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COVID-19 has become a major global public health threat. It started from Wuhan a province of China in December 2019 and has spread in every country of the globe with over 100 million people currently infected and over three million deaths as of May 2021. Nearly a year on, with many town and cities are in lockdown and with all public health measures to minimize transmission of the virus SARS-COV-2 and the scientific achievements with many vaccines developed in record time, the transmission in the second wave is still strong with new variants of the virus emerging. The pandemic has caused a serious impact on the economic, social, political, and cultural dynamics of people, globally. The majority of people with mild and moderate symptoms of COVID-19 seek primary care (PC) service as the entry point for getting medical intervention, reducing flow to hospital care. Currently, primary care settings are facing major challenges including lack of funds, poor infrastructure in some countries, and shortage of health care workers and equipment. Most, if not all primary care centers are not designed to separate people with the virus. The pandemic so far shows that strengthening primary care as the first point of contact with the health system is vital. The health systems of the future cannot be resilient without strong primary care for all, capable of meeting population health needs and aspiration for good health and well-being. [ABSTRACT FROM AUTHOR] Copyright of Middle East Journal of Family Medicine is the property of Medi+WORLD International Pty. Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

BACKGROUND Evidence suggests that perioperative blood loss and blood transfusions are associated with poorer long-term outcomes in patients undergoing other oncological surgery. The aim of this study was to determine the long-term outcomes of patients requiring a blood transfusion post-hepatectomy for colorectal liver metastases (CRLM). METHODS This is a retrospective review from 2005 to 2012. Overall survival (OS) and recurrence-free survival (RFS) were assessed using Kaplan-Meier curves. Red blood cell transfusion (RBCT) and other clinic-pathological parameters were handled as covariates for Cox regression analysis. RESULTS Six hundred and ninety patients were included. Median follow-up was 33 months. Sixty-four (9.3%) patients required a perioperative RBCT. RBCT was a predictor for decreased OS (median 41 versus 49 months, P = 0.04). However, on multivariate regression analyses preoperative chemotherapy, post-operative complications and Clinical Risk Score were independently associated with reduced OS, though RBCT was not. There was no association between RBCT and RFS (median 15 versus 17 months, P = 0.28). CONCLUSIONS RBCT is not independently associated with a poorer OS.

(1) Department of Family Medicine, Aga Khan University, Karachi, Pakistan (2) Director General, Executive Board, Health Ministers’ Council for Cooperation Council States (3) Professor of Public Health, Director, WHO Collaborating Centre, Department of Primary Care and Public Health, School of Public Health, Faculty of Medicine Imperial College London, UK (4) University of Dammam, Saudi Arabia (5) Department of Family & Community Medicine, Arabian Gulf University, Bahrain (6) Vice Dean for Clinical Affairs, Oman Medical College, Sultanate of Oman (7) Family Physician, Bahrain (8) Department of Family Medicine, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia (9) Department of Family Medicine, Cairo University, Egypt (10) Senior Specialist Family Physician, Baghdad, Iraq (11) Family Physician, Amman, Jordan (12) Head of the Primary Health Care Faculty at the Kuwait Institution for Medical Specialization. (13) Assistant Program Director in Family Medicine Residency Program-Qatar.

Evidence suggests that perioperative blood loss and blood transfusions are associated with poorer long-term outcomes in patients undergoing other oncological surgery. The aim of this study was to determine the long-term outcomes of patients requiring a blood transfusion post-hepatectomy for colorectal liver metastases (CRLM).This is a retrospective review from 2005 to 2012. Overall survival (OS) and recurrence-free survival (RFS) were assessed using Kaplan-Meier curves. Red blood cell transfusion (RBCT) and other clinic-pathological parameters were handled as covariates for Cox regression analysis.Six hundred and ninety patients were included. Median follow-up was 33 months. Sixty-four (9.3%) patients required a perioperative RBCT. RBCT was a predictor for decreased OS (median 41 versus 49 months, P = 0.04). However, on multivariate regression analyses preoperative chemotherapy, post-operative complications and Clinical Risk Score were independently associated with reduced OS, though RBCT was not. There was no association between RBCT and RFS (median 15 versus 17 months, P = 0.28).RBCT is not independently associated with a poorer OS.

Objective: Our aim was to assess the short-term impact of centralization on the outcomes of patients undergoing abdominal aortic aneurysm repair in a vascular network in the South West of England.Background: The centralization of vascular services has been implemented nationally across the National Health Service to improve patient outcomes. The full impact of these major changes has not yet been fully analyzed.Methods: A retrospective cohort study examining outcomes of patients undergoing abdominal aortic aneurysm repair, based on prospectively entered National Vascular Registry data, pre and post centralization in the South West of England. The primary outcome was mortality at 30 days. Secondary measures included 30-day morbidity, length of hospital stay, and length of intensive care unit stay.Results: The 30-day mortality was unchanged pre and post-centralization (11% vs 12%, P = 0.84). The 30-day morbidity rate was also unchanged (24% vs 25%, P = 0.83), as was length of intensive care unit stay (3 vs 3 days, P = 0.74). Overall length of stay was not significantly different (8 vs 6 days, P = 0.76). Subgroup analysis of patients with elective, ruptured, and symptomatic aneurysm repair demonstrated no differences in 30-day mortality. There was a significantly shorter stay post-centralization for patients with symptomatic aneurysms (6 vs 12 days pre-centralization, P = 0.012).ConclusionsThe process of centralisation of abdominal aortic aneurysm repair in a vascular network was safe for patients and had no immediate impact on outcomes. Longer-term outcome measures and financial data will be required to further assess the benefit of centralisation.

Background: Allergic rhinitis (AR) is the most common allergic problem in Kuwait. Most of the patients who have either AR or asthma are referred to the Al-Rashed Allergy Center. Objective: To determine if there is a seasonal variation in AR in Kuwait and to correlate it with the daily pollen count. Methods: Information about the new patients referred to the center over a 5-year study period (1996–2000) was extracted from the center’s records. The daily pollen count in Kuwait city was obtained from the Air Biology Laboratory. Results: There was a significant seasonal variation with a bimodal increase in the number of patients with AR referred to the center. The main peak in the number of patients occurred in September–October, and there was a smaller peak in April–May. The mean number ± SD of new patients per month over the 5-year period varied from 87 ± 32 for December to 367 ± 104 for September. Similarly, the average daily pollen count varied from 3.7 ± 1.0 pollens per mm3 in January to 124 ± 92 in October. There was high correlation between the number of new AR patients and the average total pollen count (Pearson correlation, r = 0.77, p < 0.001), as well as with Chenopodiaceae and Amaranthaceae (weed) pollens (r = 0.75, p < 0.001), while there was no correlation between the number of new patients and either tree or grass pollens. Conclusion: Seasonal AR occurs during two periods in Kuwait, i.e. September–October and April–May, with September–October being the main season. The rise in AR during late summer in Kuwait is mainly associated with the pollination of Chenopodiaceae species.

Recent literature shows a high prevalence of psychological distress in bronchial asthma.To find the extent of psychological distress and associated risk factors in bronchial asthma patients in Kuwait.Case-control study.In a study at Kuwait's allergy center, 102 patients aged 20-60 years with asthma (67%), asthma with allergic rhinitis (33%) completed a self-administered questionnaire (WHO-Five Well-being Index). A score below 13 was considered as psychological distress; and 13 and above, as normal. An equal number of controls, matched for age, gender, nationality, were also enrolled.The data were analyzed using SPSS software, and proportions were tested with Chi-square or Fisher's test. Odds ratio (OR) with 95% confidence interval (CI) was calculated to quantify the risk factors.A significantly large proportion (69%) of patients were found to be psychologically distressed, compared to 24% among controls (P0.001, OR=7.5; 95% CI: 4-14). As many as 83.3% of cases, in the younger (20-30 years) age group, were distressed (P0.044), compared to other age groups. A declining trend in proportion of distressed cases with increasing age was observed (P0.013). A higher proportion of females (73.8%) and Kuwaitis (71.6%) with distress were observed, both among cases and controls.We found a high rate of poor well-being and psychological distress in patients suffering from asthma. Young patients and those with relatively short duration of illness, as well as asthmatic females, are more vulnerable to distress and need further psychological evaluation.

A most unusual case of Munchausen's syndrome in an 18-year-old Yemeni female is described. The patient presented with bleeding from various sites; repeated subcutaneous emphysema of the face, orbit and upper chest; ulcers on the tongue, and dermatitis autogenica. The illness was confirmed to be factitious and self-induced when she was caught red-handed trying to inject air. We believe this to be the first report of a case where all these features occurred concurrently and only the second report where a patient developed self-induced orbital emphysema.

The presentations of acute angioedema vary and depend upon the organs involved. Acute episodes of angioedema can be life-threatening if it involves the larynx leading to the obstruction of upper airways and it is a major cause of death. Angioedema involving the lips, cheek and tongue are common with bizarre presentations. Angioedema of the gastro intestinal tract frequently mimic an acute abdomen resulting in unnecessary surgical intervention and increased morbidity. Here we present an unusual case of angioedema involving the external urethra resulting in severe discomfort and burning sensation during micturition. He was later investigated and diagnosed as idiopathic urticaria with angioedema and promptly responded to antihistamines.