In this issue Hamdan, et al., explored the barriers toward colorectal cancer screening. The authors stressed that Colorectal cancer is the third most common cancer and the second leading cause of death worldwide. Bowel cancer screening helps prevent colon cancer by early detection of polyps, leading to efficient treatment and reduced mortality. Within Qatar, primary health facilities promote bowel screening by using the faecal occult blood test. However, the popularity and use of this test are still low. Cronin's five step framework for literature reviews was utilized for this paper. This review included nine articles that were peer-reviewed and published between 2009 and 2019. The nine articles were appraised by using the Mixed Methods Appraisal Tool. This tool has separate criteria to assess the quality of the qualitative, quantitative, and mixed-method studies. The authors noted three main barriers to bowel cancer screening included knowledge deficit, personal beliefs, and organizational barriers. The authors stressed that the main barriers are related to the patients' lack of knowledge and personal beliefs. Overcoming these barriers is essential to raising awareness about this issue among all nurses, physician, and patients. It is necessary to involve stakeholders in order to mitigate barriers. Developing educational activities for healthcare professionals will provide information that they can share with patients to encourage screening and decrease the fear of the test. Developing a pamphlet to increase patient awareness will also encourage screening and work toward decreasing fear.

Helvaci et al., tried to understand prognosis of sickle cell diseases (SCD) in both genders. All cases with the SCD in the absence of smoking and alcohol were included. The study included 368 patients (168 males and 200 females). Mean age (29.4 versus 30.2 years), associated thalassemia minors (72.0% versus 69.0%), and body mass index (BMI) (21.7 versus 21.6 kg/m2) were similar in males and females, respectively (p>0.05 for all). Whereas total bilirubin value of the plasma (5.2 versus 4.0 mg/dL, p=0.011), transfused units of red blood cells (RBC) in their lives (46.8 versus 29.2, p=0.002), disseminated teeth losses (4.7% versus 1.0%, p<0.001), chronic obstructive pulmonary disease (COPD) (20.8% versus 6.0%, p<0.001), ileus (5.3% versus 2.0%, p<0.01), cirrhosis (5.9% versus 1.5%, p<0.001), leg ulcers (16.0% versus 7.5%, p<0.001), digital clubbing (13.0% versus 5.5%, p<0.001), and chronic renal disease (CRD) (10.7% versus 6.5%, p<0.05) were all higher in males, significantly. The authors concluded that SCD are severe inflammatory processes on vascular endothelium, particularly at the capillary level since the capillary system is the main distributor of the hardened RBC into tissues. Although the similar mean age, associated thalassemia minors, and BMI and absence of smoking and alcohol, the higher total bilirubin value of the plasma, transfused units of RBC in their lives, disseminated teeth losses, COPD, ileus, cirrhosis, leg ulcers, digital clubbing, and CRD in males may be explained by the dominant role of male sex in life according to the physical power that may accelerate systemic atherosclerotic process all over the body.

Mehmet et al., tried to understand presence of any atherosclerotic background of cirrhosis in patients with sickle cell diseases (SCDs). The study was performed in the Hematology Service of the Mustafa Kemal University on SCDs patients between March 2007 and June 2012. The study included 256 patients with SCDs (127 females). The mean age of them was 29.3 years. Cirrhosis was detected in 5.8% (15) of the SCDs patients without any gender difference (6.2% of females versus 5.4% of males, p>0.05). There were 15 (5.8%) patients with chronic obstructive pulmonary disease with a highly significant male predominance (3.1% versus 8.5%, p<0.001). Digital clubbing and pulmonary hypertension were also higher in males, but the differences were nonsignificant in between (4.7% versus 6.2% and 11.0% versus 12.4%, respectively). Similarly, the leg ulcers were significantly higher in males, too (5.5% versus 16.2%, p<0.001). The significant male predominance was also observed in stroke and smoking (3.1% versus 6.2%, p<0.05 and 3.9% versus 11.6%, p<0.001, respectively). There were 14 (5.4%) mortal patients during the five-year follow-up period (6.2% of females and 4.6% of males, p>0.05), and the mean ages were 31.0 and 26.8 years, respectively (p>0.05).
The authors concluded that probably cirrhosis is a systemic inflammatory process prominently affecting the hepatic vasculature, and an eventual accelerated atheroscerotic process is the main underlying cause of characteristics of the disease. SCDs are accelerated systemic atherosclerotic processes, too, and the higher prevalence of cirrhosis in SCDs patients may indicate the underlying atherosclerotic background of cirrhosis.

Dr Elghblawi looked at the the nocturnal kissing of a nuisance mosquito; unusual insect bite reaction, through a case report and a literature review. Insects represent more than half of all known living organisms in the world. Both human beings and insects share a common biodiversity and the influence of insects on human life is enormous. They share an intimate relationship in which human beings are both benefitted and harmed. Insects inflict harm by stinging, biting or transmitting diseases. Rarely, humans are harmed by inadvertently coming in contact with the toxin of an insect. Insect dermatitis is characterized by tingling and burning within 10 minutes of contact, and sometimes the incurred dermatitis is a self-healing condition. Such cases usually happen while asleep when there is a lag time between the crash of the insect and waking up on the morning. A case while sleeping, heard the insect fly around her bare chest, at summer time, and on waving it away instinctively while sleeping, and the insect had crashed on her bare upper chest skin, incurring a subsequent skin reaction without the typical red bite mark followed by an evolved burning ulcerative skin lesion, that took a while to subside and heal up completely.

Abdulrazak Abyad
Chief Editor