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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In this issue a number of paper reviewed issues of interest to the medical field including CPR, sickle cell, frailty and surgical review.

Bshabshe et al., did a retrospective descriptive study conducted in the Southern Region of Saudi arabia and enrolled 1185 subjects. After attaining a formal consent , a pre-formulated questionnaire formulated on themes from the literature review was given to the subjects which addressed some basic questions about their opinions regarding family presence during cardiopulmonary resuscitation. After attaining a formal consent , a pre-formulated questionnaire formulated on themes from the literature review was given to the subjects which addressed some basic questions about their opinions regarding family presence during cardiopulmonary resuscitation. Out of the 1185 respondents, 174 (14.6%) had witnessed the CPR of their relatives while 85.3% had never done so. This study demonstrated that more than half of the family members (58.9%) expressed a desire to be with their loved ones during resuscitation. The authors concluded that most of the family members wish to be present with their relatives at the time of CPR. However, more than 50% subjects we interviewed were concerned that it may have a negative effect on them in the long term. Thus , all family members must be allowed an option to witness the efforts of the medical team during CPR and their wishes must be respected and it is the duty of the hospital to facilitate this process by all means necessary.

Helvaci et al., tried to understand whether or not there is a significant relationship between acute chest syndrome (ACS) and atherosclerosis in sickle cell diseases (SCD). All patients with the SCD were included. The study included 434 patients (222 males) with similar mean ages in male and female genders (30.8 versus 30.3 years, respectively, p>0.05). Smoking (23.8% versus 6.1%, p<0.001) and alcohol (4.9% versus 0.4%, p<0.001) were 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 hardened RBC into the tissues. Although the higher smoking and alcohol-like strong atherosclerotic risk factors and disseminated teeth losses, COPD, ileus, cirrhosis, leg ulcers, digital clubbing, CHD, CRD, and stroke-like obvious atherosclerotic consequences in male gender, ACS was not higher in them, significantly. In another definition, ACS may not have an atherosclerotic background in the SCD.

In the second paper Helvaci et al.,tried to understand prevalence and clinical severity of sickle cell anemia (SCA) alone or sickle cell diseases (SCD) with associated alpha- or beta-thalassemias in adults. All adults with the SCA or SCD were studied. The study included 441 patients (215 females). The prevalence of SCA was significantly lower than the SCD in adults (29.0% versus 70.9%, p<0.001). The mean age and female ratio were similar in the SCA and SCD groups (31.2 versus 30.5 years and 52.3% versus 47.2%, p>0.05 for both, respectively). The mean body mass index was similar in both groups, too (21.5 versus 21.7 kg/m2, p>0.05, respectively). On the other hand, the total bilirubin value of the plasma was higher in the SCA, significantly (5.7 versus 4.4 mg/dL, p= 0.000). Whereas the total number of transfused units of red blood cells in their lives was similar in the SCA and SCD groups (43.6 versus 37.1 units, p>0.05, respectively). The authors concluded that the SCA alone and SCD are severe inflammatory processes on vascular endothelium particularly at the capillary level, and terminate with an accelerated atherosclerosis and end-organ failures in early years of life. The relatively suppressed hemoglobin S synthesis in the SCD secondary to the associated thalassemias may decrease sickle cell-induced chronic endothelial damage, inflammation, edema, fibrosis, and end-organ failures. The lower prevalence of the SCA in adults and the higher total bilirubin value of the plasma in them may indicate the relative severity of hemolytic process, vascular endothelial inflammation, and hepatic involvement in the SCA.

Abyad & Hammami reviewed evaluation of frailty. They stressed that Life expectancy continues to rise globally. However, the additional years of life do not always correspond to years of healthy life, which may result in an increase in frailty. Given the rapid aging of the population, the association between frailty and age, and the impact of frailty on adverse outcomes for older adults, frailty is increasingly recognized as a significant public health concern. Early detection of the condition is critical for assisting older adults in regaining function and avoiding the negative consequences associated with the syndrome. Despite the critical nature of frailty diagnosis, there is no conclusive evidence or consensus regarding whether routine screening should be implemented. A variety of screening and assessment instruments have been developed from a biopsychosocial perspective, with frailty defined as a dynamic state caused by deficits in any of the physical, psychological, or social domains associated with health. All of these aspects of frailty should be identified and addressed through the use of a comprehensive and integrated approach to care. To accomplish this goal, public health and primary health care (PHC) must serve as the fulcrum around which care is delivered, not just to the elderly and frail, but to all individuals, by emphasizing a life-course and patient-centered approach centered on integrated, community-based care. Personnel in public health should be trained to address frailty not just clinically, but also in a societal context. Interventions should take place in the context of the individuals' environment and social networks. Additionally, public health professionals should contribute to community-based frailty education and training, promoting community-based interventions that assist older adults and their caregivers in preventing and managing frailty. The purpose of this paper is to provide an overview of frailty for a public health audience in order to increase awareness of the multidimensional nature of frailty and how it should be addressed through an integrated and holistic approach to care.