In this issue we have a good number of papers of interest to primary care in addition to a number of reviews on various issues.

Dr. Abdel Wahid did a descriptive cross-sectional hospital-based study. The objective of this study is to assess the knowledge and practice of taking the annual influenza vaccine among adult diabetic patients in BDF Hospital. Three hundred diabetic patients who are eligible for the study were interviewed, with a structured questionnaire. Results of the survey indicated that males and females included are 48% to 52% respectively, 95.3% of the whole population are doing regular F.U. but only 55.3 were doing regular F.U. The study, it was found that the main reason for not taking the flu vaccine is that they mainly did not know about the vaccine which constituted 49, 33% of the study population. So, knowledge and use are lower than optimal in the literature but here it is the lowest, which may be mostly due to reduced awareness of the benefits of the vaccine and it will most probably increase if there are increased efforts on advising direct contacts with the patients in the diabetic or other PHC clinics or through the media to have the seasonal flu vaccine.

Al Gethami et al., did a cross-sectional study carried out on 300 type 2 diabetic patients through an online survey. The purpose of this study was to ascertain the level of awareness among persons with type 2 diabetes in Taif, Saudi Arabia, regarding their risk of CVDs. The mean knowledge of risk of cardiovascular disease among adults in Taif was 15.4 ± 5.4 . 26% of the participants had an age ranged from 50-59 years and 57.1% were females. Most of the participants had an age of diabetes diagnosis more than 30 years and 41.7% had a duration of disease less than 5 years. This study found that adults with type 2 diabetes in Taif have a high level of knowledge about the risk of cardiovascular disease. Education and preventive measures for patients about CVD risk factors and diabetes management can improve health and reduce the risk of CVD.

Alshahrani et al., reviewed graves eye disease medical and surgical Management. They stressed that Graves' disease (GD) is the most frequent cause of hyperthyroidism, where iodine levels are abundant. One of the extrathyroidal symptoms is Graves' ophthalmopathy (GO) which presents with ophthalmic symptoms that can range from minor (e.g., dry eye) to sight-threatening (e.g., corneal ulceration and compressive optic neuropathy) Features.
About 79% of Graves' disease cases can be attributed to genetic predispositions, while the remaining 21% are due to environmental factors. A low basal serum Thyroid Stimulating hormone (TSH) level has the highest sensitivity and specificity for diagnosing hyperthyroidism. Moreover, the appearance of Thyroid Stimulating hormone receptors (TSHR) autoantibodies (TRAbs) is presumed to be highly specific for the diagnosis of Graves' disease. Therefore, it is essential to restore the euthyroid state and this can be obtained by either antithyroid medications, radioactive iodine or surgical thyroidectomy.

Dr. Abdulmohsin, reviewed the implementing of Patient-centered care in primary health care .
Patient-centered care is a critical component of healthcare delivery, emphasizing the involvement of patients in their care and the consideration of their preferences and needs. In Qatar, a country dedicated to providing high-quality healthcare, the implementation of patient-centered care in primary health practices is of paramount importance. This literature review examines the existing literature on patient-centered care implementation in primary health practices in Qatar, focusing on strategies, challenges, and outcomes. The review underscores the significance of cultural considerations, patient engagement, provider training, health information technology integration, quality improvement initiatives, multidisciplinary collaboration, and care coordination.

Al-Athari et al., presented a case of sleep apnea. This case report represents a comprehensive overview of the assessment, diagnosis, and subsequent management of a 60 years old patient who sought medical attention due to debilitating fatigue. Despite displaying atypical symptoms and an absence of characteristics signs, polysomnography revealed significant degree of obstructive sleep apnea. This case highlights the importance of considering sleep-related disorders in the differential diagnosis of fatigue and the remarkable efficacy of continuous positive airway pressure (CPAP) therapy in improving the patient's quality of life.

Al-Athari et al., presented a review on Fibromyalgia. Fibromyalgia is a common medical condition which still misdiagnosed with other rheumatological disorders. It can be complex and brings many challenges. Presentation can vary from patient to patient. It is estimated that around up to 5% of population may have fibromyalgia with more cases in women. Although there is no cure for this condition but more understanding of Fibromyalgia can contribute to a well-rounded effective treatment and therapy options via a multidisciplinary approach to help relieving the symptoms.

Ahmedana et al., reviewed the current evidence of incidence, predisposing factors and the prevention of DKA in T2DM patients on SGLT2Is use. Sodium-Glucose Transport Protein 2 Inhibitors (SGLT2Is) effectively controlled diabetes. Diabetic ketoacidosis (DKA) has been reported as a life-threatening adverse effect due to SGLT2Is use. 85 studies were identified in the initial search, 75 records were removed and finally, 10 studies were included. Only studies discussing the prevention of DKA in T2DM patients on SGLT2Is were selected, extracted and categorized into main domains that included SGLT2Is use inT2DM patients and DKA (50%), SGLT2Is use in T2DM patients (20%), the clinical presentation of DKA (20%) and DKA prevention (10%). Six studies showed SGLT2Is increased the risk of DKA and with very low rates in two studies. This review summarized the prevention of DKA in T2DM patients on SGLT2Is use with consideration of incidence, a summary of evidence and predisposing factors. Physicians, health care providers and patients should be aware of SGLT2Is use, regular follow up, precipitating factors, symptoms, signs and prevention of DKA.

Hatroom, et al., evaluate the effectiveness of transobturator approach in the treatment of female stress urinary incontinence and to analyze functional results. They retrospectively reviewed all medical files of patients presenting with urinary incontinence to our Urology Center in Aden, Yemen, over a 2-year period. There were 42 patients treated with TOT and the postoperative follow up of the patients was at least 10 months. The collected data were tabulated and statistical analysis was done by estimating rates, means and standard deviations. The age of the patients ranged between 40 to 80 years and their mean age was 62.1 ± 9.7 years. We grouped the study patients in two age groups, ? 60 years and > 60 years. The authors concluded that the transobturator approach is an effective treatment of stress urinary incontinence with low morbidity and with acceptable success and outcome.

Dr Ullah, reviewed insomnia in adults. Insomnia is a common and debilitating condition in adults, especially in the elderly. It is associated with poor mental health and contributes to the development of a wide range of medical conditions, including obesity, cardiovascular disease, diabetes and dementia. The condition is frequently missed or underdiagnosed and poorly managed. This brief review summarizes the etiology, clinical features, diagnosis and latest management strategies.