In December 2019, an outbreak of Coronavirus Disease 2019 (COVID-19), an acute respiratory illness caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), was detected in Wuhan, China. On 11 March 2020, the World Health Organization (WHO) declared COVID-19 a pandemic and advised all countries to take decisive actions to prevent and control the outbreak. Thus far, as of 16 April 2020, COVID-19 has spread to 213 countries or territories and resulted in 1,954,724 confirmed cases and 126,140 deaths globally. There is no effective vaccine to prevent COVID-19, and treatment options are still experimental and unproven. Patients are just managed with supportive care and antibiotics against secondary bacterial infections. To fight this pandemic, many high-income countries, including Saudi Arabia, locked their borders, started evacuating their citizens from other countries and imposed different degrees of blockade locally to promote social distancing and, hence, controlling the spread of the virus, SARS-CoV-2. In this editorial, we will discuss the adequacy of such measures to control COVID-19 epidemic locally and globally.

Humanity has witnessed outbreaks since millennia, from limited epidemics to universal pandemics that wiped millions of lives and changed the course of civilizations. The advent of vaccines has eradicated some of the serious human pathogens and attenuated many others. However, pandemics are still a fact of our modern world, as we continue to have pandemics as ravaging as HIV and as alarming as severe acute respiratory syndrome, Ebola, and Middle East respiratory syndrome. The outbreak of COVID-19 with exponential curves racing to the 3 million confirmed cases should not have been a surprise. However, we seemed to ignore the past.[1,2] Unfortunately, COVID-19 is not the world’s last pandemic and we have to learn what we have missed, and how to avoid the failures. In this article, we try to summarize the lost opportunities as well as the lessons learned, hoping we can do better in the future.

Severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) is a minute fragment (~30 kb) of single-stranded RNA that causes coronavirus disease 2019 (COVID-19), which brought the whole world to a pause, shattering down all the insolence of modern days civilization making human realize, that still there are lots of concealed catastrophic challenges which are to be faced on this planet. In December 2019, the first expected case of COVID-19 was reported in World Health Organization (WHO) office in China from Wuhan, Hubei [1] , at that time no one knew that this novel virus would take a form of a pandemic which shutting down all the daily life activities globally and locking down humans in their homes and force them to follow social distancing. On January 30 th 2020, WHO announced COVID-19 as a Public Health Emergency of International Concern and later on March 11 th 2020, it was given the status of a pandemic [1]. Since then the cases are rapidly increasing in all over the world. As recorded on April 13 th , 2020 from worldometer website, 1,851,734 confirmed cases of COVID-19 globally and 114,179 confirmed deaths were reported from all over the world. The data on the same day also showed that the largest reported cases were reported from United States followed by Spain, Italy, France, Germany, United Kingdom and China. In United States, 22,105 people were died, which was significantly high as compared to any other countries of the world, whereas Italy, Spain, France and United Kingdom were placed on second, third, fourth and fifth places, respectively as the confirmed reported deaths were 19,899 in Italy, 17,209 in Spain, 14,393 in France, 10,612 in United Kingdom (data recorded on April 13, 2020) [2]. In Kingdom of Saudi Arabia till 13 th of April 2020, 4,462 confirmed cases of COVID-19 were recorded and 59 confirmed deaths were reported [2].           SARS-COV2 is the seventh known corona virus to cause infection in humans after 229E, NL63, OC43, HKU1, MERS-CoV and SARS-CoV [3]. The exact source of SARS-COV-2 is still not known but some metagenomic studies showed its association with bats and pangolins [4]. As compared to previous corona viruses, the infectivity rate of SARS COV-2 is comparatively much higher and the mode of transmission of this deadly virus is primarily by respiratory droplets from an infected individual to others through coughing, sneezing within a distance up to 6 feet or touching of infected surfaces where the viral particles are present [5]. It is documented that the incubation period for this virus ranges from 2 to 14 days and after that period, the disease usually starts with a high grade fever (>100.4°F or >38.0°C) with pneumonia like symptoms such as chills, headache, fatigue, generalized body pain and flue. After 2-7 days, COVID-19 patients may develop a dry, nonproductive cough that can progress to pneumonia [6]. The overall mortality rate was anticipated to be 9%, but increasing to 50% particularly those above aged 60 years [9]. Patients suffered from some underlined comorbidity such as diabetes, cardiovascular complications, etc. were also reported to prone for this viral respiratory disorder [6].          At present, the only therapeutic measures to deal with this viral infection are only supportive and preventive, which are directed only to reduce the transmission of spread in the community [1,7]. Although, it is documented that the virus has not replicated outside the living cell but it remains infectious through environmental contamination particularly from the crowded places such as shopping malls, hospitals, etc. are believed to be the vital sources of its transmission [1,7]. It is also important for the readers to know that the period of persistence of this virus viability is still not completely defined but several scientists assumed that it may influence by several factors such as temperature and humidity [8]. The transmission of virus can be decreased to a large extent by adopting strict infection control policies, which are basically a team base efforts and everyone has to play their roles. As per recommendations of WHO, everyone must adapt social distancing by residing at home and avoid unnecessary travel as much as possible [7,8]. Being an enveloped virus, SARs COV-2 is comparatively easy to disinfect, therefore hands hygiene plays a vital preventive tool from getting infected, washing hands frequently with soap and water or using alcohol based hand sanitizers to disinfect hands have strongly been recommended by WHO [1]. Other preventive measures are educating the general public by creating awareness regarding the spread of the virus that not only control in declining the incidence of disease but also prevent us to decrease the stigma of fake myths associated with COVID-19. It is also very important for the readers to know that the likely time period of this global pandemic is still uncertain and its implications are still unwinding. Therefore, this is a challenging situation that requires a team based efforts from every individual in every society in order to overcome from this deadly global disaster.

Background : Visfatin is an adipokine secreted mainly by adipose tissue and has been implicated in obesity. It also mimics the effects of insulin and its expression is hormonally regulated by hormones. Objectives : Serum visfatin concentrations were evaluated in Saudi women of different body weights in order to determine its relationships with sex hormones and obesity-induced insulin resistance (IR) in women in Saudi Arabia. Methods: In this cross-sectional study, 83 healthy Saudi women of different body weights were recruited between 2014 and 2016, from King Abdulaziz University staff and students. They were divided into three groups according to their body mass indexes (BMIs). Anthropometric measurements were recorded for all of the participants. Blood samples were collected to assess the biochemical variables, including glucose, insulin, lipid profile, visfatin, sex hormone binding globulin (SHBG), and sex hormones levels. Results: Obese women exhibited significantly higher blood pressure (BP), glucose, insulin, IR, lipid profile, and visfatin levels than overweight and lean women. However, lean women had significantly higher high-density lipoprotein-cholesterol (HDL)-C, estradiol (E2), luteinizing hormone (LH), and SHBG levels than overweight and obese women. Positive correlations were observed between visfatin levels and waist and hip circumferences, BMI, diastolic BP, systolic BP (SBP) insulin, IR, and LDL-C levels (P < 0.001 – P < 0.05). Negative correlations were observed between visfatin levels and HDL-C, SHBG, LH, and E2 levels (P < 0.001 – P < 0.05). Conclusions: The results of this study revealed that E2 and SHBG concentrations were decreased in obese women, while visfatin levels were increased in obese women with high IR levels. This suggests that visfatin levels and sex hormones interact synergistically with obesity with regard to the IR risk in obese women.

Introduction: Infraclavicular (IC) approach of subclavian vein (SCV) catheterization is widely used as compared to supraclavicular (SC) approach for pacemaker insertion. The aim of the study was to compare the ease of catheterization of SCV using SC versus IC approach and also record the incidence of complications related to the approach. Methods: In the prospective and interventional study, 102 patients enrolled were randomly divided into two groups. In one group, the right SCV catheterization was performed using SC approach, and in the other group, catheterization was performed using IC approach. The total number of participants, who fulfilled the requirements, was 92. Access time, success rate of cannulation, number of attempts to cannulate vein, ease of guidewire and catheter insertion, placement of temporary wire as cine time, patient comfort, and associated complications were recorded. The data collected were analyzed on SPSS software version 26. Results: The SC approach had a lesser access time as compared to IC approach and this was found to be significant. Non-significant parameters included complications, number of attempts, and cine time. Only one patient from the IC group developed pneumothorax. Conclusions: The SC approach of SCV catheterization is comparable to IC approach in terms of landmark accessibility, success rate, and rate of complications. However, IC approach is less feasible in terms of time constraint and is, therefore, less likely to be successful.

Objective: Skin cancers are relatively uncommon malignancies worldwide, but there is a progressive increase in the incidence over the last few decades. Materials and Methods: We have studied the clinical and histopathological features of malignant skin tumors received in the department of pathology of our tertiary care institute over a period of 3 years and 8 months. A detailed analysis of clinical, gross, and microscopic findings was performed, followed by clinicopathological correlation. Results: One hundred and one specimens of skin tumors were received during this period, of which 37 (36.27%) were malignant tumors. Keratinocytic tumors were most common (81.08%) followed by appendageal tumors (10.81%). Squamous cell carcinoma (SCC) was the most frequent malignancy followed by basal cell carcinoma (BCC). Malignant melanoma, hidradenocarcinoma, malignant proliferating trichilemmal tumor (MPTT), sebaceous carcinoma, and fibrosarcomatous dermatofibrosarcoma were also observed. Variants such as hybrid verrucous SCC, basosquamous carcinoma, infiltrating BCC, and MPTT with spindle SCC were also found. Malignant skin tumors were most frequent in the seventh decade (40.54%). Males and females were almost equally affected. Overall, head and neck region was the most common site for malignant skin tumors. Conclusion: The vast diversity of skin tumors produces difficulty in diagnosis. Any lesion, for which the diagnosis is uncertain, based on the history and clinical examination, should be biopsied for histopathological examination to rule out malignancy.

Objectives: The present study aimed to assess the levels of the cardiac biomarkers in smokers versus non-smokers chronic periodontitis (CP) patients and periodontally healthy subjects, also to correlate cardiac biomarkers level with the severity of CP. Methods: Eighty selected individuals were divided into three groups: Smokers CP (28), non-smokers CP (32), and healthy control subjects (20). The CP evaluated clinically by plaque index (PI), bleeding index (BI), clinical attachment loss (CAL), and pocket depth (PD). Serum levels of cardiac biomarkers were assayed for the following: Aspartate transaminase (AST), alanine transaminase (ALT), troponin-I (Tr-I), creatinine kinase (CK), and lactate dehydrogenase (LDH). Results: The statistical analysis of the investigated biomarkers showed that ALT and AST significantly increased in smokers versus non-smokers CP patients (P ≤ 0.05). In addition, the other biomarkers (Tr-I, CK, and LDH) showed a non-significant increase in smokers compared with non-smokers periodontitis patients (P ≥ 0.05). Furthermore, the mean values of all biomarkers, Tr-I, ALT, AST, LDH, and CK, expressed highly significant comparisons (P ≤ 0.01) in smokers and non-smokers CP patients against healthy subjects. Conclusion: The present study suggested that the cardiac biomarkers affected by CP and worse aggravated by the presence of smoking that could play a bidirectional effect on periodontitis and cardiovascular (CV) conditions. Further researches are needed to elucidate the efficacy of periodontal treatment and serum cardiac biomarkers in systemically healthy and diseased CV patients.

Objective: It is known that job satisfaction and quality of life influence nurses’ intention to resign from their jobs. However, health-care systems should examine all the possible factors that contribute to nurse turnover to retain them for the long term. To this purpose, this study further explores the aspects that affect the intention of nurses who work in Saudi Arabia to leave their current jobs. Methods: A sample of 318 staff nurses working in two public hospitals in Saudi Arabia was surveyed in this cross-sectional study. A questionnaire was used to assess job satisfaction, stress, quality of life, and intention of recruited nurses to leave their current jobs. Data were collected between April and May 2018. Results: Quality of life dimensions, such as physical and psychological health, predict nurses’ intention to resign from their current workplaces. We found that being single or of Filipino or Indian origin, working in the medical and surgical department, or having a low monthly gross salary is correlated with a high intention to leave. Conclusion: The results present a unique theoretical underpinning that expands on the previous knowledge and literature on the factors that affect nurses’ intent to leave their organizations. The findings of this study can be used as a guide to establish human resource policies toward satisfying nurses’ needs and improving job satisfaction and quality of life to promote retention.  

Introduction: Oral submucous fibrosis (OSMF), a premalignant condition, is frequently occur in the buccal mucosa and is associated with betel nut chewing. Various treatment modalities are tested to treat this condition. An effective intervention is needed, which is cost effective, safe, and efficient, considering the disease burden in high incident countries. Turmeric has promising results in the management of OSMF because of its potent anti-inflammatory and anti-oxidant pharmacological actions. Objectives: The objectives of the study were to analyze the efficacy of turmeric in managing OSMF based on the available literature. Methodology: The articles were searched from Medline/PubMed and Journal of web, which were published from 2000 to 2019 and reviewed for the determined outcomes. Results: The review showed a positive response for turmeric usage in managing OSMF, in terms of improved mouth opening and decreased burning sensation. Conclusion: Multicenter studies in high incidence countries with long-term follow-up are recommended to better understand the curative aspect of curcumin in OSMF.  

Minimal change disease (MCD) is a main cause of the nephrotic syndrome. Thin basement membrane disease (TBMD) is another disease characterized by microscopic hematuria. The present case is a young adult female who presented with classic nephrotic syndrome, but she had microscopic hematuria as well. Hematuria can be part of MCD in 21% of patients, but in this case, histopathological diagnosis confirmed MCD with concurrent TBMD. This was reported only in two cases, up to our literature review. Using steroids resulted in nephrotic syndrome improvement, but microscopic hematuria has persisted, which is mostly related to TBMD rather than a primary part of MCD. Up to our knowledge, this is the first case report of MCD with concurrent TBMD in Arab countries.