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March 2020 -
Volume 18, Issue 3

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From the Editor



Original Contribution

Evaluation of the quality of mental health referrals from Primary Care Physicians in Qatar
Kalim Zada, Mirza Anwarulhaq
DOI: 10.5742MEWFM.2020.93768

Primary Care Physicians’ Knowledge and Barriers against Practice of Healthy Lifestyle in Abha City
Hussein Ali Hussein Azaybi, Mohammed Ali Hussein Azaybi, Safar Abadi Alsaleem, Alhussein Ali Almonawar
DOI: 10.5742MEWFM.2020.93769


Knowledge about inguinal hernia among the Saudi Population
Mohammad E. Mahfouz, Alia M. AlShalawi , Abdulrahman A. Alzahrani , Sara H. Alqaidi, Rawan N. Al-Holaifi
DOI: 10.5742MEWFM.2020.93770

Predictors of Pediatric Intensive care Unit admissions among Children with Acute Asthma Exacerbation
Ali Alsuheel Asseri
DOI: 10.5742MEWFM.2020.93771

The survey of primary care physicians regarding attitude, confidence and knowledge in providing mental health care in Qatar
Kalim Zada
DOI: 10.5742MEWFM.2020.93772

Education and Training

Incorporating Resilience into the Family Medicine Training Curriculum
Mohsin Allah Ditta, Abubakar Bham
DOI: 10.5742MEWFM.2020.93776

Population and Community Studies

Determinants of autism among children in Makkah Al-Mukarramah City, Saudi Arabia: A case-control study
Abid Obaid Alqurashi,Rishi Bharti, Safar Abadi Alsaleem
DOI: 10.5742MEWFM.2020.93773

Does increased Body mass index increase the risk of recurrent pregnancy loss? Saleemah Abdul Majeed Omar, Alya Abdul-Rahman Sharef, Awara Ahmed Rashid
DOI: 10.5742MEWFM.2020.93774

Quality of Sleep among General Governmental Secondary School Students in Abha City, Saudi Arabia Yahia M. Al-Qahtani, Hamad M. Al-Qahtani, Bothyna M. Mohamed, Fatima Riaz , Ossama A. Mostafa
DOI: 10.5742MEWFM.2020.93775

Case reports

Case Report: Detection and Excision of Melanoma in Situ in an Australian Primary Care Setting
Abubakar Bham
DOI: 10.5742MEWFM.2020.93778

Disseminated Tuberculosis: A Rare Presentation
Fazila Khattak, Husam Al Saudi
DOI: 10.5742MEWFM.2020.93777

Middle East Quality Improvement Program

Chief Editor -
Abdulrazak Abyad MD, MPH, MBA, AGSF, AFCHSE


Publisher -
Lesley Pocock
medi+WORLD International

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March 2020 - Volume 18, Issue 3

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