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Issue 64 / 188 - MAY-JUNE 2022

NEWS

Introducing Fujifilm’s Expanded Portfolio of Healthcare Solutions MRI

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Sonosite POC Ultrasound Portable X-Ray Rooms

Join Fujifilm at the Emirates Critical Care Conference on May 13 - 15 MAY.JUNE 2022at2Intercontinental Dubai Festival City, Al Ras Level in the Event Center

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Publisher Arab Health Media Communication

THE WORLD IS ABOUT TO GET RID OF THE CORONAVIRUS Is there any post-pandemic health strategy?

French Professor Philippe Amouyel thinks that the coronavirus would really end this summer. Amouyel was one of those who warned, as early as last September, of a second wave of Covid-19 pandemic. However, he still believes in herd immunity that will begin to emerge at the end of this summer. Experts confirm that although there were a few weeks that they describe as “transitional” until late summer, however, in early June some activities will be reopened, under certain conditions and according to a specific health protocol. In addition, the International Air Transport Association (IATA) urged governments to accelerate relaxation of travel restrictions as Covid-19 continues to evolve from the pandemic to endemic stage. IATA called for removing all travel barriers (including quarantine and testing) for those fully vaccinated with a WHO-approved vaccine. If the hospital sector, economic growth and investment movement are among the main victims of Covid-19 at the beginning of its expanding and deadly spread, then its end is expected to allow the return of global sectors, as well as the increase of the investment movement, particularly in the health, hospital, pharmaceutical and other fields. Moreover, these promised investments, which have been raised by most countries, especially the Gulf States, will be based on two positive pillars: the experience gained from dealing with the pandemic since its onset, mitigation and elimination in addition to the health sector's more mature strategies that shape a promising future for a safer, more prosperous and sustainable world. Publisher

President Simon Chammas schammas@tahmag.com Executive Vice President Mirna Khairallah mirna@tahmag.com Senior Editor Elham Najem editorial@tahmag.com Content Executive Jessica Achkar editorial@tahmag.com Editors Aline Debes, Mark Steven, Don Karn, Andrew Weichert, Colette Semaan, Abbas Moussa Content Marketing Manager Jessie Chlela jessie@tahmag.com Creative Director Rania Khalil rania@tahmag.com Business Development Manager Wadih Chammas wadih@tahmag.com IT Manager Elie Yammine elie@tahmag.com Photographer Hanna Nehme Advertising advertising@thearabhospital.com

OFFICES AHMC, Lebanon T/F: +961 4 53 40 58 M: +961 3 60 61 00 IHMC, Cyprus +357 96 158661 Dubai +967 50 2971007 Printing

Distribution KSA - UAE - OMAN - TURKEY LEBANON - JORDAN - KUWAIT BAHRAIN - QATAR - EGYPT All images from shutterstock© unless provided by clients . All rights reserved by the HOSPITALS magazine. No part of this publication can be reproduced in any form without prior permission in writting from the publisher.

MAY . JUNE 2022

38 Prof. Abdel Rahman Ahmed Omer Chief Executive Officer at Burjeel Hospital

NEWS

10 Sheikh Shakhbout Medical City launches point-of-care tool for antimicrobial management

12 Every child matters: Tawam Hospital’s Down Syndrome Program helps children reach their full potential 14 LINET offers a Sustainable Investment Model for Quality Care and Cost Savings 18 WCM-Q Qatar Aspiring Doctors Program provides pathway to careers in medicine for high school students 22 King Abdullah Medical City in Makkah Achieves HIMSS EMRAM Stage 6 Validation with the Use of InterSystems TrakCare 28 Okadoc appoints new Chief Executive Officer of Saudi Arabia 30 Sheikh Shakhbout Medical City launches AI-guided pointof-care ultrasound academy in a regional first 34 Under the patronage of H.E. Sheikh Nahayan Mabarak Al Nahayan, Cabinet member, Minister of Tolerance and Coexis-

MAY.JUNE 2022

tence, Johns Hopkins Medicine International & Clemenceau Medical Center Hospital Dubai launch new visiting physician program in the United Arab Emirates

INTERVIEWS

38 Prof. Abdel Rahman Ahmed Omer Chief Executive Officer at Burjeel Hospital 78 Dr. Ghizlane Bendriss, Assistant Professor of Medicine at Weill Cornell Medicine-Qatar (WCM-Q)

MEDICAL INSTITUTIONS

48 HEART SURGEON DEDICATES ILLUSTRIOUS CAREER TO HELPING PATIENTS NO OTHER DOCTORS CAN SAVE Provided by UChicago Medicine 70 Acibadem Maslak Comprehensive Spine Center treats patients from 52 countries 74 Marble Medical Center celebrates first-anniversary celebration of Day Surgery Marble Plus Hospital

MAY . JUNE 2022

44 Heart Attack ARTICLES

16 Nationwide Children's: Gene Therapy for Spinal Muscular Atrophy: From Idea to Reality 58 Diabetes: Managing care by leveraging AI By Dr. Maryam Sayed Jaffar AlSharaf, Director, Data and Statistics - Emirates Health Services & Dr. Bashar Balish, General Manager & Senior Director – Middle East & Africa, Cerner 66 Endometrioma and Infertility, When To Operate By Dr Mazen Bishtawi FRCOG FACOG, Consultant in Obstetrics and Gynaecology, Subspecialist in Gynaecological Oncology and Advanced Laparoscopy at Al-Ahli Hospital - Doha / Qatar 82 Acute Pyelonephritis By Dr. Yousef Matani, Consultant Urologist at Al-Ahli Hospital - Doha / Qatar 84 Implantation for a device that changed the life of a

64 Uterine Fibroids

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54 Infection Control patient with severe heart failure in Al-Ahli Hospital By Dr. Abdul Razzaq Al-Juhani, Head of the Heart Center at Al-Ahli Hospital - Doha / Qatar

FEATURES

44 Heart Attack, Angina and Cardiac Arrest The basic steps to ensure patient safety

54 Sterilization and Infection Control

The basic steps to ensure patient safety 60 Kidney Disease and Diabetes go hand in hand Diabetes is the leading cause of chronic kidney disease 64 Uterine Fibroids The most common health problem in women of reproductive age 68 Robotic Surgery The Best Choice for Women's Health

68 Robotic Surgery

GET YOUR BEAT IN RHYTHM EXCEPTIONAL CARDIOVASCULAR CARE BEYOND HEALTHCARE. CMCDUBAI.AE | 800 262 392

Walid Shaker, MD Consultant Cardiac Surgery

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Khaled Awad, MD Consultant Interventional Cardiology & Cardiac Electrophysiology

Mazen Shaheen, MD Consultant Intervention Cardiology

Faouzi Safadi, MD Consultant Cardiothoracic Surgery

NEWS

Sheikh Shakhbout Medical City launches point-of-care tool for antimicrobial management Over-prescription of antibiotics is a major factor contributing to the increase in antimicrobial resistance. Antibiotics are often over-prescribed in situations where people actively pursue a prescription, or where doctors are not recommending alternatives or are fearful of reprisals if they withhold them. These behaviours often drive a culture promoting unnecessary antibiotic prescribing.

heikh Shakhbout Medical City (SSMC), one of the UAE’s largest hospitals for serious and complex care and a joint-venture partnership between Mayo Clinic and Abu Dhabi Health Services Company (SEHA), has become the first hospital in the Middle East to launch a prominent point-of-care tool for antimicrobial management. The launch of the tool is in aid of SSMC’s mission to promote the appropriate use of antimicrobial agents, reduce the burden of antimicrobial resistance (AMR) and shed a much-needed light on the dangers of the mismanagement and over-prescription of antibiotics. Dr. Zahir Babiker, a consultant physician at SSMC's Division of Tropical and Infectious Diseases, says: "Antimicrobial resistance is one of the biggest public health challenges of our time, with nearly 5 million deaths associated with bacterial AMR were reported in 2019 alone, based on a recent study by The Lancet. AMR occurs when germs present in the human body stop responding to the medications designed to kill them. As a result, germs such as bacteria, fungi, parasites, and viruses will continue to grow and pose a serious risk to the lives of people who are harboring those germs. Therefore, careful use of antimicrobial agents such as antibiotics is important and requires educating people and persuading clinicians to follow an evidence-based approach for prescribing antibiotics."

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Dr. Farin Foroodi, Internal Medicine Consultant in SSMC’s Division of Internal Medicine said: “The key reason we introduced the antimicrobial management tool at SSMC is to educate our clinicians and improve their access and utilization of antimicrobial management guidelines. It integrates our guidelines into a user-friendly interface on mobile and web applications. It also gives our medical practitioners quick access to the best quality information that is continuously updated with the most recent antimicrobial management guidelines to support informed decisions that will improve patient outcomes.” Antimicrobial resistance transforms illnesses that are characteristically simple to treat into infinitely more complex cases. The Tropical and Infectious Diseases team at SSMC are steadfast in their commitment to antimicrobial stewardship, which promotes the appropriate use of antimicrobials to improve patient outcomes, reduce antimicrobial resistance, and decrease the spread of infections caused by multidrug-resistant organisms.

THE NEW PLATFORM PROVIDES SSMC CLINICIANS WITH UPTO-DATE GUIDANCE ON ANTIMICROBIAL TREATMENT CHOICES, LOCAL PATTERNS OF AMR, AND DRUG-SPECIFIC INFORMATION ON ANTIMICROBIAL AGENTS TO ENSURE THEIR SAFETY AND EFFICACY. IT ALSO OFFERS AN OPPORTUNITY TO CONNECT AND SHARE EXPERIENCES WITH A VALUED NETWORK OF INFECTIOUS DISEASES SPECIALISTS FROM ACROSS THE GLOBE.

NEWS

Every child matters: Tawam Hospital’s Down Syndrome Program helps children reach their full potential • • • •

awam Hospital, part of the Abu Dhabi Health Services Company (SEHA), the UAE’s largest healthcare network, urges parents to ensure early detection and prevention of medical and developmental issues associated with Down syndrome. Down syndrome is a genetic condition in which an individual has an extra copy of chromosome 21, making their total chromosome count 47 rather than the normal 46 resulting in intellectual and physical issues. The lifelong condition is associated with considerable health issues posing several challenges to children, their parents, and healthcare providers. However, if managed effectively, children with Down syndrome can live life to the fullest as valued members of the community. Tawam Hospital offers a comprehensive Down Syndrome Program, one of the few in the UAE, to provide holistic care and support to children living with the condition. The program is designed to aid children in reaching their full potential and to function as independently as possible. Key services offered within the program include: • Comprehensive medical and genetics evaluation

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Comprehensive developmental evaluation Referrals as required to other sub-specialists and ancillary services Coordinated care for each patient managed by our staff Regular and/or continuing follow-up care (to be assessed and coordinated with primary care physicians and families based on individual needs)

DOWN SYNDROME OCCURS IN 1 IN 1,000 TO 1 IN 1,100 LIVE BIRTHS WORLDWIDE1.

Adding to this, Dr. Latifa Al Mansoori, Specialist Pediatrician at Tawam Hospital, said: “At Tawam Hospital, we recognize that irrespective of the challenges that a child with Down syndrome must overcome, he or she, like any other child, has the potential to live a complete life and grow to be contributing members of the society. Our staff works with each child’s primary care physician to coordinate the several necessary services that these children need. Additionally, they educate parents so that they can grow to be strong advocates for their children and assist them in locating useful resources within their community.” The program has already benefited several children and functions as a support system for parents. Speaking further to this, the father of a child who is part of Tawam Hospital’s Down Syndrome Program said: “Our child’s diagnosis was very overwhelming for us, both my wife and I knew very little about Down syndrome. It was very painful to see our baby getting admitted several times over respiratory illnesses. The program at Tawam Hospital really helped us when we were feeling very lost. Today, we’ve come a long way – our son has grown to love life and his future looks bright. He’s very energetic and loves sports and music.” The child’s mother added: “All my children deserve the best that life has to offer and it is my job as a mother to ensure that he lives a grand life – providing him with the right medical treatment and support is a part of ensuring a wonderful future for him.”

1. https://www.un.org/ en/observances/down-syndrome-day#:~:text=The%20estimated%20 incidence%20of%20 Down,born%20with%20 this%20chromosome%20 disorder.

BEST

CHILDREN’S HOSPITALS

ARTICLE

LINET offers a Sustainable Investment Model for Quality Care and Cost Savings

bed. This allows the patient to be given full care even when the number of staff is reduced, for example on weekends or night shifts.

atient bed is definitely one of the most important amenities of a hospital room. It is the place where patients spend most of their time and it is also an essential tool for nursing staff. The purchase and maintenance of beds is a significant item in budgets. We, therefore, consider the bed as an important long-term investment that needs to be carefully considered. A good selection can positively affect the patient experience, shorten the recovery process, support nurses daily procedures, improve nurses' safety and also bring time savings. One of the best examples of how a bed designed to address real in-bed patient care can bring tangible benefits to the patient, nurse, and management is lateral tilt. The effect of the lateral tilt of the loading surface is that through a slight rotation recumbent patients are turned over on their side. During this operation, the nurse simply releases the tilt control button (preferably on the bed foot control) and slightly holds the patient in the direction of the bed surface. With the bed tilted to the side, the nurse uses up to 67% less force when turning the patient than with the same operation on a normal bed. One nurse, instead of two, can handle the patient and make the

What are the real savings?

Jitka Stranska, Managing Director LINET Middle East and Africa

For an ICU unit with 20 beds, lateral tilt can bring a net time saving of ~ 9 hours of nursing time per day, which saves 3,418 nurse working hours per year. For example, in the UAE, where the average hourly rate for nurses is $24 an hour, using 20 beds with lateral tilt creates an annual saving of $ 82,000! Our goal is not only to involve the beds in the recovery process as much as possible and to strengthen the effects of the therapy. We also strive to provide a solution that helps reduce the physical burden on caregivers. Reducing the physical burden allows for better adherence to the care process as well as improved caregiver efficiency. It also provides a safe working environment that leads to workforce stabilization. Our priority is to offer a sustainable model where a higher initial investment in quality products ensures a return on costs and provides other benefits through professional support, such as staff training and professional accredited service..Stay with us for more innovative solutions with a higher potential for return on investments.

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MAY.JUNE 2022

Multicare X Discover new ICU solution designed by nurses for nurses

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ARTICLE

Gene Therapy for Spinal Muscular Atrophy: From Idea to Reality

n May 24, 2019, the U.S. Food and Drug Administration (FDA) approved Zolgensma® (onasemnogene abeparvovec-xioi), a first-of-its-kind gene therapy for spinal muscular atrophy which was developed at Nationwide Children's, laying the groundwork to change the lives of children all over the world.

Harnessing the ability of a virus to deliver genetic material to a cell to treat, cure or prevent disease has been the long-time goal of researchers working in gene therapy. Over the past 30 years, the journey to gene therapy has been fraught with challenges and roadblocks. But in 2017, after countless starts and stalls along the road, the field experienced many breakthroughs. No breakthrough received more attention than when researchers from Nationwide Children’s Hospital and The Ohio State University published the astonishing results of the phase 1 clinical trial of gene therapy for spinal muscular atrophy type 1 (SMA1) in the New England Journal of Medicine. The SMA1 early phase trial, led by Jerry Mendell, MD, Principal Investigator in the Center for Gene Therapy in the Research Institute at Nationwide Children’s, demonstrated extended survival and increased achievement of milestones previously unseen in the natural course of the disease — a devastating, progressive neuromuscular disease that typically results in death by age 2. An intravenous injection of AVXS-101, a modified adeno-associated virus serotype 9 (AAV9), delivered the survival of motor neuron (SMN) gene. This trial was the basis for the FDA’s approval of Zolgensma®. It builds on nearly 30 years of foundational research and collaboration. Arthur Burghes, PhD, of The Ohio State University, created the SMA mouse model that remains the standard by which all therapies are initially tested. Brian Kaspar, PhD, Senior Vice President and Chief Scientific Officer at AveXis, a clinical-stage gene therapy company developing treatments for patients suffering from rare and life-threatening neurological genetic diseases, during his appointment at Nationwide Children’s, discov-

MAY.JUNE 2022

Dr. Jerry Mendell

THE FDA APPROVED ZOLGENSMA FOR PEDIATRIC PATIENTS LESS THAN 2 YEARS OF AGE WITH SMA, INCLUDING THOSE WHO ARE PRESYMPTOMATIC AT DIAGNOSIS.

ered that the AAV9 vector can cross the bloodbrain barrier when injected into the vascular system and can deliver genes directly to motor neurons. That landmark study was published in Nature Biotechnology in 2009. “None of this would have been possible without the seminal discovery that AAV9 crosses the blood-brain barrier,” said Dr. Mendell, also a Professor of Pediatrics, Neurology, Pathology, and Physiology and Cell Biology at The Ohio State University College of Medicine. The FDA approved Zolgensma for pediatric patients less than 2 years of age with SMA, including those who are pre-symptomatic at diagnosis. “The FDA’s decision is validation of my team’s decades of work to develop a treatment that alters the course of this unforgiving condition and provides a therapeutic option for the families and infants with SMA,” said Dr. Mendell. “When you see one of the clinical trial participants – now four years old and running, jumping and dancing – it is incredible.” Research conducted since the FDA’s approval in 2019 continues to provide evidence for the safety and efficacy for the first-of-its-kind intervention. A recent study showed that with Zolgensma, a single intravenous dose of the medicine has led to improvements in muscle strength and less dependence on noninvasive ventilation. From natural history studies that enable understanding of disease progression to clinical trials of the latest innovations in therapies, Nationwide Children’s Hospital is a model for clinical research integration. Discoveries made here are impacting the lives of children all over the world. Pioneering breakthroughs like the Zolgensma® therapy has allowed Nationwide Children’s Hospital not only the opportunity to share the discovery with the world, but also develop the ideal clinical program to care for these unique patients and achieve the best possible outcomes.

To learn more about Nationwide Children’s Hospital and the treatment of neuromuscular disorders, visit NationwideChildrens.org/ Neuromuscular-Disorders

NEVER STOP LEARNING. NEVER STOP GROWING. High quality professional development opportunities for healthcare professionals based on the latest scientific and medical advances that increase competence, enhance performance and improve healthcare for patients. Visit: qatar-weill.cornell.edu/continuing-professional-development/

NEWS

WCM-Q Qatar Aspiring Doctors Program provides pathway to careers in medicine for high school students ing, so the students fully deserve our plaudits. They have shown wonderful dedication to the program and have gained a strong foundation of knowledge of the basic sciences, as well as valuable study skills and improved proficiency in English. These newly acquired attributes will serve them extremely well if they decide to join WCM-Q to pursue careers in medicine, which we hope many of them will do.” High school student Abdulla Adel AlMutawa of Gulf English School receives his certificate of participation for completing WCM-Q’s Qatar Aspiring Doctors Program from Dr. Rachid Bendriss and Ms. Noha Saleh

orty-eight talented high school students with ambitions to become physicians have completed the challenging Qatar Aspiring Doctors Program (QADP), run by the Office of Student Outreach and Educational Development at Weill Cornell Medicine-Qatar (WCM-Q). The program runs from September to March and offers advanced tuition in the physical sciences, biology, research skills and English for academic purposes to help students who wish to study medicine at WCM-Q hit the ground running. Given the challenging nature of much of the material, there was a celebratory atmosphere when the successful students gathered at WCM-Q for a completion ceremony to mark their achievements. The students, who are in grades 10, 11 and 12, were drawn from 19 high schools in both the government and public sectors. Each student who successfully completed the QADP was presented with a certificate of achievement, as well as personal congratulations from the WCM-Q faculty in attendance. Dr. James Roach, Associate Dean for Pre-medical Education and Professor of Chemistry, who delivers the physical sciences modules of the QADP said: “Completing the QADP is both immensely rewarding and extremely challeng-

MAY.JUNE 2022

In addition to Dr. Roach, the QADP curriculum is taught by Dr. Rachid Bendriss, Assistant Professor of Medicine in Education and Associate Dean for Foundation, Student Outreach and Educational Development Programs; Dr. Ghizlane Bendriss, Assistant Professor of Biology; and Ms. Reya Saliba, Librarian, Education and Research. The course instruction followed a hybrid model, with monthly face-to-face sessions and hands-on activities blended with online modules. Dr. Rachid Bendriss said: “The QADP is a wonderful vehicle for helping ambitious and talented Qatari students take their first steps towards highly rewarding careers in medicine through WCM-Q, unlocking their human potential and allowing them to make significant contributions to the ongoing development of the State of Qatar. I offer my warmest congratulations to all of the students who worked so hard to complete the QADP this year.”

Launched in 2015, the QADP is primarily aimed at Qatari nationals. Entry to the program is through nomination by school counselors, who put forward students who have shown academic excellence during their school years, particularly in the sciences and mathematics. Students must also have a good understanding of English and show a keen interest in pursuing a career in medicine. The QADP is delivered alongside the students’ normal school curriculum and is customized to fit the timetables and academic requirements of each individual participant.

Students from 19 high schools participated in WCM-Q’s Qatar Aspiring Doctors Program

NEWS

MAY.JUNE 2022

NEWS

King Abdullah Medical City in Makkah Achieves HIMSS EMRAM Stage 6 Validation with the Use of InterSystems TrakCare

nterSystems Middle East & India announces that King Abdullah Medical City in the holy capital (KAMC), a member of the Makkah Al Mukarramah Health Cluster, announced that it has achieved the HIMSS Analytics Electronic Medical Record Adoption Model (EMRAM) Stage 6, an international benchmark for the use of advanced IT to improve patient care.

HIMSS Analytics created EMRAM methodology to evaluate the progress and impact of electronic medical record systems for hospitals. The validation measures the clinical outcomes, patient engagement and the clinicians’ use of the EMR technology to strengthen organizational performance and health outcomes. This is an important milestone in the Medical City’s transformation 2020-2025 strategy. By achieving HIMSS EMRAM Stage 6, KAMC is clearly demonstrating its commitment to improving patient safety and the overall quality of clinical care through the effective deployment and adoption of its Electronic Medical Record system, InterSystems TrakCare® unified health information system. During the validation process, all doctors, nurses, and allied health professionals were able to demonstrate how care is documented in the TrakCare EMR. The amount of clinical paper being used on a day-to-day basis is very small which means that the hospital is certainly a paper–light institution. HIMSS staff performing the validation found that all the clinicians who demonstrated systems’ functionality appeared to be very familiar with the systems’ respective capabilities. HIMSS saw that the TrakCare EMR appeared to be highly intuitive, highly flexible and responsive to the needs of clinicians. Dr. Dilshad Ali Abbas, CEO of Makkah Al Mukarramah Health Cluster and the CEO of King Abdullah Medical City (KAMC), praised the work of the Medical City’s staff, including doctors,

MAY.JUNE 2022

administrators, technicians, and ICT staff for realizing this important achievement. Dr. Dilshad added that the Medical City received a congratulatory letter from the Regional Director of HIMSS Analytics praising KAMC on applying first-class standards for nursing and medical documentation. This means that the hospital might easily be a national reference site for structured data, structured forms with the ability to recall data for auditing and research purposes. “We would like to congratulate King Abdullah Medical City on this prestigious global recognition from HIMSS,” said Ali Abi Raad, Country Manager for the Middle East and India at InterSystems. “By successfully achieving the HIMSS EMRAM Stage 6 validation, KAMC now sits alongside a group of organisations across the globe who are committed to operating in a near paperless environment, and who use the electronic medical record technology to drive transformational change in all aspects of patient care. InterSystems is proud of being a strategic partner of KAMC as we work together to deliver seamless patient care, improve efficiency and patient experience with the use of our TrakCare unified health information system.”

THE GLOBAL RECOGNITION IS A TESTAMENT THAT THE HOSPITAL HAS MET ALL THE REQUIREMENTS FOR APPLYING THE HIGHEST QUALITY STANDARDS OF THE USE OF ELECTRONIC MEDICAL RECORD.

NEWS

NATIONWIDE CHILDREN’S HOSPITAL WORLD-CLASS PROGRAMS. TRAILBLAZING RESEARCH. PERSONALIZED CARE. Columbus, Ohio, may feel like a world away, but our faculty, researchers and facility have earned international reputations for expertise in rare and complex conditions. Our Cardiovascular team is leading groundbreaking development of a biodegradable tissue-engineered vascular graft for children with congenital heart defects. Our multidisciplinary Center for Colorectal and Pelvic Reconstruction excels in advanced care for even the rarest congenital disorders, motility issues, fecal incontinence concerns and more, for patients in more than 60 countries. And the powerhouse team at the helm of our Neurosurgery and Neuro-Oncology programs excels in both leadership and collaboration in multinational cancer research. When you’re here, you are the center of our attention. Come to Nationwide Children’s —nothing but the best in care, in an accessible, cosmopolitan city. Reach out to our Global Patient Services team to find out why we should be your new global destination for complex care. Learn more, refer a patient or plan a trip: NationwideChildrens.org/Global-Patient-Services GlobalPatientServices@NationwideChildrens.org +1 614 362 9127 Nationwide Children’s Hospital, Columbus, Ohio – USA

W295713

AMERICA’S SECOND

LARGEST CHILDREN’S HOSPITAL

* Based on CHA survey of utilization and financial indicators

Product Fact Sheet

CyStain VitalCount TM

Fast, safe, sensitive: Control your production the easy way

Product picture

Sysmex Partec GmbH Arndtstraße 11 a-b 02826 Görlitz Germany www.sysmex-partec.com Sysmex Partec is an ISO 9001:2015 and EN ISO 13485:2016 certified company.

Product name CyStainTM VitalCount

Manufacturer information CyStain VitalCount is manufactured by Sysmex Partec GmbH.

Summary CyStain VitalCount is a microbial detection kit for the unspecific detection and quantification of vital microorganisms, yeast and bacteria, in fruit juice, including clear fruit juices, fruit juices with fruit pulp and highviscosity fruit juices. The kit involves manual or automated sample preparation by pipetting robots in a 96-well format. Juice samples are automatically analysed and results are automatically reported by the CyFlow™ Cube 6 V2m analyser and the CyFlow™ Robby 6 Autoloading Station.

Product Fact Sheet CyStain VitalCount

Productivity values The CyStain VitalCount Kit is an automated, cost-eﬀective and rapid alternative to conventional plate counts. The enumeration of total viable microorganisms allows to assess the microbial burden during in-process control and final product control of any type of fruit juice. The objective and automated read-out of the results allows clear release decision with confidence in routine quality control during juice production.

Specifications Features

Description

Technology

Vital cell stain / Flow cytometry

Sample type

Fruit juice

Species type

Living bacteria and yeast cells

Limit of detection (LoD)

At least < 1000 cells/mL

Limit of blank (LoB)

At least < 500 cells/mL

Sensitivity of the method

1 organism/bottle for bacteria and yeast (after pre-incubation)

Decrease inventory / warehouse costs

Number of tests

480

Reduce human errors due to the automate procedure

Shelf-life

12 months

In-use stability

2 months

Simplified automated operation dedicated to this application

Storage temperature

2 - 8 °C

Format

96-well plate

Objective clear-cut decision due to standardised data reporting

Sample preparation time ~ 80 min for 96 samples

Key features in industrial testing Speed up product release

Highest sensitivity: 1 organism / bottle (pre-incubation necessary)

Ordering information Reagent Article number

Item

05-5029

CyStain VitalCount

Consumables and Instruments Article number

Item

04-2026

96 Well Filter Plates

04-2025

96 Well Receiver Plates

CY-S-3061R-V2m

CyFlow Cube 6 V2m

CY-S-3083-V2m

CyFlow Robby V2m Autoloading Station

Throughput (analysis time)

< 180 min 96 samples

Carry-Over

< 0.1 %

NEWS

Okadoc appoints new Chief Executive Officer of Saudi Arabia Rafat Taher to lead Saudi operations for the one-stop shop patient engagement platform The solution is proven to reduce no-shows by as much as 75%, increase patient satisfaction and boost operational efficiencies, resulting in better health and business outcomes

kadoc, the one-stop shop patient engagement platform, is strengthening its foundations in Saudi Arabia with the appointment of Rafat Taher as Saudi-based CEO. Taher joins Okadoc with over 15 years of leadership across the sector. Prior to joining Okadoc, he occupied senior positions in both the public and private sectors, including CEO of VPS Saudi Arabia, CEO of One Healthcare Group, Managing Director of Healthcare and Life Sciences at Saudi Arabian General Investment Authority (SAGIA), Chairman of The Critical Care department at King Saud University College of Medicine and serving as an advisor to the Saudi Ministry of Health, Vision Realization Program and the National Digital Transformation Unit. Taher will bring that depth and knowledge of the healthcare sector to lead the strategic growth of Okadoc across the Kingdom, building on the company’s strong record of success while also catering to the needs of Saudi’s healthcare sector. In line with Vision 2030 objectives, Okadoc Saudi Stategy aims to facilitate access and improve quality and efficiency of healthcare services, promote prevention of health risks, and enable full and healthy lives. “Okadoc’s mission has always been to improve the healthcare experience for all. Our strategy across the Kingdom will help providers and insurers unlock the power of technology to ensure they are maximizing both business and health outcomes while increasing patient engagement and satisfaction,” said Rafat Taher, CEO of Okadoc Saudi Arabia. Okadoc’s instant doctor booking solution is the only one-stop shop patient engagement platform that is directly integrated with providers’ health information system / electronic medical records (HIS/EMR), allowing patients to see real-time availabilities and book vid-

MAY.JUNE 2022

eo and in-person appointments seamlessly without any admin support. Not only does Okadoc’s technology reduce administrative burdens, but it is also proven to reduce noshows by as much as 75%, increase patient satisfaction, offer new revenue streams via online consultations, increase operational efficiency by optimizing appointment bookings, and increase payment options for patients. The platform allows patients to book a virtual or in-person appointment within 30 seconds or less. It allows the ability to search for doctors by name, clinic name, specialty, language spoken, gender, country of education, location. Patients can also receive reminders and can reschedule, cancel or even request earlier availability online. Okadoc caters to the needs of patients, providers and payors, including insurance companies and third-party administrators. It is compliant with local and international standards and is directly integrated with 35 HIS/EHRs, including Epic and InterSystems. Okadoc was recently awarded “Best in KLAS” for Virtual Care Platforms in the Middle East and Africa. Its white-label solution is trusted by some of the region’s leading healthcare groups and insurers, including Bupa, Daman, Mediclinic, Medcare, Emirates Hospital, UE Medical, Novomed, Valiant Clinic & Hospital and Dubai Healthcare City. Okadoc reached a milestone in 2021, managing over four million appointments across the Middle East and Indonesia – a 7x growth in appointments between fiscal year 2020 and 2021. Following the successful launch of its telehealth platform in 2020, just after the onset of the COVID-19 pandemic, Okadoc enabled more than 75,000 video consultations. It onboarded over 1,000 telehealth doctors and saw a 34x growth in telehealth appointments, ensuring that patients continue to receive the healthcare that they need and deserve and allowing providers to enable a hybrid care delivery model.

OKADOC’S SOLUTION IS THE ONLY INSTANT DOCTOR BOOKING PLATFORM THAT IS DIRECTLY INTEGRATED WITH PROVIDERS’ HEALTH INFORMATION SYSTEMS.

Award-winning care meets humankindness. NEWS

Medical breakthroughs have continued to help people live healthier lives, and we’re honored to be recognized for them. With our new rankings by U.S. News & World Report, we celebrate these advancements and the power of humankindness to provide healing for our communities in the best way. Learn more at stlukeshealth.org./bslmcinternational

NEWS

Sheikh Shakhbout Medical City launches AI-guided point-ofcare ultrasound academy in a regional first

heikh Shakhbout Medical City (SSMC), one of the UAE’s largest hospitals for serious and complex care and a joint-venture partnership between Mayo Clinic and Abu Dhabi Health Services Company (SEHA), has become the first hospital in the Middle East to launch an academy for upskilling medical practitioners using the artificial intelligence (AI)-guided pointof-care ultrasound (POCUS) device. Dr. Siddiq Anwar, Consultant Nephrologist at SSMC said: “The point-of-care ultrasound or ‘POCUS’ academy, aims to equip healthcare professionals to enhance the physical examination of patients at bedside. This multidisciplinary course is important as it improves the initial assessment process, advances the timelines and quality of care for patients and, ultimately, saves more lives. We are excited to introduce to UAE and GCC healthcare professionals the POCUS academy course, fully dedicated to hemodynamics.” “This initiative is part of SSMC’s Education Shield’s mission to become a research and innovation leader in the region and create opportunities for healthcare professionals to advance healthcare practices and deliver the highest quality of care through world leading training and strategic partnerships," he added. The multidisciplinary course is led by Dr. Siddiq Anwar, Dr. Hatem Soliman, Consultant Cardiac Intensivist at the Royal Brompton and Harefield hospitals in the UK, and Fernando Maravilla, Director of Education at a medical device company. SSMC is the first facility to provide comprehensive POCUS Hemodynamic Assessment training all in one course, making the training program a first-of-its kind in the Middle East, with only a few courses available globally that cover this integrated topic. By enabling healthcare professionals to make a more objective assessment of patients’ circulatory system, the AI-guided point-of-care ultrasound is set to replace the stethoscope over time.

MAY.JUNE 2022

Dr. Hatem Soliman commented: “This pioneering project will tremendously improve patient care as well as upskill the medical workforce with the stethoscope of the future. The stethoscope, which was invented by Laennec in 1816, derives from the Greek words ‘stethos’, which means chest, and ‘skopein’ which means to 'see', although the device actually only 'listens' to the sounds made by the heart, lungs, intestines, and the blood flow.” POCUS does not replace in-depth or comprehensive consultation with specialists, however it helps address focused questions at bedside. The artificial intelligence tool aims to aid the non-expert with the learning curve and help practitioners to get quick answers to short or urgent questions about the patient’s condition at bedside assessment. Furthermore, the device can be also used in emergency situations across various specialties by any medical staff trained in POCUS. Dr. Deanne Kashiwagi, Chair of Internal Medicine and Director of Internal Medicine Program at SSMC said: “The inclusion of POCUS training into the Internal Medicine Residency program curriculum is a priority at SSMC. This tool advances traditional patient assessment modalities and expands our capacity to provide excellent patient-centered care. For these reasons, POCUS training is an integral component of contemporary graduate medical education”.

Dr. Siddiq Anwar

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NEWS

Under the patronage of H.E. Sheikh Nahayan Mabarak Al Nahayan, Cabinet member, Minister of Tolerance and Coexistence

Johns Hopkins Medicine International & Clemenceau Medical Center Hospital Dubai launch new visiting physician program in the United Arab Emirates

lemenceau Medical Center Hospital in Dubai signed a collaboration agreement with Johns Hopkins Medicine International, the leading healthcare provider in the USA in the presence of H.E. Sheikh Nahayan Mabarak Al Nahayan, Cabinet member, Minister of Tolerance and Coexistence. World-renowned doctors from Johns Hopkins Medicine in the United States will travel to Dubai on a regular basis to provide advanced diagnostic and specialty care for patients in the region.

This collaboration comes in line with the directives of our wise leadership and the vision of H.E. Sheikh Mohammed bin Rashid Al Maktoum, Vice President, Prime Minister and Ruler of Dubai, to provide the highest level of care that complies with international standards for citizens and residents, and to make UAE a major destination for treatment in the region and the world. H.E. Sheikh Nahayan Mabarak Al Nahayan,

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Cabinet member, Minister of Tolerance and Coexistence said," We are delighted to have Johns Hopkins Medicine International as a partner in providing some of the finest healthcare in the world right here at the Clemenceau Hospital in Dubai. I am sure that the people of the UAE will benefit greatly from the superb medical care that your visiting physicians will bring to us. By launching this agreement, all of you recognize that the UAE is a country intent on improving the quality of health care for its entire population. We, in the United Arab Emirates, understand that the quality of our lives depends on good health. Under the leadership of the president, His Highness Sheikh Khalifa bin Zayed Al Nahyan, and with the guidance and strong support of Sheikh Mohammed bin Rashid Al Maktoum, Vice president, Prime Minister and Ruler of Dubai, and His Highness Sheikh Mohammed bin Zayed Al Nahayan, Crown Prince of Abu Dhabi and the Deputy Supreme Commander of the Armed Forces, the UAE is committed to an

OUR NATIONAL LEADERS HAVE MADE IT A NATIONAL GOAL FOR THE UAE TO BECOME A REGIONAL CENTER FOR HEALTHCARE, INNOVATION, SCIENTIFIC RESEARCH, AND TECHNOLOGICAL APPLICATIONS.

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as possible can receive the best care close to home and family.”

H.E. Sheikh Nahayan Mabarak Al Nahayan

excellent and responsive healthcare system. Our national leaders have made it a national goal for the UAE to become a regional center for healthcare, innovation, scientific research, and technological applications. The Clemenceau Hospital deserves special credit for its wisdom in collaborating with Johns Hopkins Medicine. This institution is widely admired for its deep commitment to international cooperation. All of you at Johns Hopkins and the Clemenceau Hospital demonstrate by this important agreement a dynamic leadership that seeks opportunities to make a difference in the world. I am confident that you will succeed in your noble endeavor, and that you will set the standard for other global healthcare providers to follow. “Since inception, Clemenceau Medical Center Hospital Dubai has dedicated its mission to meet patients’ needs in the UAE through the enhancement of the quality of healthcare and the management of complex medical conditions," added Mr. Abdulrahman Abdulaziz Khansaheb, Chairman of the Board of Directors at Clemenceau Medical Center Hospital Dubai.

Mounes Kalaawi, M.D., F.R.C.S., M.B.A., Chairman and Chief Executive Officer of Clemenceau Medicine commented: “Clemenceau Medicine International and Johns Hopkins Medicine International have a long-standing collaboration, which has resulted in many achievements in the field of healthcare. There is no doubt that this cooperation is the first of its kind in the United Arab Emirates. This agreement gives a strong push in the field of health care, as it provides a unique program of its kind in the region, including surgical operations and clinical medicine from visiting physicians and surgeons from Johns Hopkins who are globally acclaimed for their expertise and cutting-edge research. They will work as an integrated team across all advanced medical specialties all year round in Dubai, providing the best treatment for difficult and complex medical cases.” Dr. Kalaawi added: “Our doctors in Dubai will benefit from this cooperation with world-renowned senior specialists from Johns Hopkins University and Hospital by working as a group and exchanging experience, education and access to everything that is new and advanced. This is in the interest of patients to meet their needs throughout the country without the need to travel and get treatment abroad.”

Dr. Mounes Kalaawi

Prof. Charles M. Wiener

Charles M. Wiener, M.D., President of Johns Hopkins Medicine International said, “We are honored to collaborate with Clemenceau Medicine International in their efforts to advance health are in the Middle East and to share our expertise and best practices with Clemenceau Medical Center Hospital Dubai, one of the region’s premier healthcare institutions. We are deeply committed to expanding access to high-quality healthcare locally so as many people

NEWS

Bacterial count in routine quality control

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COVER STORY

MAY.JUNE 2022

COVER STORY

urjeel Hospital is a multi-specialty care hospital that uses a tailor-made approach for patients. It provides world-class, specialized healthcare to the growing population of Abu Dhabi and the MENA region."Hospitals" Magazine had the privilege to interview Professor Abdel Rahman Ahmed Omer, Chief Executive Officer at Burjeel Hospital.

Prof.Omer, can you tell us about your journey in the medical world? After completion of my schooling in Abu Dhabi, UAE, I went on to complete my basic medical education in the Faculty of Medicine University of Khartoum Sudan and University College of London (MBBS). I completed my Surgical Training between the UK and USA. During this period, I had academic studies resulting in being awarded a Master's Degree in Surgical Sciences (MSc.) from the University College London UK and a doctorate (PhD) in Medical Management from the Hartford U niversity in the US. Professionally, I completed my training in surgery in the University of London Hospitals, Oxford and Cambridge Joint Board (UK) and Cleveland Clinic Florida (USA) becoming a fellow of the Royal College of Surgeons of England, The Royal Colleges of Surgeons UK, the Ameri-

can College of Surgeons and many other international institutes worldwide. I also progressed in the academic, research and authorship achieving a Professor of Surgery position. Career wise, I worked my way to be Director of Surgery, Lead for Coloproctology Inflammatory Bowel Diseases & Cancer care, Regional Pelvic Surgeon and Lead for Emergency Surgical Care (UK) on top of collaborating with international institutes across the globe (USA, Sweden, France, Italy, Japan, India and more). I am currently the CEO and a Consultant Surgeon at Burjeel Hospital Abu Dhabi,UAE.

Can you tell us about the mission and vision of Burjeel Hospital? Our vision is to become the number one provider of excellence in healthcare, not only locally but on a regional level, and an internationally recognized center of excellence for the provision of healthcare with high patient

OUR VISION IS TO BECOME THE NUMBER ONE PROVIDER OF EXCELLENCE IN HEALTHCARE, NOT ONLY LOCALLY BUT ON A REGIONAL LEVEL, AND AN INTERNATIONALLY RECOGNIZED CENTER OF EXCELLENCE FOR THE PROVISION OF HEALTHCARE WITH HIGH PATIENT SATISFACTION AND OUTSTANDING OUTCOMES.

COVER STORY

satisfaction and outstanding outcomes. We are using our internationally recognized medical experts to provide excellence in healthcare, where we create a system that is designed to cater to patients, families and caregivers based on evidence-based practice to achieve the best outcomes that matter to our patients. We are trying to improve our quality of care by integrating hospitality as part of healthcare provision. We know that the role of hospitality and service culture in the patient experience is key to a better outcome for patients. Like a fivestar hotel service, patients arrive at our hospital with certain expectations, so we try to give them that hospitality feeling from the moment they enter the hospital until the moment they leave. We believe that psychology is a crucial part of the healing journey of every patient.

What are the added services of such a renowned multi-specialty hospital that make a difference in treating patients and give them a hotel-like feeling? Along with world-class medical professionals, the latest diagnostic equipment and superior healthcare services, we provide a hotel atmosphere from the concierge service at check-in to hotel feel ambiance in our rooms where we

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try to deliver warmth and personalized service to our patients to the point where they feel like they are in a health resort. A personalized human touch blended with innovation is what makes us different.

What are your thoughts about the healthcare sector in the UAE? The healthcare industry in the region and especially in the UAE has come a long way. The UAE is known to invest a lot in healthcare but it needed to make some changes because of the nature of the patients it caters for. Not only do UAE residents seek medical services but all the expats living and working in the UAE also created a real challenge because we needed to understand the mixture of cultures and how to provide them with the best services and make them feel like home. We always

COVER STORY

work hand in hand with the UAE government for better healthcare services from planning to delivery and I can’t but mention the great work the UAE leadership and government carried out during the Covid-19 pandemic that made the UAE one of the best countries in providing care to its residents during these difficult times extending this to the rest of the world.

Let’s highlight the state-of-the-art treatment facilities in different specialties offered at Burjeel Hospital Abu Dhabi. We, at Burjeel Hospital, o ffer services in vast areas both medically and surgically e.g. Cardiothoracic Surgery, Metabolic Medicine and Surgery, Orthopedics, Cardiology, Rheumatology and Oncology, among others. We extend the care we provide in collaboration with our stateof-the-art Burjeel Medical City Hospital (Oncology and Bone Marrow Transplant) becoming an icon of top class healthcare provision in the region. All these services are provided by highly skilled and renowned world-class professionals

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augmented by highly skilled dedicated teams that work every day to provide patients with the best healthcare experience possible and supported by the best technology available worldwide with an active international Research and Development Institute. All these services are

COVER STORY

based on the difference between the concept of department stores versus boutique stores. Our services are more like boutique stores where we offer a 7-star service with attractively designed interiors and restaurant facilities with many coffee shops that cater to all tastes. This is why we have built a strong sense of trust among patients and we became the number one center of excellence across the UAE.

The Hospital has won numerous awards, can you name a f ew? And how do you see the Hospital evolving in the future? We have won numerous awards, including the Economic Times’ Best Asian Healthcare Brand, Hospital Build & Infrastructure Middle East’s Best Laboratory Design, a recognition award from Al Hosn Gas for our contribution to the breast cancer awareness campaign and an appreciation award from IDEA annual students education exhibition. Also, we were named “Healthcare Company of the Year” by Arabian Business Achievement Awards, “Best Medical Tourism Hospital” by Global Brands Magazine and last but not least, we were invited to Sheikh Khalifa’s Award which is considered one of the top awards in the UAE and we are very proud of taking part in it. As for the hospital’s goals for the future, we are committed to excellence in everything we do. We have a mission to

maintain the quality of a 7-star hospital and the establishment of new centers of excellence within our hospital and our twin hospital, Burjeel Medical City. We also plan to centralize many services together for better enhancement of the quality of service. Digitalization is also our main priority; our target is to become paperless and be able to improve patients' experience by creating a more intelligent environment. We will be also focusing more on medical tourism; we are building special units for visitors coming from abroad and diplomats who are seeking medical services at our hospital. Those units will cater for the whole family with bespoke services. We have people coming from the UK, Europe, Sudan, India and the African Continent very satisfied with the care they received and became the ambassadors of our brand. Our main goal is to position the hospital on the global health map and to become a fullfledged advanced clinical care center for Abu Dhabi and the MENA region, which we believe is already materialized.

WE HAVE WON NUMEROUS AWARDS, INCLUDING THE ECONOMIC TIMES’ BEST ASIAN HEALTHCARE BRAND, HOSPITAL BUILD AND INFRASTRUCTURE MIDDLE EAST’S BEST LABORATORY DESIGN, A RECOGNITION AWARD FROM AL HOSN GAS FOR OUR CONTRIBUTION TO THE BREAST CANCER AWARENESS CAMPAIGN AND AN APPRECIATION AWARD FROM IDEA ANNUAL STUDENTS EDUCATION EXHIBITION.

NEWS FEATURES . Heart Attack, Angina and Cardiac Arrest ARTICLE

Heart Attack, Angina and Cardiac Arrest The basic steps to ensure patient safety

espite the fact that there are some differences between a heart attack, angina and cardiac arrest, they seem to be correlated in a way as most heart attacks do not lead to cardiac arrest. However, when cardiac arrest happens, a heart attack is a common cause. There is a lot of confusion between heart attack and cardiac arrest, but they may both have the same symptoms. Although angina and heart attack are caused by arterial blockage, and the main difference between angina and a heart attack is that a heart attack causes damage to the heart muscle, and angina does not. A heart attack occurs when blood flow to the heart is blocked. The blockage is most often a buildup of fat, cholesterol and other substances, which form a plaque in the coronary arteries that feed the heart. Sometimes, a plaque can rupture and form a clot that blocks blood flow. The interrupted blood flow can damage or de-

MAY.JUNE 2022

stroy part of the heart muscle. Angina is a type of chest pain caused by reduced blood flow to the heart. Its pain is not sudden like a heart attack, but it is present and the patient can feel it. While the chances of survival for a person who suffers from a heart attack and a cardiac arrest vary widely, about 90 percent of people who experience an out-of-hospital cardiac arrest die. Also, there is no guarantee that someone will survive from being given CPR. Also, a heart attack is considered less serious; the blocked artery can be opened quickly with the appropriate treatment.

Heart Attack It occurs when there is a sudden blockage in the arteries that supply blood to the heart. With time, the heart muscle begins to die because it isn’t getting enough blood flow. Doctors use the term myocardial infarction to refer to a heart attack. When a patient suffers from a heart attack,

A HEART ATTACK OCCURS WHEN BLOOD FLOW TO THE HEART IS BLOCKED. THE BLOCKAGE IS MOST OFTEN A BUILDUP OF FAT, CHOLESTEROL AND OTHER SUBSTANCES, WHICH FORM A PLAQUE IN THE CORONARY ARTERIES THAT FEED THE HEART.

NEWS Heart Attack, Angina and Cardiac Arrest . ARTICLE FEATURES

his heart would still be beating and working but not as efficiently. The longer it takes to treat the cause, the lower the chance of recovery. A heart attack mainly occurs when one or more of your coronary arteries becomes blocked. Another less common cause of a heart attack is a spasm of a coronary artery that shuts down blood flow to part of the heart muscle. When a heart attack happens, blood flow to a part of your heart is hindered, which causes that part of your heart muscle to die. When a part of your heart can’t pump because it is dying from lack of blood flow, it can disrupt the pumping sequence for the entire heart. That reduces or even stops blood flow to the rest of your body, which can be deadly if it isn’t corrected quickly. Common heart attack signs and symptoms include pressure, tightness, pain, or a squeezing or aching sensation in your chest or arms that may spread to your neck, cold sweat, fatigue as well as blue fingers and toes.

Symptoms vary between men and women. Symptoms of a heart attack in men include:

•

Pressure, tightness, pain, or a squeezing or aching sensation in your chest or arms that may spread to your neck, jaw or back • Heart palpitations • Shortness of breath • Cold sweat • Lightheadedness or sudden dizziness • Abdominal pain / discomfort In most cases, women do not feel the common symptoms such as pain in the chest or arm, and symptoms may begin a month before the heart attack.

Symptoms of a heart attack in women include: •

• • • • • •

COMMON HEART ATTACK SIGNS AND SYMPTOMS INCLUDE PRESSURE, TIGHTNESS, PAIN, OR A SQUEEZING OR ACHING SENSATION IN YOUR CHEST OR ARMS THAT MAY SPREAD TO YOUR NECK, COLD SWEAT, FATIGUE AS WELL AS BLUE FINGERS AND TOES.

Unexplained fatigue for several daysPressure or pain in the middle of the chest, which may spread to the arm Sleep disturbances Dizziness Shortness of breath Abdominal discomfort Pain in the upper back, or shoulder Pain in the throat and jaw

ARTICLE FEATURES . Heart Attack, Angina and Cardiac Arrest

But why these diff erences?

There are two types of angina:

During a heart attack in men, a plaque can rupture and spill cholesterol and other substances into the bloodstream. A blood clot forms at the site of the rupture and can block blood flow through the coronary artery, starving the heart of oxygen and nutrients (ischemia). While women are more likely to develop this buildup in the heart's smallest blood vessels, therefore, women are more likely to have small, non-fatal heart attacks.

1. Stable angina: Stable angina is the most common and is usually triggered by physical activity. When you climb stairs, exercise or walk, your heart demands more blood, but narrowed arteries slow down blood flow. Besides physical activity, other factors such as emotional stress, cold temperatures, heavy meals and smoking also can narrow arteries and trigger angina. 2. Unstable angina: It typically occurs when a person is resting. If fatty deposits in a blood vessel rupture or a blood clot forms, it can quickly block or reduce flow through a narrowed artery. This can suddenly and severely decrease blood flow to your heart muscle. Unstable angina can also be caused by blood clots that block or partially block your heart's blood vessels. Unstable angina is a dangerous type of chest pain that can be the start of a heart attack if left untreated.

Angina Pectoris It is chest pain or discomfort caused when your heart muscle doesn’t get enough oxygen-rich blood. It occurs without causing death or permanent damage to the heart cells, and it is a risk factor for a heart attack. Angina is described as a feeling of pressure, heaviness, tightness, or pain in the chest. Angina is caused by reduced blood flow to your heart muscle. Your coronary arteries can become narrowed by fatty deposits called plaques. Besides physical activity, other factors such as emotional stress, heavy meals and smoking also can narrow arteries and trigger angina. Angina does not lead to death; however, it requires a doctor’s visit in order to know its causes and ways to treat it, because it indicates the presence of a problem that hinders the blood supply to the heart muscle. If not treated, it may cause a heart attack, which is an emergency that may lead to death.

MAY.JUNE 2022

The following risk factors increase your risk of angina: •

• •

•

High level of low-density lipoprotein (LDL) cholesterol (also known as bad cholesterol) or triglyceride levels High blood pressure Obesity which is linked with high blood cholesterol levels, high blood pressure and diabetes, all which increase your risk of angina and heart disease. Diabetes increases the risk of coronary artery disease, which leads

ANGINA IS DESCRIBED AS A FEELING OF PRESSURE, HEAVINESS, TIGHTNESS, OR PAIN IN THE CHEST. ANGINA IS CAUSED BY REDUCED BLOOD FLOW TO YOUR HEART MUSCLE. YOUR CORONARY ARTERIES CAN BECOME NARROWED BY FATTY DEPOSITS CALLED PLAQUES.

Heart Attack, Angina and Cardiac Arrest . ARTICLE FEATURES

• • • •

to angina and heart attacks by speeding up atherosclerosis and increasing your cholesterol levels. Stress can increase your risk of angina and heart attacks. Smoking Lack of exercise Family history of heart disease

Cardiac Arrest Sudden cardiac arrest is the abrupt loss of heart function, breathing and consciousness. The condition usually results from a problem with your heart's electrical system, which disrupts your heart's pumping action and stops blood flow to your body. If not treated immediately, sudden cardiac arrest can lead to death. Cardiopulmonary resuscitation (CPR), using a defibrillator — or even just giving compressions to the chest — can improve the chances of survival until emergency workers arrive. Sometimes signs and symptoms such as chest discomfort, shortness of breath, weakness and heart palpitations can occur before sudden cardiac arrest. Cardiac arrest may be caused by irregular heart rhythms called arrhythmias. A common arrhythmia associated with cardiac arrest is ventricular fibrillation. In ventricular fibrillation, the heart's lower chambers suddenly start beating chaotically and don't pump blood. Sudden cardiac arrest isn't the same as a heart attack, when blood flow to a part of the heart is blocked. However, a heart attack can sometimes trigger an electrical disturbance that leads to sudden cardiac arrest. Cardiac arrest occurs when your heart suddenly stops beating. Unlike heart attacks, which are due to blocked arteries, this condition occurs when there’s a problem with your heart’s electrical system. It is life threatening and requires immediate treatment. When cardiac arrest occurs, blood stops flowing to the brain and other vital organs.

•

heart valve disease or other causes. Blood vessel abnormalities: These rare cases occur particularly in the coronary arteries and aorta. Adrenaline released during intense physical activity can trigger sudden cardiac arrest when these abnormalities are present.

Sudden cardiac arrest can happen in people who have no known heart disease. However, a life-threatening arrhythmia usually develops in a person with a preexisting, possibly undiagnosed heart condition such as coronary heart disease, in which the arteries become clogged with cholesterol and other deposits, reducing blood flow to the heart. Enlarged heart (cardiomyopathy) occurs primarily when your heart's muscular walls stretch and enlarge or thicken. Then your heart's muscle is abnormal, a condition that often leads to arrhythmias. Leaking or narrowing of your heart valves can lead to stretching or thickening of your heart muscle. When the chambers become enlarged or weakened because of stress caused by a tight or leaking valve, there's an increased risk of developing arrhythmia. A sudden cardiac arrest can occur due to a congenital heart disease or electrical problems in the heart.

CARDIAC ARREST MAY BE CAUSED BY IRREGULAR HEART RHYTHMS CALLED ARRHYTHMIAS. A COMMON ARRHYTHMIA ASSOCIATED WITH CARDIAC ARREST IS VENTRICULAR FIBRILLATION. IN VENTRICULAR FIBRILLATION, THE HEART'S LOWER CHAMBERS SUDDENLY START BEATING CHAOTICALLY AND DON'T PUMP BLOOD.

Causes of Cardiac Arrest • •

Scarring of the heart tissue as a result of a prior heart attack. Thickened heart muscle (cardiomyopathy): Damage to the heart muscle can be the result of high blood pressure,

MEDICAL INSTITUTION

Valluvan Jeevanandam, MD, is a world-renowned heart surgeon

MAY.JUNE 2022

MEDICAL INSTITUTION

HEART SURGEON DEDICATES ILLUSTRIOUS CAREER TO HELPING PATIENTS NO OTHER DOCTORS CAN SAVE Provided by UChicago Medicine

alluvan Jeevanandam, MD, was six months into his first job as a heart surgeon nearly three decades ago when a critically ill patient pleaded with him: Get me a heart transplant today, or I am going to die. Determined to meet the deadline, yet without an organ match for the 220-pound man, Jeevanandam did what would become a signature throughout his storied career: He looked for an unorthodox solution. Typically, a heart needs to come from a donor who is within 20% of the patient’s body size. In this case, that would mean a donor roughly between 180 and 260 pounds. But that’s not what was available. “We found a heart nearby that matched for most requirements but had belonged to an 80-pound child,” Jeevanandam said. “So, I asked the cardiologist, ‘How fast does a heart grow?’” Confident that science and skill were on his side — and with the patient’s consent to try — Jeevanandam transplanted the child's heart into the man’s body. At first, the small heart raced, unable to keep up with the body’s demands and produce enough power to fully circulate blood. Then, after one week, the care team was able to take the man off a ventilator. After six months, the heart had grown to the normal size found in adults. At just 32, Jeevanandam had performed the world’s first successful adult transplant using an undersized pediatric donor, a procedure not many surgeons would attempt even today. It was the first in a long line of record-setting accomplishments for the cardiac surgeon. Now the director of the Heart and Vascular Center and Chief of Cardiac Surgery at the University of Chicago Medicine, Jeevanandam,

UNDER JEEVANANDAM’S DIRECTION, UCHICAGO MEDICINE HAS A 5-STAR RATING FROM THE SCIENTIFIC REGISTRY OF TRANSPLANT RECIPIENTS FOR OUR EXPERTISE IN HEART TRANSPLANT. WE ROUTINELY TAKE EXTREMELY CHALLENGING CASES, WHICH INCLUDE PATIENTS WHO ARE DENIED CARE AT OTHER HOSPITALS AROUND THE COUNTRY, AND PROVIDE THE LIFESAVING TREATMENT THEY NEED.

MEDICAL INSTITUTION

recently led the surgical teams that performed the world’s first back-to-back triple-organ transplants of two 29-year-old patients, both with failing hearts, livers and kidneys. In the 12 months since that historic December 2018 event, the teams performed four more of these multi-organ transplants. Now UChicago Medicine has performed 13 of these complex transplants since 1999, more than any other institution. Under Jeevanandam’s direction, UChicago Medicine has a 5-star rating from the Scientific Registry of Transplant Recipients for our expertise in heart transplant. We routinely take extremely challenging cases, which include patients who are denied care at other hospitals around the country, and provide the life-saving treatment they need. Our esteemed 5-star rating is a recognition that we offer exceptional care to heart transplant patients, which includes the:

Shortest We have the shortest wait times in the nation for receiving a donor heart. Best We have the best survival rates in the country for heart transplant patients. Highest We have the highest proportion of African American patients transplanted in the United States.

Excellence early on The innovation and drive Jeevanandam has brought to the operating room for the past 30 years might be in his DNA. His grandfather, despite being born with no wealth in a class-based society, became the most prominent man in his hometown after building a successful produce business that began with a bicycle delivery route. His father — a PhD who helped establish India’s nuclear energy program and contributed greatly to the field of surgical metabolism — was able to attend college only after a teacher paid his application fee, the $10 price tag being too great for the family to spare.

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Even in his early years, Jeevanandam was searching for the most efficient, effective solutions to any challenge. He spent the first decade of his life in Tuticorin on India’s southern tip until he, his parents and older sister immigrated to New York City in 1970. At age 15, he was accepted to Columbia University, where he would graduate summa cum laude with a biochemistry degree at 19. At Columbia’s medical school, while other students crammed for hours before tests, Jeevanandam worked smarter. He spent the daily commute from home studying so he would have two hours of preparation before class began. The hard work paid off. He earned the school’s top awards in surgery, medicine and physiology during his final year. His mentor at Columbia — where he stayed for his residency and fellowships — was Eric Rose, MD, a giant in the field of cardiothoracic surgery and the first surgeon to perform a successful pediatric heart transplant. Rose described Jeevanandam as being “insatiably curious” and “an incredibly special human being, who is brilliant, energetic and compassionate.” It was perhaps this curiosity that led Jeevanandam to leave New York after 22 years to start a career at Temple University in Philadelphia as the associate director of the heart transplant program. He anticipated working alongside Temple’s senior surgeon, but that plan was dashed when, just months after Jeevanandam took the position, the entire heart transplant physician team but him left for another hospital. Promoted to Program Director, Jeevanandam took over and thrived, performing 52 heart transplants that year and shattering the hospital’s previous record.Initially, though, the young surgeon had doubts. He called Rose to seek advice on whether to stay. “Eric said, ‘You stay and get the job done.’ And that’s always been my theme,” he recalled. “I want to think outside the box and do something different. Instead of reading about it first and then doing it, I’d rather create it and then write about it for other people to read and learn from.”

PROMOTED TO PROGRAM DIRECTOR, JEEVANANDAM TOOK OVER AND THRIVED, PERFORMING 52 HEART TRANSPLANTS THAT YEAR AND SHATTERING THE HOSPITAL’S PREVIOUS RECORD.INITIALLY, THOUGH, THE YOUNG SURGEON HAD DOUBTS. HE CALLED ROSE TO SEEK ADVICE ON WHETHER TO STAY.

MEDICAL INSTITUTION

Triple-organ transplant patient, Sarah McPharlin, hugs heart transplant surgeon, Dr. Valluvan Jeevanandam.

Helping the helpless When he was 8, Jeevanandam watched his grandfather collapse from a massive heart attack and die before his eyes. From then on, he became fascinated with how to help others avoid this fate and was drawn to heart transplant because of the intellectual and technical challenge. He has relentlessly sought innovative ways to save lives. That includes perfecting so-called bloodless cardiac surgeries for patients, such

as Jehovah’s Witnesses, who will not accept blood transfusions, and conducting pioneering research on mechanical assist devices to provide a bridge to transplant or a long-term solution for patients who may not be transplant candidates. Colleen LaBuhn, APN, UChicago Medicine’s Cardiac Surgery Program Coordinator, admires how Jeevanandam never gives up on patients, even when the most sick, complicated or underinsured are sent his way. “He will fight for pa-

MEDICAL INSTITUTION

tients who have nothing,” she said. “He thrives on helping people nobody else can really help.”

A heart to give back Jeevanandam is one of the last pioneers of heart transplant and mechanical assist devices still practicing medicine. And for a man with more accolades, awards, publications and world records to count, one would expect a commensurate ego. However, the very nature of transplant — the lack of complete control even when a procedure is performed technically perfectly — has driven him to a devout spirituality. “In my faith, we are told ego is the biggest problem in the world,” he said. “If you think it’s all you doing it, then that becomes a real barrier. It’s not ‘I’ but the collective ‘we’ who have been entrusted with a person’s life.” Leilani Miles, RN, has worked alongside him in the operating room for all 22 of his years at UChicago Medicine. Make no mistake, she said, Jeevanandam has high expectations of his team members. But he also treats them with the utmost respect, reserving his harshest criticisms for himself. She points to the 10- and 15-year tenures of many colleagues as a testament to the cohesion and loyalty they have, to their patients and to Jeevanandam. “We see a lot of high-risk patients, people no other hospitals will take,” she said. “But Val is always calm, and that sets the tone for the entire team. He’ll never say no unless he’s truly maximized all of his options to save someone.” Jeevanandam also has not forgotten the $10 his father received that changed the trajectory of his family’s life. Strong proponents of education as a way to end cyclical poverty, Jeevanandam and his family created a fund to support children in India who have dreams of attending college but no resources to get them there. Currently, they support nine students per year, and he’s looking to expand that. Additionally, he makes annual trips back to Puttaparthi in his home country to perform volunteer surgeries, a commitment he has honored for the past 24 years.

Another milestone in medicine Jeevanandam will never be satisfied slowing

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down or resting on his laurels, despite being the world’s most experienced heart transplant surgeon nearing the sunset of his career. Each year, he sets a seemingly unattainable goal for himself and his team with every intention they’ll reach it. For 2020, he has set his sights on conquering one of the biggest remaining barriers to transplant: antibody rejection rates. Some people develop antibodies that will attack donated organs at much higher rates than normal, drastically limiting their pool of available organs and a transplant’s chances of success. No reliable method exists for decreas-

JEEVANANDAM IS ONE OF THE LAST PIONEERS OF HEART TRANSPLANT AND MECHANICAL ASSIST DEVICES STILL PRACTICING MEDICINE.

MEDICAL INSTITUTION

ing antibodies. But Jeevanandam’s research and extensive experience with multi-organ transplants have shown that the body’s most effective way of eliminating these agents is through a liver — which acts like a sponge — that belongs to the same body as the heart. What if a patient has a failing heart but a healthy liver? Jeevanandam and his team are working to perfect the domino transplant, where the patient with a failing heart would receive both a new heart and a new liver and would donate the healthy liver to a different person with a failing one. They aren’t there yet, with both political

and technical obstacles to overcome, but their success could mean a lifesaving breakthrough for those who previously had no hope. It also could be the capstone to an already-impressive career. But Jeevanandam doesn’t think like that. He sees himself and those around him as vessels for a higher power to do good work on Earth. “Every day, I do as much as I can, but, ultimately, the pressure is off,” he said. “If the cosmos wants it to happen, it will.”

uchicagomedicine.org/global

ARTICLE FEATURES . Sterilization and Infection Control

Sterilization and Infection Control The basic steps to ensure patient safety

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Sterilization and Infection Control . ARTICLE FEATURES

terilization and infection control are the cornerstone of patient and medical staff safety within the hospital environment, which is what hospitals and medical facilities have been working on in the past years to ensure that they are infection-free. In addition, international certificates of accreditation place sterilization and infection control at the very top of their priority list before granting accreditation to any institution. For that purpose, infection control departments have been established in hospitals that work to implement specialized programs aimed at preventing or stopping the spread of infection among patients and hospital staff, through the application of a set of policies, guidelines and preventive measures. For instance, standard procedures based on risk assessment and personal protection methods are used to protect healthcare providers from infection and prevent cross-contamination, while seeking to apply various methods that provide a clean infection-free environment. Hospitals are keen to follow the guidelines set by international authorities such as the World Health Organization, the Joint Commission International and other global and international authorities concerned with infection control and patient safety in hospitals. In this dedicated department, employees are trained and educated on how to apply the best healthcare practices and improve the correct medical practices. The Infection Control Department also aims at keeping the hospital clean and germ-free, while having sterile devices and tools, by selecting materials that have been globally tested to sterilize medical equipment and tools. The goal is to ensure staff safety and to provide a clean infection-free workplace through regular examinations, preparing periodic reports and conducting monthly laboratory swabs, in addition to striving to provide state-of-the-art technologies, supplies and special means that help prevent the spread of infection. Regular handwashing is one of the most effective ways to prevent the spread of germs. Clean hands can stop germs from spreading

from one person to another and throughout an entire community—from your home and workplace to childcare facilities and hospitals. The use of gloves is also fundamental and should not be considered an alternative to performing hand hygiene. Hand hygiene is required before putting on gloves and immediately after removal. Gloves should be changed between tasks and procedures on the same patient and should be removed immediately after a procedure and hand hygiene performed so as to avoid contaminating the environment. These are among the most important procedures stipulated in global health policies and implemented by hospitals to ensure the continuity of obtaining the global healthcare accreditation certificate. Hence, infection control in hospital departments is a top priority and of utmost importance and is applied in accordance with several procedures and policies within the best practices and international standards in order to ensure security and safety of patients and hospital staff, and enhance the patient’s trust in the healthcare system. Since any hospital worker may be exposed to infection, there is an infection control work methodology that relies on several pillars, namely risk assessment and control, setting policies and procedures to prevent its spread and providing infrastructure that ensures safety for high-risk procedures, in addition to focusing on mainstreaming policies and procedures with the aim of upgrading the staff experience to reduce risks within performance indicators that conform to the highest international levels through infection monitoring systems and identification of the most severe health conditions.

THE SMART STERILIZATION ROBOT IS THE LATEST ADVANCED TECHNOLOGY SOLUTION FOR SAFE STERILIZATION THAT ENSURES A SAFE EXPERIENCE FOR PATIENTS AND MEDICAL STAFF IN ALL DEPARTMENTS AND FACILITIES.

Smart Sterilization Robots for Patient Rooms Smart robots are increasingly advocated as a simple solution for the immediate disinfection of rooms and spaces of all surfaces in one process and as such they seem attractive to hospital management. However, disinfection robots do not replace manual cleaning but complement it. Robots have been successful in cleaning and sterilizing hospitals, which was fundamental during the coronavirus pandemic, as hospitals

ARTICLE FEATURES . Sterilization and Infection Control

are increasingly adopting robots that are able to kill germs, viruses and bacteria as well as sterilize rooms in a few minutes. The robot is the latest advanced technology solution for safe sterilization in a way that ensures a safe experience for patients and medical staff in all departments and facilities. The robot can navigate around a room and thoroughly sterilize the entire operating room in record time (no more than seven minutes) without the need for human intervention. The UV robot has the ability to move automatically and ensures greater and better coverage of high-contact areas. The robots use ultraviolet-powered sterilization whilst scanning all rooms and corridors in its facilities. Each robot can complete exhaustive sterilization of a room in no time. Moreover, the robots provide 360-degree coverage and can repeat the same process with high accuracy several times. The smart sterilization robot is like a revolutionary innovation in the world of safe sterilization. UV-disinfection robots offer a no-touch

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technology, delivering disinfection by irradiation of effective intensity to kill microorganisms in operating rooms, ICUs, outpatient clinics, hospital corridors, etc.

Cross-infection prevention Handwashing is the most important preventive measure against cross-infection. Medical professionals follow special procedures to help prevent infections. Aseptic technique is a common process used to sterilize equipment so harmful microorganisms can’t spread from patient to patient. Wearing gloves helps protect both patients and healthcare workers from infection. Gloves help keep your hands clean and lessen your chance of getting germs that can make you sick. Healthcare workers should wear gloves every time they touch blood, bodily fluids, bodily tissues, mucous membranes, or broken skin. They should wear gloves for this sort of contact, even if a patient seems healthy and has no signs of any germs.

WEARING GLOVES HELPS PROTECT BOTH PATIENTS AND HEALTHCARE WORKERS FROM INFECTION. GLOVES HELP KEEP YOUR HANDS CLEAN AND LESSEN YOUR CHANCE OF GETTING GERMS THAT CAN MAKE YOU SICK. HEALTHCARE WORKERS SHOULD WEAR GLOVES EVERY TIME THEY TOUCH BLOOD, BODILY FLUIDS, BODILY TISSUES, MUCOUS MEMBRANES, OR BROKEN SKIN.

Sterilization and Infection Control . ARTICLE FEATURES

Hand hygiene is described by many healthcare workers as the single most important tool in preventing the spread of healthcare-associated infections between patients. The five moments of hand hygiene outlined by WHO are: Before patient contact; before aseptic task; after bodily fluid exposure; after patient contact; and after contact with patient surroundings. Workers in operating rooms, including surgeons, assistants and others, should wash their hands and forearms with an antiseptic soap for 3-5 minutes before touching the patient.

Healthcare Apparel Healthcare apparel is also part of sterilization; employees can usually wear their normal clothes under their white scrub. But in special departments such as ICUs and operating rooms, uniform pants and a short-sleeved gown are required for men and women, and these clothes are made of an easy-to-wash material. The uniform should also be changed after exposure

to blood or if it became wet through excessive sweating or exposure to other fluids. Other basic hygiene procedures include ensuring all staff have access to single-use disposable gloves, making sure all staff can easily access hand washing facilities or hand sanitizer and safe disposal of clinical waste, blood and other body fluids. The healthcare worker should assess the level of risk of splashes or sprays of blood or body fluids, and secretions or excretions involved in the procedure being undertaken and wear appropriate apparel, ie. plastic apron, gown, mask, goggles, face shield. All healthcare workers must take precautions to prevent injuries caused by needles, scalpels and other sharp instruments or devices. The adoption of safe work practices and correct disposal is incumbent on all who use sharps. The maintenance of a safe environment for patients incorporates the basic requirement that the area a patient is nursed in, and equipment used on the patient is hygienically clean.

HEALTHCARE APPAREL IS ALSO PART OF STERILIZATION; EMPLOYEES CAN USUALLY WEAR THEIR NORMAL CLOTHES UNDER THEIR WHITE SCRUB. BUT IN SPECIAL DEPARTMENTS SUCH AS ICUS AND OPERATING ROOMS, UNIFORM PANTS AND A SHORTSLEEVED GOWN ARE REQUIRED FOR MEN AND WOMEN, AND THESE CLOTHES ARE MADE OF AN EASYTO-WASH MATERIAL.

ARTICLE

Diabetes: Managing care by leveraging AI

By Dr. Maryam Sayed Jaffar AlSharaf, Director, Data and Statistics - Emirates Health Services & Dr. Bashar Balish, General Manager & Senior Director – Middle East & Africa, Cerner

ver the past few decades, the burden of chronic diseases has significantly increased all over the world, contributing a substantial cost to the healthcare systems. These diseases are responsible for a major proportion of the top ten causes of death globally, especially in middle-to-high income countries. Chronic disease management requires a very comprehensive approach with sustained efforts to cover all segments across the spectrum of these complex diseases. While efforts are required to manage the chronic conditions, many resources are also required to prevent disease complications. To create relevant and effective disease management strategies, the role of data is more paramount than ever before . Data is increasingly being utilized to curate healthcare programs and it continues to be a source of program evaluation and enhancements in the healthcare industry. Of the many ways employed to utilize data for insights creation, visualizations have proven to be a very effective tool for creating system insights for leaders and decision-makers. Diabetes is one of the leading chronic diseases in today’s world. With an expectation of the global burden of disease to increase manifold in the years to come, healthcare leaders are looking into insightful, evidence-based approaches to address this issue.

Approach towards designing the data-driven Diabetes Management With a mission of providing innovative and high-quality care to its patients, Emirates Health Services (EHS) has a patient-centric focus. There is a high emphasis on improving healthcare quality that is aligned with the international sustainable development goals. With the increasing burden of chronic diseases and categorical increase in diabetes cases in the past few decades, EHS leadership required insights into

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WITH THE INCREASING BURDEN OF CHRONIC DISEASES AND CATEGORICAL INCREASE IN DIABETES CASES IN THE PAST FEW DECADES, EHS LEADERSHIP REQUIRED INSIGHTS INTO THEIR POPULATION STATISTICS FOR THE CONDITION. THESE INSIGHTS WOULD BE UTILIZED AS THE EVIDENCE BASE FOR PLANNING AND MANAGEMENT OF DIABETES CARE PROGRAMS FOR THE POPULATION..

their population statistics for the condition. These insights would be utilized as the evidence base for planning and management of diabetes care programs for the population.

To meet these expectations, we designed a data-driven solution utilizing Cerner EHR (called Wareed) data. This is a dashboard that gives EHS leaders a view of the distribution and well-being of their diabetic population across their entire network. The program was launched on World Diabetes Day, November 14 2021, and consists of a series of visualizations that are based on several customized reports catering to different requirements of diabetes care and management. The data analyzed spans from patient demographic details to clinical outcomes. The team worked on creating multiple reports that could accommodate massive amounts of data over a span of six years, representing the diabetic cohort enrolled with EHS. There are actionable insights into the service utilization frequencies and trends through visits analysis, which gives leaders an understanding of their resource consumption and requirements.

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Besides showcasing trends of service utilization, advanced analytics techniques were used to predict future visits that would support leaders in foreseeing the expected service utilization in the future. This can serve as an effective tool for future program planning and management by program leaders. There are visualizations that project the burden of disease and trends over a period of time. These trends can be mapped against geographical location, age category and gender of patients. Moreover, the program includes clinically-rich analytics displayed over layers that cover patient comorbidity conditions and their risk factors for disease complications. The diabetes care coordinators utilize this program to view continuity of care for their patients’ cohort, which also reflects upon compliance to recommended care practices by EHS clinicians.

Bringing Artificial Intelligence into action The platform includes a unique patient traceability feature that can be utilized by care coordinators to identify their vulnerable populations. This function is supported by the analytics feasibility to identify the coexistence of different clinical conditions at a patient level. This information can be tied back to the patient management process and used to reach out to highrisk patients through the information displayed. Clinically, it is significant for the care team to identify their patients who require a tailored approach to disease control. This rich data set can be utilized to create advanced analytics models utilizing artificial intelligence. These models can help identify high-risk characteristics from the EHS population that predispose them to a risk of poor disease control. To further elaborate on the significance of such capabilities, it can also be utilized to identify the financial impact of such preventive interventions by avoiding high resource consumption visits and events. Supported by the huge volume of data available and utilizing the machine learning capabilities, a new AI model was built that utilizes historical data to identify features of patients at risk of poor disease control. The model predicts individuals who are at risk of deterioration in the

future and patient traceability features helps to bring them back into the health system. This clinical decision support gives information to clinicians about the diabetics that need close monitoring and enhanced care NOW to reduce disease burden. By meaningful use of machine learning and advanced analytics techniques, this program provides insights that can be utilized to plan resources, identify clinical practice compliance, find out the burden and distribution of diabetes, highlighting the high-risk patients and provides the facilitation to reach out to such patients for prompt action and improved patient management. It displays a wealth of information that would support decision-makers in identifying high achievements as well as areas of refined focus for future action by using epidemiological as well as clinical evidence.

THE PLATFORM INCLUDES A UNIQUE PATIENT TRACEABILITY FEATURE THAT CAN BE UTILIZED BY CARE COORDINATORS TO IDENTIFY THEIR VULNERABLE POPULATIONS. THIS FUNCTION IS SUPPORTED BY THE ANALYTICS FEASIBILITY TO IDENTIFY THE COEXISTENCE OF DIFFERENT CLINICAL CONDITIONS AT A PATIENT LEVEL. THIS INFORMATION CAN BE TIED BACK TO THE PATIENT MANAGEMENT PROCESS AND USED TO REACH OUT TO HIGH-RISK PATIENTS THROUGH THE INFORMATION DISPLAYED.

ARTICLE FEATURES . Kidney Disease and Diabetes go hand in hand

Kidney Disease and Diabetes go hand in hand Diabetes is the leading cause of chronic kidney disease

umerous diabetic patients suffer from diabetic nephropathy, which is a complication that is expected to occur over the years due to uncontrolled diabetes. Diabetic nephropathy affects the kidneys' ability to do their usual work of removing waste products and extra fluid from your body. Over time, the two diseases form a group of complications that affect all parts of the body. Over time, the high blood sugar levels damage the millions of tiny filtering units within each kidney. This eventually leads to kidney failure. Diabetic nephropathy takes many years before it develops and symptoms appear. It rarely occurs in the first ten years of diabetes onset. Symptoms begin about 15 to 20 years after the diagnosis of type 1 diabetes.

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Diabetes harms the kidneys in several ways, including: •

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Why does sugar aff ect the kidneys? Your kidneys contain millions of tiny blood vessel clusters that filter waste from your blood. Severe damage to these blood vessels can lead to diabetic nephropathy, decreased kidney function and kidney failure. Damage to the kidneys puts stress on these vital organs and prevents them from working properly. When this happens, the body starts to lose protein through the urine, the kidneys cannot remove waste products from the blood and the kidneys cannot maintain healthy fluid levels in the body. Patients with diabetes and microalbuminuria who progress to macroalbuminuria are more likely to progress to end-stage renal disease.

However, it is difficult to determine if a diabetic patient will develop diabetic nephropathy, but there are some risk factors that increase the risk of its occurrence, namely: • •

Type 1 diabetes diagnosed before the age of 20 Uncontrolled diabetes, meaning that the patient suffers from high or low

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blood sugar levels Uncontrolled hypertension. Family history of diabetes and chronic kidney disease.

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Damage to the blood vessels inside the kidneys. Over time, high blood sugar levels can cause these blood vessels to get narrow and clogged. As your kidneys get less blood, less waste and fluid is taken out of your body. When your kidneys are not working as well as they should, protein can leak through your kidney's filters and into your urine. High blood sugar damages the nerves, and these nerves may stop sending messages to different parts of your body including the bladder. If the nerves of the bladder are damaged, the patient does not feel that it is full. This pressure on the bladder causes damage to the kidneys. If urine remains in the bladder for a long time, the patient can develop a urinary tract infection due to bacteria, especially as they grow rapidly in the urine with the high level of sugar. These infections often affect the bladder, but they may sometimes spread to the kidneys.

Early signs and symptoms The diabetic patient should do regular check-ups, especially in the case of type 1 diabetes. Having even a small amount of albumin in your urine (microalbuminuria) is a sign that early kidney damage is present. Research suggests that people with albumin in their urine are more at risk of eventually developing kidney or cardiovascular problems. Early detection limits the development of the condition, but the delay in diagnosis and the lack of appropriate treatment leads to an increased excretion of

DIABETIC NEPHROPATHY TAKES MANY YEARS BEFORE IT DEVELOPS AND SYMPTOMS APPEAR. IT RARELY OCCURS IN THE FIRST TEN YEARS OF DIABETES ONSET.

Kidney Disease and Diabetes go hand in hand . ARTICLE FEATURES

ARTICLE FEATURES . Kidney Disease and Diabetes go hand in hand

urinary albumin. Macroalbuminuria of clinical nephropathy is when albumin excretion in a 24hour urinary collection is greater than 300 mg continuously; this is called nephrotic syndrome.

should also control their glucose levels and take measures to lower blood pressure such as losing weight, reducing salt intake, quitting smoking, and increasing activity levels.

When should we perform a urine microalbumin test?

Treatment

Screening for microalbuminuria should be initiated five years after diagnosis of type 1 diabetes and at diagnosis of type 2 diabetes. The test should be repeated annually. During the microalbumin test, you simply need to provide a fresh urine sample. Your doctor may ask you to collect all of your urine in a special container over a 24hour period and submit it for analysis. Your doctor may ask you to provide a urine sample first thing in the morning or after a four-hour period of not urinating. A random urine test can be taken at any time. But to improve accuracy of the results, it's often combined with a urine test for creatinine — a waste product usually filtered by the kidneys. Managing diabetes means managing blood glucose, blood pressure, and cholesterol. The patient should follow a healthy diet, exercise regularly while taking the right medications to help control his blood sugar levels. Patients

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The most important steps of treatment and complication prevention include good control of blood sugar levels, undergoing regular checkups, especially urine microalbumin test because it indicates the presence of changes in the blood vessels that filter blood and eliminate waste. Angiotensin-converting enzyme (AEC) inhibitors are a type of medications that lower the blood pressure. ACE inhibitors prevent an enzyme in the body from producing angiotensin II, a substance that narrows blood vessels. This narrowing can cause high blood pressure and forces the heart to work harder. Angiotensin II also releases hormones that raise blood pressure. Reducing salt intake is an important step in the nutritional program developed by a nutritionist and adopted by the patient due to the damage it causes to the kidneys, in addition to limiting the consumption of animal protein such as meat and others.

SCREENING FOR MICROALBUMINURIA SHOULD BE INITIATED FIVE YEARS AFTER DIAGNOSIS OF TYPE 1 DIABETES AND AT DIAGNOSIS OF TYPE 2 DIABETES. THE TEST SHOULD BE REPEATED ANNUALLY.

Kidney Disease and Diabetes go hand in hand . ARTICLE FEATURES

What is the diet of a patient with diabetic nephropathy? An appropriate diet and drug treatment have an effective role in maintaining kidney health and controlling blood sugar level. Therapeutic nutrition for these patients aims to maintain glucose levels and improve lipid levels, as well as reduce blood pressure and complications of diabetes, including heart, eye, nerve, and kidney diseases. A low-protein diet should be followed as it puts less strain on the kidneys. As a result, this type of diet can benefit people with kidney-related disorders such as kidney disease. A low-protein diet can reduce the loss of protein through the urine and increase protein levels in the blood. The patient should also reduce or stop his salt intake and the doctor may ask him to stay away from citrus fruits, sweets, and various baked goods. Both sugary and starchy carbohydrates can raise blood sugar levels. In addition, a diet with more fruits and vegetables and less or no animal protein may lower acid in the body to promote kidney health. Prevention is the most effective way to protect the kidneys from diabetic disorders, and the most important step is to maintain normal blood sugar levels by following a healthy diet, exercising regularly and taking the medications as prescribed by the treating physician.

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low potassium fruits you can add to your diet in moderation as long as you monitor your carb intake. Grapes, berries, pineapple, mango, and apples are a few examples. Processed foods as they are high in sodium which actually alone makes up 60-70% of the daily sodium allowance. Dried fruits aren’t ideal for people with kidney disease and diabetes because they’re high in sugar and minerals like potassium. For people with kidney disease and diabetes, beans and lentils are not ideal due to their relatively high phosphorus content. Canned versions are typically also high in sodium. Various leafy green vegetables, such as spinach, chard and beet greens, because they contain high amounts of nutrients like potassium.

A LOW-PROTEIN DIET SHOULD BE FOLLOWED AS IT PUTS LESS STRAIN ON THE KIDNEYS. AS A RESULT, THIS TYPE OF DIET CAN BENEFIT PEOPLE WITH KIDNEYRELATED DISORDERS SUCH AS KIDNEY DISEASE.

Foods to avoid if you have diabetic nephropathy •

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Processed meats that are made by drying, salting, curing, or smoking meats which eliminate all nutrients. Sodas, especially dark-colored varieties, as they contain 90–180 mg of phosphorus per 355-mL serving. Healthy kidneys can easily remove excess phosphorus from the blood, but this isn’t the case when you have kidney disease. Fruit juices and other sugar-sweetened beverages because they contain many preservatives and added sugar that can cause rapid spikes in blood sugar. High potassium fruits such as bananas, avocados, apricots, kiwis and oranges. Fortunately, there are plenty of healthy

ARTICLE FEATURES . Uterine Fibroids

Uterine Fibroids

The most common health problem in women of reproductive age MAY.JUNE 2022

Uterine Fibroids . ARTICLE FEATURES

terine fibroids are one of the most common health problems in women of reproductive age, with symptoms ranging from mild to moderate and severe. Uterine fibroids are noncancerous growths of the uterus that often appear during childbearing years. Many women have uterine fibroids sometime during their lives. But you might not know you have uterine fibroids because they often cause no symptoms. Your doctor may discover fibroids incidentally during a pelvic exam or prenatal ultrasound. When treatment is necessary, there are various treatment options including drug therapy, surgery or a minimally invasive procedure. In severe and advanced cases, a hysterectomy is performed. There are few known risk factors for uterine fibroids, other than being a woman of reproductive age. If your mother or sister had fibroids, you're at increased risk of developing them. Other factors include starting your period at an early age, obesity, a vitamin D deficiency; having a diet higher in red meat and lower in green vegetables, fruit and dairy; and drinking alcohol, including beer, appear to increase your risk of developing fibroids. Estrogen and progesterone, two hormones that stimulate development of the uterine lining during each menstrual cycle in preparation for pregnancy, appear to promote the growth of fibroids. Fibroids contain more estrogen and progesterone receptors than typical uterine muscle cells do. Fibroids tend to shrink after menopause due to a decrease in hormone production.

In women who have symptoms, the most common signs and symptoms of uterine fibroids include: • • • • • • •

Heavy menstrual bleeding Menstrual periods lasting more than a week Pelvic pressure or pain Frequent urination Difficulty emptying the bladder Constipation Backache or leg pains

Fibroids are generally classified by their location. There are fibroids located inside the uterine cavity and cause vaginal bleeding between periods as well as severe pain. This type of fibroid can be removed with hysteroscopy through the cervix without laparoscopy. In some other cases, part of the fibroids is inside the uterine cavity and the other part is in the uterine wall and cause thick blood loss during the period, and it is accompanied by vaginal bleeding between periods. This type of fibroid can be removed with hysteroscopy and there is no need for traditional surgery and making a large incision. Fibroids located inside the uterine wall range in size; they can be so small and not visible to the naked eye or large and accompanied by several symptoms. There are several ways to treat this type of fibroid, but most of them do not need any treatment. There are fibers that are present outside the uterine wall or are attached to the uterus; these do not need treatment if they become large, and may lead to pain if a twisting occurs, but it is one of the easiest types that can be removed through laparoscopy.

Treatment Treatment methods vary according to the size of the tumor. If the fibroid is small, the patient can live with it or stop its growth with drug therapy. Surgical intervention may be required to remove the tumor or remove the uterus whenever it becomes large and depending on its location. Radiotherapy can also be adopted if the first two treatments were unsuccessful. If the size of the fibroid is less than 3 cm and there are no symptoms, it does not need treatment, and if the woman suffers from severe pain, painkillers, hormonal drugs or monthly injections can be used. When the tumor is large and causes discomfort and health problems, then surgical intervention is needed in order to remove it. Recent developments in the medical field have allowed doctors and surgeons to perform minimally invasive operations (laparoscopic or robotic) which contributed to a quicker recovery and less postoperative complications.

Fibroids located inside the uterine wall are difficult to remove through the cervix and require hysterectomy, which is a suitable option for women after menopause. But this option is the most difficult for women in reproductive age, therefore, the doctor resorts to other treatment options before making this decision as it affects a woman’s fertility and ability to get pregnant. If the fibroids are few in number, the doctor may opt for a laparoscopic or robotic procedure, which uses slender instruments inserted through three small incisions in the abdomen to remove the fibroids from the uterus. This type of surgery allows the patient to resume her daily activities in a matter of days, and does not require a hospital stay more than one day. It is also less painful than laparotomy.

ARTICLE

Endometrioma and Infertility, When To Operate

By Dr Mazen Bishtawi FRCOG FACOG, Consultant in Obstetrics and Gynaecology, Subspecialist in Gynaecological Oncology and Advanced Laparoscopy at Al-Ahli Hospital Doha / Qatar

ndometriosis has been estimated to affect up to 10% to 15% of reproductive-age women. Most women with endometriosis have a delay on average of 7 years from the onset of symptoms until the diagnosis is made, the symptoms could be irregular bleeding, menstrual dysfunction, pain and infertility. The association between endometriosis and infertility is well supported throughout the literature, but a definite cause-effect relationship is still controversial. The prevalence of endometriosis increases dramatically to as high as 25% to 50% in women with infertility, and 30% to 50% of women with endometriosis have infertility. The fecundity rate in normal reproductive-age couples without infertility is estimated to be around 15% to 20%, whereas the fecundity rate in women with untreated endometriosis is estimated to range from 2% to 10%. Women with mild endometriosis have been shown to have a significantly lower probability of pregnancy during a period of 3 years than do women with unexplained fertility.

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Ovarian endometriomas have always been subject for controversy, controversy on pathogenesis and controversy on treatment. We see many patients coming with endometriomas and infertility, these patients usually get conflicting advice whether to go for surgery and remove endometrioma or proceed for IVF. Ovarian endometrioma affects 17-44% of woman with endometriosis, endometriomas also known as chocolate cysts containing thick old hemorrhage that appears as brown fluid. In 50% of cases, the endometriomas are bilateral, they are more frequently located in the left ovary. Pathogenes is still controversial and many theories are trying to explain the nature and the cause of this disease. The most acceptable theory is invagination of ovarian cortex secondary to implant of metaplastic cells in the coelomic epithelium. Pelvic ultrasound is usually enough to make the diagnosis of endometrioma, however MRI is the gold standard. The causes of infertility in women with endometrioma can be attributed to many factors such as adhesions and blockage of the fallopian tube,

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inflammatory response that may participate in degradation of oocyte and sperms. Endometrioma might lead to poor embryo quality, poor ovarian reserve and inflammation affecting endometrial receptivity. Management of ovarian endometrioma can be complex and should be individualized. The optimal treatment will depend on the patient age, severity of pain, characteristics of the cyst, unilateral or bilateral, the presence of coexisting deep infiltrating lesion and clinical history of previous surgery. Laparoscopic surgeons believe that surgery should be the first step in management of endometriomas as these lesions are less likely to disappear on their own. Surgery will improve pain, improve fertility, reduce risk of ovarian cancer, reduce risk of pelvic infection at the time of oocyte retrieval, reduce risk of contamination by the chocolate material which affects the quality of oocytes, and surgery is less costly compared to IVF treatment. While IVF specialists believe that surgery might increase the damage to the ovary and further reduce the ovarian reserve, the Royal College of obstetricians and gynaecologists (RCOG) guideline advised for surgery before IVF in highly symptomatic women and those with

Ultrasound

good ovarian reserve, patients with unilateral large cysts, and cysts with suspicious features. If surgery is to be contemplated, laparoscopy is the surgery of choice, as it offers quicker recovery and resumption of everyday activities. Surgeon's expertise and technique is of paramount importance to minimize damage to the ovary. The best technique is to strip the endometrioma wall, but it is not always possible to do in all cases. Laparoscopic cystectomy for ovarian endometriomas greater than 4 cm improves fertility compared to cyst drainage and coagulation, which is associated with a high risk of cyst recurrence. Proper assessment before surgery is extremely important as a significant number of women with endometrioma had reduced ovarian reserve due to pathology itself. Transvaginal aspiration before IVF cycle is useless, dangerous and should not be contemplated. Postoperative medical therapy has been advocated as a means of eradicating residual endometriotic implants in patients with extensive disease in whom resection of all implants is impossible or inadvisable. Postoperative hormonal therapy also may treat microscopic disease; however, none of these treatments has been proven to enhance fertility. But these therapies are sometimes to reduce pain.

Laparoscopy

PATHOGENESIS IS STILL CONTROVERSIAL AND MANY THEORIES ARE TRYING TO EXPLAIN THE NATURE AND THE CAUSE OF THIS DISEASE. THE MOST ACCEPTABLE THEORY IS INVAGINATION OF OVARIAN CORTEX SECONDARY TO IMPLANT OF METAPLASTIC CELLS IN THE COELOMIC EPITHELIUM. =

ARTICLE FEATURES . Robotic Surgery

Robotic Surgery

The Best Choice for Women's Health MAY.JUNE 2022

Robotic Surgery . ARTICLE FEATURES

inimally invasive robotic surgery is one of the preferred options for patients who require surgical intervention that enables surgeons to better visualize and more precisely perform highly technical laparoscopic procedures than would otherwise be possible. It ensures patient safety without affecting women’s fertility or chances of pregnancy. Advantages of minimally invasive robot-assisted surgery include less scarring, less bleeding, less pain and quicker recovery. Robotic surgery is an evolution of laparoscopic surgery with some minor differences. During laparoscopic surgery, the surgeon makes small incisions on the patient's abdomen which allow for insertion of the camera as well as the operating instruments which are used to perform the surgery. These tools move in up/down directions only. On the other hand, robotic surgery includes a camera arm and mechanical arms with surgical instruments attached to them. The surgeon controls the arms while seated at a computer console near the operating table. The console gives the surgeon a high-definition, magnified, 3-D view of the surgical site. Control of the instruments in robotic surgery is better than in traditional laparoscopy because the instruments in robotic surgery can move in any direction that the surgeon’s hand can move. This better control means the surgeon can perform more precise movements and speed up or slow down hand movements, and it allows for easy suturing and knot tying. There are many gynecological operations that have shifted from traditional surgery to laparoscopic surgery and then to robotic surgery, as determined by the treating physician and surgeon, ranging from simple hysterectomy to more complex pelvic surgeries with severe endometriosis. In addition, robotic surgical systems have been used to perform surgery for endometrial, cervical cancer and ovarian cancer that involve the removal of metastatic tumors. About 90 percent of gynecological surgeries can be performed by the minimally invasive approach (laparoscopic or robotic). Large and complex operations require a robot because it

gives us very accurate results. Robot-assisted surgery is used in the removal of uterine cancer, along with the ovaries and lymph nodes, in case the tumor has spread, depending on the tumor size and how far it has spread. It is noteworthy that most patients who undergo this type of surgery are elderly, and therefore, they have lower pain tolerance and higher risk of postoperative complications, hence, this type of robotic surgery is considered safer for them. Robotic myomectomy, a type of laparoscopic myomectomy, is a minimally invasive way for surgeons to remove uterine fibroids while leaving the uterus intact, thereby preserving the possibility of future pregnancy. A uterine fibroid is a common type of benign tumor that develops within the uterine wall. Uterine fibroids occur in 20-40% of all women during reproductive years. If a woman suffers from endometriosis, robot-assisted surgeries can help in the management of symptoms by eliminating scar tissue and removing endometrial implants. This type of surgery offers the physician the dexterity inside the abdomen to safely and accurately remove adhesions that are harder to extract with traditional surgery. Robotic hysterectomy surgery removes all or part of a woman’s uterus and is one of the most common operations that require robotic intervention, especially if the woman had a caesarean section, which causes the presence of uterine adhesions. Robot-assisted prolapse repair has been also successfully performed, with the exception of some cases. In the past, all of these surgeries were performed in the traditional way, which required a large incision in the abdomen. The benefits of minimally invasive surgery include fewer complications, such as surgical site infection, less pain and blood loss, quicker recovery and smaller, less noticeable scars. Robot-assisted surgery is performed through tiny incisions of one to two centimeters that cause minimal impact to the surrounding area. Patients are often able to go home after a very short hospital stay, and many women report little or no significant pain after surgery. The faster recovery time allows them to return to their daily activities in a matter of days.

ROBOT-ASSISTED SURGERY IS USED IN THE REMOVAL OF UTERINE CANCER, ALONG WITH THE OVARIES AND LYMPH NODES, IN CASE THE TUMOR HAS SPREAD, DEPENDING ON THE TUMOR SIZE AND HOW FAR IT HAS SPREAD. IT IS NOTEWORTHY THAT MOST PATIENTS WHO UNDERGO THIS TYPE OF SURGERY ARE ELDERLY, AND THEREFORE, THEY HAVE LOWER PAIN TOLERANCE AND HIGHER RISK OF POSTOPERATIVE COMPLICATIONS, HENCE, THIS TYPE OF ROBOTIC SURGERY IS CONSIDERED SAFER FOR THEM.

MEDICAL INSTITUTION

Acibadem Maslak Comprehensive Spine Center treats patients from 52 countries

round one billion people across the world live with spinal pain. It is the leading cause of disability worldwide, affecting all age groups, from children to the elderly. The treatment of spinal disorders is often a complex process involving specialists from various medical fields. Acibadem Maslak Comprehensive Spine Center in Turkey is a trusted leader in spine care, welcoming patients from 52 different countries. The center provides advanced diagnostic and treatment options for a broad spectrum of spinal diseases, from spine deformities to degenerative disc conditions, spinal tumors, infections, and spinal cord injuries. A highly advanced procedure performed at Acibadem is Vertebral Body Tethering (VBT) for the treatment of scoliosis in children and adolescents. Unlike traditional surgery with spinal fusion, VBT corrects the curvature without causing loss of spinal mobility. Acibadem Maslak Comprehensive Spine Center was the first to apply the new method outside of the USA, where it was first invented. For the last 7 years, more than 150 patients have been successfully treated with Vertebral Body Tethering at Acibadem, which makes it one of the most experienced centers around the world.

MAY.JUNE 2022

THE CENTER REPORTS 7 YEARS OF SUCCESSFUL RESULTS WITH VBT, A NEW SCOLIOSIS SURGERY.

MEDICAL INSTITUTION

Scoliosis is the most common spinal deformity detected in childhood. When the spine curves sideways, this is called scoliosis. It affects 3 in every 100 adolescents, boys and girls, and the onset is usually between 10 and 15 years of age. In nearly 8 out of every 10 cases, the cause of scoliosis is unknown. This is usually called idiopathic scoliosis. In most cases, the curve is mild and does not require treatment. When the curvature develops over time and exceeds 45 degrees, it reduces the space within the chest and makes it difficult for the lungs and heart to function properly. For severe scoliosis, the standard treatment is surgery involving spinal fusion. The procedure stabilizes the spine with screws and rods, and it is highly effective. But fusion eliminates motion between fused vertebras and limits the remaining growth of the patient. For a specific group of scoliosis patients, Vertebral Body Tethering can be an alternative. VBT is a minimally invasive procedure that reduces the recovery period after surgery. It is performed through 6 small incisions, between 1 and 3 cm in length, which can easily be concealed. The surgical area is visualized using a miniature camera inserted through the ports together with all thoracoscopic tools. During the surgery, vertebral body screws are placed in the curved area. Then a rope-like device called a tether is placed over the screws and tightened. The applied force results in defor-

mity correction over time. In VBT, the curve is only partially corrected during the surgery. Afterward, spontaneous correction is achieved by the patient’s own growth. Since the spine is not fused, its flexibility and normal growth are preserved. A further advantage of this method is the fast return back to school within a week or two. Besides, the patient can engage in all types of sports 3 months after surgery. However, Vertebral Body Tethering is not appropriate for all scoliosis patients. The best candidates are between 10 and 16 years of age, diagnosed with idiopathic scoliosis, with curvatures between 35 and 80 degrees, who are still growing. The correct assessment of the remaining growth potential is crucial for success. The safe application of the VBT technique requires expertise from several medical specialties. Spinal surgery is usually associated with specialists in orthopedics. Yet, the surgical field is very close to large vessels during this procedure and a cardiovascular surgeon is also needed. A thoracic surgeon helps to prepare the ports for access. A neurologist monitors the process to avoid damage to vital functions. Working as a team allows a lower risk and better clinical results. Multidisciplinary approach is a routine practice at Acibadem, and that is one

THE SAFE APPLICATION OF THE VBT TECHNIQUE REQUIRES EXPERTISE FROM SEVERAL MEDICAL SPECIALTIES. SPINAL SURGERY IS USUALLY ASSOCIATED WITH SPECIALISTS IN ORTHOPEDICS. YET, THE SURGICAL FIELD IS VERY CLOSE TO LARGE VESSELS DURING THIS PROCEDURE AND A CARDIOVASCULAR SURGEON IS ALSO NEEDED.

MEDICAL INSTITUTION

of the reasons why it is one of only a handful of medical centers in the world successfully performing the VBT procedure. The surgery is applied by the team of the renowned Prof. Ahmet Alanay, an active member of the most respected scientific societies in this field internationally. Moreover, at Acibadem Maslak Comprehensive Spine Center, the patients get access to the unique know-how, comprehensive care and the latest technology of a world-class center of excellence. During spinal surgeries, high-tech equipment helps to improve safety and reduce the risk of injury. Spinal navigation makes it easier to perform safe and secure placement of screws. Neuromonitoring allows surgeons to identify a potential injury caused by the surgical procedure and eliminates the risk of paralysis to a great extent. 3D printing makes it possible to produce an exact copy of a patient’s spine and simulate the operation on the model, thus reducing the risk of complications. Spinal deformities like scoliosis and kyphosis are usually associated with childhood and adolescence. However, they are often seen later in life due to a sedentary lifestyle and increased life span. It is estimated that spine deformities are encountered in 60 out of every 100 people over the age of 60. Many other conditions can affect the spine anywhere from the neck to the lower back, disturbing the quality of life. Along with aging, spinal fractures and disc hernias are often faced. Acibadem Comprehensive Spine Center provides advanced surgical and non-surgical options for common and complex spine disorders in children and adults. The center performs more than 4000 outpatient consultations and over 300 surgeries per year. Minimally invasive surgical techniques are preferred whenever possible, to avoid potential risks and complications related to conventional surgery. A team approach that brings together experienced neurologists, orthopedists, surgeons, neurosurgeons, radiologists, anesthesiologists, orthotists, rehabilitation specialists is applied for comprehensive care and better outcomes. Prof. Ahmet Alanay, Director of Acibadem Maslak Comprehensive Spine Center, Orthopedics & Traumatology Specialist commented: “Our spine is like a bridge that carries two-

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thirds of our body weight. It has an important role in our healthy breathing and the function of our heart. Therefore, it is crucial for us to have a healthy spine. The Acibadem Maslak Comprehensive Spine Center offers diagnostic and treatment facilities for a wide spectrum of spinal diseases, including pediatric and adult spine deformities, scoliosis, kyphosis, vertebral slippage, spine injuries, and neck hernias. During all these advanced diagnostic and treatment procedures, we apply a multidisciplinary approach that includes all related specialists. This approach provides a rapid transfer of information between the sections. Thus we minimize the patient’s loss of time and proceed to the problem-solving phase. Do not forget: your spinal health is your life quality.”

Professor Ahmet Alanay, M.D, Department of Orthopedics and Traumatology, Chair of Acibadem Maslak Comprehensive Spine Center, has been chosen as President-elect of the EUROSPINE. EUROSPINE, the leading Spine Society of Europe, is a dynamic, international society of 8600 spine specialists from 80 countries who represent the full spectrum of spine care disciplines.

THE CENTER PERFORMS MORE THAN 4000 OUTPATIENT CONSULTATIONS AND OVER 300 SURGERIES PER YEAR. MINIMALLY INVASIVE SURGICAL TECHNIQUES ARE PREFERRED WHENEVER POSSIBLE, TO AVOID POTENTIAL RISKS AND COMPLICATIONS RELATED TO CONVENTIONAL SURGERY. A TEAM APPROACH THAT BRINGS TOGETHER EXPERIENCED NEUROLOGISTS, ORTHOPEDISTS, SURGEONS, NEUROSURGEONS, RADIOLOGISTS, ANESTHESIOLOGISTS, ORTHOTISTS, REHABILITATION SPECIALISTS IS APPLIED FOR COMPREHENSIVE CARE AND BETTER OUTCOMES.

MEDICAL INSTITUTION

Marble Medical Center celebrates first-anniversary celebration of Day Surgery Marble Plus Hospital

Dr. Dima Shehadeh, General Director & Dr. Mohamed Saada, Executive Director

arble Medical Center in Qatar has achieved outstanding accomplishments and has been at the forefront of medical centers specializing in dentistry, dermatology, gynecology, obstetrics, cosmetic medicine and others.

teamwork using the latest equipment and technology, which allows us to provide the highest standard of service and convenience.

The outstanding success had to be translated through the expansion of the Marble Plus Center in the Lusail area last year to be an added value and milestone in the course of medical and cosmetic services across the State of Qatar. Marble Medical Center was established to provide a world-class clinic, with highly skilled

The plastic surgery clinic at Marble Medical Center in Qatar provides consultations for plastic surgery, face, breast, body contouring, reconstructive and aesthetic medicine treatments. Plastic surgery at Marble Medical Center guarantees the best results, in the short recovery period. Through our new services in plastic

MAY.JUNE 2022

MEDICAL SERVICES Plastic Surgery Department

MARBLE MEDICAL CENTER WAS ESTABLISHED TO PROVIDE A WORLDCLASS CLINIC, WITH HIGHLY SKILLED TEAMWORK USING THE LATEST EQUIPMENT AND TECHNOLOGY.

MEDICAL INSTITUTION

surgery and medicine, people in Qatar can get the best cosmetic services. Marble Medical Center relies on providing the most famous plastic surgeons from Europe.

Furthermore, there are the Physiotherapy and Nutrition Department. Marble Medical Center provides these services under the supervision of an integrated medical team.

Operations Department

Skin Care Department

This department conducts day-to-day operations, and is equipped with the latest devices accompanied by the department of anesthesia, resuscitation, laboratory and radiology. Marble Medical Center provides a medical team and experienced nurses to perform the operations while following the highest standards of sterilization and hygiene. The Operations Department consists of operating rooms and recovery rooms, and patients wards after surgery.

Dermatology and Cosmetology Department An integrated protocol for the treatment of skin allergies as well as treatment of acne, warts, benign tumors and skin fungi, hair diseases (alopecia - hair loss). Cosmetology and Laser using the most advanced devices.

Medical Recreation Department Medical Recreation Department at Marble Medical Center is a department of relaxation and well-being. The patient can receive a complete care from massage, skin cleaning, laser, body contouring.

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(Skin Analysis): accurate skin analysis by the device. Deep cleansing for face (HydraFacial). (Golden HydraFacial) Cleansing face with gold. Physiotherapy and Massage Department Medical body massage. Lymphatic drainage massage. Sauna room. Steam room. Dry cupping.

Department of Slimming and Body Contouring Body contouring with the latest devices such as: (Viora and Onda), body contouring devices are used for slimming, tightening and cellulite treatment. Also, body contouring devices work on restructuring collagen that gives rejuvenation to the skin. The patient needs 6 sessions, one session approximately every week, with the need to follow a specific diet and exercises to achieve the desired results.

MARBLE MEDICAL CENTER PROVIDES A MEDICAL TEAM AND EXPERIENCED NURSES TO PERFORM THE OPERATIONS WHILE FOLLOWING THE HIGHEST STANDARDS OF STERILIZATION AND HYGIENE.

MEDICAL INSTITUTION

Dental Department The Dental Department offers oral and dental surgery using laser, immediate implantation, impacted tooth extraction, orthodontics and transparent orthodontics. There is also a pediatric clinic where patient can find everything he needs.

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Nutrition Clinic

ENT Department

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Diagnostics and treatment of ear, nose and throat diseases, whether they are medical or surgical, and all required surgical interventions.

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Family Medicine Department Providing health and medical consultations for all family members (Clinical examination/laboratory and radiological examinations).

Pediatric Clinic Diagnose all children's diseases from birth to adolescence, diagnosis of birth defects, jaundice and metabolic disorders. Diagnosis of blood diseases such as anemia and leukemia. Treatment of endocrine diseases such as short stature, diabetes, rickets and obesity. Providing vaccines for kids.

Gynecology and Obstetrics Department • • •

Treatment of delayed childbearing and infertility. Follow-up of pregnant women and 4D Ultrasound. Diagnosis and treatment of menstrual disorders.

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Treatment of polycystic ovaries. IUI Intrauterine insemination.

The Nutrition Department provides: Nutritional counseling. Diet Plans. Meals delivered to your doorstep. Rapid Food Intolerance Test for 55 food types. Food Intolerance Test for 240 foods. Slimming machines for body contouring and tightening.

Physiotherapy Department Physiotherapy is a specialty based on providing services for a variety of physical problems of the musculoskeletal system, nerves and the lymphatic system.

Orthopedic Surgery The orthopedic clinic provides medical examination of all orthopedic cases and the necessary interventions and surgeries.

Psychiatric Clinic All kinds of stress diseases, including panic, obsessive-compulsive disorder, general anxiety and social shyness.

Radiology Department The Radiology Department at Marble Medical Center is equipped with modern and high efficiency and performance equipment to meet the needs of the patients.

THE OUTSTANDING SUCCESS HAD TO BE TRANSLATED THROUGH THE EXPANSION OF THE MARBLE PLUS CENTER IN THE LUSAIL AREA LAST YEAR TO BE AN ADDED VALUE AND MILESTONE IN THE COURSE OF MEDICAL AND COSMETIC SERVICES ACROSS THE STATE OF QATAR.

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Medical Laboratory Department The medical laboratory at Marble Medical Center provides a wide range of medical analyses that are performed to find out the chemical and physiological changes that occur in the body. The Medical Laboratory Department works hard to provide high-quality diagnostic services to help the medical team to provide appropriate care to the patients. In addition to PCR tests, rapid tests and antibody tests regarding Covid-19 disease.

INTERVIEW

Dr. Ghizlane Bendriss

Assistant Professor of Medicine at Weill Cornell Medicine-Qatar (WCM-Q)

“Our main objective is to educate our audience about advances in medicine." and Continuing Professional Development (CPD) activities around the gut-brain axis, including the role of the gut microbiome in health and diseases. She is the lead investigator of the first music-based clinical trial registered in Qatar, which explores the EEG and emotional correlates of Middle Eastern music modes or ‘maqams’ in a multiethnic population. She is the founder of the Mind & Music Association in France, which aims to promote equity in access to music culture and raise awareness of the power of music to influence health. Her research team published two reviews in 2020 on the role of the microbiota in asthma and atopic disorders as well as an exploration of the high-level taxonomic bacterial diversity in neurodevelopmental and gastrointestinal disorders. In addition, she is a co-investigator of a research project aiming to explore the probiotic content of dairy products in Qatar.

What was your motivation to create the Role of the Gut Microbiota in Health and Disease online program as a Continuing Professional Development activity at WCM-Q?

hizlane Bendriss is a neuroscientist who obtained a PhD in neurophysiology and neurobiology and a Master's degree in cognitive neuroscience from the University of Aix-Marseille, France. Dr. Bendriss obtained her diploma in lifestyle medicine from the International Board of Lifestyle Medicine. She is currently Assistant Professor of Biology at Weill Cornell Medicine-Qatar, where she teaches neurosciences and biology in the premedical division and leads numerous research projects

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THIS ONLINE COURSE IS A REAL UPDATE ON THE ROLE OF THE GUT MICROBIOTA IN HEALTH AND DISEASES FOR THOSE WHO HAVE NEVER HEARD ABOUT THAT.

The role of microbes was becoming increasingly essential in our understanding of diseases, as noted by the significant number of publications on microbiota during the past ten years. If you look at the number of publications including the term “microbiota” in 2017, there were about 9,111 studies on the PubMed database. However, out of those 9,111, only three were from Qatar. Only two research studies were running in Qatar on the microbiome at that time, and it was clear to us that there was a need to raise awareness of this paradigm shift that is affecting all health sciences. In 2017, a quick survey

INTERVIEW

among 44 healthcare professionals showed that 88.6% of them admitted they were not knowledgeable of the role of microbiota in inflammatory bowel diseases or in neurodevelopmental disorders such as autism and attention deficit hyperactivity disorders. Neurosciences were the first to experience a paradigm shift with the identification of the hut as the “second brain” and the existence of the gut-brain axis. Today, scientists are talking about the gut-skin axis, gut-liver axis, gut-lung axis, gut-heart axis, gut-kidney axis, gut-muscle axis etc. In 2021, the PubMed database recorded 20,277 studies including the term “microbiota” and more than 25,000 including the term “microbiome”. Through this CPD activity, I wanted to let professionals be aware of what is happening in research and how these new discoveries could not only benefit their practice but also completely change it in the future.

Why did you choose to run it as an enduring material (online modality)? The content of this course is dense and mostly about filling gaps of knowledge. It was more appropriate to run this course in a selfpaced manner, so participants could read, watch and reflect on the material at their convenience before taking the required tests for validation of the course. The evidence that is presented comes from fundamental and clinical studies and can only impact practice after awareness has been raised. For this reason, the online model was a good way to reach out to more people and easily disseminate a foundation of knowledge the about latest advances in this area from around the globe.

Please describe the program you created. This program is constituted of eight modules, the first one being a pre-test to evaluate the participant’s knowledge before taking the course. This is an important step to create self-awareness about knowledge gaps and trigger curiosity in the participant’s mind. The subsequent modules discuss the role of the gut microbiota in health and diseases, the role of nutrition, probiotics, antibiotics and the latest advances in using fecal transplants

TODAY, SCIENTISTS ARE TALKING ABOUT THE GUT-SKIN AXIS, GUT-LIVER AXIS, GUT-LUNG AXIS, GUT-HEART AXIS, GUT-KIDNEY AXIS, GUT-MUSCLE AXIS ETC. IN 2021, THE PUBMED DATABASE RECORDED 20,277 STUDIES INCLUDING THE TERM “MICROBIOTA” AND MORE THAN 25,000 INCLUDING THE TERM “MICROBIOME”. THROUGH THIS CPD ACTIVITY, I WANTED TO LET PROFESSIONALS BE AWARE OF WHAT IS HAPPENING IN RESEARCH AND HOW THESE NEW DISCOVERIES COULD NOT ONLY BENEFIT THEIR PRACTICE BUT ALSO COMPLETELY CHANGE IT IN THE FUTURE.

to treat various diseases. Technologies used are also described to allow the participants to understand the published scientific literature and stay updated. In short, this course provides the essential tools to healthcare professionals to understand and stay up to date with the growing number of studies published daily on the role of the gut microbiome in many healthcare specialties.

What factors influenced the type of training you developed? It actually all started with a very personal story. I suffered from complications of Crohn’s disease ten years ago. As I was searching and reading to find out solutions, I came across what I never would have thought would become the center of my studies: the gut microbiota. One book, “Breaking the Vicious cycle” of the Canadian scientist Elaine Gotshall was like a revelation to me; she claimed that through nutrition and probiotic intake, inflammation could be controlled and gut dysbiosis treated, and that could solve many symptoms not only in inflammatory bowel diseases but also in neurodevelopmental disorders like autism, because there was a link between the gut and the brain. To me, a neuroscientist, that was an illumination. When I found out that thousands of studies have actually been done worldwide, and that dysbiosis has indeed been associated to almost all modern diseases, I realized that we were living a paradigm shift and not many people were aware of that. So, I decided to let people know.

Who is the target audience and what is the benefit of healthcare professionals undertaking this training? All healthcare professionals can benefit from this course, from the dentist to the physiotherapist, to the nutritionist, to the physician, to the surgeon and so on. This is because the gut microbiota composition is influenced by all lifestyle components: nutrition affects the gut microbiota, stress affects the gut microbiota,

INTERVIEW

physical activity, sleep, drugs can all affect the composition of microbes. Studying the gut microbiome emphasizes that various specialists have to work together in an integrative manner to approach a disease. At the end of this course, participants are able to: 1/ describe the general principles governing interactions between gut resident microbes and humans; 2/ identify the numerous facets of human biology that are influenced by the gut microbiota in health and disease; 3/ define the factors that can alter the microbiota in everyday life, including antibiotics and diets, which directly impact microbiota composition and function; 4/ explain the principles behind the use of fecal transplants, the potential benefits and risks; 5/ discuss the incorporation of gut microbiota analysis into the daily practice of medicine.

How would you envision the future of this activity and topic? This online course is a real update on the role of the gut microbiota in health and diseases for those who have never heard about that. I recommend it not only to healthcare professionals but to anyone who would like to understand the importance of our microbes in current diseases. This course can greatly influence people on the impact of living a healthy

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MICROBIAL COMPOSITION CAN BE MODULATED BY NUTRITION, BY PROBIOTIC INTAKE, AND BY STRESS AND PHYSICAL ACTIVITY; THESE ARE IMPORTANT VARIABLES THAT HEALTH PROFESSIONALS SHOULD CONSIDER IN THEIR PRACTICE FROM NOW ON.

lifestyle and raises the question of the danger of antibiotic misuse. This topic is expanding in all directions of health sciences, as gut microbes have been found to interact with almost all organs and it is important that, with the fast-paced development of findings, healthcare professionals stay updated with the current clinical trials and options available to them.

How do you intend to develop the training you offer in the future? After taking this course, participants could benefit from having a closer look at evidence of the interactions of the gut microbes with their respective specialties. For example, the gut-skin axis for dermatologists; the gut-brain axis for neurologists and neuropsychologists; the gut-liver and gut-pancreas axes for endocrinologists and many more. You’ll be amazed at how microbes can play important roles in the pathogenesis of diseases or maintenance of health. Microbial composition can be modulated by nutrition, by probiotic intake, and by stress and physical activity; these are important variables that health professionals should consider in their practice from now on.

UPCOMING EVENTS 2022 May

13-14

Obesity: A Translational Outlook from Basic Molecular Mechanisms to Clinical Management – On-site at WCM-Q

13-14

Simulation Educator Course: Designing and Debriefing Effective Simulations – On-site at WCM-Q

20-21

Getting Started in Mixed Methods Research: Training & June to Enhance Care and Education in the Diverse Cultural 3-4 Context of Qatar – Virtual workshop

Introduction to Qualitative Research

to June – Virtual workshop

June

6-7

Understanding Biostatistics in the Medical Literature – Live webinar

September

2-3

Introductory Applied Biostatistics for Healthcare Professionals – Hybrid activity

12 October

2-5 17

Critical Appraisal of Randomized Clinical Trials – Live webinar Applied Biostatistics using STATA – Virtual workshop Understanding Survival Analysis – Live webinar

Visit our website for more details: https://qatar-weill.cornell.edu/continuing-professional-development

ARTICLE

Acute Pyelonephritis

By Dr. Yousef Matani, Consultant Urologist at Al-Ahli Hospital - Doha / Qatar

cute pyelonephritis (APN) is an infection involving the kidney and renal pelvis. It represents a more severe form of infection than acute cystitis. The main features that define this syndrome include the triad of high fever, flank pain and tenderness. 80 % of cases may present with storage lower urinary tract symptoms such as burning, frequency and urgency. The causative uropathogen is isolated by urinalysis and culture and the most common bacteria isolated is E. coli and other gram-negative bacilli. APN may be mild or severe resulting in sepsis and shock. The severity is dependent on host factors e.g. presence of comorbidities, immune status, presence of obstruction and elderly patients (> 65 years).

Epidemiology APN is a common disease. The estimated global annual incidence is 10.5 to 25.9 million cases. It is common among females. Percentage of hospitalized patients is higher among children and elderly than among healthy young women. APN is a major cause of mortality. This is largely due to associated sepsis and septic shock. It is estimated that APN accounts for 10% of septicemia cases. The total estimated cost is very high, however, recent introduction of observation units and change in practice have resulted in significant drop in rates of admission.

Risk Factors APN occurs in around 3% of cases of cystitis and asymptomatic bacteriuria. It also complicates cases of urinary tract obstruction e.g. pregnancy, stones. Others include genetic predisposition, high bacterial load and virulence and presence of comorbid conditions e.g. diabetes.

the bladder and ascend to the kidneys. Rarely, organisms such as Staphylococcus aureus or candida seed the kidneys hematogenously. With appropriate care, clinical manifestations usually decrease progressively. However, resolution may require up to 5 days. Worsening or no improvement by 24 to 48 hours arouses concern for potential complications that may warrant urgent intervention. These complications may include obstruction (e.g. stones), abscess formation, severe gas-forming infection (especially in diabetics), acute kidney injury (usually transient), advanced renal failure and recurrent pyelonephritis (rate of < 10%).

Diagnosis Diagnosis of APN is dependent on clinical evaluation, urine culture and supportive imaging modalities. It depends largely on isolation of bacteria by urine culture. Imaging is, initially, recommended in patients with sepsis or septic shock, known or suspected urolithiasis, or a new decrease in the glomerular filtration rate. Subsequent imaging is indicated in patients whose condition worsens or does not improve after 24 to 48 hours of therapy.

Differential diagnosis for flank pain or tenderness, with or without fever, include: 1. Acute cholecystitis 2. Appendicitis 3. Urolithiasis 4. Paraspinous muscle disorders 5. Renal-vein thrombosis 6. Pelvic inflammatory disease

Pathogens •

Natural History APN occurs when enteric bacteria enter

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Dr. Yousef Matani

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Among young healthy women, E. coli account for more than 90%of pyelonephritis cases. In contrast, among men, elderly women,

APN IS A COMMON DISEASE. THE ESTIMATED GLOBAL ANNUAL INCIDENCE IS 10.5 TO 25.9 MILLION CASES. IT IS COMMON AMONG FEMALES. PERCENTAGE OF HOSPITALIZED PATIENTS IS HIGHER AMONG CHILDREN AND ELDERLY THAN AMONG HEALTHY YOUNG WOMEN.

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and urologically compromised or institutionalized patients, other organisms are involved in addition to E.coli strains. Emerging antimicrobial resistance is growing due to antibiotic abuse and bacterial virulence.

Management The three pillars of pyelonephritis management are:

1. Supportive Care: a. Fluid resuscitation b. Medications to control symptoms, such as analgesics, antipyretics

2. Antimicrobial Therapy: a. Must be started promptly without waiting for the urine culture result b. Type and duration of empirical antibiotics, route of administration and necessity for admission are dictated by many factors including, but unlimited to, microbial resistance, severity of infection and host-related risk factors c. Duration of antibiotic treatment ranges between 1 to 4 weeks. d. Monitoring of effectiveness of therapy is essential. Clinical worsening or lack of any improvement after 1 to 2 days of antibiotic ther-

apy mandates repeat urine culture and imaging to identify an underlying cause and/or abscess formation.

3. Source Control: a. Indications for initial and subsequent imaging (i.e., baseline risk factors and clinical worsening or lack of improvement after 24 to 48 hours of therapy) to assess for obstruction, abscess, or necrotizing infection b. Ultrasonography is more sensitive than computed tomography (CT) for the diagnosis of hydronephrosis, less expensive and available at the bedside c. Unenhanced CT is the preferred initial method for management of acute flank pain or tenderness d. Contrast enhanced CT is more sensitive for the diagnosis of abscesses, inflammation, and gas formation.

DIAGNOSIS OF APN IS DEPENDENT ON CLINICAL EVALUATION, URINE CULTURE AND SUPPORTIVE IMAGING MODALITIES. IT DEPENDS LARGELY ON ISOLATION OF BACTERIA BY URINE CULTURE.

Special Populations •

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Pyelonephritis during pregnancy can progress rapidly, causing life-threatening complications in both the mother and the fetus. It requires hospitalization. Febrile UTI in children is usually associated with underlying congenital anomalies.

ARTICLE

Implantation for a device that changed the life of a patient with severe heart failure in Al-Ahli Hospital By Dr. Abdul Razzaq Al-Juhani, Head of the Heart Center at Al-Ahli Hospital - Doha / Qatar

here has been tremendous amount of research and improvement in the treatment of heart failure, over the last 20 years. Some important drugs have been introduced and tested which made a big difference to the life of patients of heart failure. However, there are many patients who continue to suffer from symptoms of heart failure, despite maximum medications. These patients often need repeated admissions, from time to time, to control their heart failure by giving medications via injections. In some, heart failure is so severe that they may need to be intubated and put on ventilator (artificial respiration via a tube introduced through the mouth into the air-pipe). For such patients, there has been an extremely important discovery of implantable devices called CRTD-ICD, and which made a huge difference to their life. We hereby report one such patient who had severe heart failure who saw his life turn around after the implantation of a special heart device. Mr. DD is a middle-aged British gentleman who works as an engineer. He had suffered from increasing fatigue and breathlessness which he thought because of activity at work, but his symptoms got much worse that he could not climb stairs at all, and sometimes finds walking or even going to the toilet a difficult task. He attended the Cardiology Clinic of Dr. Gehani (Consultant Cardiologist and Chairman of Ahli Heart Center) in March 2018. He complained of severe breathlessness both on walking and at rest. Some nights he had to sit up, because lying down made him feel chocked. He said that sometimes he felt he was going to die. Dr. Gehani, said that the patient also had evidence of fluid in the lungs and swelling of both legs, which are highly suggestive of Heart Failure. He was immediately admitted and investigations confirmed severe weakness of heart muscle.

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The Echocardiogram revealed the pumping efficiency of the heart muscle was only 27% (Normally 55-65%). During admission, he was given medications by intravenous drip to reduce the fluid overload on the lungs and the body. Coronary angiogram was carried out to exclude blockage of the coronary arteries that supply the heart muscle, which is one of the most important causes of heart failure. This is done by passing a fine catheter from the arm or the groin and injecting small amount od dye directly in the coronary arteries, which can uncover any narrowing or blockage of the coronary arteries. There was no blockage and therefore cardiac MRI (Magnatic Resonance Imaginging) was carried out to study the structure of the heart muscle in details. This confirmed that there was extensive scarring of the heart muscle leading to its weakness. This is called Cardio-myopathy. The patient had good response to the medications when given in the hospital by intravenous drip, but he was given tablets to take at home, he became worse again and needed another admission to give the medications by drip. It has become clear that he needs more assistance than just medications. One modern option which has shown a great promise in such cases is a device called Cardiac Re-Synchronization Therapy Device (CRTD). This is implanted under the skin and has wires which are passed through the veins under the collarbone to the heart. These devices look like pacemakers, but are much more complicated. Traditional pacemakers only deal with slow heart rate (Bradycardia) which can cause dizziness or loss of consciousness. Under these circumstances the pacemaker gives extra beats to prevent loss of consciousness, but they cannot treat abnormal fast heart rate which can also cause sudden cardiac death. In each admission, Mr. DD showed good response when medications were given by drip,

THE IMPLANTATION PROCEDURE FOR CRTD-ICD DEVICES IS DONE IN THE CARDIAC CATHETERIZATION ROOMS AND TAKES BETWEEN 1-2 HOURS ON AVERAGE. THEY CAN BE DONE UNDER SEDATION AND LOCAL ANESTHESIA, BUT IN PATIENTS WHO COULD NOT TOLERATE LYING FLAT STILL (WHICH IS OFTEN THE CASE IN PATIENTS WITH HEART FAILURE), GENERAL ANESTHESIA IS OFTEN NECESSARY AND ADVISABLE.

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but whenever this was replaced by tablets to allow him to go home, he had some recurrence of symptoms and therefore oral medications were not able to completely control his symptoms. It was clear that he needs more than just oral medications and therefore, we had a long discussion with Mr. DD about the option of implanting one of the modern devices that has been shown to add to the improvement achieved by medications. Such devices can also prevent sudden cardiac death which is known to be a real threat in patients with heart failure. After studying the ECG (Electrocardiogram) and Echocardiogram (Ultrasound scan) of the heart, it became obvious that CRTD-ICD is the device of choice in this case. CRTD-ICD devices can, in addition to treating slow heart rate, also improve the function of the heart muscle by improving the coordination between the left and right ventricles of the heart. This coordination is lost in many patients with heart failure which makes heart failure much worse. This is the important function of the CRTD part of the device. The other part of the device is called ICD (Implantable Cardioverter Defibrillator) which has another very important function, that is the prevention of Sudden Cardiac Death which is common in patients of Heart failure. The ICD Technology continuously monitors the heart rate of the patient and if this becomes abnormal and threatens sudden arrest of the heart, the ICD deals with this by giving an electric shock that can bring the heart rhythm back to normal and prevent cardiac arrest. The implantation procedure for CRTD-ICD devices is done in the Cardiac Catheterization rooms and takes between 1-2 hours on average. They can be done under sedation and local anesthesia, but in patients who could not tolerate lying flat still (which is often the case in patients with heart failure), general anesthesia is often necessary and advisable. The implantation procedure was done by Prof. Gehani, and the anesthesia was administered by Dr. Iman Daoud, Consultant Cardiac Anesthetist. The procedure was straightforward without complications and three wires were passed from the CRTD-ICD device to the following chambers of the heart: One to the Right Atrium, one to the

Right Ventricle and the third was passed to a special venous channel in the back of the heart, called coronary sinus, because it is close to the third chamber that we wanted to pace, the left ventricle said Prof. Gehani. The patient was discharged on the third day. He was seen for follow-up for nearly 2 years before he travelled back to his country. He experienced a huge improvement of daily life after the implantation of the CRTD-ICD device. He is now able to climb up to 3 flights of stairs without stopping and can sleep almost flat without waking up with a cough and breathlessness. The device was programed from time to time to optimize its function and the patients response was excellent every time, and we were able to reduce the number and quantity of medications, said Prof. Gehani.

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Bayer presents positive results from first Phase 2b trial on safety of asundexian in patients with atrial fibrillation

ata from the PACIFIC-AF trial demonstrated lower observed rates of ISTH major and clinically relevant non-major bleeding for asundexian (a FXIa inhibitor) compared with apixaban in patients with atrial fibrillation at risk of stroke. The data, simultaneously published in The Lancet, found that both 20 mg and 50 mg doses of asundexian were well-tolerated and resulted in significantly lower rates of bleeding compared with apixaban while achieving almost complete inhibition of FXIa. This trial was designed as a dose-finding phase 2 clinical study. It was not powered to discern or test differences in the rates of thrombotic events.

THE CENTER REPORTS 7 YEARS OF SUCCESSFUL RESULTS WITH VBT, A NEW SCOLIOSIS SURGERY.

ulation, once-daily FXIa inhibitor asundexian is being investigated to become a new treatment option in thrombosis prevention. The findings were presented at the American College of Cardiology’s 71st Annual Scientific Session (ACC.22), and simultaneously published in The Lancet. “There is an unmet need for stroke prevention in people with atrial fibrillation,” said Manesh Patel, Richard S. Stack Distinguished Professor, Chief of the Division of Cardiology and Co-Director of the Heart Center at Duke University. “Despite guidelines recommending oral anticoagulation treatment of patients with atrial fibrillation, around 40% of AF patients are either under-treated, receiving a lower dose than is recommended, or not treated at all. This can leave patients vulnerable to potentially life-changing thrombo-embolic events, such as stroke.” He continued, “The PACIFIC-AF data showed asundexian had significantly less bleeding compared to apixaban in AF patients at risk of stroke, while achieving near complete FXIa inhibition levels. As we embark on approval studies, this potential new therapy would mark a much-welcomed advance in patient care.”

Bayer announced positive data from the PACFIC-AF trial which compared the safety of the investigational, oral Factor XIa (FXIa) inhibitor asundexian with apixaban (a non-vitamin K antagonist oral anticoagulant) in patients with atrial fibrillation (AF). The results found that the bleeding rate for the primary endpoint (ISTH major and clinically relevant non-major bleeding) was reduced by 67% (incidence proportion of 0.33**) in patients receiving asundexian compared to those receiving apixaban. By selectively modulating coag-

Gabri Labs and Dubai Science Park sign agreement to construct AED18 million medical devices facility in Dubai

abri Labs, a pharmaceutical technologies company, has announced the development of a 10,000 sq. ft. facility to locally produce medical devices. The global firm has signed on with Dubai Science Park, the leading science-focused community, to construct a medical devices facility at an AED18million investment, reinforcing Dubai’s attractiveness as a global hub for healthcare and pharmaceutical manufacturing, in line with the UAE government’s Operation 300bn strategy.

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The medical devices will have the ‘Make it in the Emirates’ stamp – a government-backed initiative to boost the local manufacturing industry – and will be distributed to markets across the Middle East and North Africa (MENA) region.

Marwan Abdulaziz Janahi, Managing Director of Dubai Science Park, said, “Our leadership’s focused efforts to advance the manufacturing sector and boost innovation under Operation 300bn are directly enhancing Dubai’s healthcare landscape.” Elio Gebrayel, Managing Director of Gabri Labs, said, “We are thrilled to enter a new chapter of our story in Dubai and the wider MENA region with the construction of our brand-new facility in the emirate.”

How does expenditure turn into health? . ARTICLE FEATURES

RANKED AMONGST TOP 100 WORLDWIDE HIGHEST RANKED HOSPITAL IN THE MIDDLE EAST ONLY HOSPITAL RANKED IN LEBANON

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Healthcare: The Cause & ‘Cure’ of Climate Change? By Maha El Akoum, Head of Content and Research Fellow, World Innovation Summit for Health, Qatar Foundation

e, if you’ll allow me this presumptuous ‘we’, the healthcare sector, talk a lot about climate change. It’s practically a no-brainer, climate change and health are inextricably linked. Climate change is a health issue. We know how climate change impacts the spread of communicable diseases, non-communicable diseases, mental health and how it affects children’s wellbeing and early development. We know that rising temperatures and other consequential changes to the climate will inevitably and undoubtedly threaten food security and we also know that, as often is the case, the negative effects have been felt and will continue to be felt by vulnerable populations. What we also know, but tend to turn a blind eye to, is that the relationship between climate change and health is very much bidirectional. Even though to most, the very essence of the word “healthcare” is associated (almost synonymous even) with the concept of healing, the healthcare sector is also a major contributing source of health-damaging pollution. Now read that last sentence again. As things stand, the healthcare industry is currently among the most carbon-intensive sectors in the world, being responsible for 4.4-4.6 percent of greenhouse gas emissions worldwide. To put this into perspective, the global healthcare climate footprint approximately equates to the annual greenhouse emissions from 514 coal-fired plants. Basically, if the healthcare sector was a country, it would be the fifth-largest emitter on the planet. Yet, ironically, our sole mission is to protect and promote human health.

How exactly does the healthcare sector contribute to environmental damage? Each country is different. Yet, the common denominator is that every nation’s healthcare sector contributes in one way or another, by

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directly or indirectly releasing greenhouse gases while delivering their services. Exactly how is largely driven by factors that are unique to each setting, such as healthcare demand and available resources. However, generally speaking, greenhouse emissions are produced through energy consumption, transportation, the manufacturing of certain products, their use and their disposal. What is in a way unique to the healthcare sector is that direct emissions that originate from healthcare facilities and healthcare-owned vehicles account for only about 17% of the sector’s worldwide carbon footprint. Indirect emissions released from energy sources such as electricity, steam, cooling, and heating, only compromise an additional 12% of emissions. The largest share of emissions is predominantly from the healthcare supply chain, accounting for 71% of the sector’s total footprint. This means that, the production, transportation, and disposal of goods and services, such as chemicals, pharmaceuticals, PPEs and other hospital equipment and instruments, together are responsible for the lion’s share of emissions. Food waste is also, a huge problem. It is perhaps easy to appreciate how hospitals and healthcare facilities in general utilize such vast quantities of materials that ultimately end up as waste. Research has shown that the average US hospital generates approximately 29 pounds of waste per bed per day. We, as consumers, are probably even comforted by the fact that the gloves used by healthcare workers are discarded after every examination. However, it is crucial, given the current climate change emergency, that patient safety and public health, together, are the influencers and drivers of healthcare decisions, neither one alone in a vacuum. Cost wise, the hospital supply chain is considered the second largest expense on a hospital’s balance sheet, second only to labor costs. Approximately one third of a hospital’s

AS THINGS STAND, THE HEALTHCARE INDUSTRY IS CURRENTLY AMONG THE MOST CARBONINTENSIVE SECTORS IN THE WORLD, BEING RESPONSIBLE FOR 4.4-4.6 PERCENT OF GREENHOUSE GAS EMISSIONS WORLDWIDE. TO PUT THIS INTO PERSPECTIVE, THE GLOBAL HEALTHCARE CLIMATE FOOTPRINT APPROXIMATELY EQUATES TO THE ANNUAL GREENHOUSE EMISSIONS FROM 514 COAL-FIRED PLANTS. BASICALLY, IF THE HEALTHCARE SECTOR WAS A COUNTRY, IT WOULD BE THE FIFTHLARGEST EMITTER ON THE PLANET.

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annual operating budget is spent on supply chain functions. As such, there is a strong correlation between a nation’s healthcare spending, and its health sector’s climate footprint. This becomes ever the more frightening with increased investment and national expenditure on healthcare. We could, very quickly, find ourselves in a situation where increased funding leads to more healthcare, leads to increased and accelerated environmental damage. However, generally, investing in healthcare is an extremely sensible thing to do. Therefore, if the growth of this sector and increased investment is coupled with a new core strategy and road map towards net zero emissions, we can decrease our climate footprint significantly, while still continuing to grow our investment in healthcare. This all sounds very simple in theory but could be slightly more complicated to put into practice. Only slightly. The first and most important step forward is for the healthcare industry to take responsibility for its growing impact and contribution to the global climate change emergency. This doesn’t stop at only treating those affected by the direct or indirect consequences of climate change, but also through prioritizing public health, health promotion and primary prevention. Healthcare organizations at a national, regional, hospital or primary care levels should all measure and track their individual environmental footprint over time, the same way they track their health outcomes and financial costs. The goal of net zero emissions will only be fully realized once the healthcare sector reduces its very own emissions. Global, cross-sectoral partnership is fundamental to achieving these goals by 2050. As recommended by the Health Care Without Harm report published in 2019, the healthcare sector, together with the larger government sector, ministries, manufacturers and suppliers of healthcare goods and services, must work hand in hand. The purchasing power of the healthcare industry should be harnessed in a way that drives other sectors to transition towards sustainability. This means that everything produced for the healthcare sector should be effective, have good value for money, and should be produced in a sustainably conscious way.

Up until now, the majority of research has focused on reducing healthcare emissions in higher income countries (HIC), with adaptation in lowand middle-income countries (LMICs). Very few LMICS have been included in studies that assess and evaluate carbon emissions from the healthcare sector. An article commissioned by The BMJ for the World Innovation Summit for Health on decarbonizing healthcare in LMICs recommends that healthcare providers in LMICs should be held accountable by ministries of health to calculate the carbon footprints of their organizations and to strive to work towards reducing emissions while delivering universal health coverage. More research is needed to strengthen the evidence base on healthcare and climate change, across populations. Further scientific research is needed to comprehend the trends in the interplay of healthcare and climate change. This research should also include analysis studies on the expected future trajectories of healthcare emissions, as well as the health analysis of the costs expected benefits of transitioning towards greener healthcare systems. Once a solid evidence base is established, national and subnational governments should then use the available data and evidence to develop climate-smart action plans for the healthcare industry. These action plans should build on existing initiatives, where relevant, to decarbonize their healthcare systems, foster resilience and drive an overall improvement in healthcare outcomes. The action plans should also contribute to and be embedded within the national governments climate policies. At an individual level, be it in LMICs or HICs, healthcare professionals, from physicians to nurses to managing staff and advisory board members, should all understand the environmental footprint of the services they provide and imminently take steps to reduce it. These steps may include using resources more efficiently, choosing or advocating for greener product choices, or improving waste segregation at the workplace. Frontline workers are also encouraged to engage with their hospital’s procurement teams to influence product choices and replace some single-use plastics with environmentally friendly, washable and biodegradable alternatives.

Significant effort is needed for the healthcare sector to address its contribution to the climate change crisis. While the goal may seem daunting, it is certainly achievable. Hospitals and healthcare systems have already committed to meeting the Paris Agreement and have started working towards this goal of improving their overall environmental performances. However, sadly, they currently represent the exception and not the rule. The universal call for urgent action is now louder and more resounding than ever. Cleaning up the healthcare sector will ultimately give us the opportunity to prevent more illnesses and save more lives, and, most importantly, “do no harm”.

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OGT welcomes Adrian Smith as CEO

New leadership will drive OGT’s mission to improve clinical care by partnering with customers

GT, A Sysmex Group Company, announces the appointment of Adrian Smith as CEO from 1st April 2022. The appointment comes as Dr John Anson retires from his position as CEO and member of the board, after more than 16 years with the company. Smith is a highly experienced, successful and well-regarded business leader in the life science and in-vitro diagnostics field. Both OGT and its parent company Sysmex Corporation are united in the conviction that he is an ideal fit for the next stage of OGT’s growth. Smith joins the company from breakthrough diagnostic and medical imaging solutions company, Hologic, where he was General Manager of the UK and Ireland. Prior to this, he held leadership positions in Qiagen and Roche —both leading diagnostic companies—and brings a wealth of sector experience. Under the decisive leadership of Anson,

OGT made great strides in developing its molecular diagnostics portfolio of CytoCell® FISH probes, CytoSure® microarray and NGS products and SureSeq™ NGS panels. He commented, “It has been a pleasure and an honour to serve at OGT for the past 16 years. This is a company truly devoted to its customers with a unique and dedicated team that go above and beyond every day. I know this is an ethos that Adrian strongly shares and I can’t think of a better person to take OGT forward.” As CEO, Smith will now lead the company in its next chapter as OGT looks to reinforce, develop, and grow its mission to improve clinical care by partnering with its customers. OGT’s support, expertise and comprehensive range of genomic solutions are already highly regarded, with the focus now on expanding the portfolio and increasing the accessibility to these worldwide.

Vacuum Lancing Technology Enters the UAE, Making Virtually Painless Glucose Checks now a Possibility for People Living With Diabetes

iapointME LLC, is the leading place for people touched by Diabetes. Diapoint offers community, events, education, advocacy and products in the health and wellness space for people with diabetes. DiapointME has signed an agreement with Genteel LLC, one of the largest Bioscience & Health Technology companies in the US Pacific Northwest as it continues to improve health outcomes for people with diabetes in the region. DiapointME will be distributing Genteel’s vacuum lancing device in the UAE under a new, international distribution partnership. Genteel manufactures the only vacuum lancing device FDA-cleared for use anywhere on the body. With blood sample readings from palms matching those of sensitive fingertips, Genteel significantly reduces pain associated with blood glucose monitoring. As an authorized distributor

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of the Genteel lancing device, Diapoint is honored to have joined the Genteel mission of providing relief from discomfort and fear through comfortable glucose checks. Vice President of Sales and Marketing, Mark Berkovich, commented on the deal saying, “I am absolutely thrilled to bring the Genteel solution to more people. Through the pursuit of less pain, we are improving patient adherence, and ultimately health outcomes for those who need it most.” Founder and Managing Director of Diapoint, Pamela Durant is equally excited about the agreement. “It is so important for us that we are aligned with our business partners as we support people with diabetes in all aspects of their care. Genteel is certainly one of those partners who like us, wants to improve the quality of life of people with diabetes and those around them.”

Both companies are proud to make this technology available to a population in great need of support and improved diabetes management. According to statistics from the International Diabetes Federation, the UAE holds one of the highest prevalence of diabetes globally.

NEWS NEWS

Nurses are heroes. Nurses are professionals. Nurses are mentors. Nurses are changemakers. Nurses are leaders. Nurses are therapists. On International Nurses Day, BD and the Saudi Nurses Association salute the unwavering commitment of Nurses from around the Kingdom and the invaluable contributions they make to the health and wellbeing of our communities and the Kingdom’s healthcare system. We are thankful to your heroism and professionalism and commit to offer you leading skilling programs, best practices and cutting-edge innovations to help secure your safety while enhancing patient safety and treatment outcomes.

Learn more: sna.org.sa | bd.com