From the Editor
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This is the third issue this year. This issue span papers from Qatar, Turkey, UAE, Nepal, Kuwait and Jordan

A paper from Qatar evaluates the prevalence of Enuresis and its recovery rate among children in the Western Area of Doha, and evaluated the different associations between Nocturnal Enuresis (NE) and medical and psychological conditions, and assessed the impact of the condition in children and families. The results indicated a 36.3% prevalence of Enuresis in children. Significant associations of medical and psychological problems such as snoring, brachial asthma and stressful events were found. Recovery rates of 26, 24, and 19% were observed after 3 times follow-up at 6, 12, and 18 months respectively. This study confirms the prevalence of Nocturnal Enuresis among children frequenting the primary health care centers of the Western area of Doha, and the Medical and Psychological associations are similar to those of similar studies from various countries of the Arab countries area. Health education will encourage the parents to be aware, deal with this problem and find appropriate medical advice.

A paper from Jordan evaluates the incidence of ischiofemoral impingement (IFI) syndrome among patients who presented for pelvic MRI as a case of pelvic pain at KHMC. A total of 125 pelvic MRI done between august 2015 and august 2016, for patients presented as cases of LBP or pelvic pain at KHMC were reviewed. Seven patients of the 125 had the full blown picture of IFI syndrome accounting for around 5 % of patients. Two of them had long standing unexplained pelvic pain. Five of them had the changes after history of pelvic surgery or trauma. The authors conclude that Ischiofemoral impingement syndrome should be considered in differential diagnosis of patients with LBP, hip pain or unexplained pelvic pain especially in patients with history of pelvic surgery or trauma

A paper from Turkey looked at the aging syndrome. The authors stressed that Aging syndrome or accelerated endothelial damage syndrome or metabolic syndrome is a chronic inflammatory process on vascular endothelium both at arterial and venous systems of the body. It terminates with an accelerated endothelial damage, an accelerated atherosclerosis, end-organ insufficiencies, early aging, and death. Male sex, sedentary life style, animal-rich diet, overweight, obesity, smoking, alcohol, white coat hypertension, hypertension, impaired fasting glucose, impaired glucose tolerance, diabetes mellitus, hypertriglyceridemia, dyslipidemia, chronic infections, chronic inflammations, chronic depression, cancers, overuse of the body, and sickle cell diseases may be the major parameters of the metabolic syndrome. Cirrhosis, chronic obstructive pulmonary disease, chronic renal disease, myocardial infarction, stroke, early aging, and death may be the main terminal end-points of the syndrome. As a conclusion, calendar ages should not be accepted as the real physiologic ages of patients with the above parameters and terminal end-points of the metabolic syndrome. On the other hand, long term underweight in the absence of any pathology such as anorexia nervosa, sudden weight loss, malignancies, chronic infections, chronic inflammations, or chronic depression may even decelerate the aging by decreasing insulin resistance, mean arterial blood pressure, and vascular endothelial damage and it may be a good property for a long lifespan.

A cross-sectional study was conducted in an ambulatory healthcare clinic, self-reported questionnaire was used to assess foot care behaviors, prevalence of diabetic foot risk factors and safety of footwear among diabetic patients. Inlow's 60-second Diabetic Foot Screen was used to examine foot, ADA risk classification was used for risk assessment. The total patients were 74, majority of respondents was local UAE patients 46(71.88%) with diabetes duration of 8.8 years, mean age was 59.1±10.11 years, male to female ratio was nearly similar, mean A1c level was 7.45 ±1.81with only 21 out of 50(42%) patients had their HbA1c controlled (<7), 80.28% of patients completed at least elementary school. Frequency patients received foot care education and foot examination were 60 (81.08%) and 55 (74.32 %) respectively, 42 (55.56%) walked barefoot indoors, 43(56.97%)wore shoes without socks, 35(47.95%) tested the water temperature with hand / elbow before taking a bath or a shower, 50 (68.49%) self-treated corns or calluses with a blade, 67 (90.54%) wore sandals, almost all 73(98.93) relied on feeling the fit of the shoes when buying a new pair, overall shoes assessment was improper shoes in 64 (86.49 %) , there were callus formation in 30(42.26%) ,foot deformity in11(15.28%) ,loss of sensation by monofilament in 0 to 9 sites out of 10 in foot 26 (40.55%) ,absent of dorsalis pedes pulse in 10 (13.89%) and 40 % were classified at risk category 1 to develop foot ulcer. Foot care practices are still substandard among diabetic patients, there was a gap between what patient receive in foot education by health care provider and what patients did in real practice, potential harmful foot care behaviors were high and protective foot care practice were low, finally there were one or more risk factor of diabetic foot ulcer in majority of patients.

A prospective, open label, double arm, observational, longitudinal registry study was carried in Kuwait looking at hyperglycemia in pregnancy in Arab Population. A total of 480 subjects comprising two equal groups (Group A with a known history of type 2 diabetes mellitus and Group B with GDM) were recruited, their obstetric history captured and followed up on a regular basis till delivery. Mode of delivery and neonatal status especially APGAR status at birth, 5 minutes and 10 minutes were closely monitored and captured using an eCRF by the study physicians. Statistical analysis revealed a significant difference in the obstetric history-parity (p=0.000), previous abortion history (p=0.007), previous caesarean sections (p= 0.000) and type of delivery (vaginal, caesarean, vacuum (p value= 0.000, 0.000 and 0.006 respectively) while there were no statistically significant variations amongst the neonatal statuses except for higher birth weight (p=0.02) and neonatal complications (p=0.033). The authors concluded that Hyperglycemia with pregnancy is a steadily increasing problem that can seriously affect both mother and baby as shown in the present study , however, the present study did not show any significant differences in the weeks of delivery (preterm vs term).

A community based cross-sectional survey was conducted in Nepal to find the prevalence of stunting including severe stunting and its determinants in pre-school children aged 3-4 years in Kharelthowk VDC, Nepal. A total 464 pre-school children of rural Kharelthowk VDC (Kavre district), both males and females of age between 3-4 years were enrolled in the study. A structured questionnaire was used to obtain information on socioeconomic characteristics and life style factors of children. The prevalence of stunting in pre-school children was 46.9%. The prevalence of stunting was significantly higher among male children (51%) than female children (42.7%). The study revealed that stunting was significantly associated with inadequate nutrition intake, infections, poor child care and socio-economic status of the family. The authors concluded that the magnitude of stunting is very high as compared to developed countries. Thus, proper attention should be given for the intervention on causes of stunting among pre-school children in order to avoid further risks in future.

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