In this issue a number of authors from the region discussed important issues in primary care, in addition to the usual interest in the Covid epidemic in the MENA area.

Al Moslih , et al., attempted establishing the trends and emerging practices in healthcare project management with a concerted interest in determining the role played by the CCMR in controlling and stopping the spread of the virus in Aseer region. The study adopted the exploratory research approach which sought to investigate the research phenomenon. The CCMR formed the focus of the study. 17 participants working in the CCMR were selected using the purposive sampling technique. Data were collected using in-depth interviews where a clear and detailed description of the phenomenon under research was obtained. The collected data were subjected to thematic analysis and classified into three thematic areas. The findings of the study established that the CCMR had a critical role in coordinating government activities within Aseer region. New management practices were based on the experiences of the pandemic and ranged from evidence-based decision making, use of modern technology, and collaboration of various entities. The pathological spectrum was key in risk assessment.

Alrabaiai, et al ., did a cross-sectional study conducted between June-August 2020 via a self- reported online questionnaire that includes fear of COVID-19 scale for parents, Revised children's anxiety and depression scale to assess Quarantine's psychological effect, fear of getting the infection, and also to know the family's attitude towards COVID-19 and public health measures. The authors concluded that the Quarantine impacted psychologically and financially on some parents, Children are also more vulnerable to psychological effects resulting from the commitment of families to Quarantine, so we see that special attention and care is needed to prevent these effects on them, especially children with allergic or immune diseases.

Al-Hajeili, et al., did a retrospective study to evaluate the operative and pathologic factors associated with long-term survival and local recurrence in patients treated for urothelial tumors. In this study, 89.36% of patients had bladder tumors, and most were diagnosed based on transurethral resection of bladder tumor (TURBT). The histological grade was high in 74.47% of patients; in patients who underwent surgery, 17.39% had positive margins, 45.45% had perineural invasion, and 38.10% had lymphovascular/perivascular invasion. The median recurrence time was 40.2 months, and recurrence-free survival rates were 85.5%, 71.6%, and 44% for one, two, and five years, respectively. The authors stressed that their outcomes are comparable to those in the literature; however, more accurate data collection and future national collaboration are essential to improve patient outcomes.

Alsaleh, et al., aims to assess. knowledge, attitude and practice toward covid-19 pandemic among pregnant women living in Jeddah ,Saudi Arabia. A considerable number of pregnant women have been affected by the current pandemic.

Al-Amri,et al., did a descriptive cross-sectional survey looking at prevalence of dry eye symptoms and risk factors in Saudi Arabia. Data was collected using structured questionnaire included person's socio- demographic data, addition on that we will use OSDI ( ocular surface disease index) combined by questions have relevant to the target of our research ((the repetitive habitual/behavioral factors leading to Dry eye disease (DED). Out of 2527 total respondents, 694 (27.5%) have no issues related to eye , while 1833(62.5%) have eye related issues. The mean (SD) of age was 29.4(8.9) Years. 67.0% were females while 33.0% were males. 22.9 % exposed with air conditioner, 22.9% used contact lenses, 7.36 % used lubricant drops, while 6.3% living in dry weather area. The authors concluded that dry eye illness is a prevalent ophthalmological condition with a number of clinical predictors, including the use of electronic devices and other risk factors. Teachers and health professional should teach the students and nation about the awareness regarding dry eye problems

Al Mahfud, et al., did a cross sectional study to assess the misunderstanding regarding LP among parents in Taif city. The study was done on 687 of parents of children who required LP procedure from birth till the age of 18 in Taif Children Hospital 15.7% of parents were asked to take a sample of the cerebrospinal fluid of one of their children, of them, 61.2% agreed, with the average age of the child at the LP being 2.24 ± 3.28 years. A consultant discussed the LP technique to 37.8% of them, and 86.5% and 56.2% said the doctor clarified the nature and complications of the treatment to them. For parents not asked for LP before, 41.4% will not agree for it in the future. For parents who refused LP when indicated and hose refusing it in the future, the most common causes were the side effects as paralysis (60.6%), pain (11.3%) and no trust in HCWs and fear of medical errors (10.9%). For them, the most common sources of refusal were information from friends and relatives (41.2%).

Hameed et al., discussed training of general practitioner to be able to do Epley's manever. The most effective and non-invasive treatment for BPPV is Epley's Maneuver which is usually performed by trained ENT specialists or consultants in secondary care settings. Based on this study, the following conclusions can be drawn:

1. The efficacy of the Epley's maneuverer proves it the treatment of choice for BPPV.
2. This treatment can be safely given in primary care set up.
3. Performing this procedure in primary care is very much cost effective and can save significant sum of money and reduce the referral rate to secondary care.
4. Primary care doctors felt confident with this training and the project and gave an overall better work satisfaction to all the participants.
5. Pre-medication with Prochlorperazine and Betahistidine reduced the discomforting vertiginous feeling in all patients during the procedure.

Alanazi, et al., did a cross-sectional study was conducted among the general population
to study the level of awareness among general population towards diabetic complications and explore the relationship between level of awareness and different socio-demographic factors. A total of 508 participants completed the study of whom 67.5% were males. We found that 91.1% of the participants had good awareness about diabetic complications. The majority of the participants (93.9%) were diagnosed with DM or knew someone diagnosed with it. This study revealed that the general level of awareness about diabetic complications among the general population of Saudi Arabia was good.

Huneif et al., did a cross?sectional study among primary care physicians (PCPs) looking an knowledge and practice among primary care physicians in Najran (south west region), Saudi Arabia regarding Maturity Onset Diabetes of the Young (MODY). The questionnaire was created following a series of conversations between a panel of experts, which included subject specialists, researchers, and language experts. 12% responding completely regarding definition of MODY, 55.5% have knowledge regarding mode of inheritance of Mody, 9% were aware about the type of the MODY,60% were about typical symptoms of MODY, Diagnostic tools of MODY (45%). The authors concluded that clinicians should maximize alternative therapy in the era of CF modulators and correctors to improve outcomes and prevent long-term morbidity and mortality.

Dr. Musallam, did a quality improvement project on improving patients centered care by documenting their contribution in the plan of care at west bay health center, Qatar. Our project showed remarkable improvement, in physician's documentation of patient contributions in their plan of care. We found that, physician documentation of patient contributions in their plan of care, improved from 50%to 89 .3% and that exceeds our aim by 39.3%. The strength of our project, is that , the project was applied to the family medicine clinic ,which is the most busy clinic in our health centre , compared to other speciality clinic .on the other hand , the limitation of our project is small sample size, the total number of physician contributions checked was 300 , which is relatively small number. The authors concluded that Their intervention showed remarkable improvement in the percentages of physician's documentation of patient contribution in their plan of care.

El-Gamal, et al., did a cross sectional study to explore the oral manifestations associated with the use of inhalation therapy among patients with asthma in Jeddah city. Data were collected using interview questionnaire, the standard 5th ed. WHO survey on oral manifestations, measurement of vital signs and anthropometric parameters, as well as clinical oral examination. The majority of patients with asthma (95%) used inhalation therapy, without use of spacers. The authors concluded that use of inhalation therapy in patients with asthma was significantly associated with increased occurrence of oral health problems. Health education programs about proper use of inhalers and oral hygiene should be implemented by primary health care personnel.

Dr Daud, reviewed the Clinical Potential of Lorcaserin in the Treatment of Obesity. He stressed that obesity is a chronic disease characterized by excessive fat accumulation and associated with impaired metabolism and cardiovascular disease. The high global prevalence of obesity has resulted in the production of anti-obesity drugs over the last couple of decades, normally to be used in combination with lifestyle modifications such as physical activity and diet. One such medication is Lorcaserin, a selective serotonin 5-hydroxytryptamine2C (5-HT2C) receptor agonist approved by the FDA in 2012 as a drug therapy for weight management in conjunction with lifestyle modifications. This review addresses Lorcaserin's therapeutic potential for the treatment of obesity, considering the pre-clinical and clinical trials describing its efficacy in weight loss along with its adverse carcinogenic effects to ultimately determine the likelihood of its reintroduction into the market.

Fardan et al., looked at the Knowledge of school teachers regarding Asthma in Aseer region of Saudi Arabia. The data for this cross-sectional study was acquired using a specially designed questionnaire. Out of total 759 respondents, the mean (S.D.) of the respondents were 31.6(12.8). 14.2% were male while 85.8% were females. The Cronbach alpha of the questionnaire was 0.79. we have observed that age and education have a significant impact over the prevalence of the Asthma. The authors concluded that we should train our teachers by conducting series of seminars, webinars , workshops , We will also incorporated training for trainer sessions for teaching staff to enhance their skills to deal with asthma.

Algethami, et al., did a descriptive cross-sectional survey to assess parental knowledge and practices toward aerodigestive paediatric foreign bodies ingestion or inhalation, Saudi Arabia. A total of 611 child care givers completed the study questionnaire. Exact of 508 (83.1%) respondents were children's mothers and 103 (16.9%) were their fathers. Exact of 93.1% of the study parents heard of swallowing or inhaling foreign objects and 77.3% reported that children aged 1-5 years are more likely to swallow or inhale foreign objects while 20.5% reported for children aged less than 1 year. The authors concluded that the study revealed that parental knowledge and practices toward FBA were on average (but not satisfactory) especially for the correct actions for swallowed objects and timing to visit ER even for asymptomatic ingested FB. On the other hand, safe practice especially keeping small objects out of children reach was high but observing young aged children while playing was unsatisfactory.

Alshahrani et al., did a cross-sectional study con-ducted among male secondary school students to examine the relationship between obesity and negative emotional states among male secondary school students. Three hundred and ninety eight students participated in the study. Their mean age (±SD) was 16.98±0.93 years. Overweight and obesity was present among 44.2% and 38.4% of participants, respectively. The overall prevalence rates for symptoms of depression, anxiety and stress among participants were 57%, 64.6% and 39.4%, respectively. The authors concluded that the burden of overweight and obesity are high among the male secondary school students. Overweight and obesity are associated with symptoms of depression, anxiety and stress. There- fore, there should be emphasis on implementing interventions to raise awareness about maintaining normal body mass index among the school students and thereby reducing the risk of mental disorders.

Abdulrazak Abyad
Chief Editor