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 of the journal various authors discussed a number of issues related to the field. A paper from Jordan looked at Adaptive Support Control Volume (ASV) and Early weaning of Ventilator in Intensive Care Unit. The aim of the authors is to demonstrate the role of choosing the mode of ventilator in the patient's outcome and therefore early weaning from ventilators. One hundred twenty six patients were randomly taken in this study, in two groups, sixty four patients in group (A) using the synchronized intermittent mandatory volume (SIMV) , and other sixty two patients (B) group using an adaptive control volume (ASV) as an other mod . the authors found that patients who were on adaptive support volume(ASV) group (B) has faster process of weaning and early extubation, and show better arterial blood gases with easier management ,which lead to early discharge from the ICU. They concluded that training to use the new mechanical ventilators modes like adaptive support ventilation(ASV) is advisable, in some patients to wean and extubate early in comparison with the ( SIMV) mode with best arterial blood gases and early discharging from the intensive care unit.

A paper from Libya reviewed the culture and the rituals around skin colors. Skin is the most voluminous structure of the body. There is an exponential interest both from the doctors as well as our patients seeking resolutions towards maintaining and attaining a perfect skin. White skin is the dream of all Arab women with a particular attention in Libya and a fair skin is symbolized as a beauty sign. Libyan women tend in the summer time to shade themselves from the sun and deprive themselves from the benefit of sun and vitamin D for their big wedding day. Skin lightening cosmetics are widely used in most African countries including Libya where Libyan women are obsessed by it due to certain brands ruthlessly advertising fair and lovely skin, and it is a growing problem. Use of cosmetic products to bleach or improve the skin texture and color is a habit chiefly among dark-skinned Libyan women. The concept of having white' skin complexion has been considered trendy and desirable. The active ingredients in these cosmetic products are mainly hydroquinone, mercury and corticosteroids in higher concentrations. Several additives are used to enhance the bleaching achievement. Since these products are used mostly for longer period, on a large body surface area, and under hot moist circumstances, the per-cutaneous absorption is boosted. Thus the complications of these products are very detrimental and are sometimes can be deadly. Hyperpigmentation disorders and skin lightening treatments have a significant impact on the dermatologic, physiologic, psychological, economic, social, and cultural aspects of life. Raising patient's awareness is vital to avoid such irreversible complications. The author concluded that, it is mandatory to raise more knowledge and understanding on the occurrence and dangers of this misuse practice.

A paper from Turkey looked at the effect of low dose aspirin on sicke cell patients. SCDs patients with red blood cell (RBC) 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. The study included 224 patients (70.8%) in the first and 92 patients (29.1%) in the second groups (p<0.001). Mean ages were similar in both groups (28.9 and 30.0 years, respectively, p>0.05). Male ratio was significantly higher in the second group (45.5% versus 64.1%, p<0.001). Although smoking was also higher in the second group (12.0% versus 17.3%, p>0.05), the difference was nonsignificant probably due to the small sample size of the second group. Mean units of transfused RBCs were 12.9 and 99.0 in the groups (p<0.000). Although white blood cell and PLT counts of peripheric blood were higher in the second group, the difference was only significant for the PLT counts (p= 0.005), probably due to the same reason above. Number of painful crises per year, digital clubbing, chronic obstructive pulmonary disease, leg ulcers, stroke, chronic renal disease, and coronary heart disease were higher in the second group, significantly (p<0.05 for all). The authors concluded that SCDs are chronic inflammatory processes on endothelium mainly at the capillary level, and there was a highly significant association between PLT count and severity of the SCDs. So low-dose aspirin will probably be beneficial for patients with SCDs.

A paper from Lebanon reviewed progressive ataxia of unknown origin. The hereditary ataxias are a heterogeneous group of diseases. Most attempts at classification have been based on pathologic findings and are not always useful for the clinicians. Many of these disorders are multisystem degeneration in which the underlying biochemical or other defect is usually unknown. The pathophysiology is correspondingly poorly understood. Hereditary ataxia can be divided into the hereditary congenital ataxia, the ataxia linked with metabolic disorder, and early onset ataxia of unknown etiology.