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Background: Telemedicine, once defined merely as the treatment of certain conditions remotely, has now often been supplanted in use by broader terms such as ‘virtual care’, in recognition of its increasing capability to deliver a diverse range of healthcare services from afar. With the unexpected onset of COVID-19, virtual care (e.g., telephone, video, online) has become essential to facilitating the continuation of primary care globally. Over several short weeks, existing healthcare policies have adapted quickly and empowered clinicians to use digital means to fulfil a wide range of clinical responsibilities which until then, have required face-to-face consultations. Objective: This paper aims to explore the virtual care policies and guidance material published during the initial months of the pandemic and examine their potential limitations and impact on transforming the delivery of primary care in high-income countries. Methods: A rapid review of publicly available national policies guiding the use of virtual care in General Practice was conducted. Documents were included if issued in the first six months of the pandemic (March to August of 2020) and focused primarily on high-income countries. Documents must have been issued by a national health authority, accreditation body, or professional organisation, and directly refer to the delivery of primary care. Results: We extracted six areas of relevance: primary care transformation during COVID-19, the continued delivery of preventative care, the delivery of acute care, remote triaging, funding & reimbursement, and security standards. Conclusion: Virtual care use in primary care saw a transformative change during the pandemic. However, despite the advances in the various governmental guidance offered, much work remains in addressing the shortcomings exposed during COVID-19 and strengthening viable policies so as to better incorporate novel technologies into the modern primary care clinical environment.

Pramendra Prasad Gupta,1 Rabin Bhandari,1 Deebya Raj Mishra,2 Krishna Kumar Agrawal,3 Rupak Bhandari,1 Sunil Jirel,1 Gyanendra Malla1 1Department of General Practice and Emergency Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal; 2Department of Internal Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal; 3Department of Internal Medicine, Nepal Medical College and Teaching Hospital, Kathmandu, Nepal Background: Drug-induced hypersensitivity reaction is of great clinical significance in therapeutics. The objective of this reporting of two cases is to show that anaphylaxis reaction can occur with pantoprazole. Case summaries: A 38-year-old female reported to the emergency ward in a critical condition, with a history of periorbital edema, edema of the skin, pruritus, nausea, vomiting, and difficulty breathing 20 minutes after ingestion of a pantoprazole 40 mg tablet. A 32-year-old female reported to the emergency ward in a critical condition, with complaints of rashes all over the body, itching on the whole body, and swollen lips and eyes after ingestion of a pantoprazole 40 mg tablet. Conclusion: It is necessary for all health care providers to know that pantoprazole can cause anaphylaxis, which is a life-threatening reaction, and to be cautious while prescribing it. Keywords: anaphylactic reactions, pantoprazole, proton pump inhibitors