From the Editor

This is the eleventh issue this year which is very rich with papers from the Region including Saudi Arabia, Qatar, Iraq, UK, and Canada. The topics are of great interest to primary care and family physicians.

Al Thagfan et al., did a cross-sectional study aiming at assessing the public awareness regarding the effects of food and sunlight on vitamin D homeostasis in Al-Madinah Al-Munawwarah. The authors found that 91% of the participant (n=719) had a sufficient knowledge about vitamin D. High atmospheric temperature causes low participants' exposure to sunlight followed by absence of appropriate places and lack of suitable time. We found that 47.6% (n=367) of participants are taking vitamin D supplements with females as a majority (62.8%) (n=267) vs (29.9%) (n=109) for males. Females' clothes cause less exposure to sunlight and 38.4% (n=150). Participants in the healthcare fields (48.9%, n=170) are staying more in the sunlight in a 15 minutes duration. (p=0.016). The authors concluded that it is recommended to increase the number of outdoor walking sites. Awareness level and health education regarding vitamin D need to be improved in the population of Almadinah Almunawwarah.

Al Saleeem et al., cross-sectional study included 751 female students at Health Colleges of KKU, to assess how far female students at King Khalid University (KKU) use contact lens and to assess their practices and care of contact lenses. Two-thirds (66.2%) used contact lenses, mainly soft lenses (82.7%) and for cosmetic reasons (23.3%) and to correct errors of refraction (29.4%). (56.5%) of participants used contact lenses for 4-7 hours daily. The authors concluded that most students used it as cosmetic. They mostly obtain it from glasses shops. Their awareness is suboptimal and lack proper practices. Their awareness and practices should be increased.

Prof Allihaibi did a comparative case-control study to assess prevalence of exclusive breastfeeding practices and risk factors for failure to fulfill exclusive breastfeeding for twins delivered in Saudi Arabia. This study comprised 178 mothers who delivered twins and 122 mothers who delivered singleton babies. The author concluded that twins usually start their first breastfeeding later than singleton babies, and also tend to achieve exclusive breastfeeding less than singleton babies. Exclusive breastfeeding is less practiced by mothers whose children are admitted to NICU and whose children did not start breastfeeding within the first 6 hours. Mothers of twin babies are less confident than those of singleton babies regarding being able to exclusively breastfeed their babies. Rooming-in of mothers with their babies should be allowed at NICU.

Soliman et al., did an audit intended to evaluate current practice of PPls prescriptions against best practice international guideline and suggest changes for improvement.
50 medical records were identified by simple random sampling from total of 2021patient's health records who had been prescribed PPI prescribed during the audit period from 1st October to December 2019 and review retrospectively based on the audit criteria. Findings found showed PPls were prescribed for justified indications in 24/50(49%) health records. 26/50(51%) cases PPls prescriptions were found for unjustified clinical indications. However, duration for prescribing PPls according to its specific indication were found suitable in 9/24(37.5%) health records.
PPls stop date was not documented in 41/50(82%) health records but it was documented in 9/50 (18%) health records.

Al-Qasem et al., did a descriptive cross sectional survey was applied targeting women attending the Obstetrics and Gynecology Departments to assess awareness, knowledge and practice towards cervical cancer and Pap smear among Saudi females.
This survey included 1116 women from Aseer Region, whose ages ranged from 18 to 58 years, with a mean age of 33.5 years. Only 36.6% heard about cancer cervix, and 24.3% knew about screening methods. Very few had good knowledge regarding cancer cervix. As for practice, only 27% underwent Pap smear, while only 23.7% were advised to undergo Pap smear by their physicians. The authors concluded that Saudi females' knowledge regarding cancer cervix and its screening methods is poor. More attention should be paid to improve their knowledge and practice regarding cancer cervix prevention.

Hameed et al., reviewed data of reported 21626 personnel that investigated for HBsAg were retrieved from the Salahdeen health directorate covering a period of one year (2018). The authors stressed that Viral hepatitis gained little attention and funding from global health policymakers. Every year one million people die from viral hepatitis-related chronic consequences. Iraq; a country of intermediate endemicity for hepatitis B rates had been noted to increase with a stated prevalence rate of 1.6% among general population. The prevalence of HBsAg was 1.2%, males were affected more females, winter season carried more positive records of hepatitis B than other months of the year. Majority of HBsAg positive were between 15-45 age group, zero cases were recorded below 15 years of age. The authors concluded that monitoring the general population and subpopulation is a continuous process that is inclined in controlling hepatitis B, encouraging Hepatitis vaccination and promoting education about risky behaviors is quite needed.

Malik & Shaikh discussed the various type of monogenic diabetes. They stressed that there
are various forms of monogenic diabetes and these include neonatal diabetes mellitus, maturity-onset diabetes of the young (MODY), mitochondrial diabetes, and rare diabetes-associated syndromic diseases. Single gene forms of diabetes represent an uncommon heterogeneous group of conditions mainly characterized by functional defects of pancreatic beta cells with consequential moderate to severe hyperglycemia. The body of the article focused mainly on MODY. The classic presentation of MODY includes nonketotic noninsulin-dependent diabetes with diagnosis before the age 25 and with an affected parent. According to various studies, there is a substantial number of individuals with a confirmed genetic diagnosis of MODY that do not fit the classic clinical description and approximately > 80% of MODY cases are not diagnosed by molecular testing.

Soliman , et al., report a case of ecotopic pregnancy in patient with irregular menstrual bleeding. 33 years old female p3 +1 abortion known hyperthyroidism on Carbimazole, she was on IUCD (Intra Uterine Contraceptive Device ) for 5 years then stopped it for more than 1 year trying to conceive but failed, she came for result review for her blood tests done for her irregular menses , and secondary infertility. Beta HCG and urgent pelvis ultrasound requested to rule out pregnancy (ectopic/ abortion), 2nd day of seeing patient result came as positive for B. HCG of 193 so patient contacted on her phone and asked to go direct for WWRC Emergency to rule out ectopic pregnancy. The case diagnosed with ectopic pregnancy and followed up by 48 hours B.HCG level which found to be decreasing and currently she is for expectant management of ectopic pregnancy.

Prof AlSabaani did a cross-sectional study to explore physicians and nurses' overall attitudes and perceptions towards patient safety culture and to evaluate any differences in their cultures. The study included 369 participants. The majority of participants were females (70.7%). The mean score for the overall patient safety grade was 72.3. A statistically significant difference between physicians and nurses were found in 8 dimensions out of 12 dimensions of patient safety culture. The authors concluded that nurses and physicians scored patient safety differently. Their perceptions regarding "teamwork within units", "organizational learning-continuous improvement" and "feedback and communication" were good. However, other patient safety dimensions need to be improved. Overall, nurses' perceptions are significantly better than physicians' perceptions. To improve healthcare delivery in the region, capacity-building programs should focus on improving the patient safety culture among health care providers, in general and with physicians in particular. Further studies are recommended among healthcare workers at other levels of healthcare in the region in order to improve patient safety practices.

Shehata et al., did a descriptive cross-sectional approach was used to estimate Prevalence and association between sleep, stress, and physical activity among medical students in southern region, KSA. The study included 490 medical students whose ages ranged from 17 to 28 years old with mean age of 22.7 ± 1.7 years. Male respondents were 256 (52.2%) and 310 students (63.3%) were in the clinical grades (4th -6th) and 49 (10%) were intern. Exact of 351 students (51.2%) reported that their sleep quality is either bad or bad. As for perceived stress level among the medical students (table 3), low stress level was diagnosed among 67 (13.7%) students, moderate stress among 355 (72.4%) students while 68 (13.9%) students had high stress level. Considering physical activity pattern, table 4 demonstrates that 291 (59.4%) students never practice vigorous sports while 51 (10.4%) practice it for 4-7 days per week. The authors concluded that students had poor sleep hygiene, high stress, and proper practice of physical activity.

Ahmed K et al., looked at virtual pain management clinic during Covid-19 in Qatar.
With the emergence of the COVID-19 pandemic in Qatar, the outpatient clinics
were run through telephonic conversations with the patients. In the pain management clinics, most interviewed patients are those following for traumatic spinal cord injuries and those with neuropathies who have chronic pain necessitating a continuous supply of a wide range of narcotics and analgesics. During the COVID-19 pandemic, we have noticed an increase in the number of consulted patients by around 50%, which is most probably due to the new convenient telephonic consultation system. Despite that, the service was maintained with high efficiency which was reflected in the observed patients' satisfaction. The authors found the experience in the pain management clinics during the COVID-19 pandemic is
promising and will have an impact after the return to normal services once the pandemic is over.

Dr. Najam Khan discussed telemedicine difficulties for Family Physicians in dermatological cases. He stressed that family physicians are facing difficulties in assessing skin-related cases, especially when dealing with patients concerned about undiagnosed skin conditions. The task of history taking is not only complex but also depends on the patient's literacy (for example one patient was confused with a simple benign skin tag and on the other hand a mom would like to confirm diagnosis for Molluscum contagiosum). Some patients give a very thorough and detailed history, while others require more probing in order to reach a probable diagnosis. The authors included few common telephone cases (fungal, atopic, squamous vs basal CC and melanomas) to discuss during presentation. He used tool of consensus to select safe decision making in managing these concerned patients appropriately and timely (emergency skin rashes including infectious diseases related are excluded in this discussion).

Alqurashi et al., did a cross-sectional study through an online survey on 6113 of residents to assess the attitude and awareness about heart attack symptoms and lifesaving actions among those population. A pre-designed questionnaire was used to collect data about sociodemographic characters, having a heart disease, a heart attack in the participant. 40% of the participants heard about heart attacks and 65.5% knew that the first step to take if they witness a person suffering from symptoms of heart attack was to call the ER. Participants with a university education, who had a medical specialization, who had a heart disease himself or had a heart attack in one of his/ her family and those who had a friend as a source of information had a significant higher mean Knowledge score about heart attack and CPR. The authors concluded that there is s need to raise knowledge about heart attack and train the Saudi population in lifesaving action by conducting training courses and awareness campaigns.

Arain et al., did an online cross-sectional case- control study among cases of women diagnosed with EP and controls of women who had normal pregnancy. The aim was to assess the association and evidence supporting the relationship between appendectomy and EP. The mean age of the participants was (36.71 ±11.49) years, 11.9% had a family history of EP, 77.3% used intrauterine devices, 13.9% had a previous history of a pelvic intervention, 9.9% had a past history of pelvic inflammatory diseases, and 22.8% had a history of appendectomy. Cases had a significant higher percent of those who suffered pelvic inflammatory diseases and those who had a history of appendectomy compared to controls.. The authors concluded that there is need for taking a careful history from all pregnant women to assess any risk factors of ectopic pregnancy and to make a proper management to all health problems that may be considered a risk factor of EP.

Mathkhor et al., stressed that Fibromyalgia syndrome (FMS) can coexist with many autoimmune, rheumatic and inflammatory disorders. Their study aims to evaluate these features and to investigate whether patients with CU are also affected by FMS. Eighty two patients with CU and 86 healthy controls were enrolled to this study. All patients were assessed for autologous serum skin test (ASST), and urticaria total severity score (TSS).

A total of 50(60.9%) patients with chronic urticaria were found to have widespread pain. A total of 28 patients met the criteria of FMS with a prevalence rate of 34.1%; of them, 20(71.4%) were women. The authors concluded that FMS and its associated clinical features are more prevalent in patients with CU than in the general population. Women with CU are more frequently affected by FMS than are men. Awareness of this comorbidity is an essential part in the treatment of CU.

Saleh et al., did a retrospective case control study done in Women cancer Center. The study aimed at identifying risk factors associated with ECA. All complete Patient records from Jan. 2016-July 2019 was reviewed, (2176) women records was included in the study. Epithelial cell abnormality found among 508(23.3%). Cervical epithelial cell abnormality was higher among those aged > 45 years 199(39.2%), widow 9(1.8%) and divorced 4(0.8%). About 102 (20.1%) of those with epithelial cell abnormality had the 1st sexual contact at age < 15 years, in comparison with those with normal cytology 285(17.1%). Post coital bleeding as a presenting symptom was higher among those with ECA 105(20.7%). Bivariate logistic analysis showed significant relation with age groups of 45 years or older (Adjusted odds ratio (AOR) 1.4, 95 % CI: 1.1 - 1.81.), Post coital bleeding (AOR 1.92, 95 % CI: 1.1 - 3.43). High percent of women had ECA. The most common risk factors was age older than 45 years, the 1st sexual contact at age < 15 years, and high parity >3, and post coital bleeding.

Chief Editor:
A. Abyad
MD, MPH, AGSF, AFCHSE
Email: aabyad@cyberia.net.lb

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