This is the ninth issue this year that has a variable topic from the region, including topics on hip fracture, hypothyroidism, breast feeding, contraception, heart problems, obesity, and Covid 19.

Dr Sabana stressed that Hypothyroidism is a common condition which is often managed in primary care. There is considerable prevalence information on the condition in Europe and USA, however little is known about the prevalence in the Middle East, particularly in Qatar. The purpose of the study was to establish the burden of the disease in the primary care population in Qatar. He did observational study using electronic health data from primary care records of all adults registered with Primary Health Care Corporation (PHCC). Patients were identified as having hypothyroidism by using selected Snomed CT codes. The prevalence of hypothyroidism was estimated at approximately 4.74% The majority of hypothyroid patients (57.23%) were found to suffer with additional comorbidities. Given the ease of access to private health care, and those patients choosing to have health care outside the country, this may be an underrepresentation of the true prevalence.

Dr Mohsen did a retrospective study of patients presenting with intertrochanteric fracture
to the Department of Orthopaedic Surgery at Algamhoria Teaching Hospital and at two private hospital in Aden, Yemen, during the period January 2018-December 2019 to evaluate the clinical outcomes of intertrochanteric fractures that were treated with Dynamic Hip Screw in Aden. Out of 48 patients, 29 patients were females (60.4%) and 19 patients (39.6%) were males and the mean age was 75.1±7.4 years. The mean age of male patients was 76.4 ± 6.9 years while for females was 74.2±7.7 years. The causes of injuries were significantly different among the age groups of patients (P < 0.05). We found (58.3%) of intertrochanteric fractures were in the right side and (41.7%) were in the left side. The authors concluded that the dynamic hip screw is a modality of choice in patients with intertrochanteric fracture; it is effective, simple, and safe. Further studies are needed to compare between our modality and other modalities.

Al nashar et al., did a cross-section study to find the level of awareness in mothers about the relative and absolute contradiction of breastfeeding among Taif city The assessment of knowledge level related to breastfeeding showed that only 7.9% had good knowledge, and most of the participants had poor knowledge (82.1%)When we assessed the relationship of this knowledge level with the age of the mothers, it was found that mothers who were 18-28 years of age had comparatively more 'good' knowledge (20.0%) than other age groups. The authors concluded that the level of awareness in terms of contraindications of breastfeeding in our study was very low, so we need to increase awareness by Healthcare professionals as they have a critical role in spreading information and encouraging women to breastfeed. The health education program should be implemented as soon as possible.

Alsaleh et al., stressed that emergency contraception (EC) plays a vital role in preventing unintended pregnancy up to 98% by delaying ovulation or preventing implantation. It is available over the counter in most Arab world.In our study,the investigating group wanted to explore knowledge attitude and practice among women of Saudi Arabia toward EC . To achieve this objective,a validated survey was used as study tool. It was found that there is improved knowledge ,attitude and practice among women towards EC utilisation.
El-Gamal, et al., did a cross-sectional study of 378 subjects to explore the pattern of KAP towards HRIs among the subjects in Jeddah city. 18.2% of the subjects suffered from HRIs, and 49% never received health education about HRIs. Increased KAP score was associated with increased age (b= 0.177, p<0.000), more encountered in the females (b= -2.25, p <0.000), in those who owned air conditioning (b = 5.3, p < 0.024), in the smokers (b= 1.77, p<0.35), and in those who received health education about HRIs (b=2.327, p< 0.000). the authors concluded that
subjects' awareness of the prevention of HRIs needs to be strengthened.

Alabdali, et al., did a retrospective study was done on 529 patients aged 30 to >75 years of both gender who had CAD to assess the different types of arrhythmias in patients with ischemic heart diseases in Taif city. All patients had a type of arrhythmia during their hospital stay. The main types of arrhythmias were AF (26.8 %), conduction disturbance (38.2%) and first-degree heart block (9.1 %). Patients who had STEMI with symptoms of heart failure and arrhythmias had a significant higher percentage for the need of DC shock compared to other patients. Patient with UA develop low EF showed to have significant as regard arrhythmias rather than normal EF. while the number of affected vessels had no effect on the development of arrhythmias during acute stage. The development of arrhythmia that required DC shock is more common in STEMI patients especially who developed heart failure symptoms. The authors concluded that the
need of assessment of heart failure symptoms and EF in patients with UA is essential to expect the need for implantable device insertion. Also, early administration of b-blocker decreases the risk of development of arrhythmia during acute ischemic event.

Bham & Ditta reviewed the use of Semaglutide for the treatment of obesity. The use of existing medicinal strategies such as sibutramine and orlistat have not been very successful due to their own limitations. Semaglutide is a glucagon-like peptide-1 analogue that has been utilized in type 2 diabetes mellitus treatment. Its use in weight management has been recently explored in several studies. A review of literature can provide insight into whether semaglutide is a potential avenue for long term and sustainable weight loss. All studies reviewed identified that study participants on semaglutide experienced a significantly higher overall weight loss than placebo and most other comparison treatments. There were gastrointestinal adverse events recorded in most studies, but these did not seem to have an impact on the overall weight loss. Semaglutide provides a promising avenue for weight loss in obese and overweight individuals, although further research on management avenues for the GI events may ensure long term and sustained use.

Two papers discussed covid issues in the region Alharthi, did an An explanatory mixed method study was conducted among 45 participants (owners, managers and supervisors of super-markets and major shops) along with a qualitative technique Key Informant Interview that was done among 9 purposively selected managers and supervisors to further explore the factors influencing adherence to social distancing and PPE use in Bisha City, KSA. The aim was to determine the knowledge and understanding of the concepts of social distancing and personal protective equipment (PPE), and its adherence among the owners and managers of Supermarkets and Major shops, which could be the main places for community acquired infection in Bisha City, Kingdom of Saudi Arabia (KSA), during COVID-19 Pandemic. The action taken by the government to provide education on COVID-19 have reached the people evenly and equally. Owners were less understanding than other cadres on social distancing and use of PPE. There was a significant correlation between participants' knowledge and their adherence level. The in-depth interviews revealed remarkable outcomes with several facilitating and hindering factors on social distancing and use of PPE. The authors concluded that the actions taken by the government to provide education regarding COVID-19 spread and prevention have reached the target population evenly and equally. However, there is chance for improvement to prevent the cross infection in the community work-place settings with stringent implementation of the norms of social distancing and scientific use of PPE.

While Ebrahim, et al., did an online based cross-sectional study done from April to May 2021 to explore the degree of anxiety and perceived stress in junior and mid senior physicians working at Cairo University Hospitals amid COVID 19 pandemic. Most of the participants were females (66.3%), single (66.8%), not previously infected with COVID-19 (63.5%) and not included in the care of COVID 19 patients (64.9%). The mean GAD total score was 8.99±5.58 with 57.7% of the participants suffered mild to moderate anxiety. The mean PSS score was 20.76±5.3 with 80.3% found to have moderate stress. Except for the relation between gender and perceived stress (p value= 0.003), and the relation between psychiatric illness and perceived stress (p value=0.026), there was no statistical significance between anxiety and perceived stress from one side and sociodemographic and clinical data from the other side. The authors concluded that anxiety & perceived stress among physicians during the COVID-19 pandemic is considered high regardless of the different sociodemographic and clinical characteristics.

Abdulrazak Abyad
Chief Editor