This is the first issue this year of the journal which include papers from various countries dealing with important issues.

Asiri., et al., did a quantitative cross-sectional study to evaluate nurses' perceived organizational support during the COVID- 19 pandemic in Aseer Region, Saudi Arabia.The study included 288 nurses working in 13 governmental hospitals. A self-administered questionnaire was designed by the researchers (in both English and Arabic versions), which included sociodemographic characteristics and the COVID Organizational Support Scale. Most participant were Saudi (79.5%), females (91.3%), aged 23-35 years (93.1%). About one two-thirds of nurses (61.8%) had 1-2 years of work experience in Saudi Arabia. Most nurses (87.2%) had a Bachelor degree. Most participants dealt with COVID-19 patients and had previous experience with previous outbreaks (77.8% for both). The majority of nurses agreed regarding having access to appropriate personal protective equipment (75.3%), and they can get tested for COVID-19 once they need to (70.8%). However, 90.3% of participants agreed that they are exposed to the risk of getting COVID-19 at work and they may take the virus home to their families, while 22.2% agreed that they have access to childcare during increased work hours and school closure, and 46.5% lack access to up-to-date information and communication from healthcare system. Almost half of nurses (47.2%) perceived a poor organization support level, while 44.1% perceived good support level and only 8.7% perceived an excellent support level. Poor organizational support was most perceived by those aged 23-35 years (49.3%, p=0.044), while it was least perceived by female nurses (47.9%), non-Saudi nurses (50.8%), single nurses (48.8%), having no children (49.5%), with 1-2 years' experience in Saudi Arabia (50%), with Bachelor degree (48.6%), who deal with COVID-19 patients (50%) and with no previous experience with previous outbreaks. However, apart from nurses' age groups, differences in perceived organizational support according to nurses' personal characteristics were not statistically significant. The authors concluded that nurse perceived organizational support in Aseer Region during the COVID-19 pandemic is suboptimal. Therefore, training should be provided to nurses in order to handle and cope the increased workload during the COVID-19 pandemic, and to mitigate any experienced exhaustion.

Helvaci, et al., investigated the possibility that obesity may actually be a pre cirrhotic condition in adults. The authors followed consecutive patients with an umbilical hernia and/or a surgical repair history of the umbilical hernia were included. There were 46 patients with the umbilical hernia with a mean age of 62.0 years, and 73.9% of them were female. Body mass index was higher in the hernia patients (33.6 versus 29.1 kg/m2, p= 0.000). Although the prevalence of hypertension (HT) was also higher in the hernia group (50.0% versus 27.3%, p<0.01), mean values of triglycerides and low density lipoproteins and prevalence of white coat hypertension (WCH) were lower in them (p<0.05 for all). Although prevalences of diabetes mellitus (DM) and coronary heart disease (CHD) were also higher in the hernia patients, the differences were nonsignificant, probably due to the small sample size of the hernia group. The authors concluded that there may be some significant relationships between the umbilical hernia, obesity, cirrhosis, and other endpoints of the metabolic syndrome including HT, DM, and CHD, probably on the bases of prolonged inflammatory, atherosclerotic, and pressure effects of excessive fat tissue on abdominal wall muscles. The inverse relationships between obesity and hypertriglyceridemia and hyperbetalipoproteinemia may be explained by the hepatic fat accumulation, inflammation, and fibrosis induced relatively lost hepatic functions in obesity. Similarly, the inverse relationship between obesity and WCH may be explained by progression of WCH into overt HT in obesity. So obesity may actually be a precirrhotic condition in adults.
Irritable bowel syndrome (IBS) is one of the frequent causes of recurrent upper abdominal discomfort in adults. Helvaci et al., looked at Acute phase reactants in irritable bowel syndrome. Consecutive patients with the IBS and age and sex-matched control cases were studied. IBS was diagnosed according to Rome II criteria in the absence of red flag symptoms including pain, diarrhea interfering with sleep, weight loss, fever, and any pathological finding in physical examination. The study included 473 patients with the IBS (308 females and 165 males) and 271 control cases. Mean age of the patients was 43.0 years. Interestingly, 65.1% of the patients with IBS were female. The authors concluded that probably IBS is a low-grade inflammatory process initiated by smoking, infections, inflammations, anxiety, depression, sleep disorders, illness fear, and cancer fear-like stresses, and eventually terminates with dysfunctions of the gastrointestinal and genitourinary tracts and elevations of ESR and CRP-like acute phase reactants (APR) in the plasma. The elevated APR will probably terminate with an accelerated atherosclerotic process all over the body and a shorthened survival in both genders.

Baker, et al., reviewed the effect of regular exercise during pregnancy on duration of labor: a systematic review and meta-analysis Literature searches were undertaken; the following electronic databases were searched: PubMed, Cochrane, ProQuest Nursing, and MEDLINE. Also, the electronic database search was manual searching of reference lists in articles to locate any relevant related material that may not have been shown. The search included the late 2018 through 2022. The date of the search was 3rd of March 2022.A total of Three studies were included in the final synthesis of evidence. In this analysis, data from various other subjective were pooled together using the standardized mean difference statistic (SMD). The overall effect of regular exercise during pregnancy on duration of labor demonstrates a statistically significant difference between the intervention and control group (n=548, standardized mean difference (SMD) -1.75, 95% confidence interval (CI) -3.40 to -0.09, p = 0.04) when compared to control group. The authors stressed that the meta-analysis established that undertaking regular exercise throughout pregnancy has a positive effect on the duration of labor, and further clinical trials should be conducted to validate and replicate the findings.

Abdulrazak Abyad
Chief Editor