Alexandre Favero Bulgarelli has his expertise in evaluation and assessment of Primary Health Services in development of Public Health Systems. Currently, he is a Public Health Professor at Federal University of Rio Grande do Sul, Brazil.

Statement of the Problem: The Brazilian awareness and investments to the control of tuberculosis (TB) are associated with subjects like infectious diseases control programs, health promotion and construction of public policies regarding primary health assistance by means of the Unifi ed Health System (Portuguese Acronym is SUS). Somehow, Primary Health Care (PHC) contains the infrastructural and professional resources to carry out diagnosis and treatment of TB. Primary health care has good operational indicators regarding the control and management of TB in Brazil. Aim: Th e purpose of this study was to analyze physical infrastructure resources of primary health care centers at SUS regarding the control of TB in Brazil. Methodology & Th eoretical Orientation: It is a cross-sectional study based on data collected from 38812 primary health care centers in all Brazilian territory. All the health centers were visited by a group of researchers between 2011-2013. Th e researchers developed interviews with the health centers managers and checked for all infrastructure resources. Dependent variable were described by the presence and availability of the following infrastructure items: nursing consultation; vaccination facility room; air circulation; refrigerator; individual protective equipment; plastic jar to sputum; tuberculosis notifi cation form and BCG-ID vaccine. Th e covariables were related to: type of primary health center, week days of attendance, shift s of attendance, indoor services signaling and nursing consultation room with privacy. Poisson regression with robust variance was used to calculate prevalence ratio, with intervals of confi dence of 95%. Results: Of 38812 primary health care centers evaluated, only 1628 (4.18%) presented a positive result in all assessed infrastructure items, which drew up the study outcome. Among all types of centers, Primary Health Centers were associated with the highest quality in infrastructure for tuberculosis, in all Brazilian macro regions. Th e centers with larger shift s of attendance, as well as those that presented a list of off ered services and nursing consulting room, also presented highest quality. Conclusions: Th e present study points that improvements should be done regarding infrastructure resources to reach a satisfactory tuberculosis control nationwide. Public health policies should support these improvements to infectious diseases control within primary health care in Brazil.

Muna Habib Dawood Al Lawati , working as a head of Quality and Safety for primary health care at Directorate general for Muscat Region, Ministry of Health. Currently pursuing her PHD in patient safety at the University of Sydney, Australia.

Background: Patient safety is a universal issue which can affect countries at each stage of health system development. Research regarding patients’ safety in primary care concluded that millions of patients globally suffer disabilities, injuries or death annually due to unsafe medical practice. This has led to the wider recognition of the issue, incorporating of strategic plans in health care organizations and more widespread research in this field. Little has been published about patients’ safety in primary care from the Gulf Cooperation Council Countries (GCC) including Oman Aims: The aim of this project is to assess the understanding of primary health care staff regarding safety culture and their awareness of safety measures that should be followed during encounters with the patients. Methods: The study is a cross-sectional survey which assessed the perceptions of patient safety culture among health care professionals working in primary health care in Muscat, Oman, using an existing questionnaire known as Hospital Survey of Patient Safety Culture tool (HSOPSC). The systematic review which was conducted at an earlier identified that this tool was used in many cross cultural samples such as Turkey, Iran and Kuwait to assess safety culture, the same tool has been used to assess the safety culture in the Omani hospitals and it had been used in Kuwait which is one of the GCC countries, with a similar primary health care setting as Oman. By using this tool we will also be able to compare the patient safety culture in Oman with other countries. The survey was conducted in primary health care centers in Muscat, the capital of Oman. The sample included 22 health centers out of 28 health centers because they had services which includes general practice, nursing care and pharmacy these services are functional 7 times a week in addition to services such as laboratory, X ray services and dentistry care provided 5 days a week excluding weekends. The target population were all full time frontline health care professionals working in primary care in Muscat region. (Doctors, nurses, pharmacist, radiologist, laboratory technicians). A simple random sampling scheme was used in each primary health care center to select 10% of the outlined staff in each category. Hence, the total number of 207 participated in the survey. Preliminary results one hundred and eighty one (91%) of the participants responded in the study which included 42 Doctors (95%), 56 nurses (89%), 19 pharmacists (86%), 22 radiographer (100%), 22 laboratory technicians (100%) and 20 dentist (90%). Conclusion The results of this survey will inform policies and process for improving patient safety in primary care in Oman. In addition the results will enable comparisons with in other Eastern Mediterranean Countries which have used the same tool such as Iran, Kuwait, and Turkey. The study will help to form a possible template for building of a safety culture in primary health care in the context of a rapid economic development.

Marina Polić-Vižintin graduated from the School of Medicine, University of Zagreb in 1982. She defended her PhD thesis in 2015 at the same School of Medicine. She passed her specialist exam in Social Medicine in 1989. She is working at Dr Andrija Štampar Teaching Institute of Public Health. She did her postgraduate study in Gerontology and in Public Health. She was a Senior Lecturer at the University of Applied Health Studies in Zagreb. She participated in a number of research projects, took active part in many congresses and seminars in Croatia and abroad. She has published numerous professional and scientific papers in Croatian and international periodicals.

Aim: Depression is one of the most common mental disorders in general population. The aim of this study was to determine the effect of antidepressant consumption on the rate of hospitalization for depression and to reinforce the role of family physician in the early recognition and treatment of mild to moderate depressive disorders. Methodology: Hospitalization data were collected for every hospitalized patient in Zagreb hospitals during 2001-2010 period. Using the WHO Anatomical-Therapeutic-Chemical classification/Defined Daily Doses (ATC/DDD) methodology, the number of DDD was calculated from data collected from all Zagreb pharmacies on the number and size of drug packages. Results: From 2001 to 2010, the rate of hospitalization for depression has increased from 168,26/100.000 to 337,04/100.000. The mean length of hospital stay was reduced from 35 to 34.5 days. Outpatient utilization of anti-depressants increased by 90% (11.4 DDD/TID vs. 20.59 DDD/TID). The highest rise was recorded in the consumption of SSRI by 148 %, with an increased proportion of sertralin and fluvoxamine. Outpatient consumption of nonselective inhibitors of monoamine reuptake decreased by 68%. In the subgroup of other antidepressants, a rise was recorded in the consumption of mirtazapine and venlafaxine in particular. The anxiolytic/antidepressant ratio decreased from 6.45 in 2001 to 2.55 in 2010. Conclusion: Although the overall outpatient utilization of antidepressants increased during the study period, the rate of hospitalization for depression increased as well. The decrease in the utilization of anxiolytics with symptomatic action and the increased utilization of antidepressants with etiologic action points to improved psychopharmaceutical prescribing quality. Utilization of anxiolytics is still too high and irrational due to the high utilization of benzodiazepines. Continuous education of primary care physicians in early detection and treatment of mental disorders is required. Introduction of a questionnaire for early recognition of depression symptoms at the primary healthcare level would be highly useful.

Huda saleh alraddadi is a physician, graduated from medical school ,Taiba University in 2014. She is working as Demonstrator at Taiba University, family and community medicine department. First year resident in commuinty medicine Saudi board program. And has one published paper in Journal of Taiba university medical sciences in 2016

Objective: This paper aims to provide a brief overview of the published data about the prevalence of physical activity among young people aged from 14 to 25 in Saudi Arabia and discuss the factors associated with physical inactivity. Method: A literature Search was conducted in December 2016 with PubMed, Medline Saudi Journals and J store search using the following search term: physical activity, physical inactivity, lifestyle, adolescent, young, and college students. only studies done on Saudi population were selected. All related published articles from any time period through December 2016 were included. All studies don’t contain the prevalence or factor associated with physical inactivity are excluded. 40 articles talking about physical activity in Saudi Arabia were found, but 7 articles only targeted this young group who aged from 15-25 included .the rest of the 40 articles excluded because it targeted another age groups. Once the list of the selected articles were identified we extracted and cross checked the following for each: Authors, region in which study was conducted, samples characteristics( number, size, gender, age), physical activity measurements tools, and physical activity prevalence. Result: The samples in the studies included, ranged from 94 to 2908. Most studies used the Arab Teens Lifestyle Study (ATLS) questioner. the total rate of physical activity for both gender ranged from 13.9% to 26%. While physical inactivity was high as it ranged from 57& to 64.4% for both It Time constraint seems to be the major factor contributing to inactivity, lack of facility was listed next, followed by health condition Conclusion: prevalence of physical activity among adolescents in Saudi Arabia is low and, the sedentary lifestyle is prevalent among this young group Thus, prevention of lifestyle-related disease at an early age is an important public health priority, especially considering the fact that children and adolescents account for more than 50% of the Saudi population.

Dr. Aws Obaid has completed his Bachelor degree of physical therapy at Umm Alqura University; he has also participated in many international conferences and workshops. He is also a member of prestigious societies like, Saudi Scientific Diabetes Society, Saudi Physical Therapy Association SPTA, Saudi Spine Association, and Virtual Medical Academy Team.

Objective of the study : 1- To determine the differences between Infraspinatus radiating pain and C5 and C6 radiculopathy. 2- 2- To outline the similar signs and symptoms of Infraspinatus radiating pain and C5 radiculopathy. Case Description : A 38 year-old male patients chief complaint was neck pain , numbness and pain radiating to the left arm that started two years ago. Furthermore signs and symptoms included weakness in shoulder muscles and hand grip , affected Activity of Daily Living , as well as the pain had progressed. Pain constant and 6/10 according to Visual Analogy Scale. Subsequently he went to an orthopedic surgeon for an examination. MRI findings was (C5–C6 diffuse disc bulge and bilateral foraminal stenosis more in the left side) The physician thus recommended surgery for him: it was Anterior Cervical Discectomy and Fusion. post-surgery, the patient felt improvement but after five months symptoms re occurred ; the pain progress and became continuous , subsequently, he returned to his doctor, who then referred him to the physical therapy department. He came to the physical therapy clinic and a full assessment was conducted . Findings was nothing indicative to problem in the cervical and there was tightness in the Infraspinatus muscle . Dealing with him as a muscular dysfunction case, we treated him as follow: Myofascial release techniques , stretching exercises and Kinesio taping. After this session, the patient felt improvement and the symptoms started to disappear. In this case after the clinical examination there is no clinical evidence concerning nerve compression and the referral zone of the Infraspinatus muscle is very similar to C5 and C6 dermatomes; this may lead to confusion in the diagnosis of patients like this.

Hazem Amer has completed his Egyptian Fellowship in emergency medicine at 2008,and in 2016 he achieved membership by examination in Royal College of emergency medicine, worked as emergency medicine registrar in armed forces in KSA, where he was a member of morbidity and mortality committee, and the medical education director in emergency department in Prince Mansour Military Hospital.Joining Hamad Medical Corporation in 2013, where he became a faculty member and a mentor in residency program.He participated in educational activities, audits, headed a quality improvement project in Hamad General Hospital.

Introduction: Toxic epidermal necrolysis (TEN) is a severe mucocutaneous adverse reaction that is generally rare, but potentially life-threatening and commonly drug induced. The incidence of TEN is 1.2-6/million person-years. The average reported mortality rate of TEN is 25-35%;Phenytoin is commonly prescribed antiepileptic drugs. The incidence of phenytoin induced TEN was found to be 13.04%. Case presentation: Our patient is 38 years old male Nepalese patient who presented with seizures. His CT brain revealed neurocysticercosis. He has been discharged on phenytoin as prophylactic therapy. One month later he presented with fever, sore throat and rashes for the last month. Amoxicillin/Clavulanate prescribed to him for assumed tonsillitis. 3 days later, patient presented with extensive skin peeling of 100% of body surface area with mucous membranes involvement. Management and outcome: Supportive care started in ED and patient has been admitted to ICU for continued management. Discussion: Although unpredictable, serious sequelae of TEN can be prevented by early recognition and withdrawal of the culprit medications.