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Background: Globally, Primary Health Care (PHC) remains the backbone of health systems and the entry point to access healthcare services. During COVID-19 pandemic, the PHC remain disrupted, and its essential functions were thus taken over by hospitals. This created intense pressure on already strained hospitals and thus the role of PHC got overlooked. It is therefore important to invest in PHC to make it resilient to crisis. As the global evidence on the role performed by PHC during the COVID-19 pandemic is continuing to evolve. The gap in the available evidence do not provide insights on how well the PHC systems remain resilient in continuing to provide the healthcare service during the pandemic. Objectives: To generate and synthesize evidence from low- and-middle- income countries (LMICs) on resilience of PHC systems during COVID-19 pandemic. Methods: A scoping review will be carried out. This will include a broad and iterative search strategy using multiple data electronic database involve: National Library of Medicine (NLM) and WHO COVID-19 research data bases. The scoping review approach proposed by Arksey and O’Malley will be used. This includes, identifying the research question, selecting search strategies to select available literature, study selection and screening and data extraction and analysis. Data from the identified studies in low- and middle-income countries (LMICs) will be charted in the data extraction sheet comprising of three components of PHC strategy addressed by Astana declaration, mentioning of WHO building blocks, resilient strategies adopted, targeted services, targeted audience, key recommendations, main outcome alongside the required details of the paper/documents. Later, the health systems building blocks framework (governance, financing, service deliver, workforce, supplies and equipment and information system) adapted from WHO Position paper, Sagan et al, 2020 and Blanchet et al, 2017 for PHC health systems resilience will be used to analyze and synthesize the available evidence on the shock absorptive, adaptive and transformative capacity of PHC system. Expected Outcomes: The study will provide a holistic understanding of the resilience of PHC system in LMICs across the six health systems building blocks.

Introduction Ventilator-associated tracheobronchitis is a condition that occurs prior to the development of ventilator-associated pneumonia among patients who have been intubated. This study aimed to determine the impact of nosocomial tracheobronchitis (NTB) related to new bacteria on the outcome in patients with chronic obstructive pulmonary disease (COPD). Methodology A prospective, observational study was conducted in the department of surgical ICU of a tertiary care hospital between May 2019 and December 2019. All patients ventilated, irrespective of age and gender, were enrolled in the study. Individuals who had nosocomial pneumonia, before or followed by NTB, were excluded. Throughout the study, endotracheal aspirates for quantitative bacterial cultures were obtained routinely on admission, weekly thereafter, and whenever NTB or nosocomial pneumonia was suspected. All data were prospectively collected by the researchers from admission day till discharge or death of the patient. The outcomes of NTB patients were compared with those without NTB. Results A total of 24 patients with NTB and 214 patients without NTB were evaluated. There were a total of 24 patients who were diagnosed with NTB and 214 patients were NTB negative. There was a dominance of the male gender in the NTB group; however, the difference was not significant. The most common complication in patients was renal failure. During hospitalization, the Aspergillus tracheobronchitis (ATB) rate was significantly higher in patients with NTB as compared to patients with no NTB, i.e., 18 (75%) vs. 80 (37.4%) (p < 0.001). The mean length of stay in patients with NTB was significantly greater than the NTB negative group (p < 0.0001). The mortality in the case group was significantly greater than in the NTB negative group, i.e., 66.67% vs. 48.50% (p = 0.03). Conclusion NTB is associated with an increased duration of mechanical ventilation and hospitalization in intensive care units. The mortality rate in the NTB group was considerably higher than in the patients who did not have NTB. Future studies can explore the interventional and management aspect of the disease, such as determining whether early administration of broad-spectrum antibiotics can help improve the prognostic outcome of patients with NTB on mechanical ventilation.

COVID-19 is a global pandemic that has emerged and it is rapidly spreading throughout the world and subsequently causing great damage to the global economy and health-care. Patients with diabetes or other comorbidities are at a greater risk of developing severe illness. Knowledge and awareness are key elements to stimulate practice of preventive measures. The present study evaluated the level of knowledge and awareness about COVID-19 among individuals with diabetes and their compliance with the preventive measures against it. A total of 242 individuals who were diagnosed with diabetes mellitus and were 18 years or older participated in the study. The data was collected using an interview based questionnaire. Data was analyzed using Statistical Package for Social Sciences(SPSS) version 24. The mean age ± SD of the study population was 50.78 ± 11.24 years. In this study, 215 (88.8%) participants were aware that COVID-19 is caused by a virus and the disease is spread through droplets after sneezing or touching and shaking hands with an infected person (78.5%). However, only half the study populace regularly monitored their glucose level and complied with the “sick day rules” that is applicable during this pandemic. The present study indicates that despite the adequate knowledge and awareness about the coronavirus disease, the study participants were non-compliant with the practice of preventive and precautionary measures against the pandemic.