This is the second issue of the journal this year with papers from Saudi Arabia, Turkey, Lebanon and Australia.

Aboshaiqah et al., did a systematic review was performed to assess cultural competence among nurses in Saudi Arabia. Nursing staffs are typically multi-national, especially in Saudi Arabia, and Saudi nurses deal with multicultural patients, which creates a culturally diverse atmosphere. As a result, cultural competence is essential. The study provides in-depth summaries of 11 papers included in this review. No studies published before 2014 investigated the cultural competence of Saudi Arabian nurses. However, the authors noted a sharp rise from 2020 in the number of studies dealing with this issue. Sample sizes ranged from 11 to 650 participants. The authors concluded that Healthcare systems should be structured to encourage the empowerment of nurses from different nationalities and build effective communication policies to improve cultural competency among nurses. Future research should look at the relationship between individual training programs designed to increase cultural competence and their effect on the quality

Dr. Mujallad, reviewed the Nursing Profession in the New Era of Saudi Arabia. People unfamiliar with Saudi Arabia will never realize the change the country is experiencing today. Women have become empowered over a short period. Change is happening now and is happening quickly. Women who have never even considered being engaged in higher positions are taking managerial and leadership positions. Along with the change that is taking place, the healthcare sector is one priority for the newly crowned prince Mohammed bin Salman in his 2030 vision to the nation; the Minister of Health addresses that nursing is the top priority to achieve the vision of the Kingdom of Saudi Arabia, pointing out that 50% of the total workforce in the health sector are nurses. The researcher used secondary data from the Ministry of Health in Saudi Arabia to do a Descriptive Comparative Research Design to compare the number of nursing students to medical students in the major public universities in Saudi Arabia to see if there is a big difference between choosing nursing and medicine in the light of the high demand for the nursing profession.

Helvaci*, et al., looked whether autosplenectomy which is higher in females in sickle cell diseases is a good prognostic sign. The authors studied 222 males and 212 females with similar ages (30.8 vs 30.3 years, p>0.05, respectively). Although the higher prevalence of autosplenectomy (50.4% vs 53.3%, p<0.05), transfused units of red blood cells (RBCs) in their lives (48.1 vs 28.5, p=0.000), disseminated teeth losses (5.4% vs 1.4%, p<0.001), ileus (7.2% vs 1.4%, p<0.001), cirrhosis (8.1% vs 1.8%, p<0.001), leg ulcers (19.8% vs 7.0%, p<0.001), clubbing (14.8% vs 6.6%, p<0.001), coronary heart disease (CHD). The authors concluded that the sickled or just hardened RBCs-induced capillary endothelial damage initiates at birth, and terminates with multiorgan failures even at childhood. Although RBCs suspensions and corticosteroids in acute, and aspirin with an anti-inflammatory dose plus low-dose warfarin plus hydroxyurea both in acute and chronic phases decrease severity, survivals are still shortened in both genders, dramatically. Although the higher prevalence of autosplenectomy, transfused units of RBCs in their lives disseminated teeth losses, ileus, cirrhosis, leg ulcers, clubbing, CHD, CRD, COPD, and stroke were all lower in females. So there may be an inverse relationship between autosplenectomy and severity of SCDs, and spleen may act as a chronic inflammatory focus as a filter of blood for these sickled or just hardened RBCs.

Helvaci*, et al., looked whether Male gender alone may be a bad prognostic feature in sickle cell diseases. Patients with RBCs transfusions of less than 50 units in their lives were put into the first and 50 units or higher were put into the second groups. There were 224 and 92 patients in the first and second groups, respectively. Mean ages were similar in them (28.9 vs 30.0 years, respectively, p>0.05). Although the lower prevalence of autosplenectomy (56.2% vs 45.6%, p<0.05), male ratio (45.5% vs 64.1%, p<0.001), white blood cells (WBCs) (14.931 vs 15.346/µL, p<0.05) and platelets (PLTs) (435.670 vs 498.310/µL, p= 0.005) counts, painful crises per year (3.8 vs 8.4, p= 0.000), smoking (12.0% vs 17.3%, p<0.05), clubbing (7.1% vs 15.2%, p<0.01), chronic obstructive pulmonary disease (COPD) (6.6% vs 20.6%, p<0.001), leg ulcers (11.6% vs 21.7%, p<0.01), stroke (5.8% vs 11.9%, p<0.05), chronic renal disease (CRD) (4.9% vs 14.1%, p<0.001), and coronary heart disease (CHD) (4.0% vs 8.6%, p<0.05) were higher in the second group, and mean age of mortality was lower in males (29.7 vs 33.3 years, p<0.05). The author conclude that although the lower prevalence of autosplenectomy, male ratio, WBCs and PLTs counts, painful crises per year, smoking, clubbing, COPD, leg ulcers, stroke, CRD, and CHD were higher in the second group, and mean age of mortality was lower in males. So autosplenectomy may be a good, and male gender alone may be a bad prognostic feature that can not be explained by smoking alone at the younger age.

Helvaci*, et al., looked whether Red blood cell supports prolong the survival in sickle cell diseases. Patients with red blood cells (RBCs) transfusions of less than 50 units in their lives were put into the first and 50 units or higher were put into the second groups. There were 224 cases in the first and 92 cases in the second groups. Mean ages were similar in them (28.9 vs 30.0 years, respectively, p>0.05). Although the lower prevalence of autosplenectomy (56.2% vs 45.6%, p<0.05), male ratio (45.5% vs 64.1%, p<0.001), white blood cells (WBCs) (14.931 vs 15.346/µL, p<0.05) and platelets (PLTs) (435.670 vs 498.310/µL, p= 0.005) counts, painful crises per year (3.8 vs 8.4, p= 0.000), smoking (12.0% vs 17.3%, p<0.05), clubbing (7.1% vs 15.2%, p<0.01), chronic obstructive pulmonary disease (COPD) (6.6% vs 20.6%, p<0.001), leg ulcers (11.6% vs 21.7%, p<0.01), stroke (5.8% vs 11.9%, p<0.05), chronic renal disease (CRD) (4.9% vs 14.1%, p<0.001), coronary heart disease (CHD) (4.0% vs 8.6%, p<0.05), and mean age of mortality (29.5 vs 34.6 years, p<0.05) were all higher in the second group. The
Authors concluded that although the lower prevalence of autosplenectomy, male ratio, WBCs and PLTs counts, painful crises per year, smoking, clubbing, COPD, leg ulcers, stroke, CRD, CHD, and mean age of mortality were higher in the second group. So autosplenectomy may be a good, and male gender alone may be a bad prognostic feature that can not be explained by smoking alone at the younger age, and RBCs supports prolong the survival.

Abdulrazak Abyad
Chief Editor