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From
the Editor
This issue is rich with topics of concerns
to primary care in the Region and Worldwide.
Alqurashi A.O et al carried a case-control
study design, 100 autistic children 3-12 years
old were selected from four rehabilitation autistic
children in addition to 100 age-matched non-autistic
children (control group) who were recruited
from nearby kindergarten centers and primary
schools. The aim was to identify risk factors
associated with autism among autistic children
in Makkah Al-Mukarramah City. Most autistic
children (74%) were diagnosed at the age of
4-8 years. The mean age at diagnosis was 6.1±2.4
years.. Mothers of autistic children have been
significantly more exposed to smoke than those
of non-autistic children (15% and 6%, respectively,
p=0.038). Autistic and non-autistic children
did not differ significantly according to their
family, prenatal and postnatal characteristics.
The author concluded that most autistic children
become diagnosed at 4-8 years old. The female:male
ratio among autistic children is about 1:3.
Advanced parental age is a significant risk
factor for autism among their children. Exposure
of mothers to smoke is a risk factor for autism
among her children.
In two papers the issues of mental health in
Qatar within primary care was presented. Zada
K and Anwarulhaq M evaluated the the quality
of mental health referrals from primary care
physicians in Qatar. They collected 234 psychiatric
referrals from Qatari primary care clinics and
assessed their quality using a seven-item inclusion
checklist derived from existing research and
best practices. Psychiatrists rated all of the
checklist items as important, with "reason
for referral" and HPI rated as most important.
The authors concluded that mental health referrals
from primary care physicians in Qatar suffer
from a profound lack of basic data; reasons
for this may include gaps in primary care physicians'
knowledge and self-efficacy about mental health
care. Primary care physicians must be supported
to improve referral quality, which will result
in better and more efficient mental health care
delivery. K Zada, K et al , collected anonymous
surveys from primary care physicians working
in the Primary Health Care Corporation (PHCC).
The survey collected demographic data about
the respondents, and used the well-validated
Mental Illness: Clinicians' Attitude Scale (MICA-4)
to assess attitudes and confidence about mental
health treatment, as well as a knowledge assessment
tool developed locally. There were 115 respondents,
most of whom were male (67%) and aged 36-55
(80.4%). Most respondents (75.7%) had less than
two years of psychiatric training or experience,
and had taken two or fewer psychiatric education
courses in the last year (83.4%). The authors
concluded that Primary care physicians in Qatar
are willing to treat mental health conditions
and feel confident about doing so. They have
good fundamental knowledge but appear to lack
knowledge of local (PHCC) policies about managing
common mental health conditions.
Azaybi H.A.H et al, carried a descriptive cross-sectional
study including all physicians worked in the
primary health care centers (PHCCs) in Abha
City. In order to assess primary care physicians'
knowledge and identify barriers against achievement
of a healthy lifestyle. Also to detect which
of the physicians' characteristics are significantly
affecting their knowledge level. High knowledge
regarding health lifestyle was recorded among
84.3% of the included physicians and 77.9% had
good healthy life. None sleeping for enough
duration was the most recorded barriers among
physicians (62.1%) followed with non-fixed time
to go sleep (55.7%). The authors concluded that
knowledge of the PHCCs physician regarding healthy
life style was high especially old aged experienced
physicians. Many barriers were recorded for
adopting health lifestyle, especially sleeping
time.
Asseri A.A did a retrospective chart review
study was approved by the institutional review
board at Abha Maternity and Children Hospital,
Saudi Arabia. Children were also enrolled if
the parents reported previous use of inhaled
corticosteroids for asthma control therapy.
The diagnosis of asthma was confirmed by either
a pediatric allergist or a pulmonologist who
was actively involved in inpatient and outpatient
asthma care. Of the 128 patients enrolled in
the study, 31 required PICU admissions. No statistically
significant difference was detected between
age and age categories (<3, 3-6, and >6
years) in children admitted to the pediatric
ward and PICU. The authors concluded that previous
PICU admissions and SpO2 measurements at the
emergency department (ED) are independent predictors
of needing intensive care admission for children
between 2 and 12 years of age with acute asthma
exacerbation. Nevertheless, further studies
are needed to explore additional modifiable
predictors that could help in identifying children
with a high risk for intensive care admissions.
Al-Qahtani Y.M et al , investigated sleep quality
and its associates among secondary school students.
A total of 400 secondary school students (200
males and 200 females) in Abha City were included.
A total of 171 students (42.8%) had poor quality
of sleep, while 177 students (44.3%) had insomnia.
The authors concluded that poor sleep quality
and insomnia are common among secondary school
students in Abha City. Females and cigarette
smokers are more prone to poor sleep quality.
Insomnia among secondary school students is
significantly associated with older age.
Mahfouz , M.E et al, did a cross-sectional
study and was done from May to August 2017.
1119 people participated in this study. The
aim was assessing the knowledge and awareness
about causes, risk factors, and proper management
of an inguinal hernia among the population of
Kingdom of Saudi Arabia (KSA). The electronic
online questionnaire was published through social
media in all regions of Saudi Arabia. It consists
of socio-demographic data, Past medical and
surgical history, Questions related to risk
factors. The authors concluded that the majority
of participants in our study were not fully
aware of the causes and management of a hernia.
Age, marital status, education level, number
of kids and occupation play a significant role
in the awareness. More educational programs
about inguinal hernias are needed.
Omar S.A.M et al, did a cross sectional study
of randomly selected 402 patient in reproductive
age, data obtained through standardized questionnaire
including obstetrical , medical and surgical
history information. BMI was divided according
to the the WHO criteria: underweight <19,
normal (19±24.9), over weight (25-29.9),
and obese women (BMI >30). Recurrent pregnancy
loss was no significantly more among those had
?5 kids 2(12.5%) than those had 0-1kids 14(6.1%).
Risk to have 1-2 miscarriage was significantly
0.3 times among those aged <18 years than
those aged 19-30 years, and those had 2-4 kids
1.6 times than those had 0-1 kid. The authors
concluded that obesity was significantly associated
with increased risk of RPL, it is important
to recommend females with recurrent pregnancy
loss to decrease weight in order to get better
results.
Helvaci M.R et al, tried to understand significance
of high density lipoproteins (HDL) in metabolic
syndrome. Patients with plasma HDL values lower
than 50 mg/dL were collected into the first
and 50 mg/dL and higher into the second groups.
Although the decreased male ratio, smoking,
plasma triglycerides values, and COPD, the mean
age, BMI, FPG, LDL, WCH, HT, and DM increased
by the increased plasma HDL values. Due to the
significant relationships between male ratio,
smoking, plasma triglycerides values, and COPD,
HDL may not be good prognostic parameters of
the metabolic syndrome.
Ditta M.A & Bham A discussed incorporating
Resilience into the Family Medicine Training
Curriculum. They stressed that family medicine
training curriculum is of upmost importance
in that it informs the learner what needs to
be learned, the teacher what needs to be taught
and also then determines that which is to be
assessed. A study conducted using the Maslach
burnout inventory (MBI) surveyed 564 GPs. The
results showed 46% had high levels of "emotional
exhaustion and depersonalisation" and 34%
reported low levels of personal accomplishment.
Therefore the authors stressed that Training
curricula can be enhanced is by incorporating
'resilience' training in to the formal curriculum.
The GMC mention behaviours as well as knowledge
in their definition of curriculum so resilience
could be behaviour trait that is encouraged
through curriculum design, planning and consideration
for nations that have formal family medicine
residency programmes.
Khattak F & Al Saudi H, reported a case
of an atypical presentation of disseminated
tuberculosis in a forty-one-year-old otherwise
healthy female. Although tuberculosis has been
known to mankind for centuries and there is
a vaccine against the disease and multiple newer
antibiotics available in today's world, still
it is one of the major causes of morbidity and
mortality and its presentation can be deceptive
and diagnosis can be difficult.
This is a case report of a 41-year-old female
who presented with a short history and acute
symptoms that are atypical for tuberculosis.
This case demonstrates the deceptive presentation
of this disease and hence importance that clinicians
need to be more vigilant, otherwise an important
disease that needs timely diagnosis and treatment
can be missed.
Bham A, report a case of Melanoma in Situ in
Australian primary care setting. Melanoma rates
in Australia are amongst the highest in the
world and there is an increasing global incidence
of rates of melanomas. The life time risk being
2.4% in Caucasians. A 65-year-old farmer presented
to a Family Practice Clinic in Mundijong, Western
Australia which is a semi-rural practice. He
had a long-standing skin lesion on his upper
back that had recently changed color which is
a red flag. The patient had a past medical history
of Ischemic Heart Disease, Mechanical Heart
Valve and Atrial Fibrillation and was taking
Bisoprolol, Atorvastatin, Ramipril and Warfarin.
He had no allergies. This 65 year old farmer
presented with a pigmented skin lesion that
was assessed using dermoscopy which suggested
features of melanoma. Dermoscopic examination
can aid early detection of skin malignancy.
An excisional biopsy revealed a Melanoma in
situ and a re excision was conducted to ensure
adequate 10mm margins. Primary care can play
an important role in the early detection and
management of pigmented skin lesions.
Chief Editor:
A. Abyad
MD, MPH, AGSF, AFCHSE
Email: aabyad@cyberia.net.lb
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