knowledge regarding the indications for and complications associated with sleeve gastrectomy is not satisfactory.

Goweda et al., did a cross-sectional study was carried out in Makkah city and 451 patients were recruited. The aim is to screen for the Prevalence of Obstructive Sleep Apnea among Patients with Cardiovascular Diseases. The majority of studied patients were males 315(69.8%), Saudis 370(82%), married 353(78.3%), diabetic 291(64.5%), and their age between 40 to 59 years. The authors concluded that OSA is highly prevalent among cardiovascular disease patients. physicians' awareness regarding screening, diagnosis, and treatment of OSA is essential to prevent cardiovascular disease risks.

Muhid & Khan, did a quality improvement project looking at The monitoring of DOACs in primary care, a quality improvement project. They stressed that direct acting oral anticoagulation play a key role in preventing thrombotic stoke and thromboembolism. DOACs require careful drug monitoring to prevent unnecessary strokes and hemorrhage. Quality improvement projects/Audits are necessary to highlight, how robust DOAC monitoring is in Primary care.

Alqifari, et al., did a A retrospective survey among patients with history of HZ throughout KSA between June and December 2021. 68 patients were included and data were collected by online questionnaire and telephone interviews. Females were predominantly affected by HZ. Overall Mean age at diagnosis was 39.43±16.50 years. Among all the symptoms; painful blisters were frequently re-ported in 81% of participants. The authors concluded that HZ is a prevalent condition affecting a wide range of patients including geriatrics. Available vaccine products help in reducing both the incidence of HZ and its complications. With the given efficacy of the vaccine prod-cuts, vaccine access should be widened across KSA.

Al Ateeq et al., did a cross-sectional study that was conducted among patients who admitted to dental clinics in order to assess the satisfaction level toward health services using Patients Satisfaction Questionnaire (PSQ-18) that was distributed among the participants using online Google sheets. In this study, we were able to collect data from 300 patients who went to private and governmental dental clinics and agreed to participate in this study. This study showed slightly more than half of the patients of dental clinics were satisfied with health services provided by the clinics especially considering technical aspects. Older patients, non-Saudi patients, less educated patients, and those with lower income showed lower level of satisfaction

Albahrani et al., followed a questionnaire-based cross-sectional survey conducted in outpatient clinics in several hospitals and primary care centers. The aim was looking Hypertensive and Diabetic Patients Knowledge of Myocardial Ischemia and Stroke Symptoms. We enrolled 339 participants who has diabetes, hypertension or both. Poor knowledge score of IHD symptoms showed in 24.8% of participants and 26.3% had poor knowledge score of stroke symptoms. The authors concluded that knowledge of IHD and stroke symptoms was poor in a quarter of at-risk patients in Al Ahsa, Saudi Arabia. The history of IHD in the participants did not correlate with a better knowledge score. Our findings call for more efforts to establish and expand the awareness campaign.

Atalla , et al., included Hypertensive patients attending a single tertiary care hospital in Taif city were recruited for our study after taking informed consent and ethical approval from the institution. The objective is to assess the prevalence of depression symptoms among hypertensive patients in Taif city, Saudi Arabia, and also to analyze various determinants related to their co-existence. The prevalence of depression among these hypertensive patients was 27.5%, and 2.5% had a severe form of depression. The authors concluded that
considering the high prevalence of depression among hypertensive patients, it is critical to developing screening programs and community education campaigns.

Raza & Haque reported a case of headache with rare diagnosis. Headache is a common presenting symptom in Primary Care with a wide list of differential diagnoses and important red flag symptoms.It is also crucial to recognise when to get help from secondary care colleagues when faced with rare and complex cases that may need hospital admission for further investigations, management and monitoring. This case highlighted the importance of being aware of different, including rare, differentials when confronted with a common presenting symptom.

Bin Al-Zou, et al , did a retrospective chart review of patients presenting to the dermatology private clinic in Almansoora, Aden, over a 2-year period, complained of acne vulgaris and treated with oral isotretinoin. The total study patients were 86 (68.6% females and 31.4% males). The mean age of patients was 25.6 ± 7.9 years. The difference between means related to sex shows statistically significant (p = 0.006). The patients of the age group ? 20 years were predominant.

Alfaifi et al., reviewed overtime prevalence of substance use in Saudi Arabia
The authors stressed that substance use disorder is a chronic brain disease. Recently, Saudi Arabia's rank was among the top of the world in amphetamine seizures. Drug smuggling as well as conflicts and wars in the surrounding counties might play a role in that. The current review found a few articles talking about substance use prevalence in Saudi Arabia, much of that work was about Khat substance. In the end, we concluded that there is a considerable need for further research in this field.

Bughamar et al., report a case of Osteoid osteoma of the proximal femur. They presenting a case of a 12 years old male with Proximal femoral OO who was managed conservatively in the beginning and then treated using X-Ray Guided percutaneous Drilling of the lesion with good postoperative clinical outcome.In this Report we are discussing the surgical steps as well as the prognosis compared to other treatment options. The authors stressed that a delay of the diagnosis can occur due to the majorities of differential diagnosis and the difficult the interpretation of the diagnostic imaging , so a high clinical suspicion and early interventions using more advanced imaging modalities allows earlier diagnosis of ''OO'' and therefore quicker treatment and relief of patient symptoms .

There are two papers related to covid Abedalrahman et al., did a descriptive study of 68 patient case series. The aim of this study is to describe the clinical characteristics of simultaneous cases of COVID 19 in pregnant women with neural tube defects in their newborns. The series included cases of Neural Tube Defects which their mother were affected with COVID19 infection that reported in Zahko Maternity hospital- labour unit. The general and obstetrical history of the patients, the current study revealed that the affected age group of mothers are as follows; 28 (41.2%) of them (26-30 years), 15 (22.1) of them (> 35). Anemia and fever in the 1st trimester were found in 54 (79.4%) of them. The drugs received during pregnancy, as follows; antibiotic all patients 100%, antihypertensive drug received from 14 (20.6%), antipyretics 29 (42.6%), antacid 21 (30.9%), antifungal 16 (23.5%). Ibraheem et al., looked at case series of patient infected with Covid. The aim of this study is to describe the psychoneurotic symptoms among COVID infected patients. Case series study of 101 patient infected with COVID virus of different severity of the disease.in Tikrit city during 2020-2022. The auditory hallucinations reported among 4(40%), olfactory hallucinations reported among 5(50%), and visual hallucinations among 1(10%). The authors concluded that Neuropsychiatric symptoms was reported as follows; sleeplessness, tremor, and hallucination. Hallucinations mainly affect males, while tremor and sleeplessness mainly occur in females. The patient that had hallucinations had high lung involvement measured by CT of the chest. The patients that had hyperglycemia had higher percentages of sleeplessness, hallucinations. COVID 19 vaccinated persons had lower percentages of sleeplessness, hallucinations and tremor.

Alotaibi, et al., did a cross-sectional study was done on diabetic patients in Taif city
the current study aims to explore the level of knowledge about diabetes and diabetic foot among the general population. A questionnaire was distributed randomly to the general population and their demographic information were recorded after obtaining their consent. The authors concluded that Healthcare providers should devote more time to educating patients and their families about diabetes, particularly the complications.

Sari, et al., conducted a study among 218 pregnant women who attended one primary care center in Abha City. The aim of this study is to assess the knowledge, attitude and practice of pregnant women regarding the obesity and its negative impact on maternal and fetal health. The participants were interviewed during their visit to the antenatal clinic using valid questionnaire which include many questions exploring the knowledge, attitude and practice regarding obesity during pregnancy. The prevalence rates of overweight and obesity among many pregnant women were high. Knowledge related to obesity and its maternal and fetal risk were inadequate. False beliefs regarding lifestyles during pregnancy were evident. Preconception structured health education program to upgrade knowledge, change attitude, to improve practice and to correct misbeliefs regarding obesity during pregnancy is mandatory.

Basurrah, et al., did a cross-sectional community-based study was done and data was collected via a self-administered Google form questionnaire in Taif city,. Data about demographics,, knowledge about symptoms of BPPV and how to improve this knowledge were collected. to evaluate overall knowledge and perception about the disease among the different demographics of the population in Taif city including its nearby statements. The authors Concluded that a low level of knowledge about vertigo was found among studied sample. Education level was associated with knowledge level, thus awareness campaigns should be done to raise awareness about BPPV.

Aijaz, et al., did a Cross-sectional randomized study to study health-related behaviors of undergraduate medical students of the public sector university of Karachi by analyzing the following aspects :1, Daily water intake and its importance.2, Refractive errors and the importance of their correction3, Sun protection. The authors concluded that with an aspiration to become a nobility amongst doctors, medical students must recognize their responsibility in being the representatives of right and wrong. Thus, the participation of the students in this study provides valuable insight into their health related behaviors portrayed against the risks of sun exposure and the benefits of using sunscreen as a protective measure, along with corrective measures chosen against poor sight such as spectacles, and determining the daily water requirements and their benefits.

Karrar, et al., reviewed the clinical aspect of breast cancer. Breast cancer is considered one of the major healthcare problems and one of the top biomedical research priorities among other biomedical research. The incidence of breast cancer to be more aggressive is increasing, with around one million and seven hundred thousand new cases that get worse yearly. Worldwide, Breast cancer is the most common cancer affecting women. The mortality rates for women who are already diagnosed with breast cancer have improved, but even that, the median survival in the metastatic stage is low around 24 months. For the treatment, chemotherapy is the gold-standard approach for most cancer types and the modest improvement in both survival rates and toxicity reduction. Early detection of breast cancer at a stage when it is potentially curable and there is the possibility of saving a breast should be the goal of all health care professionals. Also, Careful consideration should be given to the unique nature of each tumor and patient. This article aims to provide a brief introduction and the clinical picture of the disease, Etiology, Pathophysiology, Epidemiology, Nutrition, Prevention, and good practice management advice.

Dr. Alshehri , did a cross-sectional study that was conducted among physicians of different regions of Saudi Arabia. The study was conducted using a self-reported questionnaire which was distributed online. The aim of this study is to assess the level of knowledge of physicians in Saudi Arabia toward necrotizing fasciitis of spine. This study was conducted among 161 physicians where 59 % of them were males while 53.4 % of the participants were younger than 35-year-old. n general, 47.2 % of the physicians in this study had adequate knowledge considering NF. The author concluded that there is higher percent of physicians who have inadequate knowledge considering NF including spinal symptoms especially among general practitioners. Urgent need to improve the awareness of physicians toward NF and other rare conditions is important in order to improve the early diagnosis of these conditions and starting medical intervention in earlier stages.

Dr Abdulrazak Abyad
Chief Editor
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