From the Editor
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Ahmad Husari
Editor, Middle-East Journal of Internal Medicine
Director, American University of Beirut Sleep Disorders Center
Director, American University of Beirut outpatient clinical care services
Assistant Professor
Division of Pulmonary and Critical Care Medicine
American University of Beirut Medical Center
Beirut Lebanon
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This the last issue this year for the journal. We would like to send a special thanks for the authors that submitted papers to the journal, our readers, reviewers and production staff headed by our publishing manager and the editorial office.

Almubarak et al., report an interesting case of Small Cell Cancer of the Parotid Gland. The authors stressed that salivary gland small cell carcinomas (SmCC) are extremely rare and metastasis from lung only being reported in select case studies. This is a case of parotid gland SmCC and lung SmCC. The pulmonary mass may represent metastasis from the parotid tumor. However, a new lung primary could not be excluded. A synchronous primary lung SmCC appears to be more likely.

Helvaci et al., stressed that Triglycerides may be acute phase reactants which are not negatively affected by pathologic weight loss. They pointed that Sickle cell diseases (SCD) are chronic inflammatory process on vascular endothelium terminating with atherosclerosis induced end-organ failures in early decades of life. Consecutive patients with the SCD and controls were studied. The study included 363 patients with the SCD (169 females) and 255 age and gender-matched controls (119 females). Mean ages of the SCD patients were similar in males and females (31.1 versus 31.0 years, respectively, p>0.05). Although the body weight and body mass index (BMI) were significantly retarded in the SCD patients (59.9 versus 71.5 kg and 21.9 versus 25.6 kg/m2, respectively, p= 0.000 for both), the body heights were similar in both groups (164.9 versus 167.0 cm, p>0.05). Parallel to the retarded body weight, fasting plasma glucose (92.8 versus 97.6 mg/dL, p= 0.005), total cholesterol (121.4 versus 165.0 mg/dL, p= 0.000), low density lipoproteins (70.4 versus 102.4 mg/dL, p= 0.000), high density lipoproteins (26.0 versus 39.6 mg/dL, p= 0.000), systolic blood pressures (BP) (115.2 versus 122.6 mmHg, p= 0.000), and diastolic BP (73.0 versus 86.6 mmHg, p= 0.000) were all lower in the SCD patients, significantly. Interestingly, only the triglycerides (TG) value was higher in the SCD patients (129.4 versus 117.3 mg/dL, p= 0.000), significantly. Similarly, the alanine aminotransferase value was not suppressed in the SCD patients, too (27.4 versus 27.3 U/L, respectively, p>0.05). The authors concluded that plasma TG may be acute phase reactants indicating disseminated endothelial injury and accelerated atherosclerosis all over the body, and their plasma values are not negatively affected by pathologic weight loss.

Helvaci et al., stressed that total bilirubin value of the plasma may have prognostic significance in sickle cell diseases (SCD). All patients with the SCD were included between March 2007 and June 2016. They studied 253 patients (128 females) with a plasma bilirubin value of lower than 5.0 mg/dL and 109 patients (43 females) with a value of 5.0 mg/dL and higher. There were 31 deaths during the ten-year period (14 females with a mean age of 33.3 and 17 males with a mean age of 30.2 years, p>0.05). Although the similar mean ages (30.2 versus 31.7 years, p>0.05), male ratio (60.5% versus 49.4%, p<0.05), ileus (3.9% versus 10.0%, p<0.01), digital clubbing (6.3% versus 26.6%, p<0.001), leg ulcers (12.2% versus 20.1%, p<0.05), pulmonary hypertension (9.4% versus 23.8%, p<0.001), cirrhosis (1.5% versus 15.5%, p<0.001), chronic renal disease (CRD) (6.7% versus 12.8%, p<0.05), and exitus (4.7% versus 11.9%, p<0.001) were all higher in patients with the plasma bilirubin value of 5.0 mg/dL and higher. The authors concluded that SCD are severe inflammatory processes on vascular endothelium, particularly at the capillary level and terminate with an accelerated atherosclerosis induced end-organ failures in early years of life. Total bilirubin value of the plasma may have prognostic significance due to the higher prevalences of ileus, digital clubbing, leg ulcers, pulmonary hypertension, cirrhosis, CRD, and exitus in patients with the plasma bilirubin value of 5.0 mg/dL and higher. The higher bilirubin values may either show the severity of hemolytic process initiated at birth or an advanced hepatic involvement in such cases.

A paper from Lebanon reviewed the overall strategies for management of Parkinson disease. It is part five of a series of papers on Parkinson disease. The author stressed that Parkinson's disease has a wide variety of motor and non-motor symptoms. Treatment aims to control the patient's symptoms by replenishing the dopaminergic system with levodopa or dopamine agonists. Monoamine oxidase B inhibitors are also effective first-line drugs. Keeping symptoms under continual control early in the course of the disease may have beneficial effects as Parkinson's disease progresses. Therapy is tailored to each patient's response to the drugs and their ability to tolerate them. Limited responses of motor and many non- motor symptoms may require the addition of other treatments. The adverse effects of drugs used in the treatment of Parkinson's disease are usually reversible. As the disease progresses and problems accumulate, deep brain stimulation (DBS) surgery may be a reasonable therapeutic option for some individuals, although many people with PD do not qualify for DBS for a variety of reasons. In addition nonpharmacological alternatives are helpful , including diet, exercise and occupational therapy. However, the majority of people with PD can lead full and active lives with good symptom control for many years.