HOSPITALS Magazine issue 33

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Issue 33 / 126 March / April 2017 www.tahmag.com

HER life matters

Learn about the necessary tests for every stage of women's life

Vitamin B Complex Keeps our bodies running like well-oiled machines

3D & 4D IMAGING

Oers real-time advantages

LUNG CANCER 1

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Publisher Arab Health Media Communication General Manager Simon Chammas E: schammas@tahmag.com

Our health sector IN GOOD HANDS

Creative Department Roula Haddad - Georges Habka Creative Director: Jessy Chlela Photographer Hanna Nehme Copy EDITOR Jessica Achkar

There is no doubt that the Arab world is abuzz with conferences and the health ones are rapidly advancing to be at the forefront, but the Arab Health Exhibition & Congress in Dubai added a special feature and an unmatched glow to February. After its inauguration by Sheikh Hamdan bin Rashid Al Maktoum, the exhibition’s 42nd edition witnessed the largest gathering of healthcare professionals in the region and the participation of a large number of international speakers and specialists in the healthcare field around the world. Featuring 4,400 companies showcasing their latest innovations and around 110,000 attendees from over 70 countries, more than 8,500 medical professionals from around the world attended the show. The event saw the introduction of the new Hands-on-Training (HoT) sessions, which allow more than 900 physicians, surgeons and technicians from the region to learn and practice new techniques using state-of-the-art equipment for specialized treatments in medical fields. During this year’s event, surgical myectomy for the management of Obstructive Hypertrophic Cardiomyopathy will be performed for the first time in the Middle East. Established 42 years ago, Arab Health has grown and evolved with the growth of Dubai and the UAE as a whole, as there has been an increase in the need of healthcare facilities and infrastructure. As a result, “Arab Health” has rapidly expanded and is now one of the most important global events in the healthcare agenda. It is also the largest healthcare exhibition and medical conference in the Middle East and the second largest in the world. Hence, we pay tribute to the organizers and participants in this event, which raised the level of health in the Arab world, and strongly contributed to promoting Dubai’s international position, as it became the most popular destination for conferences and forums in the world, and a hub for experts and major international institutions which consider it a promising platform for the economy, health and business. Hoping for more success and a more active health sector as we know day after day that it is in good hands.

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EDITORS Aline Debes, Mark Steven, Don Karn, Andrew Weichert, Colette Semaan, Abbas Moussa Advertising & Marketing advertising@tahmag.com Mirna Khayrallah E: mirna@tahmag.com Roula Fakhry E: roula@tahmag.com Dayane Al Dib dayane@thearabhospital.com Jessie El Hajj jessie@tahmag.com Business Development Manager Ralph Rahal tahmag@tahmag.com Offices & Adresses AHMC, Lebanon Mansourieh High way, Jihad Wakim center, 3rd floor. T/F: +961 4 53 40 58 M : +961 3 60 61 00 E: tahmag@tahmag.com Simon Chammas E: schammas@tahmag.com Dubai Schammas@tahmag.com +967 50 2971007 KSA Moussa ALHAKIM - KSA Market Manager POBox 116197, Fahd Bin Zaghir Road Al Zahraa - Jeddah 21391 – Saudi Arabia T +966 55 600 88 60 France “Media & PR” 9 rue Victor Hugo 92400 Courbevoie, France T: + 33 1 43 34 24 90 M: + 33 6 19 03 31 86 E: jpcressot@wanadoo.fr

Kuwait Trivisions - Global Int›l Rony Kikano (Managing Director) P.O.Box 36578 Ras Salmiyah Media@trivisions.net +965 99133911 China China International Health & Medical Tourism Association (CIHMTA) 中华医疗健康旅游协会 Dr. JIA XIAO FANG T: +86-010-82825920 Whats app +86-18675588998 M: +86-18675588998 E: CIHMTA@hotmail.com Printing Offset Printing Press S.A.L. Distribution: KSA - UAE - OMAN LEBANON - JORDAN SYRIA - KUWAIT - BAHRAIN - QATAR - EGYPT

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March - April 2017

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NEWS

8 Pharmaceutical products gsdp

26 TPP provides centralised electronic health records

certificates awarding ceremony

for Dubai concierge service The

10 The wind of NPISTANBUL

Health Bank

52 Snoring 90 3D & 4D imaging

INTERVIEWS

on holistic approaches to type 2

56 Mr. Tomas Kolar & Mr. Zbynek Frolik 58 Mr. Peter Makowski, Dr. David Hayes

Party Administrator”

diabetes care in Lebanon

and Dr. Aaron Han

12 King’s College Hospital London

Health Bank

Hospital in Dubai

10 GlobeMed Wins 2017 “Third

28 Boehringer Ingelheim focuses

Selects Cerner’s Clinical and Financial

68 Arab Health Exhibition &

Management System

Congress 2017

14 Philips’ Next Generation Image Guided Therapy Platform Azurion to Deliver More Effective Patient Care

16 MEDLAB 2017 18 Al-Ahli Hospital Promotes Continuous Professional Development

20 Royale Hayat Hospital Celebrates 7 Years of Trust

22 Hamdan Medical Award organizes awareness campaign on rare diseases

24 In-vitro Fertilization industry in UAE will see 11.8% growth over last year: IVI Middle East

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MEDICAL INSTITUTIONS

74 Qatar University College of Medicine

82 Pan by BHM 94 Hamad Medical Corporation 98 Home Care Lebanon S.A.L.

FEATURES

32 Lung Cancer 36 Vitamin B 42 Women’s day 44 Estrogen 46 Cervical cancer

62 Dr. Hamad Ghazle 76 Dr Egon Toft

ARTICLES

34 Vitamin D 50 What does osteoporosis mean? 51 Hypertension in pregnant ladies 60 Consumerization of health & life, Fiction or reality?

80 Lateral Ankle Instability in Adults 84 Orthodontics, at the right time: parents role!

86 10 Global Healthcare marketing trends

88 Spine deformities 92 Adverse drug reactions constitute a major health hazard

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Pharmaceutical products gsdp certificates awarding ceremony Prominent figures have also attended the event, the president of the Syndicate of Importers and Manufacturers of Medicines in Lebanon Mr. Armand Phares, Mrs. Carole Abi Karam, the President of the Private Hospitals Syndicate of Lebanon Mr. Sleiman Haroun, the President of the Syndicate of Biologists, Dr. Christian Haddad, and a large number of health and pharmaceutical institutions directors.

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n official awards ceremony organized by the Ministry of Public Health represented by HE Mr. Ghassan Hasbani, Minister of Health, and its General Director Dr. Walid Ammar took place on Friday February 10, 2017 at ESA business school. The awarded certificates bear witness of the compliance of pharmaceutical products institutions with the good storage and distribution practices (GSDP) set and circulated by the Ministry of Public Health in Lebanon. Mr. Ghassan Hasbani has indeed awarded 57 institutions/stores of pharmaceutical products in compliance with the established standards. The Minister of Health has also granted appreciation awards to the people who contributed to the success of the project: Dr. Walid Ammar, Director General of Health, Miss Chrystelle Fransawi, GSDP Committee member, Dr. Rita Karam, Director of the Ministry’s quality and assurance program of pharmaceutical products and GSDP Committee member, Dr. Colette Raidy, Head of the inspection department at the Ministry and member of GSDP committee, Mrs. Perrine Malaud Wakim, ESA representative to the

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GSDP committee and Dr. Myriam Watfa, member of GSDP Committee. This project aims to reinforce the registration and launching procedures of medicines, the quality of their storage, distribution and pharmacovigilance. A comprehensive study on the bioequivalence of generic medicines has also been launched. The sector professionals have been trained by the members of the committee on the new procedures and the implementation of a quality control system on all steps of the supply chain in collaboration with experts from the French specialized healthcare institution (ANSM). Representing the French ambassador, Mrs. Veronique Aulagnon, Director of the French Institute in Lebanon and Cooperation and cultural adviser, has reiterated in her speech the importance of the Franco-Lebanese cooperation in the healthcare sector.

The ceremony marks an important step towards the development of Franco-Lebanese cooperation projects, which have for the past ten years contributed to the improvement of the healthcare sector. The ceremony coincided with the visit of the French Minister of Health and Social Affairs to ESA Mrs. Marisol Touraine, who met prior to the ceremony her Lebanese counterpart, Mr. Hasbani, Vice Prime Minister and Minister of Health, and both parties have signed a cooperation protocol. Such agreement emphasizes the sustainability and efficiency of the cooperation projects that have been carried out for ten years in the healthcare sector in Lebanon and highlights the ongoing role of the partnering institutions, such as the French National Blood Service (EFS), the ANSM, the HAS (French National Authority for Health), the French Embassy in Lebanon, The French Development Agency (AFD) and the operator of such projects ESA business school.

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The wind of NPISTANBUL Hospital in Dubai During the fair that welcomes approximately 100,000 participants every year, NPİSTANBUL Hospital shared its work on psychiatry, psychology, neurology and addiction with health professionals.

Full-fledged “neuropsychiatry” hospital

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PİSTANBUL Hospital being the Brain Base of Turkey in the fields of psychiatry, psychology and neurology offers treatment services in many areas such as addiction, schizophrenia, Alzheimer’s, depression, personality disorders, mood

disorders, and anxiety disorders. Üsküdar University NPİSTANBUL Hospital delegation was in contact with leading representatives of the healthcare industry at the Arab Health Fair which took place at the Dubai International Convention and Exhibition Center.

NPİSTANBUL Hospital being the first in its field in Turkey is a full-fledged neuropsychiatry hospital with a closed area of ​​7 thousand square meters, 50 bed capacity open and closed units, intensive care, brain imaging, neuroscience center, magnetic stimulation therapy, anesthetic ECT, sleep and toxicology laboratory… The NPİSTANBUL Hospital delegation that especially shared its work on addiction with health professionals at Arab Health, one of the world’s most important fairs in the field of health, will hold one-on-one talks with sector organizations in Dubai.

GlobeMed Wins 2017 “Third Party Administrator” at the MENA IR Insurance Awards

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lobeMed Group has won the prestigious “Third Party Administrator” award at the annual MENA IR Insurance Awards event. The winners were announced on the evening of February 1, 2017, at a gala dinner at the Ritz-Carlton DIFC, Dubai, UAE. Mr. Ziad

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Kharma, Vice-President for Actuarial Services, received the award on behalf of GlobeMed Group. Congratulating the team members on this success, Mr. Z. Kharma expressed his pride for this achievement, stating that this award is a distinguished recognition for the GlobeMed group, which will reinforce the will of GlobeMed to provide further Solutions and creative services to its clients and their members. The event, organized by the prestigious MENA Insurance Review Magazine, honored GlobeMed Group for providing innovative and pioneer services and solutions that cater to the needs of its clients, using the latest technological advancements in the Healthcare Benefit

Management sector. Throughout 2016, the Group introduced solutions to enhance automation and its expert system dedicated to automated issuance of the coverage decisions, aiming at processing the largest number of claims without any complications. Subsequent to celebrating its Silver Jubilee crowning twenty five years of achievements, GlobeMed Group adds this award today, to its growing list of achievements having won the “Medical Administrator” award in 2014 and “TPA of the Year” in 2015 also in Dubai, a testament to the collective efforts that pushed GlobeMed Group to assume its leadership role, expanding to 12 countries in the MENA region.

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King’s College Hospital London Selects Cerner’s Clinical and Financial Management System facilitating preventive medicine.”Millennium Revenue Cycle™,Cerner’s portfolio of financial management solutions designed to optimize provider and user workflow, will also be implemented with the enterprisewide EHR. This integration will result in a Clinically Driven Revenue Cycle™, which is designed to provide clinicians and staff with the resources to update the billing process throughout the patient’s visit, enhance clinical documentation to help improve reimbursement and limit claims errors.

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ing’s College Hospital NHS Foundation Trust, one of London’s largest and busiest teaching hospitals, has selected Cerner, a global leader in healthcare technology, to integrate a networkwide health IT system at its coming Dubai-based hospital, King’s College Hospital Dubai. This hospital is a joint venture with Al Tayer Group, Dubai Investments and UK-based Ashmore Group Plc. The announcement was made at the Arab Health Exhibition and Congress, the Middle East’s largest healthcare trade show. Following the announcement, Dr. Simon Fraser, Medical Director, King’s College Hospital London, Dubai, explained: “The UAE is home to a very diverse population, and we adopt a holistic approach for all patients, irrespective of background and lifestyle. Disease management and prevention are no longer secondary to diagnosis and treatment.” King’s Dubai’s implementation of Cerner technology

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will aid in the automation of care venues and moving toward a paperless environment,initiatives that support the UAE Vision 2021 National Agenda, a national program developed to advance national priorities and achieve a world-class healthcare system. The Cerner Millennium® electronic health record (EHR) will be implemented across King’s Dubai, a 100bed, multi-specialty hospital set to open in 2018 at the heart of the premium community, Dubai Hills Estate, and two multi-specialty clinics. The EHR is designed to support an individual’s health care journey across the continuum, from the doctor’s office to the hospital and outpatient clinics, through an online patient portal. Simon added, “Using Cerner Millennium, King’s doctors will have access to investigate the patient’s predisposing factors within their respective clinical fields. This will help doctors treat and follow each patient in a unique way,

King’s Dubai will have a single source of truth for patients’ financial liability, which will benefit patients with a streamlined experience. “The UAE’s 2021 vision encourages its population to lead healthier lives by creating a culture of proactive health management. The networkwide EHR will help King’s Dubai create apatient-centric healthcare delivery system and engage individuals across the region,” said Ali Slimani, General Manager, Cerner Middle East. “We are honored that King’s Dubai has shown such confidence in Cerner andare proud to welcome them as the first private hospital in the UAE to the Cerner family.” King’s Dubai is set to become one of the first UAE-based hospitals to offer liver transplant procedures. While its doors will open in 2018, its Dubaibased clinics will open in 2017. King’s Dubai’s expansion follows the opening of its flagship Medical & Surgical Centre in Abu Dhabi in 2014.

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Philips’ Next Generation Image Guided Therapy Platform Azurion to Deliver More Effective Patient Care

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hilips has introduced Azurion, a next generation Image Guided Therapy (IGT) platform that allows physicians to provide superior care for patients, and perform procedures more effectively, whilst optimizing lab productivity. Developed in close collaboration with clinicians, a range of procedures can be performed on Azurion, ranging from diagnostic angiography and PCI (percutaneous coronary intervention) to complex vascular exams. Azurion enables clinicians to provide superior care through pre-programmed, personalized settings to help minimize preparation errors, and features high quality imaging at ultra-low radiation exposure. The platform has been designed to help clinicians work efficiently by reducing preparation and procedure time, enabling more patients to be diagnosed and treated. Azurion can be used to diagnose and treat patients in hospitals and specialist clinics across a range of therapy areas including cardiology, oncology and vascular. The new workflow approach of the Azurion platform can support interventional teams in carrying out a high number of procedures, and help them increase the consistency and efficiency of procedures. It offers several advanced workflow improvements, designed to help clinicians. ConnectOS, a real-time multi-workspot technology was designed specifically for the Azurion interventional suite.

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Arjen Radder, CEO, Philips Middle East and Turkey said, “Our vision for IGT is to provide integrated solutions that advance minimally invasive procedures by helping physicians decide, guide, treat and confirm the right therapy for each patient at the point of care. First time right imaging is critical as the need to repeat even one scan can put physicians behind schedule, increasing patient waiting times and staff overtime. Working together with physicians to realize this vision, we are committed to saving and improving lives, reducing the total cost of care by making therapy more efficient, more appropriate and more personal. Our unique industry positioning combining systems and smart devices has brought us to this milestone. The launch of Azurion marks Philips’ next big step in IGT.” Dr. Marco J.L. van Strijen, Chairman of Radiology, Radiologie Midden-Nederland commented, “The healthcare landscape is changing rapidly and this is creating a new environment for IGT. Technology in the future has to adapt to the evolving needs of patients and physicians while ensuring the financial health of the hospital or clinic.” Five key market trends are currently shaping the future of IGT – cost efficient care delivery, increasing demand for complex procedures, growing competition amongst hospitals, consolidation of healthcare facilities and metric driven outcomes. These trends are transforming the way care should be delivered and posing challenges in interventional labs across the world.

NEWS

Dr. Barry T. Katzen, clinical professor of radiology and surgery, Associate Dean Clinical Affairs Baptist Health, Herbert Wertheim College of Medicine, Florida International University added, “For patients, reduced preparation time can improve the overall patient experience and could mean less waiting time for the family. For clinicians and administrators, it would mean that they can support the treatment of more patients in less time. Parallel working technology enables clinicians to complete different tasks simultaneously.� Enabling deep clinical insights for superior care, the platform includes a 12-inch detector that provides high quality images and approximately 40 per cent additional field of view. A flexible screen at the operating table provides clinicians with instant access to patient data during procedure. Tableside control via FlexVision Pro and TSM Pro means less walking for clinicians between exam and control rooms. Less walking can reduce the sterility breaks and lower infection risk. Multiple workspots in a lab can also give clinicians the flexibility to view, control and manipulate applications and switch seamlessly between procedures. Procedure cards enable clinicians to pre-program routine tasks and personal preferences also enable saving time. Pre-programming of routine tasks can help minimize preparation errors. Hospital checklist uploads can help safeguard procedure consistency. Azurion is also very safe, working in an ultra-low radiation dose environment

supported by Zero Dose positioning. The platform easily connects interfaces and enables control with Philips Volcano devices, alongside other brands of peripheral equipment; providing a standardized user interface to aid training and make it easier to rotate medical staff. Philips has pioneered a steady stream of innovations in Live Image Guidance that help clinicians determine the most advantageous course of treatment with confidence, including StentBoost, EchoNavigator, HeartNavigator, EP Navigator, OncoSuite, XperCT and many more. All these advanced interventional tools are seamlessly integrated into the Azurion 7 to support your clinical workflow. In a simulation study with over 60 users globally, the consensus received was that that the possibility to display Checklists & Protocols on the system will help minimize preparation errors, with 91 per cent believing that Azurion will help reduce procedure time, and 96 per cent satisfied with the ease of use. Philips is introducing this new futuristic Azurion platform at Pan Arab Intervention Radiology Society Congress (PAIRS) being held in Dubai for its Middle East customers. Philips has installed a simulator of Azurion in the exhibition hall at PAIRS congress so that the customers can have first-hand experience on how this new solution improves performance while delivering superior care.

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Technology and Innovation on show at MEDLAB 2017 in special protein testing, which offers laboratories reliable results without compromising speed and efficiency.” Meanwhile, Sysmex Corporate, one of the leading international providers of solutions for systemising processes for medical laboratories, will be at MEDLAB to showcase their new urinalysis series. For the first time, they are offering an ‘all-in-one’ series of analysers that will allow you to examine both through chemistry and sediment, followed by imaging and validation.

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s the UAE gears up for a boom in the In-Vitro Diagnostics (IVD) market, expected to reach USD 0.83 billion by the end of 2020, the medical community has turned its focus towards exciting new products and technologies to keep up with the demand for new diagnostic capabilities that can have a real impact on improving the health of patients across the region. MEDLAB Exhibition & Congress, the world’s leading event for laboratory management and diagnostics, which takes place on 6th – 9th February 2017 at the Dubai International Convention & Exhibition Centre, presents a huge opportunity for global laboratory industry leaders, including manufacturers, dealers and distributors, to showcase new innovations and to introduce some cutting-edge products to the UAE market. More than 30,000 visitors are expected to attend the four-day exhibition where they can explore over 400 products and services from more than 700

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exhibitors from 38 countries. A number of companies associated with ABIMO (Brazilian Medical Devices Manufacturers Association) will be at MEDLAB to showcase products and services including diagnosis and laboratory reagents, IVD, devices for medical tests, laboratory tests,laboratory refrigerators and products for hematology. According to Clara Porto, ABIMO’s marketing and exports manager, “There is almost no national production of the sector and, as such, the region is quite dependent on imports. Generally, there is a great acceptance of Brazilian products so we expect to make good contacts and profitable deals at this year’s show.” Binding Site, one of the largest independent providers for IVD tests and equipment in the United Kingdom, will be at MEDLAB to launch its latest protein system that can process complex protein assays 40% faster than current systems. Charles de Rohan, CEO from Binding Site commented: “We wanted to bring simplicity to complex analytical processes. The result is Optilite, the latest innovation

Another exhibitor bringing something new to the market is American Medical Technologists (AMT), an internationally recognised certification agency for allied health professionals, who will promote a set of practice exams for its respected laboratory certifications including Medical Technologists (MTs), Medical Laboratory Technicians (MLTs) and Phlebotomists. “With a new practice test for those preparing to take the certification exam for medical technologist through AMT, candidates have an important tool to take them a step closer to becoming certified members of the clinical laboratory community,” said Christopher Damon, JD, Executive Director of AMT. This year at MEDLAB, a selection of free workshops will also be available for all industry professionals offering learning and training opportunities from leading international IVD and laboratory companies. The free workshops are an addition to MEDLAB’s conferences, which will span fromblood transfusion medicine, laboratory informatics, clinical diagnostics of cardiology and diabetes, to laboratory management, microbiology, immunology and clinical chemistry.

NEWS

Dr Mansour Al-Zarouni, Member, General Secretariat Committee at Sultan Bin Khalifa International Thalassemia Award (SITA) and Chair of MEDLAB said: “With new cutting-edge innovations having a lifecycle of approximately 24-48 months, it’s crucial for this congress to play a role in connecting and merging pre-existing gaps between clinicians and laboratory professionals, through the conferences, to ensure everything is done to improve patient care outcomes.” According to Simon Page, Managing Director of Informa Life Sciences Exhibitions, the organizer of MEDLAB: “It is not enough for our visitors to simply view the new technologies from afar - we want them to get a hands-on experience of these products through the free workshops directly offered by the manufacturers. For example, LabCorp from the USA and National Reference Laboratory in the UAE are coming together to host

a workshop on coagulation reference testing to discuss the significance of the coagulation reference laboratory.” “Another example is Sidra’s workshop, the Pediatric Pathology symposium, which will address anatomical pathology, hematopathology, microbiology and molecular microbiology, clinical chemistry, and genetics, which will be led by international experts and attended by pathologists, lab physicians

and scientists in the region, who work with pediatric specimens”, he added. MEDLAB Exhibition & Congress is supported by the UAE Ministry of Health & Prevention, Health Authority Abu Dhabi, Dubai Health Authority, Dubai Healthcare City Authority, Jebel Ali Free Zone, College of American Pathologists, Clinical and Laboratory Standards Institute and the Saudi Society for Clinical Chemistry.

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BHM-Tech Produktionsgesellschaft mbH | 7423 Grafenschachen 242, Austria

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Al-Ahli Hospital Promotes Continuous Professional Development and outcomes.” Al-Ahli Hospital currently runs hospital-wide educational events thus creating opportunities for licensed healthcare practiotiners to earn QCHP category 1 points on-site.

Dr Luai Al-Fakhri

Mr khalid Al-Emadi

Head of Staff Training and Development Department / Al Ahli Hospital

Chief Executive Officer of Medicare & Al-Ahli Hospital

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ontinuous Professional Development (CPD) is the process of updating knowledge and skills as well as the development of one’s personal skills required to fulfill successful professional, managerial and technical responsibilities throughout one’s career.

The CPD accreditation program for healthcare practitioners was established in Qatar on the 7th of March, 2016. This program encourages and supports licensed healthcare practitioners to improve their knowledge by keeping up-to-date with changing healthcare trends thus enabling them to meet the needs of their patients. Mr. Khalid Al-Emadi the Chief Executive Officer of Medicare & Al-Ahli Hospital said that, “Al-Ahli Hospital is committed to providing continuous medical education and professional development for its healthcare practitioners and in 2016 it was granted accreditation from the Qatar Council for Healthcare Practitioners Accreditation Department (QCHP-AP) for three years effective from 9th June 2016”.

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In Addition Mr. Al-Emadi said that The mission statement of Al-Ahli’s CPD program is “The Continuous Professional Development (CPD) Program is committed to delivering educational activities through blended learning opportunities to all Licensed Healthcare Practitioners to address identified gaps in knowledge, skills and behaviors that will enhance our guests’ healthcare

Dr Luai Al-Fakhri Head of Staff Training and Development Department at Al-Ahil Hospital states that to date we have run 13 CPD events that have been attended by 1,320 licensed healthcare practitioners from Al Ahli Hospital. This level of activity has enabled our licensed Staff to claim 1,320 category 1 CPD points saving them time and cost as they have not had to attend such programs at other accredited providers or even outside the country. Our future plan and vision is to run accredited symposia and to collaborate with other accredited providers in subsequent educational events. We also plan to expand our activites to involve other staff members such as the administrative teams in order to offer the highest quality of service to our guests.

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Royale Hayat Hospital

Royal Brompton & Harefield Hospitals surgeons

Celebrates 7 Years of Trust

perform innovative cardiac procedure

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uring a complex cardiac surgery performance at Arab Health 2017, specialist surgeons from Royal Brompton & Harefield Hospitals (RB&HH) took to the show floor to demonstrate a procedure that provides rapid relief for those suffering Obstructive Hypertrophic Cardiomyopathy in the Middle East. Through this surgery, patients are able to experience a substantial improvement in quality of life and the risk of sudden cardiac arrest is reduced. RB&HH is one of few specialist Inherited Cardiac Conditions (ICC) centres across the globe, and the procedure provides hope to patients in the Middle East with obstructive Hypertrophic Cardiomyopathy, an inherited heart disease, which affects as many as 1:500 people across the world. Performed to an audience made up of show visitors, the technically demanding practise was simulated by Mr Fabio De Robertis, adult consultant cardiac and transplant surgeon at RB&HH while Dr Antonis Pantazis, consultant cardiologist at RB&HH, Lead of the Cardiomyopathy Service, talked through the procedure. The simulation was the first time that RB&HH performed the surgery in the Middle East. The demonstration took place on the Association of British Healthcare Industries (ABHI) stand (UK Pavilion, Zabeel Hall 1, Stand Z1D30).

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oyale Hayat Hospital has been named Best Hospital in Kuwait for the seventh year at the Service Hero Awards, Arab World’s 100% consumer-driven customer satisfaction index.

“Receiving this award for the seventh time is an honor. We value this award, because it reflects the satisfaction of our community and customers. At Royale Hayat Hospital, we work as a team to provide the best and most advanced services and technology in the medical and hospitality industry. As chairman and members of the board, we are committed to fulfilling the needs of patients and families in Kuwait.” Since launching in 2006, Royale Hayat continues to provide the safest, most modern and highest quality of medical care and services to the Kuwaiti society in an environment of compassion, comfort and care. This vision has guaranteed Royale Hayat’s leading place in the health sector and has redefined the benchmarks in hospitality.

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Hamdan Medical Award organizes awareness campaign on rare diseases and medical authorities at the state level to conduct more studies on these disorders and then putting the appropriate preventive strategies”, he added. WITH RESEARCH POSSIBILITIES ARE LIMITLESS

‫بــالعـــــــــــــــــــــــــــــلم‬ ‫ال مســـــــــــــــــــــتحــيل‬

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n conjunction with the Rare Disease Day 2017, which is an annual event that comes on the last day of the month of February, and under this year’s slogan “With research possibilities are limitless”, Sheikh Hamdan Bin Rashid Al Maktoum Award for Medical Sciences (HMA) organized its awareness campaign on rare diseases. On this occasion, the HMA has received the participations in the competition of the distinguished school in the activities of rare diseases from a number of public and private schools within the UAE. The participating schools submitted their reports about their innovative cultural and artistic programs through which the students worked on raising awareness on the rare diseases and the rights of patients. These programs included many lectures, plays, songs, workshops and competitions which were organized by the students, as well as field visits to a number of Emirati families, during which they distributed the brochures they made on this topic. Within the same context, Abdullah bin Souqat, a member of the Board of Trustees of HMA, said: For the 7th consecutive year, the award sheds light on the topic of the rare diseases, especially that the UAE is among the countries which is interested in preserving the rights of people with special needs. “Despite the specificity of rare diseases, affecting a limited number of people from all over the world, the patients have the right of getting the accurate diagnosis and the effective medicine in order to put their diseases under control and to prevent its development into mental or movement disabilities, or even to death”, he added. “By raising the slogan of the Rare Disease Day 2017 namely, “With research possibilities are limitless”, the Hamdan Medical Award calls on the research organizations, and health

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“In the light of the new research aspects such as the personalized medicine, I believe that the anticipated remarkable leap in the medical research, would be positively reflected on the better diagnosis and treatment for rare diseases,”. “The HMA works on combating rare diseases, and its Centre for Arab Genomic Studies (CAGS) has recently succeeded, in cooperation with Latifa hospital for Women and Children in Dubai, to detect new genetic mutations’ links to a number of genetic disorders among Arab children”, Abdullah bin Souqat added. For her part, Dr. Fatima Bastaki, Consultant Pediatrician and Clinical Geneticist, Latifa Hospital for Women and Children and the Chairman of the Organizing Committee of the campaign, spoke about the main goal of the awareness campaign which is educating people from all segments of the society about rare diseases, the preventive ways, and early detection. She said: To this end, the awareness campaign has 3 stages, the first of which was on February 25, at the Children’s City in Creek Park. The HMA organized a ceremony that was attended by the patients and their families. “The ceremony includes many entertainment activities for children patients and a round-table discussion to be attended by specialists such as clinical Geneticists, researchers, psychologists, sociologists, and officials from health authorities”, she said. “The aim of this discussion is to answer the questions of patients and to give them solutions for their problems”. “Also, during the ceremony, the winners of the competition of the distinguished school in the activities of rare diseases were honored”. Dr. Fatima Bastaki mentioned to the second stage of the awareness campaign, on 26 and 27 February, during which a group of Emirati clinical geneticists presented a number of awareness lectures to the students of public and private secondary schools in Abu Dhabi, Al Ain, Sharjah, and Ras Al-Khaimah. As for the third stage of the campaign, from February 28 until March 2, a group of professionals and volunteers was at the Mirdif City Center, in order to communicate with the various visitors of the shopping center. The visitors knew more about the rare diseases. Also, handbooks, brochures and souvenirs were distributed.

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NEWS

In-vitro Fertilization (IVF) industry in UAE will see 11.8% growth over last year: IVI Middle East “Changing lifestyle conditions; reduced ovarian reserve in women, delayed pregnancy, gynecological conditions and fertility disorders are some of the major factors that drive the market growth,” said Dr. Human Fatemi, Medical Director at IVI Middle East. Commenting on the evolving market, he added: “Infertility is one of commonly encountered medical conditions in the Middle East. According to various reports, it has been estimated that infertility affects 15 per cent of the global population of reproductive age, but this percentage is even higher in the Middle East. This has paved way for the industry to experience growth in the region.”

Dr. Human Fatemi Medical Director at IVI Middle East

A

new study carried by IVI Middle East about the In-Vitro Fertilization (IVF) market estimated that the IVF global market will cross USD 27 billion by 2020. The same research anticipated that the UAE would command USD 1.50 billion by the same period, a 5.5 per cent of the global figure. The overall Middle East IVF market will control USD 1.01 billion in 2017 registering a growth of 11.8 per cent compared with last year, said the international medical centre that has main regional headquarters in Abu Dhabi along with branches in Dubai and Muscat. MAR.APR 2017

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IVI Middle East Fertility Clinic is a part of Equipo IVI, headquartered in Spain, the world leader in the field of infertility treatments. It commenced its operations with its first fertility clinic in Abu Dhabi, UAE. Within a short span, the centre has witnessed a success rate of over 70 per cent – the highest in the region. Statistics revealed by IVI Middle East Fertility Clinic suggest that Intra-cytoplasmic Sperm Injection (ICSI) has contributed to over 98 per cent of successful pregnancies for the clinic in the last one year. The innovative and customized treatment approach at IVI clinics backed by strong research on infertility causing factors in the region has delivered over 70 per cent success rate in the Middle East, much higher than the clinic’s success rates in other parts of the world. “With 900+ couples been treated at IVI Middle East Fertility Clinic, it is noted that majority of couples lie in the age

group of 31-40 years. Of these, 49.7 per cent account for women while 53.8 per cent are men. The percentage of women suffering from infertility conditions is high. Women in the Middle East, in particular, suffer from Vitamin D deficiency, are obese, face the impact of parental consanguinity, delayed pregnancies – all leading to the rise in infertility. However, infertility is as much a man’s problem as it is for a woman. We have witnessed and treated over 40 per cent of male infertility cases. Infertility among the Middle Eastern men is also an outcome of their sedentary lifestyles leading to obesity, smoking and Vitamin D deficiency,” added Dr. Human Fatemi. IVI Middle East Fertility Clinic revealed that of the couples opting for fertility treatments, local couples accounted a higher percentage - around 77 per cent as against the expats, who accounted for only 23 per cent. “At IVI Middle East Fertility Clinic, each patient is treated with utmost care based on their condition. Our in-depth understanding of the latest scientific methods combined with our local experience has led us to success,” concluded Dr. Human Fatemi. IVI Middle East Fertility Clinic also offers a highly advanced genetic test called the Carrier Genetic Test (CGT) that helps prevent the risk of having a baby with genetic disorders. This test is exclusively available at IVI and is highly recommended to all couples trying for conception naturally or through IVF to avoid the possibility of genetic diseases being transferred to their children.

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NEWS

TPP provides centralised electronic health records for Dubai concierge service The Health Bank Brook, Director at TPP said “the collaboration with The Health Bank is a unique opportunity TPP encountered through our ongoing work and presence in the GCC region. We are delighted to be the chosen clinical supplier to provide a Universal Electronic Health Record (UEHR) for present and future clients of The Health Bank.”

T

PP, the innovative health software provider, has signed a partnership agreement with The Health Bank, after several months of close co-operation to deliver the integrated electronic records software and patient portal. The signing took place during the Arab Health Exhibition on 30th January and was attended by directors from both companies. The Health Bank, a global medical concierge service based in the UAE, provides a range of healthcare services to its clients, members of an international private members network. TPP are a UK based clinical software company, providing a range of products including the flagship electronic health record system, SystmOne. Following a successful rollout in July, The Health Bank is the first company to offer a Universal Electronic Health Record (UEHR), instantly connecting their clients with the highest quality care providers wherever they are in the world. The Health Bank will send the SystmOne record to a selected

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care facility, and will receive the updated record once their clients have received care. The Dubai based company is the first in the world to offer a UEHR in this way, with the potential to transform its clients’ healthcare experience. The concierge has now released an app to cater for its growing client base and provide users with greater flexibility, wherever in the world they are. Commenting on TPP’s support to provide The Health Bank members with the best healthcare worldwide, Ashley

A spokesperson from The Health Bank added “TPP was the obvious choice for us. It has a 20-year track record of success in the UK and has a growing GCC presence. We look forward to continuing to use SystmOne to provide our growing client base with an unparalleled service, ensuring their international healthcare journey is as seamless as possible.” The signing comes with TPP’s attendance at the Arab Health exhibition where they hope to reinforce the relationships they’ve been building over the past few years while also looking for new business partners in the region. The new collaboration further reinforces TPP’s presence in the region following the previous announcement in Qatar in 2016, which will see TPP Middle East deliver the SystmOne clinical system to approximately 300 primary care sites across Qatar.

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27

NEWS

Boehringer Ingelheim focuses on holistic approaches to type 2 diabetes care in Lebanon

Dr. Maurice Khoury

Professor Salim Jambart

Mr. Fouad Jeweidi

oehringer Ingelheim, one of the world’s leading pharmaceutical companies, recently held its 2nd Cardio Metabolic Summit in Lebanon. The company hosted more than 300 endocrinologists and cardiologists as well as a media roundtable to focus on the prevalence of type 2 diabetes and the disease’s relationship with cardiovascular risk.

Lebanon has led to increased rates of type 2 diabetes. Lifestyle interventions and adherence to medications are central to disease prevention and management. The SGLT2 inhibition treatment paradigm aims at reducing the overall reabsorption of glucose into the bloodstream, allowing excess glucose to pass through the urine, leading to urinary glucose excretion. SGLT2 inhibition is important because the management of type 2 diabetes is complex and challenging – a large number of people with the disease do not achieve their blood glucose targets.”

which includes diabetes and hypertension. Cardiovascular disease is the number one cause of death in people with type 2 diabetes worldwide and reducing cardiovascular risk, including death, is an essential component of diabetes care.” “The relationship between diabetes and CVD is complex; diabetes is a risk factor for CVD and conditions such as high blood pressure and obesity, that are more common in people with diabetes, are also risk factors for CV disease. Moreover, people with T2Dare at increased risk of heart disease and stroke. When patients have both hypertension and diabetes, which is a common combination, the risk for cardiovascular disease doubles,” added Dr. Khoury.

B

Participants during the event provided a pragmatic approach on how treatment can be further simplified with the leading classes of current oral treatment options, and providing individualized approaches for type 2 diabetes management. Healthcare professionals from the region noted that cardiovascular disease is the underlying cause in over half of deaths in people with type 2 diabetes and is the principal cause of death. In 2015, according to the International Diabetes Federation (IDF), there were 464,200 cases of diabetes in Lebanon. The number of diabetes related deaths accounted for 5,723.8 for the same year, where the cost of treatment and management per person is USD 870.2. Professor Salim Jambart, Emeritus Professor of Endocrinology, and former head of the Endocrinology and metabolism division at Hotel-Dieu de France Hospital said, “The rapid change of lifestyle in

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“Given the important relationship of CVD and diabetes, a broad range of studies are being conducted on a several new treatments of the same class, with the objective of closely investigative long-term clinical CV outcomes of adults suffering from type 2 diabetes and are at high risk for CV events. Primary Results have showed a significant reduction of all-cause mortality of cardiovascular related deaths.” added Professor Jambart. Dr. Maurice Khoury, Director of Cardiac Electrophysiology at the American University of Beirut’s Medical Center (AUBMC) also noted that, “The continuous change of lifestyle in Lebanon and generally, across the region generally increased the prevalence of chronic diseases,

Fouad Jeweidi, Boehringer Ingelheim Country Head of Lebanon said, “At Boehringer Ingelheim, we continue to host leading discussions in Lebanon and across the region that shed light on best practices in overall T2D management. Being diagnosed with T2D is a critical life event, a main reason why we have heavily invested in current resources to find innovative solutions that address this growing burden in Lebanon and throughout the region. We are guided by a clear determination to provide sustainable solutions that place patients at the core.”

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REGISTER NOW +971 (0) 4 336 7334 obs-gyne@informa.com www.obs-gyne.com

19 - 21 APRIL 2017

Dubai International Convention and Exhibition Centre, UAE

THE REGION’S LARGEST GATHERING OF OBSTETRICIANS AND GYNAECOLOGISTS NEW FOR 2017 Earn up to 19 CME accredited points Network with over 2,500+ health professionals Learn from over 50 international, regional and local experts who will discuss topical issues currently facing practitioners in the field THE 2017 SPEAKER LINE-UP INCLUDES: Prof Steve Robson, President, British Maternal & Fetal

Dr Maria Sophocles, Consultant: Obstetrician-Gynecologist & Medical Director, Women’s Healthcare of Princeton, Princeton, New Jersey, USA

Dr Joseph Monsonego, Gyne-Oncologist, Medical

Dr Faysal El Kak, Senior Lecturer - Faculty of Health

Prof Raymond O. Powrie, Professor: Obstetrics, Gynecology and Medicine, Alpert School of Medicine of Brown University; Chief Medical Quality Officer, Care New England, SVP for Population Health; Chief of Medicine, Women & Infants Hospital of Rhode Island, Providence, Rhode Island, USA

Prof Antonio La Marca, Associate Professor: Department of Medical and Surgical Sciences Maternal-Infantile and Adult’s Gynecology and Obstetrics - Pathophysiology of Human Reproduction, University of Modena and Reggio Emilia, Modena, Italy

Prof Medhat Amer, Chairman & Senior Andrology Consultant, Adam International Hospital, Cairo, Egypt

Dr Wisam Al Kurdi, Associate Professor, Alfaisal University; Head: Section of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, King Faisal Specialist Hospital & Research Centre, Riyadh, KSA

Prof Gerald P. Schatten, Director, Pittsburgh Development Centre; Deputy Director, Magee-Women’s Research Institute; Professor & Vice Chair of Obstetrics, Gynecology and Reproductive Sciences, and Cell Biology and Physiology & Director of the Division of Developmental and Regenerative Medicine, School of Medicine Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA

Prof Dilly OC Anumba, Honorary Consultant Obstetrician/

Medicine Society; Chairman, RCOG Academic Committee; Consultant & Prof: Fetal Medicine, Newcastle University, Newcastle, UK

Director, Institute of the Cervix; Chairman, European Research Organisation on Genital Infection & Neoplasia (EUROGIN), Paris, France

For more information and registration contact us on Provided by

www.obs-gyne.com

Science; Clinical Associate-Women’s Health Centre, Department of Obstetrics & Gynecology, American University of Beirut, Beirut, Lebanon

Gynaecologist-Subspecialist in Maternal and Fetal Medicine; Academic Training Programme Director, Sheffield Medical School & South Yorkshire and Humber Deanery Academic Unit of Reproductive and Developmental Medicine-Obstetrics and Gynaecology, School of Medicine and Biomedical Sciences, The University of Sheffield, Sheffield, UK

+971 (0) 4 336 7334

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ARTICLE FEATURES . Lung Cancer

MAR.APR 2017

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ARTICLE FEATURES . Lung Cancer

L

ung cancer is one of the most common and serious types of cancer. It claims more lives each year than do colon, prostate, ovarian and breast cancers combined. Most lung cancers do not cause any symptoms until they have spread, but some people with early lung cancer do have symptoms. If you go to your doctor when you first notice symptoms, your cancer might be diagnosed at an earlier stage, when treatment is more likely to be effective. Cigarette smoking is the number one risk factor for lung cancer. According to the World Health Organization, cigarette smoking is linked to about 70% of lung cancers worldwide. People who smoke have the greatest risk of lung cancer. The risk of lung cancer increases with the length of time and number of cigarettes you’ve smoked. If you quit smoking, even after smoking for many years, you can significantly reduce your chances of developing lung cancer. Most lung cancers do not cause any symptoms until they have spread, but some people with early lung cancer do have symptoms. If you go to your doctor when you first notice symptoms, your cancer might be diagnosed at an earlier stage, when treatment is more likely to be effective. The most common symptoms of lung cancer are a cough that does not go away or gets worse, coughing up blood or rust-colored sputum (spit or phlegm), chest pain that is often worse with deep breathing, coughing, or laughing, hoarseness, weight loss and loss of appetite, shortness of breath, feeling tired or weak, infections such as bronchitis and pneumonia that don’t go away or keep coming back and new onset of wheezing.

Effects of smoking on the lungs

Signs and symptoms of lung cancer typically occur only when the disease is advanced, they may include: • A new cough that doesn’t go away • Changes in a chronic cough or “smoker’s cough” • Coughing up blood, even a small amount • Shortness of breath • Wheezing and chest pain • Hoarseness • Losing weight without trying • Bone pain and fever There are two main types of primary lung cancer: • Small cell lung cancer: It usually starts near the center of the chest in the bronchi. It is a fast-growing form of cancer that tends to spread in its early stages. It tends to grow and spread much faster than NSCLC. SCLC is rare in nonsmokers. • Non-small cell lung cancer: It is the most common form of lung cancer.

Smoking causes lung cancer by damaging the cells that line the lungs. When you inhale cigarette smoke, which is full of cancer-causing substances (carcinogens), changes in the lung tissue begin almost immediately. At first your body may be able to repair this damage. But with each repeated exposure, normal cells that line your lungs are increasingly damaged. Over time, the damage causes cells to act abnormally and eventually cancer may develop. Your lungs can be very badly affected by smoking. Coughs, colds, wheezing and asthma are just the start. Smoking can cause fatal diseases such as pneumonia, emphysema and lung cancer. Smoking causes 84% of deaths from lung cancer and 83% of deaths from chronic obstructive pulmonary disease (COPD). COPD, a progressive and debilitating disease, is the name for a collection of lung diseases including chronic bronchitis and emphysema. People with COPD have difficulties breathing, primarily due to the narrowing of their airways and destruction of lung tissue. Typical symptoms of COPD include: increasing breathlessness when active, a persistent cough with phlegm and frequent chest infections.

There are many types of NSCLC and each type has various cancer cells that grow and spread differently. The classification of lung cancer is important due to the different treatment between the two main types. SCLC is more dangerous and less responsive to treatment than NSCLC.

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ARTICLE FEATURES . Lung Cancer

Lungs with COPD

The cancer treatment plan is based on a number of factors, such as the patient’s overall health as well as the type and stage of the cancer. Options typically include one or more treatments, including surgery, chemotherapy, radiation therapy or targeted drug therapy. Despite the modern and advanced treatments, quitting smoking remains the only way to survive from this disease. Some patients with advanced lung cancer have benefited greatly from immunotherapies, experiencing durable remissions and prolonged survival. During surgery your surgeon works to remove the lung cancer and a margin of healthy tissue. The surgeon may remove a small section of lung that contains the tumor along with a margin of healthy tissue or a larger portion of lung, but not an entire lobe, he may remove the entire lobe of one lung or the entire lung.

Healthy

Inflammation & execc mucus

Whilst the early signs of COPD can often be dismissed as a ‘smoker’s cough’, if people continue smoking and the condition worsens, it can greatly impact on their quality of life. You can slow down the progression of the disease and stopping smoking is the most effective way to do this. A number of factors may increase your risk of lung cancer. Some risk factors can be controlled, for instance, by quitting smoking. And other factors can’t be controlled, such as your family history.

Risk factors for lung cancer include: • Smoking • Exposure to secondhand smoke • Exposure to radon gas • Exposure to asbestos and other carcinogens • Family history of lung cancer Secondhand smoke (SHS) has the same harmful chemicals that smokers inhale. There’s no safe level of exposure for secondhand smoke. Non-smokers who breathe in SHS take in nicotine and toxic chemicals the same way smokers do. The more SHS you breathe, the higher the levels of these harmful chemicals in your body.

MAR.APR 2017

Promising Treatments

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Chemotherapy uses drugs to kill cancer cells. One or more chemotherapy drugs may be given through a vein in your arm (intravenously) or taken orally. A combination of drugs usually is given in a series of treatments over a period of weeks or months, with breaks in between so that you can recover. Chemotherapy is often used after surgery to kill any cancer cells that may remain. It may also be used before surgery to shrink cancers and make them easier to remove. In some cases, chemotherapy can be used to relieve pain and other symptoms of advanced cancer. Radiation therapy uses high-powered energy beams from sources such as X-rays and protons to kill cancer cells. Radiation therapy can be directed at your lung cancer from outside your body (external beam radiation) or it can be put inside needles, seeds or catheters and placed inside your body near the cancer (brachytherapy). Radiation therapy can be used after surgery to kill any cancer cells that may remain. It may also be used as the first treatment for lung cancers that can’t be removed during surgery. For people with advanced lung cancer, radiation therapy may be used to relieve pain and other symptoms. Quitting smoking reduces your risk of lung cancer, even if you’ve smoked for years. Avoid secondhand smoke. According to the WHO, it is estimated that tobacco causes about 8.8% of deaths (4.9 million) worldwide. That figure is expected to rise to 10 million deaths per year by the 2020s or early 2030s, with 70% of those deaths occurring in developing countries.

ARTICLE FEATURES . Lung Cancer

Lung Cancer Stages First, cancer is tiny in size and has not spread into deeper lung tissues or outside the lungs. In Stage 2, the cancer may have spread to nearby lymph nodes or into the chest wall. Stage 3, the cancer is continuing to spread from the lungs to the lymph nodes or to nearby structures and organs, such as the heart, trachea and esophagus. In Stage 4, the cancer has metastasized throughout the body and may now affect the liver, bones or brain.

stage 1

stage 2

stage 3

stage 4

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ARTICLE FEATURES . Vitamin B

Referred to as vitamin B complex, the eight B vitamins play an important role in the body. These essential nutrients help convert our food into fuel, allowing us to stay energized throughout the day. While many of the following vitamins work in tandem, each has its own specific benefits — from promoting healthy skin and hair to preventing memory loss or migraines. The eight vitamins that make up the B complex are water soluble, meaning the body does not store excess amounts, with the exception of vitamin B12, which is stored in the liver. Rather, unused B vitamins are excreted through urine. This means you need a continuous supply on the B vitamins from the diet. All B vitamins help to metabolize the foods we eat, with special consideration given to the conversion of ingested carbohydrates into glucose, the body’s preferred method of fuel. The body burns this fuel to produce what we refer to as energy. Some experts suggest vitamins B3 and B6 for better sleep. The B vitamins promote normal adrenal gland function. If the adrenal glands are not working properly, wakefulness and insomnia may occur. Vitamin B3 increases REM (rapid eye movement) sleep, which can decrease the number of times you wake during the night. Vitamin B6 supports the production of serotonin, a neurotransmitter that can be converted to melatonin, the hormone that helps to regulate the body’s sleep-wake cycle.

Many types and important functions in the body

Types of Vitamin B: • B1 (Thiamine):

B1 helps the body make healthy new cells. It’s often called an anti-stress vitamin because of its ability to protect the immune system. • B2 (Riboflavin):

This B vitamin works as an antioxidant to help fight free radicals. It is also important for red blood cell production, which is necessary for transporting oxygen throughout the body.

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ARTICLE FEATURES . Vitamin B

• B3 (Niacin):

It is involved in chemical reactions that provide your cells with the energy they need for normal metabolism. • B5 (Pantothenic Acid):

In addition to breaking down fats and carbs for energy, it’s responsible for the production of sex and stress-related hormones including testosterone.

B vitamin deficiencies may be linked to depression, psychiatric disorders, memory function, cognitive impairment, and dementia. B complex vitamins can help with a variety of health conditions, including acne, anxiety depression, fatigue, heart disease, premenstrual syndrome, and skin problems. In addition, many people take a B complex vitamin to increase energy, support brain health, enhance mood, improve memory, ease stress, stimulate the immune system, and to boost hair and skin health.

• B6 (Pyridoxine):

B6 helps regulate levels of the amino acid homocysteine. Pyridoxine is a major player in mood and sleep patterns because it helps the body produce serotonin, melatonin and norepinephrine, a stress hormone. • B7 (Biotin):

Because of its association with healthy hair, skin and nails, this B vitamin also goes by “the beauty vitamin.” It may help people with diabetes control high blood glucose levels, too. • B9 (Folate):

It may help keep depression at bay and prevent memory loss. This vitamin is also especially important for women who are pregnant since it supports the growth of the baby and prevents neurological birth defects.

Each B vitamin is essential to certain bodily functions. B1 and B2 are important for healthy functioning of the muscles, nerves, and heart. B1 helps the body make new cells, and B2 is important for red blood cell production and fighting free radicals. B3 helps regulate the nervous and digestive systems, helps convert food into energy. B5 breaks down fats and carbohydrates for energy and is responsible for the production of hormones. B5 and B12 are required for normal growth and development. B6 supports the immune system, helps the body produce hormones, and aids the body in breaking down protein. B7 is involved in the production of hormones. B9 helps cells make and maintain DNA, promotes the growth of red blood cells.

• B12 (Cobalamin):

It works with vitamin B9 to produce red blood cells & help iron do its job: create the oxygen carrying protein, hemoglobin. B complex vitamins play an important role in health, such as helping the body to produce energy and form red blood cells.

B12 helps regulate the nervous system and plays a role in red blood cell formation. B6, B9, and B12 help to regulate levels of the amino acid homocysteine - an amino acid thought to contribute to heart disease when it occurs at elevated levels.

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ARTICLE FEATURES . Vitamin B

Beauty benefits

Food Sources of B Complex Vitamins

Vitamin B has recently received attention within the world of beauty, with a number of studies demonstrating how the inclusion of Vitamin B in face creams can help to prevent ageing. In particular, Nicotinamide, a derivative of Vitamin B3 (Niacin), has been shown to improve the ability of the epidermis, the upper-most layer of the skin, to retain moisture – leading to softer, smoother skin with less dryness and flakiness, and a reduction of fine lines. Nicotinamide can also serve as an effective skin-lightening agent when added to moisturizers.

To boost your intake of B vitamins, look for the following foods. B1 can be found in whole grains and breakfast cereals. B2 in almonds, cereals, chicken, fish, green leafy vegetables, kidney beans, eggs, soybeans, spinach, turkey, yogurt, wild rice. B3 is found in chicken, eggs, fish, nuts, red meat, whole grains and yeast. B5 in avocados, eggs, legumes, meat, while B6 is found in bananas, beans, beef, brown rice, chicken, chickpeas, carrots, cheese, lentils, potatoes, salmon, spinach, sunflower seeds, tuna, turkey, whole grain cereals.

B-Complex Vitamins enhance beauty by promoting healthy hair, skin and nails, by counteracting damage caused by free-radicals – molecules that break

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B7 is found in bananas, chicken, cauliflower, egg yolks, fish, milk, nuts, oats, potatoes, liver. B9 is found in asparagus, beans, beets, broccoli, bulgur wheat, chicken, citrus fruits, nuts, dark leafy greens, salmon, whole grains and B12 is found in eggs, cheese, beef, fish, milk, shellfish. down healthy cells and contribute to ageing and disease. B vitamins help us metabolize food sources, providing nutrients to the whole body including the hair and hair follicles. Deficiencies of vitamins B1, B2, B3, and B5 can result in poorly-nourished hair follicle cells.

Not getting enough Vitamin B9 or Folic Acid can also slow down cell division within the hair follicles, which also slows down hair growth. Vitamin B7 (Biotin) is also essential for maintaining the texture, tone and strength of your locks, and a deficiency can lead to hair loss.

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..ARTICLE

V

itamin D is a fat-soluble vitamin. Vitamin D and its metabolites have a significant clinical role because of their interrelationship with calcium homeostasis and bone metabolism. Rickets (children) and osteomalacia (children and adults) due to severe vitamin D deficiency are now uncommon except in populations with unusually low sun exposure, lack of vitamin D in fortified foods, and malabsorptive syndromes. Subclinical vitamin D deficiency, as measured by low serum 25(OH)D, is very common. In the National Health and Nutrition Examination Survey (NHANES) 2005 to 2006, 41.6 percent of adult participants (≼20 years) had 25(OH)D levels below 20 ng/mL (50 nmol/L) [1].

BENEFITS Vitamin D deficiency was originally discovered as the cause of rickets due to lack of exposure to sunshine or vitamin D-rich food. This disease is still endemic in major parts of the world [2]. Subsequently, several meta-analyses showed that supplementation with vitamin D and calcium decreased the risk of osteoporotic fractures in older adults. In addition to its role in calcium and bone homeostasis, vitamin D potentially regulates many other cellular functions. The vitamin D receptor (VDR) is nearly universally expressed in nucleated cells. Approximately 3 percent of the human/mouse genome is under the control of 1,25-dihydroxyvitamin D, the active form of vitamin D. Furthermore, at least 10 tissues outside the kidney express 1-alpha-hydroxylase (CYP27B1), the enzyme responsible for converting vitamin D to its active form, and therefore, the active hormone can

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be generated in an auto- or paracrine way. Thus, the spectrum of activity of the vitamin D endocrine system is much broader than calcium/bone homeostasis, and in this regard, the vitamin D-VDR system resembles that of other ligands of nuclear receptors, such as thyroid hormone [3-5].

OPTIMAL VITAMIN D FOR EXTRASKELETAL HEALTH There are a large number of epidemiologic data indicating that the risks of cancer and infectious, autoimmune (such as Multiple Sclerosis), and cardiovascular diseases are higher when 25-hydroxyvitamin D (25[OH]D) levels are <20 ng/mL (50 nmol/L) and that risks decrease with higher 25(OH)D concentrations. However, there are no convincing randomized trial data that vitamin D supplements can decrease cancer risk or prognosis, decrease the risk or severity of infections or autoimmune diseases, or decrease cardiovascular risks or metabolic diseases [6-9].

SOURCES Very few foods naturally contain vitamin D (fatty fish livers are the exception); dermal synthesis is the major natural source of the vitamin. Previtamin D3 is synthesized nonenzymatically in skin from 7-dehydrocholesterol during exposure to the ultraviolet (UV) rays in sunlight. Previtamin D3 undergoes a temperature-dependent rearrangement to form vitamin D3 (cholecalciferol). This system is exceedingly efficient, and it is estimated that brief casual exposure of the arms and face is equivalent to ingestion of 200 international units per day [10].

D3 to inactive metabolites (lumisterol, tachysterol, 5,6-transvitamin D, and suprasterol 1 and 2). In addition, sunlight induces production of melanin, which reduces production of vitamin D3 in the skin. Infants, disabled persons, and older adults may have inadequate sun exposure, while the skin of those older than 70 years of age also does not convert vitamin D effectively. In addition, at northern latitudes, there is not enough radiation to convert vitamin D, particularly during the winter [13, 14].

Optimal serum 25-hydroxyvitamin D The best laboratory indicator of vitamin D adequacy is the serum 25(OH) D concentration [15]. The lower limit of normal for 25(OH)D levels varies depending on the geographic location and sunlight exposure of the reference population (range 8 to 15 ng/mL). However, there is no consensus on the optimal 25(OH)D concentration for skeletal or extraskeletal health. The IOM concluded that a serum 25(OH)D concentration of 20 ng/mL (50 nmol/L) is sufficient for most individuals [16], but other experts (Endocrine Society, National Osteoporosis Foundation [NOF], International Osteoporosis Foundation [IOF], American Geriatrics Society [AGS]) suggest that a minimum level of 30 ng/mL (75 nmol/L) is necessary in older adults to minimize the risk of falls and fracture. The serum parathyroid hormone (PTH) level typically is inversely related to 25(OH)D levels in adults, and may be a useful secondary indicator of vitamin D insufficiency. In general, this relationship is weak for children [17-21].

ARTICLE

EXCESS The intake at which the dose of vitamin D becomes toxic is not clear. The Institute of Medicine (IOM) has defined the “tolerable upper intake level” (UL) for vitamin D as 100 micrograms (4000 international units) daily for healthy adults and children 9 to 18 years [22]. This is also the UL for pregnant and lactating women. The UL for infants and children up to nine years old is lower. High doses of vitamin D of 10,000 to 50,000 units daily may be necessary to replete vitamin D in some patients. Such patients require careful monitoring to avoid toxicity. Vitamin D intoxication generally occurs after inappropriate

use of vitamin D preparations. It may occur in fad dieters who consume “megadoses” of supplements or in patients who take vitamin D replacement therapy for malabsorption, renal osteodystrophy, osteoporosis, or psoriasis. Vitamin D intoxication has been documented in adults taking more than 60,000 international units per day. Symptoms of acute intoxication are due to hypercalcemia and include confusion, polyuria, polydipsia, anorexia, vomiting, and muscle weakness. Chronic intoxication may cause nephrocalcinosis, bone demineralization and pain. The diagnosis and treatment of vitamin D toxicity are reviewed separately [23].

Dr. Waleed Farouk Mohamed MBBS, MSC Internal Medicine Healthpoint -UAE

References: 1. Forrest KY, Stuhldreher WL. Prevalence and correlates of vitamin D deficiency in US adults. Nutr Res 2011; 31:48. 2. Prentice A. Vitamin D deficiency: a global perspective. Nutr Rev 2008; 66:S153. 3. Bouillon R. Vitamin D: from photosynthesis, metabolism and action to clinical applications. In: Endocrinology, Jameson JL, De Groot LJ (Eds), Saunders Elsevier, Philadelphia 2010. Vol 1, p.1089. 4. Holick MF. Vitamin D deficiency. N Engl J Med 2007; 357:266. 5. Bouillon R, Carmeliet G, Verlinden L, et al. Vitamin D and human health: lessons from vitamin D receptor null mice. Endocr Rev 2008; 29:726. 6. IARC. Vitamin D and Cancer. IARC Working Group Reports Vol.5, International Agency for Research on Cancer, Lyon. November 2008. http://www. iarc.fr/en/publications/pdfs-online/wrk/wrk5/Report_VitD.pdf 7. Bouillon R, Van Schoor NM, Gielen E, et al. Optimal vitamin D status: a critical analysis on the basis of evidence-based medicine. J Clin Endocrinol Metab 2013; 98:E1283. 8. Rosen CJ, Adams JS, Bikle DD, et al. The nonskeletal effects of vitamin D: an Endocrine Society scientific statement. Endocr Rev 2012; 33:456. 9. Kupferschmidt K. Uncertain verdict as vitamin D goes on trial. Science 2012; 337:1476. 10. Haddad JG. Vitamin D--solar rays, the Milky Way, or both? N Engl J Med 1992; 326:1213. 11. Terushkin V, Bender A, Psaty EL, et al. Estimated equivalency of vitamin D production from natural sun exposure versus oral vitamin D supplementation across seasons at two US latitudes. J Am Acad Dermatol 2010; 62:929.e1. 12. Binkley N, Novotny R, Krueger D, et al. Low vitamin D status despite abundant sun exposure. J Clin Endocrinol Metab 2007; 92:2130. 13. Holick MF. Vitamin D: A millenium perspective. J Cell Biochem 2003; 88:296. 14. Holick MF, MacLaughlin JA, Doppelt SH. Regulation of cutaneous previtamin D3 photosynthesis in man: skin pigment is not an essential regulator. Science 1981; 211:590. 15. Food and Nutrition Board of the Institute of Medicine. Vitamin D. In: Dietary reference intakes for calcium, phosphorus, magnesium, vitamin D, fluoride, National Academies Press, Washington, DC 1997. p.250. 16. http://books.nap.edu/openbook.php?record_id=13050 (Accessed on December 08, 2010). 17. Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2011; 96:1911. 18. Vieth R. What is the optimal vitamin D status for health? Prog Biophys Mol Biol 2006; 92:26. 19. Dawson-Hughes B, Mithal A, Bonjour JP, et al. IOF position statement: vitamin D recommendations for older adults. Osteoporos Int 2010; 21:1151. 20. American Geriatrics Society Workgroup on Vitamin D Supplementation for Older Adults. Recommendations abstracted from the American Geriatrics Society Consensus Statement on vitamin D for Prevention of Falls and Their Consequences. J Am Geriatr Soc 2014; 62:147. 21. 2013 Clinician’s guide to prevention and treatment of osteoporosis http://nof.org/files/nof/public/content/resource/913/files/580.pdf (Accessed on January 23, 2014). 22. Institute of Medicine. Report at a Glance, Report Brief: Dietary reference intakes for calcium and vitamin D, released 11/30/2010. http://www. iom.edu/Reports/2010/Dietary-Reference-Intakes-for-Calcium-and-Vitamin-D/Report-Brief.aspx (Accessed on December 01, 2010). 23. Morgan SL, Weinsier RL. Fundamentals of clinical nutrition, Mosby, St. Louis 1998. p.3.

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ARTICLE FEATURES . HER life matters

Learn about the necessary tests for every stage of your life

I

nternational Women’s Day is celebrated on March 8 every year to shed light on women’s achievements. On this occasion, “Hospitals” magazine salutes all women around the world and offers tips and advice to ensure they have a healthy carefree life that allows them to enjoy their achievements both at the professional and family level. In addition to these tips, we offer a list of the necessary tests needed for each age group based on the editorial team’s principle

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that focuses on prevention, which has always been favored by doctors. Medical studies and scientific research proved that “a healthy lifestyle” is the cornerstone in the prevention of diseases and could greatly reduce the likelihood of their occurrence over the years. Healthy living may prevent many illnesses like heart disease, diabetes, hypertension and obesity as well as the health problems associated with them. Making healthier choices will not only reduce your risk for chronic disease, but will also make you feel better and improve your overall quality of life. No one is guaranteed a healthy life. But following certain guidelines -- namely, eating well, exercising, and not smoking can do a lot for you. Following a healthy, balanced diet can help you maintain a healthy weight, lower your cholesterol and reduce your risk for disease. Choose high fiber, lower fat foods and 5-10 servings of fruit and

vegetables every day. Exercise regularly even for just 30 minutes a day because physical inactivity and unhealthy food can cause a lot of damage to your body. Avoid smoking in order to prevent many health issues especially respiratory problems and lung cancer. On the other hand, women are advised to avoid stress as this causes great damage to the body.

Necessary health tests at every age We all worry about our health as we get older. But by undergoing routine health checks, which take just minutes to perform, you can spot any problems in the early stages when they are easier to treat. Specialized doctors are able to detect any cancer tumors at an early stage when it is possible to treat them and recover from them. Hence, diagnostic tests and routine check-ups are measures that put you on the right track to enjoy a healthy life free from diseases as much as possible. These tests differ depending on the person’s health and age.

ARTICLE FEATURES . HER life matters

20s 30s 40s 50s 60s

+

You should see your doctor for regular medical check-ups. Screening tests help doctors detect many diseases, such as cardiovascular disease, diabetes and some cancers in their early stages. Tests include blood, urine and stool test to detect any infection in the intestines or colon. In addition to that, women should also undergo a blood sugar test for the detection of diabetes. If you are or will get married, you should visit a gynaecologist annually even if you have no problem in order to undergo a Pap smear and pelvic exam as well as have STD tests. Visiting the dentist is a must at every age; you should have regular checkups every six months to maintain healthy teeth and mouth.

You should start building a strong body in preparation for the next stages of life. You can build a strong physical structure that protects you from many diseases in the future. You have to undergo an annual test to check your cholesterol level, especially in the case of any chronic disease or obesity, or if you smoke. If the test result is normal, it can be repeated every five years. In addition, visiting the gynecologist annually is a must.

You are now required to undergo further exams such as mammography screening, ECG and visiting the ophthalmologist annually, except in conditions that require regular follow-up with your physician.

In addition to the tests require in your 40s, you should also undergo a colonoscopy, which is an important test that should be done every 5 years. Since bones become less dense, lose strength and break more easily with age, a bone density test (DEXA) helps to determine the health of your bones.

Now you need your family and grandchildren to enjoy your health and peace of mind; however, visiting your doctor regularly becomes more necessary than ever to make sure there is no health problem. A healthy life remains the only way towards a disease-free body; avoiding physical inactivity, fatty foods and smoking is key to a happy healthy life.

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ARTICLE FEATURES . HER life matters

E

strogen, the main female hormone, shapes the uniqueness of a woman’s body. It ignites the physical transformation from childhood to womanhood, regulates, along with progesterone, the menstrual cycle, keeps the vagina lubricated and generates the proper womb environment for implantation and nourishment of the early embryo. It maintains bone density and skin elasticity, protects the brain and the cardiovascular system. While the ovaries stop releasing viable eggs at menopause, the body’s need for estrogen never stops and the body tries to make estrogens in other tissues and organs – the skin, liver and fat tissue for example. Estrogen is necessary for healthy living.

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ARTICLE FEATURES . HER life matters

For much of a woman’s life, estrogen fluctuates up and down. This occurs within the monthly cycle and also within the general framework of a lifetime. It peaks in young adulthood and ebbs with the years. Estrogen’s effect on mood is due to its ability to increase serotonin, and beta-endorphins which are associated with positive mood states. Many women may develop symptoms of depression, anxiety, and mood swings as estrogen levels begin to fluctuate during perimenopausal years then further decline at menopause. Progesterone and estrogen are necessary to prepare the uterus for menstruation, and their release is triggered by the hypothalamus.

Estrogen the years Estrogen increases and decreases depending on the changes occurring in women throughout their life starting from puberty, menstruation, pregnancy and menopause. The body maintains high levels of estrogen that decrease after menstruation; estriol is only produced in significant quantities during pregnancy. During menopause, ovarian secretion of estrogen and progesterone ends. Although the ovaries stop

producing estrogen, they still continue to produce small amounts of the male hormone testosterone, which can be converted to estrogen (estradiol) in body fat. In addition, the adrenal gland continues to produce androstenedione (a male hormone), which is converted to estrone and estradiol in the body fat. The total estrogen produced after menopause is, however, far less than that produced during a woman’s reproductive years.

What is the function of estrogen in women? • It prepares the girl’s uterus and ovaries for puberty • Estrogen levels naturally increase during puberty in order to regulate many processes related to pregnancy • It regulates menstruation in women and controls ovulation • Prepares the uterus every month for possible conception and causes lining of the uterus to thicken during the menstrual cycle • Protects pregnancy by regulating progesterone levels • It kick-starts one of the major processes of fetal maturation, without it, a fetus’ lungs, liver and other organs and

tissues cannot mature • Low estrogen levels cause miscarriage • Estrogen stimulates the growth of the vagina to its adult size • Stimulates growth of breast tissue • Estrogen boosts sex drive in women • It protects against heart disease • It affects the liver cells to reduce bad LDL and increase good HDL • It maintains good calcium levels in bones

What are the risks of low estrogen? Estrogen levels fall after menopause, or when a woman stops menstruating. This is when women know that they entered a new stage in their life, which is menopause accompanied by some health problems. Symptoms caused by the reduction in estrogen production include: • Depression and mood swings • Frequent night sweats and hot flashes and difficulty sleeping • Fatigue, headaches and heart palpitations • Weight gain • Osteoporosis • Frequent urinary and vaginal infections • Vaginal dryness • Breast tenderness

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ARTICLE FEATURES . HER life matters

A

womanâ&#x20AC;&#x2122;s uterus is solely responsible for the continuation of humanity; perhaps this definition sheds light on the importance of maintaining this organ safe and sound for the ultimate goal in life, which is reproduction. Hence, recent years have seen awareness campaigns aimed at educating women about the importance of early detection of any disease that might affect the womb because it is the only way to prevent its development. Cervical cancer has always been the major title of awareness campaigns that urged women aged between 20 and 50 to consult a gynecologist regularly in order to carry out all the necessary tests that contribute to detecting any abnormal condition early before turning into cancer. 1.4 million women suffer from cervical cancer worldwide and 450,000 new cases are detected every year.

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Today, in light of medical developments, we can say that cervical cancer is the most curable disease given the clear diagnostic tests that allow the doctor to detect abnormal cells before turning into cancer, provided

there is regular check-up. Cervical cancer is a type of cancer that occurs in the cells of the cervix â&#x20AC;&#x201D; the lower part of the uterus that connects to the vagina. Cancer of the cervix often has no symptoms in its early stages.

ARTICLE FEATURES . HER life matters

If you do have symptoms, the most common is unusual vaginal bleeding, which can occur after sex, in between periods or after the menopause. If cervical cancer is diagnosed at an early stage, it’s usually possible to treat it using surgery. In some cases,

it’s possible to leave the womb in place, but it may need to be removed. The surgical procedure used to remove the womb is called a hysterectomy. Abnormal cervical cell changes rarely cause symptoms. But you may have symptoms if those cell changes

grow into cervical cancer. Symptoms of cervical cancer may include abnormal vaginal bleeding such as bleeding between menstrual periods, after sex, or after menopause, pain in the lower belly or pelvis, pain during sex and abnormal vaginal discharge.

HPV the main cause of most cases of cervical cancer Almost all cases of cervical cancer are caused by the human papilloma virus (HPV). HPV is a very common virus that can be passed on through any type of sexual contact with a man or a woman. There are more than 100 different types of HPV, many of which are harmless. However, some types of HPV can cause abnormal changes to the cells of the cervix, which can eventually lead to cervical cancer. Two strains of the HPV virus (HPV 16 and HPV 18) are known to be responsible for 70% of all cases of cervical cancer. These types of HPV infection don’t have any symptoms; so many women won’t realize they have the infection. However, it’s important to be aware that these infections are relatively common and most women who have them don’t develop cervical cancer. Using condoms during sex offers some protection against HPV, but it can’t always prevent infection, because the virus is also spread through skin-to-skin contact of the wider genital area. HPV vaccination can reduce the risk of infection by the HPV types targeted by the vaccine. The Food and Drug Administration (FDA) has approved three vaccines to prevent HPV infection: Gardasil®, Gardasil® 9, and Cervarix®. These vaccines provide strong protection against new HPV infections, but they are not effective at treating established HPV infections or disease caused by HPV (15, 16). Gardasil is currently approved for use in girls and women ages 9 through 26 for the prevention of cervical, vulvar and vaginal cancer caused by HPV types 16 and 18; precancerous lesions caused by types 6, 11, 16, and 18; and genital warts caused by types 6 and 11 in men and women. In addition to providing protection against the HPV types included in these vaccines, the vaccines have been found to provide partial protection against a few additional HPV types that can cause cancer, a phenomenon called cross-protection. The vaccines do not prevent other sexually transmitted diseases, nor do they treat existing HPV infections or HPV-caused disease. The HPV vaccine is given as three injections in the upper arm. The vaccine works best if you have it over a six-month period, with the second dose of the vaccine two months after the first, and the final dose four months after the second (at 0, 2 and 6 months).

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ARTICLE FEATURES . HER life matters

Pap smear Pap smear is a very important test that every woman should get as it is the only way to detect any cervical abnormality that may develop to become cancer. Generally, you should start getting regular Pap smears at age 21. During the test, your doctor will scrape a small sample of cells from your cervix using a tool called a spatula. Most women feel a slight push and irritation during the brief scraping. The sample of cells from your cervix will be preserved and sent to a lab to be tested for the presence of abnormal cells. Even though a Pap smear doesn’t test for HPV, it identifies cellular changes caused by the virus. By detecting cervical cancer cells early with a Pap smear, treatment can start before it spreads and becomes a bigger problem. In addition to being able to detect cervical cancer, Pap smears can also detect other diseases, such as:

• Cancer diseases as the Pap test finds changes in the cells

• Detection of parasites that are caused by abnormal secre-

of the cervix (themouth of the womb) that are not normal. When a female gets Pap test, she is being screened to make sure that there are no abnormal or precancerous changes in the cells on her cervix. If the Pap test results show these cell changes, this is usually called cervical dysplasia.

tions and discharge that usually has an unpleasant or fishy smell. The most common infection is Trichomonas, which is a sexually transmitted disease and the couple should be treated with antibiotics.

• Vaginal infections such as having a large number of bacteria, which cause abnormal secretions. The primary cause of bacterial vaginosis is an overgrowth of anaerobic bacteria that is found naturally in the vagina and the Gardnerella organism.

• Viral infections as we can detect herpes through the Pap smear and it is a sexually transmitted infection that should be treated immediately because it is a serious disease in pregnant women who will have a normal birth, as it can cause disability or death for the newborn while coming out of the vagina.

• Some causes of infertility: Pap smears reveal a lack of certain nutrients, such as folic acid making it an unsuitable environment for sperm, mainly affecting women in poor communities. • Cervical polyps: Many cervical polyps do not cause symptoms and are found by chance during a routine pelvic examination that includes a Pap smear. They cause vaginal bleeding especially after intercourse and pain in the lower abdomen.

• Yeast infections that also cause abnormal vaginal dis-

• Vaginal atrophy: It is a condition in which low estrogen levels cause a woman’s vagina to narrow, lose flexibility and take longer to lubricate.

charge, itching, redness of the vagina, and Candida are the most common yeast infection and can be treated with antifungal medicines.

• AIDS: It is a widely spread sexually transmitted disease in the West and is a serious condition that causes cervical cancer.

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..ARTICLE

What Are the Signs and Symptoms of Osteoporosis? Osteoporosis is called a “silent disease” because there are generally no symptoms or pain until you break a bone. Back pain, however, may be due to osteoporosis or other conditions such as osteoarthritis or degenerative disc disease. It is possible to have osteoporosis and osteoarthritis as well as other conditions at the same time.

How Is Osteoporosis Detected?

O

steoporosis (meaning porous bone) is a disease in which bone loss occurs, so that bones become thin weak and are more likely to break. Without prevention or treatment, osteoporosis can progress without pain or symptoms until a bone breaks (fractures). Fractures from osteoporosis commonly occur in the hip, spine, ribs, and wrist.

What Causes Osteoporosis? Bones may seem like hard and lifeless structures, but they are in fact living tissue. Old bone is constantly broken down and remodeled (through a process called bony resorption) by our bodies, while new bone is simultaneously deposited. When bone is broken down faster than it is deposited, low bone mass (osteopenia) and osteoporosis can occur.

When Does Osteoporosis Occur? Osteoporosis can occur at any age. However, it is more common in people older than 50 years of age, and the older a person is, the greater the risk is of osteoporosis.

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Unfortunately, many people do not know they have osteoporosis until they experience a broken bone. By that time, bones are already weak. However, osteoporosis can be prevented or delayed by early detection and treatment. Specialized tests called bone density tests can measure bone density (solidness) in various sites of the body, such as the hip, spine, and wrist. A bone density test can detect osteoporosis before a fracture occurs and can predict your chances of having a broken bone in the future, and used to monitor the effects of treatment.

Who Is at Risk for Osteoporosis? • A small and thin frame • A member of the immediate family with broken a bone as an adult • Postmenopausal woman • Early or surgically-induced menopause • Use of certain medications that affect the bone metabolism such as High doses of thyroid medication or steroids • Immunosuppressive medications or chemotherapy to treat cancer • Diet low in dairy products and other sources of calcium • Physically inactive • Smoking cigarettes or drink alcohol in excess

How Can Osteoporosis Be Prevented? Few things that can be done to maintain healthy bone are as follows:

Mohamed Aboyoussef Consultant Rheumatologist Healthpoint -UAE

• Get enough calcium and vitamin D by drinking milk or eating milk products. • Weight-Bearing exercises • Do not smoke. • Avoid excessive intake of alcohol

What Is the Treatment for Osteoporosis? Treatment includes both lifestyle changes and medications. Treatment programs focus on nutrition, exercise, and safety issues to prevent falls that may result in broken bones. The doctor may prescribe a medication to slow or stop bone loss, increase bone density, and reduce fracture risk. Generally there are two types of medications to treat osteoporosis. Anti-resorptive therapy which are medications to maintain the bones such hormone replacement therapy, Selective estrogen receptor modulators, bisphosphonates,denosumab or calcitonin) or Anabolic therapy which builds new bones such as teriparatide injections. Finally, it is important to realize that osteoporosis is no longer considered an incurable disease due to aging. This article is to raise awareness for prevention, early detection and treatment in order to prevent fractures which can negatively impact the quality and quantity of life.

• • • • • • • • • • • • • •

Bariatric & Metabolic Surgery Cardiology Dental Dermatology Diagnostic Imaging Ear, Nose & Throat (ENT) Family Medicine Gastroenterology General Practice General Surgery Gynecology Internal Medicine Hair Transplant Orthopedics and Sports Medicine provided by Abu Dhabi Knee & Sports Medicine

• Physiotherapy & Rehabilitation • Plastic & Cosmetic Surgery • Podiatry • Respiratory & Sleep Medicine • Rheumatology • Spine Care provided by Wooridul Spine Centre • Urology increases the • Vascular Surgery tion, in which • Wound Care

ARTICLE

Hypertension

risk of placental abrupHealthpointUAE the placenta separates from the inner your uterus be02 wall 492of9000 www.healthpoint.ae fore delivery. Severe abruption can cause heavy bleeding which can be Located at Zayed Sports City, Abu Dhabi, UAE There are different types of hypertension life-threatening .

in pregnant ladies

during pregnancy

Healthpoint Full-page Advert_Print_21.11.16.indd 1

• Gestational hypertension; means that hypertension develops after 20 weeks of pregnancy. • Chronic hypertension; high blood pressure that was present before pregnancy or that occurs before 20 weeks of pregnancy. • Chronic hypertension with superimposed preeclampsia; chronic high blood pressure before pregnancy, then worsening and other health complications during pregnancy. • Preeclampsia; a pregnancy complication characterized by high blood pressure and signs of damage to other organs - usually after 20 weeks of pregnancy. If left untreated, preeclampsia can lead to serious complications for mother and baby.

MATERNAL PERSONAL RISK FACTORS FOR PREECLAMPSIA The following are maternal personal risk factors for preeclampsia: • First pregnancy • Age younger than 18 years or older than 35 years • History of preeclampsia • Obesity (BMI ≥30) • Interpregnancy interval less than 2 years or longer than 10 years

Why is high blood pressure a problem during pregnancy? • It poses various risks, including; • Decreased blood flow to the placenta; This can lead to slow growth, low birth weight or preterm birth. • Placental abruption. Preeclampsia

11/21/16 4:54 PM

• Premature delivery. Sometimes an early delivery is needed to prevent potentially life-threatening complications. Home and ambulatory blood pressure measurements are increasingly being used in the pregnant population. Assuming the blood pressure device is accurate (validated relative to an office measurement), the measurements may provide valuable additional data regarding hypertension severity and control during pregnancy. • Laboratory testing; includes testing for target organ damage, potential secondary causes of hypertension, and other risk factors. Such studies include: urinalysis; complete blood cell (CBC) count; and serum sodium, potassium, creatinine, and glucose levels.

Iman Esmat Msc , MD CARDIOLOGY/ Specialist Cardiovascular Disease / Member of the European and Egyptian Society of Cardiology Healthpoint -UAE

mild antihypertensive with a slow onset of action, and associated fatigue may limit patient tolerability of this medication. Labetalol has a more rapid onset of action, may be given orally or parenterally, and is generally preferred as a firstline agent.

Is it safe to take blood pressure medication during pregnancy? • Echocardiography and Electrocardiography; An (ECG 12-lead electrocardiogram) is performed to evaluate for LVH in women with chronic hypertension . Echocardiography may be performed to evaluate for LVH in chronic hypertension and to exclude cardiomyopathy or occult valvular disease in pregnant women. • Pharmacologic treatment; The goal of pharmacologic treatment should be a DBP of less than 100-105 mm Hg and an SBP less than 160 mm Hg, however women with preexisting end- organ damage from chronic hypertension should have a lower threshold for starting antihypertensive medication (ie, >139/89) and a lower target blood pressure (< 140/90). Methyldopa has an established safety record, but it is a

There are many medications that are safe to be used during pregnancy to control the blood pressure and have been used for years . If you need medication to control your blood pressure during pregnancy, the doctor will prescribe the safest medication at the most appropriate dose. Take the medication exactly as prescribed. Don’t stop taking the medication or adjust the dose on your own.

What to do to reduce the risk of complications? • Keep your prenatal appointments. Visit the doctor regularly throughout your pregnancy. • Take your blood pressure medication as prescribed.. • Stay active. • Eat a healthy low salt diet..

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ARTICLE FEATURES . Snoring

SNORING S

It can have serious health ramifications more than just a noisy nuisance

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noring occurs when your breathing is partially obstructed in some way while youâ&#x20AC;&#x2122;re sleeping. More than just a noisy nuisance, snoring may indicate a serious health condition. It occurs when air flows past relaxed tissues in your throat, causing the tissues to vibrate as you breathe, which creates those irritating sounds.

ARTICLE FEATURES . Snoring

Habitual snorers can be at risk for serious health problems, including obstructive sleep apnea. Sleep apnea creates several problems, including interruptions of breathing (lasting from a few seconds to minutes) during sleep caused by partial or total

obstruction or blockage of the airway, frequent waking from sleep, even though you may not realize it. Waking up so many times a night interferes with the normal pattern of sleep causing more time to be spent in light sleep than in more restorative, deeper sleep. Prolonged suffering from obstructive

sleep apnea often results in hypertension and may cause enlargement of the heart, with higher risks of heart attack and stroke. It also causes poor nightâ&#x20AC;&#x2122;s sleep that leads to drowsiness during the day and can interfere with your quality of life and increase risk for car accidents.

WHAT ARE THE UNDERLYING CAUSES OF SNORING? WHAT DISEASES DOES IT CAUSE? Sinus Infections (Sinusitis) The sinuses are small air pockets located behind your forehead, nose, cheekbones, and eyes. The sinuses produce mucus, which is a jelly-like liquid that protects the body by trapping germs. Sometimes, bacteria or allergens can cause too much mucus to form, which blocks the openings of your sinuses. Excess mucus is common if you have a cold or allergies. This mucus buildup can encourage bacteria and germs to grow in your sinus cavity, leading to a bacterial or viral infection. Most sinus infections are viral, and go away in a week or two without treatment. Swollen or blocked turbinates in the nose can cause difficulty breathing, which in turn can also cause snoring and various recurring sinus problems such as those mentioned above, plus running noses and the like. The effect while sleeping can be similar to mild sleep apnea. Breathing is obstructed, and as a result, you often awake in the morning un-rested and feel dog tired all day.

of people OVER 30 snore

of people OVER 40 snore

of YOUNG CHILDREN snore

Viral Infections Nasal obstruction is one of the main complaints in viral infections of the upper respiratory tract, and of course there are other accompanying symptoms, such as fever, runny nose, cough and sore throat. But the stuffy nose increases the difficulty of breathing and causes narrowing of the throat, leading to snoring.

Nasal Problems Obstructed nasal airways can cause snoring. Some people snore only during allergy seasons or when they have a sinus infection. Deformities of the nose such as a deviated septum - a structural change in the wall that separates one nostril from the other - or nasal polyps can also cause obstruction. Throat and tongue muscles can be too relaxed, which allows them to collapse and fall back into the airway. This can result from deep sleep, alcohol consumption, or use of some sleeping pills. Normal aging causes further relaxation of these muscles. A long soft palate or a long uvula (the dangling tissue in back of the mouth) can narrow the opening from the nose to the throat. When these structures vibrate and bump against one another the airway becomes obstructed, causing snoring.

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ARTICLE FEATURES . Snoring

Being overweight Being overweight can exacerbate snoring, because one of the causes of the turbulence in the throat is the narrowing of the airway due to neck fat. Extra fat deposited around the neck and throat can cause the surrounding tissues to sag, which stops air flowing smoothly through and causes vibration. This is more of a problem for men, who are more likely to store extra fat around the neck. Losing weight can help alleviate the problem by reducing fat in the neck and helping to open the airway.

Smoking Smoking can dry out your throat very quickly. This isn’t a major cause of snoring, but it can contribute to it. The second way smoking can cause snoring is by direct irritation. When you smoke, the smoke itself irritates a number of things in your mouth and throat. These include mucus membranes and the bronchial tubes among other things.

IMPORTANCE OF DETERMINING THE TYPE OF SNORING Nasal snoring is the one caused by partially blocked nasal passages, which forces more air through the mouth. This forced air actually then causes the airway to collapse as it cannot handle the pressure. Vibration will then occur, as previously explained, and the snoring sound will be made. Tongue-based snoring is caused by the tongue blocking air from reaching your lungs. When you sleep the soft tissues and muscles in your throat relaxes, and with tongue based snorers it relaxes so much that it actually falls back in the throat, blocking airflow. The tongue is therefore in the wrong position. Most snorers, roughly up to 50%, are tongue based snorers, with men mostly falling in this category. People with excessive weight around their neck area are also prone to be tongue based snorers, because of the excess fatty tissue around the base of the tongue. Mouth snoring is caused when the soft tissues of the soft palate such as the uvula vibrates against each other, also called palatal snoring. This type of snoring is mostly found in people that tend to breathe through their mouths when they sleep. It also happens that many people breathe through their mouths at night, because their noses are blocked. So there might be other underlining nasal problems which are merely becoming the mouth’s ‘problem’. Mouth snorers are also prone to infections, because air that travels to the lungs has not passed through the natural filter of the nasal passages.

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ARTICLE FEATURES . Snoring

TREATMENTS OF SNORING To treat your condition, your doctor likely will first recommend lifestyle changes, such as losing weight, avoiding alcohol close to bedtime, treating nasal decongestion, avoiding sleep deprivation and avoiding sleeping on your back. Losing even a little bit of weight can reduce fatty tissue in the back of the throat and decrease, or even stop, snoring. Smoking irritates the membranes in the nose and throat which can block the airways and cause snoring. While quitting is easier said than done, it can bring quick snoring relief. Avoid alcohol,

sleeping pills, and sedatives because they relax the muscles in the throat and interfere with breathing. Be careful what you eat before bed as research shows that eating large meals or consuming certain foods right before bedtime can make snoring worse. Exercise in general can reduce snoring, even if it doesn’t lead to weight loss. That’s because toning various muscles in your body leads to toning the muscles in your throat, which in turn can lead to less snoring. There are also specific exercises you can do to strengthen the muscles in your throat.

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INTERVIEW

work, learning from your mistakes and always trying to look forward: that is the secret of a person’s success. As for LINET, I think innovation is the key to success, fulfilling the desire of your customer is the main secret. I can also add, knowing the needs of your customers and here they are patients and caregivers at the same time. Every year we introduce up to 3 new projects to the market along with small innovations that we add to our existing products. 3 main ideas are behind our innovations; patient safety, mobilization and hospital efficiency.

Managing Director at LINET Group

Founder & CEO of LINET Group

Mr. Tomas Kolar

Mr. Zbynek Frolik

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s Europe’s number one manufacturer of healthcare beds and provider of hospital and nursing home solutions, LINET offers a complete service solution for its clients. “Hospitals” magazine had the chance to meet with Mr. Zbynek Frolik, Founder & CEO of LINET Group and Mr. Tomas Kolar, Managing Director at LINET Group, to discuss the secret behind the company’s success and the latest technologies they are presenting in Arab Health 2017.

Can you give us an overview about your professional background and the idea behind Linet? Mr. Frolik: When I was introduced to the healthcare sector, Czechoslovakia was still under the communist regime, I worked as director of the technical department in the University Hospital of Prague with 3000 beds. We were still an underdeveloped country and throughout my work, I realized that

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we needed new innovations in the healthcare bed industry that can help patients get better services, based on this, and with the help of my colleague Mr. Tomas Kolar who is a bioengineer, we started the company. From a small player in the healthcare to a global player, what is the secret behind LINET success? Mr. Frolik: I would first say hard

What sets you apart from other companies? Mr. Kolar: Patient care is very noble but challenging at the same time, this profession can be very physically demanding, I think our concern to provide nurses with the best tools to give the best service to the patients, and succeeding in that gave us a step forward in the business. Our system changed the way simple things are done on a daily basis, like changing patient’s bed, or changing their clothes even repositioning a patient has become much easier with our new innovations. But success is not only having a good product, it also includes training and continuous education on the use of our product, and that is what we always aim at in our strategy. What are the main innovations that you are showcasing at Arab Health? Mr. Kolar: First, we have the Eleganza 5 that works with the foot control leaving both hands of the nurse free to work with the patient. Another feature for this new bed is safety; the

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countries. The products we are selling here are at the same level of the ones sold in Europe and in the United States. Our main strategy for this year without a doubt is the opening of our first representative office here in Dubai. We have been operating in the region for 16 years and now is the time to expand our activities and will allow us to be closer to our customers and understand more and more their needs and culture in order to be able to deliver better services. What do you think of Arab Hospital Show? Mr. Frolik: It is our 17th time this year; it has come a long way since then, from the organization point of view and also the professionalism level of the show. I think it is a prestige thing to be present in Arab Health, your clients expect you to be linked to well-known and well-established exhibitions and thatâ&#x20AC;&#x2122;s why we are always present.

bed is continuously monitored to a secure system to prevent any injury that a patient can be at risk having. Also, a new method of information streaming that makes the caregiver job much easier. We have also the AVE 2 birthing bed which is the perfect solution for a woman from labor, delivery to recovery. A woman doesnâ&#x20AC;&#x2122;t need to be moved from one bed to another during childbirth. Our main concern is to always

ensure a practical use of our products from caregivers to increase the safety and quality of care of patients. How do you evaluate the healthcare sector in the MEA? And what are your next strategies for this market? Mr. Frolik: The market in the MEA is expanding every year and we are aware of the challenges that the region is facing, like the wars in some of its countries; but it is still a very potential market for us, especially in the GCC

What are the new technologies you expect to offer your clients in the future? Mr. Frolik: I think we will always be in the bed industry, I am sure we still have many things to offer for our patients, bed is where the patient stays in contact 100% of his time at a hospital. Our target is to gain more information from the patient through the bed and at the same time channel more information about the patient and be in full control of the patient movement. This is our continuous strategy. To conclude, our partnerships are very important to us, we have worked with our clients as a family and thatâ&#x20AC;&#x2122;s what we continue to do. We always listen to their needs and feedback on our products performance so we can offer them better technologies in the future.

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INTERVIEW

CEO at American Hospital Dubai

Med. Director Mayo Clinic Care Network & Med. Director IntlStrategies

Chief Medical Officer – Acting at American Hospital Dubai

Mr. Peter Makowski

Dr. David Hayes

Dr. Aaron Han

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merican Hospital Dubai, the high technology state-of-the-art hospital whose mission is to provide high quality standard healthcare, is the first hospital in the Middle East to be selected to join the prestigious Mayo Clinic Care Network, a network of healthcare providers committed to better serving patients and their families through collaboration. “Hospitals” magazine met with Mr. Peter Makowski, CEO at American Hospital Dubai, Dr. David Hayes, Med. Director Mayo Clinic Care Network and Med. Director Intl Strategies and Dr. Aaron Han, Chief Medical Officer at AHD to talk further about this important step, its added value to AHD and the reason behind this collaboration. Below is the full interview:

The American Hospital Dubai has recently become a member of Mayo Clinic Care Network. What did it add to thehospital that has already established a reputation? Mr. Makowski: We are very proud to be selected by Mayo Clinic Care Network in June 2016 to be part of their international affiliations; this will allow our physicians and team to have access to the latest Mayo Clinic Scientific

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Research Network. And as a member, we, at American Hospital Dubai will work closely with Mayo to be able to give our patients the best patient care and best health service specifically to those with extreme complicated cases. We are sure that with this collaboration and access to the latest health information we will be able to solve even the most severe cases.

Why was AHD selected by the most prestigious hospital in the US Mayo Clinic? Dr. David Hayes: Mayo Clinic’s strategy in the region was to make affiliations with high quality organizations in the region instead of having their own hospital established. These organizations should share with us a similar philosophy in healthcare and have a very good reputation that we can build on

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together. We had some cooperation in the past with American Hospital Dubai and we knew that they have the same vision as we do concerning, quality care, clinical care and safety care. We wanted a strong partner in the region and we found that AHD is the best to reflect our standard of care in the region. How do you describe this new collaboration and what was its impact on patient care? Mr. Makowski: The ultimate benefit from this collaboration is that our patients will continue their treatments in Dubai but with an added value that is the expertise and know-how of Mayo Clinic.

excited to join AHD based on the reputation of both AHD and Mayo Clinic.

Another area of cooperation is the exchange of expertise between our physicians and Mayoâ&#x20AC;&#x2122;s.

What can you tell us about the impact on patient care? Dr Han:We are really lucky to be able to take part of Mayo Clinic Genomic Program; this affiliation has given us the opportunity to be more relevant in this field and we are looking forward to being able to provide our patients with personalized treatments and being able to develop the so-called individualized medicine, which is the future of medicine.

We can have our staff visiting Mayo Clinic premises or having professionals from Mayo Clinic coming to AHD for training.I can also add that GCC residents treated in Mayo Clinic in the US and wish to continue their treatment in the region, now have the opportunity to be closer to their families and environment and be treated with the same efficiency as in the States but this time in Dubai - all this without any additional cost on the patient. Last but not least, this new partnership will attract high level of physicians who are

What about foreign patients coming for treatment in your hospital.What are the services that you provide? Dr. Han: I see the healthcare tourism evolving in the region especially with the 2021 vision that the government has put for the healthcare sector. We will have to offer unique and high quality services to our patients with transparent outcome. Our services in this area are well-established, we can assist our patient from the time he contacts us till the time of treatment and then discharge him.

We have the eConsults that will enable our physicians to connect electronically with Mayo specialists for additional information on a specific case especially in oncology; we can have access to the latest research and expertise from Mayo specialists for better and more efficient healthcare services.

We provide all the logistics and we make it very convenient for the patient and his family if he wishes to have them coming with him, to travel to Dubai and get the best treatment in American Hospital Dubai. How do you perceive the healthcare sector in the region? Dr. Hayes: The UAE healthcare sector witnessed a dramatic expansion over the past few decades and I see that the sector has come a long way since I came to the region for the first time. The overall level of services has improved a lot. Thatâ&#x20AC;&#x2122;s why Mayo Clinic was looking for an organization in the region, and after deep evaluation we chose American Hospital Dubai to join our network of affiliated healthcare providers. With this affiliation, we will be working as a team with AHD and they will have access to all our resources and expertise. We have over 35 members all over the world and we are strongly excited about our latest and first affiliation in the Middle East.

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Consumerization of health & life By Michael Schelper, Chief Operating Officer - Middle East & Africa, Cerner Middle East

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e have experienced many disruptions of established industries in the recent past, starting with photography, where Kodak went from 170,000 employees to being bankrupt within three years, the movie rental industry where the video stores like Blockbuster entirely vanished as we are having the films on our fingertips from our home at all times for example with Netflix, or transportation and accommodation where the two largest companies, Uber and AirBnB, donâ&#x20AC;&#x2122;t own any assets. Will it be healthcare next where the largest provider does not own any hospitals or practices, does not employ any clinical staff? It is clear that the way we all worked 5 years ago is drastically

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different from how we work today and we will need to further adapt in the future. 95% of jobs are supposed to not exist the same way in 2020 as they exist today. This is due to the exponentially growing innovation we are experiencing every day. Though, what does this mean for healthcare, or should I better say health and life? There are some innovations and dynamics that will have a substantial impact on the healthcare industry as we know it today. 1. Virtual Reality 2. Augmented Reality 3. Mixed Reality 4. Artificial Intelligence 5. Consumerization of health & life We all know Virtual Reality and might have tried a game using an Oculus Rift or enjoyed a virtual flight over the

Grand Canyon with our Smartphone plugged into a cardboard frame. It has actually been used for two decades in a healthcare setting to treat post-traumatic stress disorder patients as well as for pain management of burn patients to distract them from the pain during their treatments. Phobias have also been treated effectively by using this technology already over a decade. Now, first pilots are launched to utilize virtual reality in the recovery of stroke and Parkinsonâ&#x20AC;&#x2122;s disease patients, where one can walk through the forest, along the shore or even go on a sailing boat. This clearly requires multiple body areas to work in harmony and is shortening the healing process, based upon the first results that were obtained. Furthermore, the positive

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impact on the patient, who does not only see the treadmill and a view on the room’s wall or out the window or plays on a gaming console to be distracted. There are many more areas where the use of virtual reality can have a profound impact from better connecting with the loved ones even including holoportation, in the training and medical education where students are enabled to take part in a surgery and obtain best-practices almost ‘first-hand, or to prepare and familiarize people that are carrying out critical live saving tasks and need to function in the case of an emergency. Augmented reality is enhancing our real life experience with digital content, which can particularly be beneficial during surgeries where additional critical information are presented to the surgeon in a non-disruptive manner while executing the procedure. MindMaze took this concept even further and is projecting an avatar into the virtual reality for post-stroke and Parkinson’s disease patients to imitate the movements and thus positively impacts the recovery by aiding the correct execution of the specific movement patterns. Getting the right guidance or feedback can not only help patients in their healing but also in the onboarding of new staff members to gain full proficiency of the new role more quickly. Now imagine that digital content is injected seamlessly into our normal life and even tricking our brain into believing it is part of reality. This sounds more like science fiction for most of us, but actually a company called MagicLeap is exactly planning to do that. They digitized the visual signal that our eyes use to process the things we see and thus enable the possibility of having virtual content seamlessly integrated into our life experience. This Mixed Reality is clearly still some time out before it will

be mainstream adopted. However, the possibilities particularly for the health care & life space are enormous. But what does all the data that is capture or presented to us in whichever shape or form help, if it is not enhanced with intelligence? Thankfully, besides the exponential increase in collected information that is following Moore’s law, we also see the same increase in processing power and storage. This is enabling us to catch up on utilizing the captured data appropriately and that in a timely manner. All of us have toyed around with the digital assistants surrounding us, be it Apple’s Siri, Amazon’s Echo or OK Google, to name a few. However, I doubt that any of you is using those helpers excessively. The potential though with a further maturing of Artificial Intelligence is immense. Lighthouse projects such as Google’s Deepmind Health Project, IBM’s Watson, or iCarbonX are paving the path of what the future of AI in healthcare could be and Babylon in the UK has already launched an app for basic medical consultation that is utilizing AI. So, the question is whether doctors will remain the way we know it today? The answer is from my point of view very clear, as a machine is a better data collector than a human being. Consequently, the role of a medical practitioner will evolve further and AI will take over a large portion of the tasks they carry out today. Virtual clinics are on the rise as experiences gained will instantaneously be available to all other patients and do not reside with the one healthcare specialist that gained them. Despite the fear of a negative impact or control of AI, the right governance has to be put in place as the foundation. This is inevitable and maybe one of the more critical items to be thought through properly. Lastly, Genomics is

still in the early stages, though prices are dropping and usage is increasing. This will lead in due time to a data foundation that enriched with AI will identify patterns and connections we don’t know of yet and in turn will enable the creation of new treatment plans. Where does it all come together? Each of us is having more technology in our lives. The way we are living today is completely different from how we lived 10 years ago. If I ask people what will happen in ten years’ time, it feels like it is so far away, but in hindsight 10 years feel like a very short period of time for the same group of people. The entire dynamic of consumer focused services has already started in the health space and it will not take too long till a complete Consumerization of Health & Life will be our daily reality. We are already carrying around our fitness trackers and smart watches that are capturing information, using applications to obtain ‘right-now & righthere’ services. This will be no different when it comes to health & life. Be it our clothes, patches, or implants that will constantly monitor our wellbeing, personalized health coaches will become a natural part of our life moving forward. This does not mean that it has to be a human being we are interacting with. More and more care is already provided outside the four wall of a health facility. Thus, like with the virtual clinics, we will receive recommendations and guidance for our daily activities due to the richness of information available about our current state of health. In turn every citizen will benefit from the findings and what treatments resulted in a higher improvement. To me all of this sounds on the one hand a bit scary, but on the on the other hand, I can’t wait for it to become a reality. The future of a consumer focused health & life experience has already begun.

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Professor and Director of the Diagnostic Medical Sonography Program in the College of Science at the Rochester Institute of Technology

Dr. Hamad Ghazle â&#x20AC;&#x153;My Love and motivation for sonography led me to what I am todayâ&#x20AC;?

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ospitals magazine met with Dr. Hamad Ghazle, Professor and Director of the Diagnostic Medical Sonography Program in the College of Science at the Rochester Institute of Technology during Arab Health 2017 to talk about his passion for sonography, Arab Health and the use of diagnostic sonography. Below is the full interview:

Dr. Ghazle, can you tell us about yourself and your passion for sonography? I have earned my bachelorâ&#x20AC;&#x2122;s degree in ultrasound and a Master of Science in health professions education in 1991. During this time, I discovered my passion for ultrasound and was amazed by this technology. My love and motivation for sonography led me to what I am today. My initial interest in the field of diagnostic sonography was built through my experience of the use of this technology; I realized that the use of sonography is not only limited to checking fetal development and babies, but can be also used in a wider range in the diagnostic of diseases and that was the ultimate goal of this diagnostic imaging technique that I really believed in. At the beginning, it was mainly used in OB/Gyn but in other areas sonography was just waiting to be used. Where are we now from the use of diagnostic sonography or ultrasound? Nowadays, diagnostic medical sonography has expanded in application to be used in different areas of medicine, it is used to see internal body structures such as skin, tendons, muscles, joints vessels and internal organs and is also used to look at the function of the heart. Ultrasound has evolved tremendously over the years. Compared to other methods of medical imaging, diagnostic sonography has several advantages; it is entirely a non-invasive

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procedure, it is lower in cost and at the same time can be very simple and efficient in providing images, but the key to a successful diagnostic is a skilled operator using it. How would you describe your experience with the CARESTREAM Touch Ultrasound displayed at Arab Health 2017? Ultrasound for me is the future of medicine; its diagnostic value has become so important because of its accuracy to cover nearly every tissue in the human body. Not to forget that we have become more and more concerned of the radiation caused by many other technologies that can lead to cancer and different health problems in patients on the long run. So medical ultrasound is the safest imaging exam that can be used in diagnostics. The new Touch Ultrasound from Carestream is simple and yet very sophisticated in transmitting the images that show us with more details the body structures and tissues. The new CARESTREAM Touch ultrasound system is in fact very advanced but simple at the same time, and is able to give us more flexibility with a console that can be maneuvered by the sonographer at his own convenience without any limitations. The touch screen feature is very user-friendly and very easy to clean efficiently and effectively so as to limit the spread of pathogens.

Can medical ultrasound replace other types of screening especially mammography for breast cancer? I think ultrasound has come a long way and still has many undiscovered potentials in the future. The popularity of the use of ultrasound will definitely grow in the near future. With proper training and education, this part of medicine will be at the forefront of improving quality of care for patients and reducing at the same time the healthcare cost and avoiding unnecessary invasive tests that can be avoided by ultrasound test. How do you evaluate Arab Health exhibition and what was your impression as a speaker for the first time in the region? I have been to many medical shows during my career, but I can say this one is very interesting for me; I was able to meet so many people from healthcare professionals to practitioners from all over the world. I was very pleased with the high level of interest and large number of delegates who attended the Advanced Ultrasound training offered by Carestream. I see it as an opportunity to exchange ideas, experiences and knowledge. This is the best way to learn and evolve in all aspects. It was a great opportunity for me with Carestream and I hope to be able to cooperate again in the future.

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NEWS

Osteopaths join hands to bring forth new patient centric approaches for effective rehabilitation, at the first Emirates Osteopathic Conference The first Emirates Osteopathic Conference is testimony to the increasing potential of Osteopathy in the region, and we hope to sustain our efforts to raise the level of expertise in the field.” said Malcolm Gregory, President Emirates Osteopathic Society Keynote presentations, workshops and poster demonstrations discussed existing knowledge and innovative osteopathic interventions, along with finding new ideas and ways of research in the field of osteopathy.

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he first ‘Emirates Osteopathic Conference’ in the region was hosted in Dubai, under the patronage of the Emirates Osteopathic Society (Emirates Medical Association), organized by Osteopathic Health Centre on 17-18 February, 2017. The Dubai Healthcare City Authority awarded the conference 17 CPD (Continuing Professional Development) credits. The conference theme, “Osteopathy across the Life Span” reflected the wide scope osteopathic practice helping people of all age groups, beginning from care of infants to the care of the elderly. It saw participation of international experts from 11 countries from all over the world. The key note address was delivered by Sheikh Saqer Bin Humaid Al Qasimi. An advocate of osteopathy, he has been instrumental in encouraging the need to bring osteopathic education to the region. Over two days, the sessions were designed to cover a full range of subjects including, regulation in the field of osteopathy, challenges and opportunities, treating premature newborns, overcoming barriers for effective re-habilitation of patients using new techniques in pain management, osteopathic management of women’s health issues in various life stages, and multimodal geriatric care.

Attendees included osteopaths, physiotherapists and other healthcare practitioners involved in patient care. They also explored how practitioner-centered barriers such as education, programming skills, time and resource allocation require a shift in education delivery at both the pre and post-professional levels for Osteopaths. “Recovering from a health condition is often a difficult experience, and osteopaths help people overcome these challenges, while facilitating recovery using a natural and holistic approach. Scientific review and evidence-informed outcomes have a high priority in patient treatment and case management. Healthcare professionals are increasingly recognizing that traditional medicine and osteopathy can go hand in hand to garner long-term positive health outcomes for patients.” Expressed Jorge Esteves, Osteopath, Associate Professor, Chair of the Emirates Osteopathic Conference Scientific Committee.

Taking into account the phases of human development from conception to old age and how human adaptation changes over time, the presenters brought forth a multi-dimensional intervention strategy which can promote health and wellbeing of individuals.

Medical professionals and healthcare regulators were also present to understand osteopathy and its role in patient care. The conference was supported by C.O.ME. Collaboration, a foundation and a charity under Italian Law, duly recognized and dedicated to high-quality multidisciplinary research, and by Instituto Piaget, Portugal. Osteopathy is a form of drug-free non-invasive manual medicine that focuses on total body health by treating and strengthening the musculoskeletal framework. It is a natural form of manual medicine based on the philosophy that disease and dysfunction are mainly due to the loss of the body’s structural integrity. It is a person-centered system of healthcare.

“Osteopathy has been practiced in UAE for over 30 years, and is rapidly gaining popularity as an important healthcare profession. UAE is a fast developing hub for medical tourism in the MENA region, and osteopathy can play a very important role in patient careif we provide the right guidance and training to budding talent.

Looking for the cause of the pain rather than relieving symptoms, osteopathic treatment aims to restore the structural balance in the body and promote its optimal health. It follows a set of unique natural principles, the key one being the body’s ability to heal itself. Following the conference, participants had the opportunity to attend

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a specialized workshop to enable healthcare practitioners to improve theoretical and practical knowledge, and skills in the field of pediatrics osteopathy. Through a critical discussion of the literature and a clinical-based approach, attendees were trained to develop essential knowledge and clinical capabilities on how to approach the different pediatrics age groups in terms of osteopathic diagnosis

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and treatment. The World Health Organisation recognizes the need to formulate and implement national policies and regulations on traditional (TM) and complementary and alternative medicine (CAM) to support their proper use. ‘Benchmarks for Training in Osteopathy’ is one of the series of documents for training in selected types of TM/CAM care as part of the implementation of the WHO resolutions.

Unlocking the Heart-Protective Benefits of Soy

product of digesting a micronutrient found in soy may hold the key to why some people seem to derive a heart-protective benefit from eating soy foods, while others do not, a University of Pittsburgh Graduate School of Public Health-led study discovered. Japanese men who are able to produce equol—a substance made by some types of “good” gut bacteria when they metabolize isoflavones (micronutrients found in dietary soy)— have lower levels of a risk factor for heart disease than their counterparts who cannot produce it, according to the research published in the British Journal of Nutrition. “Scientists have known for some time that isoflavones protect against the buildup of plaque in arteries, known as atherosclerosis, in monkeys, and are associated with lower rates of heart disease in people in Asian countries,” said senior author Akira Sekikawa, M.D., Ph.D., an associate professor of epidemiology at Pitt Public Health. “We were surprised when a large trial of isoflavones in the U.S. didn’t show the beneficial effects among people with atherosclerosis in Western countries. Now, we think we know why.” All monkeys can produce equol, as can 50 to 60 percent of people in Asian countries. However, only 20 to 30 percent of people in Western countries can. Sekikawa and his colleagues, who include scientists in Japan, recruited 272 Japanese men aged 40 to 49 and performed blood tests to find out if they were producing equol. After adjusting for other heart disease risk factors such as high blood pressure, cholesterol, smoking and obesity, the team found that the equol-producers had 90-percent lower odds of coronary artery calcification, a predictor of heart disease, than the equol non-producers. The daily intake of dietary isoflavones—found in traditional soy foods such as tofu, miso and soymilk—is 25 to 50 milligrams in China and Japan, while it is less than 2 milligrams in Western countries. Equol is available as a supplement— bypassing the need for gut bacteria to produce it—though no clinical trials have been performed to determine a safe dosage for heart protective effects, or if it even does provide

such protection. “I do not recommend that people start taking equol to improve their heart health or for any other reason unless advised by their doctor,” said Sekikawa. “Much more study is needed.” Sekikawa and his team are pursuing funding for a much larger observational study to expand on their findings and eventually a randomized clinical trial to examine the effect of taking equol on various medical conditions and diseases. “Our discovery about equol may have applications far beyond heart disease,” said Sekikawa. “We know that isoflavones may be associated with protecting against many other medical conditions, including osteoporosis, dementia, menopausal hot flashes, and prostate and breast cancers. Equol may have an even stronger effect on these diseases.” Additional authors on this research include lead author Vasudha Ahuja, Ph.D., of Pitt Public Health; and co-authors Katsuyuki Miura, M.D., Ph.D., Akira Fujiyoshi, M.D., Ph.D., Maryam Zaid, Ph.D., Naoko Miyagawa, M.D., Ph.D., Aya Kadota, M.D., Ph.D., and Hirotsuga Ueshima, M.D., Ph.D., all of Shiga University of Medical Science in Japan; Abhishek Vishnu, M.D., Ph.D., and Rhobert Evans, Ph.D., both of Pitt Public Health; Takashi Hisamatsu, M.D., Ph.D., of Shiga University of Medical Science and Shimane University in Japan; and Tomonori Okamura, M.D., Ph.D., of Keio University in Japan. This research was funded by National Institutes of Health grant R01 HL68200, Japanese Ministry of Education, Culture, Sports, Science and Technology grants B16790335 and A13307016, and a small grant from Pitt Public Health’s Department of Epidemiology.

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According to the joint research project between the Centre for Arab Genomic Studies and Latifa Hospital namely, anovel mutation in the WDR62 gene. Patients with this syndrome have small head and brain, with mental disability”.

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r Mahmoud Taleb Al Ali, the Director of the Centre for Arab Genomic Studies (CAGS), affiliated with Sheikh Hamdan Bin Rashid Al Maktoum Award for Medical Sciences, announced that the Joint research project between CAGS and Latifa Hospital, affiliated with Dubai Health Authority, has revealed links between 12 hereditary rare diseases among Arab children and 16 new genetic mutations in 14 genes. This was included in 13 scientific researchstudies conducted on a group of 20 patients from the UAE, Jordan, Sudan, and Yemen, and recently published in a number of international peer-reviewed PubMed-indexed journals. In this context, Dr. Mahmoud Taleb Al Ali praised the fruitful cooperation between the Sheikh Hamdan Bin Rashid Al Maktoum Award for Medical Sciences and the Dubai Health Authority. He said: “The concerted efforts by clinical geneticists, from Latifa Hospital, and Geneticists, from the Center for Arab genomic studies is the main reason behind the success of this important scientific project, as it is expected to play a vital role in the completion of the Arab Genome”. He added, “This valuable scientific project boosts efforts exerted for the

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early detection of rare genetic diseases, and for finding out effective treatment for them. These serious disordersusually appear after birth, and can deteriorate quickly and may lead to death at an early age”. On the other hand, Dr. Fatima Bastaki, Consultant Pediatrician and Clinical Geneticist, Latifa Hospital, spoke about the results of this research project, and mentioned the genetic mutation, which has been discovered in the INSR gene as a cause of the Rapson-Mendenhall syndrome. Among the symptoms of this syndrome is early-onset diabetes in children, with very high resistance to insulin, along with skin deformities, short stature and muscle weakness. “As for the mutation discovered in CDKN1C gene, it leads to Beck with-Weidmann syndrome, a disorder with a symmetrical over growth in the patients’ body organs and increased risk of cancer”. Dr. Bastaki added that: “The study discovered a new mutation in the SOX18 gene which leads to hypertrichosis-lymphedema-telangiectasia syndrome. Patients with this syndrome have spider veins, lose their hair, and suffer from edema in their lower limbs”. “An additional cause of microcephaly was also uncovered,

“As for the novel mutation discovered in GPSM2 gene, it leads to Chudley-McCullough syndrome, which involves deafness, skull deformities, and accumulation of fluid inside the brain”. “Regarding the alpha-thalassemia X–linked intellectual disability syndrome,it affects males more than females, and may occur as a result of a mutation in ATRX gene. Among the symptoms of this syndrome in children, are severe developmental disability, speech delay,muscle weakness, birth defects, and thalassemia”. Dr. Abdul Rezzek Hemzeh, Senior scientific coordinator, CAGS,continued talking about the results of the scientific project conducted under the collaborative work between CAGS and Latifa Hopital. He said: “Novel genetic mutations have been discovered in both ECEL1 andCHRNG genesand these result incongenital arthrogryposis. Affected children suffer a number of musculoskeletal deformities such as contractures of knees and elbows”. “As for the previously unreported mutation in FGD1 gene, it leads to the Aarskog-Scott syndrome. Among the symptoms of this syndrome is mental retardation, congenital malformations of the face and muscular system, along with short stature”. “The study revealed a link between Marinesco-Sjögren syndrome and a novel mutation in the SIL1 gene, which leads to muscles weakness, inability to control body movement, mental retardation, and cataracts”. “A novel

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mutation in the PNKP gene leads to dwarfism with microcephaly,and mental disability. As for the novel mutation discovered in ECHS1 gene, it leads to delayed mental and motor growth,muscle weakness,as well as heart disease”. Dr. Hemzeh added, “As for the autosomal recessive congenital

ichthyosis cases, our studies showed the causality of 4 novel genetic mutations in TGM1, ABCA12, and ALOX12B genes. Among the symptoms of the disease are severe dryness and cracking of the patient’s skin, as well as many other skin disorders”. It is worth mentioning that since March 2015,

CAGS has started working on this ambitious scientific project, in collaboration with Latifa Hospital in Dubai. Over the next few months, new genetic mutations and their relationship with many hereditary diseases in Arab children are expected to be revealed.

His Excellency Humaid Mohammed Obaid Al Qatami inaugurates the world’s largest laboratory exhibition and congress MEDLAB accredited conferences and welcomes over 30,000 laboratory and trade professionals. With MEDLAB looking at bridging the gap between the laboratory and clinical settings, the congress focused on two key topics - laboratory management and cardiac markers (measurement of heart functions), with healthcare leaders addressing topics varying from the risks of the use of social media in healthcare, to how to improve cardiac testing.

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he first standalone edition of MEDLAB Exhibition & Congress, the world’s largest laboratory event, was officially inaugurated by His Excellency Humaid Mohammed Obaid Al Qatami, Chairman of the Board and Director General of the Dubai Health Authority. Following 15 years of success alongside the region’s flagship healthcare event, Arab Health, the laboratory show is now a standalone event and took place from 6th- 9th February 2017 at the Dubai International Convention & Exhibition Centre in the United Arab Emirates (UAE). Spanning over six exhibition halls, the show accommodates more than 700 international exhibitors, over 400 ground breaking medical laboratory products and services, 11 CME-

This event also saw the start of the 5th Middle East Diabetes Conference, led by Dr Nader Lessan, Consultant Endocrinologist, Imperial College London, Diabetes Centre, who gave regional insights into diabetes care. The conference, which is normally held at Arab Health, is now part of MEDLAB to improve the relationship between the laboratory and clinicians when diagnosing and treating diabetes. During the four-day congress, MEDLAB unveiled the industry’s latest updates on laboratory testing and developments in clinical diagnostics. Within its new scientific programme, comprising 11 multi-disciplinary conferences, the congress introduced three new tracks including blood transfusion medicine, laboratory informatics, and

clinical diagnostics of cardiology and diabetes, in addition to the more established laboratory management, microbiology, immunology and clinical chemistry tracks. Offering delegates the chance to earn up to 28.0 credits of Continuing Medical Education (CME), the conferences are spearheaded by regional and global industry leaders, who presented the latest research, innovations, and drive discussions on best practice in laboratory medicine. Simon Page, Managing Director of Informa Life Sciences Exhibitions, the organisers of MEDLAB, explained how important the show is in bringing healthcare professionals together to improve the provision of healthcare in the region. “MEDLAB provides access to hundreds of laboratory innovations and insights into medical breakthroughs that will help improve healthcare, both in the Middle East and globally. The congress has been designed to foster collaboration and encourage the sharing of knowledge and skills between two pillars of healthcare – the laboratory and clinicians - to ultimately improve patient care outcomes, particularly in this part of the world,” he said.

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His Highness Sheikh Hamdan Bin Rashid Al Maktoum officially opens the Middle East’s largest healthcare trade show Arab Health Exhibition & Congress for economic trade and business exchange, and fostering future relationships. This is in line with the vision of His Highness Sheikh Mohammed Bin Rashid Al Maktoum, UAE Vice President and Prime Minister and Ruler of Dubai, for Dubai to be central to all future projects including those in healthcare.”

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he 42nd edition of Arab Health Exhibition & Congress, the region’s largest gathering of healthcare and trade professionals, was officially inaugurated by His Highness Sheikh Hamdan Bin Rashid Al Maktoum, Deputy Ruler of Dubai, UAE Minister of Finance and the President of the Dubai Health Authority. The event, which spanned over four days from the 30th January – 2nd February 2017 at the Dubai International Convention and Exhibition Centre, offers an unmatched business development, training and learning opportunity for healthcare trade professionals from across the world. This year’s Arab Health features an additional 400 exhibitors, with 4,400 companies showcasing their latest innovations to 110,000 + attendees from over 70 countries. The event saw the introduction of the new Hands-on-Training

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(HoT) sessions, which allow more than 900 physicians, surgeons and technicians from the region to learn and practice new techniques using stateof-the-art equipment for specialised treatments in areas such as cardiology, neurology, surgery, gastroenterology, urology, oncology and radiology. Thesenovel training tracks aim to support the need for more specialised medical training in the region, and bridge the gap between advanced medical techniques and regional expertise. Commenting on the opening of Arab Health 2017, His Excellency, Humaid Al Qatami, Chairman of the Board of Directors and Director-General of the Dubai Health Authority (DHA) said: “Dubai has become one of the world’s most attractive destinations to gather international experts and major institutions for conferences and forums. The city provides a promising platform

“The Arab Health Exhibition & Congress is an important opportunity for international health institutions to exchange knowledge, access the latest in medical technology, and review what has been achieved within healthcare and emerging fields of healthcare such as smart health technology. The DHA is always keen to embrace unique medical solutions that help deliver better health outcomes and such congresses provide us a platform to network with experts in the field from the region and abroad,” His Excellency concluded. Speaking about the growing focus of specialised healthcare and Dubai Healthcare City’s participation as a leading congress supporter at Arab Health, Khalid Ahmed Al Sheikh Al Shamsi, CEO, Dubai Healthcare City Authority, said, “We have witnessed positive changes in the health sector whereby patients nowadays demand for higher degrees of efficiency and flexibility from the healthcare system. In this context, we at DHCA are proud to support a platform such as Arab Health Exhibition & Congress which provides a great insight into the latest developments within the healthcare industry.” Simon Page, Managing Director, Informa Life Sciences Exhibitions, the organisers of Arab Health, said: “Hosting the

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region’s most-awaited healthcare event each year comes with great responsibility and an expectation to bring forward the latest breakthroughs at both the exhibition and medical congress. As Arab Health continues to expand year-on-year, so does the demand for advanced medical technology and services in the Middle East. Once again, we are proud to be able to bring together many of the world’s pioneering medical manufacturers, respected healthcare providers and most eminent medical professionals all under one roof, to explore the latest industry innovations, network and do business.” Running for the second year and following its success in 2016, the 3D Medical Printing Zone has expanded for this edition of Arab Health, reflecting the growing use of 3D printing technology in healthcare, estimated to grow by 18.3% annually until 2020. Items on show include 3D-printed bionic limbs and real life models of 3D-printed organ models among others. “Our vision for 3D printing to become the standard of care is becoming a reality, based on forward thinking groups and

leaders such as Dr. Mohammad Al Redha in the Department of Organisational Transformation in the Dubai Health Authority and the adoption of 3D printing across its hospitals,” said Scott Rader, GM Medical Solutions at Stratasys, Industry Partners at Arab Health 2017. Arab Health’s multi-track congress offers the highest quality programme of Continuing Medical Education (CME) to over 8,500 attending medical pro fessionals in the region. The opening day features the 3D Medical Printing Conference, the Public Health Forum as well as the Oncology, Orthopaedics,

Surgery and Paediatrics Conferences and the Total Radiology Conference. A total of 14 conferences will be held over four days including Workforce Empowerment, Big Data, HealthcareBusiness Forum, Quality Management, Emergency Medicine, Gastroenterology, and the Leaders in Healthcare conference, which will officially be inaugurated by Chairperson of Dubai Healthcare City Authority HRH Princess Haya Bint Al Hussein, wife of HH Sheikh Mohammed Bin Rashid Al Maktoum, Vice-President and Prime Minister of the UAE and Ruler of Dubai on the final day of the congress.

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Honeywell to highlight connected solutions designed to transform healthcare at Arab Health 2017

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oneywell (NYSE: HON) showcased how it is leading the Internet of Things (IoT) drive within the healthcare sector at this year’s Arab Health Exhibition & Congress. By merging physical and digital technology, Honeywell demonstrated how connected solutions can integrate hospital infrastructure by connecting management systems, clinicians and patients in innovative ways to deliver better care. Honeywell’s“ Connected Hospital”, “Connected Patient” and “Connected Clinician” initiatives streamline healthcare operations to improve the health of patients across the Middle East through reduced complexity and improved productivity.

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“The provision of quality healthcare is vital for a successful and prosperous society, and we are very excited to be meeting with our partners and customers from across the Middle East at Arab Health to discuss the latest trends, technologies and solutions that we have available,” said Norm Gilsdorf, President of Honey well Middle East, Russia and Central Asia. “Connectivity is at the core of everything we do at Honeywell, and we are actively leveraging the Internet of Things (IoT) to combine our expertise and cutting-edge technology with ground-breaking software to facilitate smoother operations and a more personalized and improved patient expe-

rience,” Gilsdorf added. Gulf Cooperation Council (GCC) countries are expected to see considerable growth in healthcare expenditure over the coming years. This is due to a number of trends including a growing and increasingly older population, a rise in chronic lifestyle diseases, increasing medical tourism demand and a move towards improved medical technology innovation and digital transformation. According to recent studies by Gartner*, healthcare providers in the Middle East and North Africa spent US$2.78 billion on IT products and services in 2016, as the industry moves to leverage technology for improved operations and patient services. At the show,

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Honeywell’s “Connected Hospital” proposition to integrate infrastructure and ensure rapid information flow and more agile operations for a smoother patient journey will be on display. Honeywell delivers productivity solutions, such as handheld computers, bar code scanners and printers that provide hospital staff with the data they need for patient identification, medicine administration, specimen collection and supply tracking.The “Connected Patient” initiative, on the other hand, demonstrated technologies that can improve the health of patients through effective monitoring in the hospital and beyond while reducing costs and the rate of re-admissions. The company will also highlight its “Connected Clinician” initiative, that leverages automated workflows and communications technology to help hospital staff increase their productivity and responsiveness to achieve greater patient satisfaction and enhanced hospital operations.

Norm Gilsdorf President of Honeywell Middle East, Russia and Central Asia

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Siemens Healthineers introduces world’s first mobile operative CT scanner to improve patient comfort

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lobal medical technology business, Siemens Healthineers, introduced the world’s first mobile operative CT scanner to the Middle East at the Arab Health Exhibition and Congress. The Somatom go. reduces patient discomfort during CT scans, as new survey findings reveal 48% of UAE residents feel anxious about a CT scan when facing a health issue1. Involving more than 1,000 people from across the UAE, the survey shows people, find full body scans more intimidating than other routine tests like X-Rays (11%), blood pressure checks (6%) and blood tests (28%). Speaking at Arab Health, Kay Zwingenberger, Managing Director Middle East and Africa, Siemens Healthineers, said: “Patients, especially young children, are often frightened after being prescribed a CT scan for further investigation. With the Somatom go., healthcare professionals are able to stay with their patients each step of the way helping to ease their fear and improve the quality of care.

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With CT scanners commonly used across the globe each day, the Somatom go. is a groundbreaking technology that will benefit patients massively.” “This is the first time healthcare professionals in the region will have access to highly complex scanning technology that can be simply controlled via a tablet. The Somatom go. platform not only provides highly advanced scans, but also makes the experience more comfortable for the patient”, he added. The Somatom go. platform was developed together with users, ranging from radiologists, radiology assistants, CFOs, patients, and referring physicians from a variety of countries. The result offers high quality standards and responds to the current needs for efficient workflows, and to clinical and financial requirements. The automated and standardized equipment, comprises two scanner variants, the ‘Somatom go.Now’ and ‘Somatom go.Up’. The standardization of the equipment also negates the need

to repeat scans meaning decreased waiting times and workloads. In addition, the scanners’ automated post processing allows staff with a basic level of training to carry out examinations, required particularly during peak times and emergencies. Siemens Healthineers offers medical imaging, laboratory diagnostics and advanced medical services, consulting and healthcare IT services in the region. With a new strategic direction, Siemens Healthineers aims to enable healthcare providers in the region to meet their current challenges and to excel in their respective environments. Through products and solutions designed to increase efficiency and to reduce costs, Siemens Healthineers is setting new trends in healthcare together with its customers – working under the motto “Let’s shape the future of healthcare together”. Siemens Healthineers Academy aims to lead the way in healthcare education Alongside several medical imaging equipment on display; ranging from X-ray machines and MRI scanners to Ultrasound units, the business will also present its recently introduced Siemens Healthineers Academy which aims to lead the way in healthcare education. The Academy offers CME/CPD accredited courses which have been designed together with renowned hospitals and academic institutions. These courses assist healthcare professionals in ensuring improved patient care to the highest, international standards and achieve higher confidence in diagnosis. Reinforcing the strategic partnership, Siemens Healthineers previews its latest innovation in laboratory automation, the game-changing AtellicaTM Solution, at the Ministry of

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Health booth. The solution will be showcased once again at the Siemens Healthineers booth at next week’s Medlab exhibition and congress. Siemens Healthineers is the separately managed healthcare business of Siemens AG enabling healthcare providers worldwide to meet their current challenges and to excel in their respective environments. A leader in medical technology, Siemens Healthineers is constantly innovating its portfolio of products and services in its core areas of diagnostic and therapeutic imaging and in laboratory diagnostics and molecular medicine. Siemens Healthineers is also actively developing its digital health services and enterprise services. To help customers succeed in today’s

dynamic healthcare marketplace, Siemens Healthineers is championing new business models that maximize opportunity and minimize risk for healthcare providers. In fiscal 2016, which ended

on September 30, 2016, Siemens Healthineers generated revenue of €13.5 billion and profit of over €2.3 billion and has about 46,000 employees worldwide.

Medcare introduces QFR technology in the Middle East revolutionizing angiography procedures for accurately detecting coronary artery disease

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edcare, the premium healthcare division of Aster DM Healthcare, has announced the launch of its first state-of-the-art cardiac catheterization laboratory (Cath lab), expanding its heart care offerings for patients, at Arab Health 2017. The facility will see the introduction of an advanced technology to optimize coronary angiography procedures. QFR (Quantitative Flow Ratio) analysis is an innovative technology that involves 3D model reconstruction of the blood vessels. It provides doctors with an accurate assessment of the extent of artery blockage in a patient, while eliminating the need of repeatedly using invasive adenosine drugs and/or pressure wire insertions into the patient’s coronary arteries. This is the first such introduction in the Middle East, after successful launching in Europe. The Cath lab will be a part of a

hospital’s cardiac care facilities. It is an examination room in a hospital with diagnostic and therapeutic imaging equipment, and is used to visualize the arteries of the heart and the chambers of the heart and to treat any abnormality found. “The QFR (Quantitative Flow Ratio) analysis technology will provide us with a precise assessment of the severity of blockages in the artery through better visualization, and optimal viewing angles of the problem area in the patient’s blood vessels, without inserting catheters or drugs. Further, the technology has the ability to quickly calculate the rate of blood flow in the affected artery, which in turn will help us make a much more accurate decision about the need for inserting stents. It will highly improve safety and efficacy of the coronary intervention and stenting.” said Dr. Yehya Kiwan, Consultant Interventional Cardiologist at Medcare Coronary

angiography is a procedure carried out at a Cath Lab to detect blockages in the coronary arteries of the patient that are caused by plaque (fat deposits) buildup. Blockages prevent the heart from getting enough supply of oxygen and important nutrients. This procedure is used to diagnose coronary heart disease after chest pain, sudden cardiac arrest, or abnormal results from tests such as an electrocardiogram (EKG) of the heart or an exercise stress test are found. “At Medcare, we strive to continuously strengthen our service offerings, and our new Cath Lab will be equipped with the latest diagnostic imaging devices in the sphere of cardiac care. Our effort is to bring to our patients; the most advanced medical technologies that can help deliver optimal health outcomes at power following international standards.” said Dr. Shanila Laiju, Chief Operations Officer at Medcare.

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QU CMED faculty co-authors major study that finds mass deworming leads to a significantly greater reduction in prevalence in children than targeted deworming

A Dr Suhail Doi Associate professor of Clinical Epidemiology

study co-authored by Qatar University College of Medicine (QU-CMED) researcher Dr Suhail Doi who is also affiliated with The Australian National University, and published in the Lancet -- one of the world’s leading medical science journals -- showed that mass deworming leads to a significantly greater reduction in prevalence in children than targeted deworming, for both hookworm and Ascaris lumbricoides, while no effect was seen for Trichuris trichuria.

in school-aged children. These worms are not common in Qatar, said Dr Doi, adding, “but a study conducted this year by QU and published in Parasites and Vectors reported a prevalence of combined helminths of 7% in Qatar’s migrant population being highest among the western Asians. While this is an indirect impact of the burden of infection with Qatar’s Asian neighbors, the eradication strategy recommended in this study will be of much greater consequence for these nations themselves.”

This study was conducted in collaboration with The Australian National University in Canberra, Australia.

He added: “The results of this meta-analysis contribute to the evidence base surrounding the benefits of expanding drug therapy programs for control of soil-transmitted helminths to all members of the community. Our findings support those of modelling and cost-effectiveness studies. We suggest that soil-transmitted helminth control guidelines should be re-evaluated with consideration of expansion to community-wide drug administration in endemic areas.”

Soil-transmitted helminth infections are a major global health issue, causing substantial morbidity in the world’s poorest populations. Regular delivery of anthelmintic drugs is the mainstay for global soil-transmitted helminth control. Deworming campaigns are often targeted to school-aged children, who are at high risk of soil-transmitted-helminth-associated morbidity. However, findings from the study suggest that deworming campaigns should be expanded community-wide for effective control of soil-transmitted helminth transmission. The research team carried out a systematic review and meta-analysis to compare the effect of mass (community-wide) and targeted (children only) anthelmintic delivery strategies on soil-transmitted helminth prevalence

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QU Vice President for Medical and Health Sciences and CMED Dean Dr Egon Toft said: “This research reflects CMED’s collaborative efforts with international partners to advance the health care sector in Qatar, and to promote research on issues that are relevant to the Qatari society. It also shows QU’s commitment to advancing its positioning to become a center of excellence for public health, clinical epidemiology and related translational research in the region.”

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Qatar University College of Medicine Prof Bared Safieh-Garabedian was invited as a special speaker at the Joint Molecular Biosciences and Biomedicine Seminar Series

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Prof Bared Safieh-Garabedian Professor of Biochemistry

atar University College of Medicine (QU-CMED) Professor of Biochemistry Prof Bared Safieh-Garabedian was invited as a special speaker at the Joint Molecular Biosciences and Biomedicine Seminar Series, which was recently organized and hosted by Cardiff University School of Biosciences.

more prominent. Understanding these pathways of communication has important clinical consequences for neurodegenerative diseases”. Furthermore, Dr Bared noted that the communication pathways between the immune and the nervous system are bidirectional, intricate and not well defined.

Prof Bared gave a lecture entitled “Targeting unresolved neuroinflammation: Can Thymulin related peptide (PAT) come to the rescue?”.

It is difficult to define physiological and behavioral signs of central nervous system (CNS) inflammation, Dr Bared said.

Dr Bared noted that inflammation, as part of the innate immune response, plays an important role in homoeostatic processes such as tissue repair. He also noted that chronic inflammation is tightly linked to neurological diseases, cardiovascular diseases, metabolic diseases, chronic inflammatory diseases, and cancer. He explained that the non-resolution of inflammation has many causes, which are not clearly understood such as an uncontrolled production of proinflammatory mediators, a failed phenotypic switch in macrophage and T cell population, an inadequate production of resolution mediators, a persistent stimulation by microbes and allergens, and a prolonged or excessive response or a subnormal response. Over the last 20 years, the functional autonomy of the immune and nervous system has been challenged, Dr Bared said, adding, “The central nervous system (the brain) and the immune system are intimately linked and do not function as independent systems. During inflammation these interactions are

He added: “Chronic hyperactivation of brain immune cells can result in neurotoxic actions due to excessive production of several pro-inflammation mediators.” He went on to discuss the importance of developing new animal models for neuroinflammation and during the talk he described one such model developed by his group. Dr Bared stressed the importance of establishing and implementing new approaches such as elucidating inflammatory reactions in the CNS, identifying the main players that can act as therapeutic targets (microglial cells), determining biomarkers for disease such as cytokines and neurotrophic factors, and characterizing molecular targets such as blocking toll-like receptors (TLR) expressed in the CNS. Dr Bared went on to the discuss the development of the PAT with powerful anti-inflammatory actions. This molecule has been patented by his group and undergoing clinical trials. He discussed the potential use of this drug as a novel therapeutic agent for use in neurodegenerative diseases.

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INTERVIEW

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ince its establishment in November 2014, Qatar University’s College of Medicine (QU-CMED) continues to deliver its mission and vision to support Qatar’s growing healthcare sector and national strategies in healthcare, education and research. Working collaboratively with key healthcare providers and educators, the College is making valuable contributions to strengthening clinical practice, medical education and research in Qatar overall. During an interview, QU Vice President for Medical and Health Sciences and CMED Founding Dean Dr Egon Toft outlined the College’s learning approach, research strategy, and key achievements, as well as its contribution in advancing thehealthcare sector in Qatar. Can you elaborate on the learning approach at CMED? Is it only specific to the College, or will it be adopted to QU Health colleges? The learning environment at CMED aligns with international best practices in “student-centered learning” and promotes opportunities for educational innovation. In this context, we try to involve the students in active learning by enabling them to retrieve the information themselves and by engaging them in lifelong learning.

QU Vice President for Medical and Health Sciences and CMED Founding Dean

Dr Egon Toft “We Will Continue Advancing the Quality of Medical Education and Research in Qatar” MAR.APR 2017

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Hence, the College adopts an interactive and engaging pedagogy that incorporates team-based learning, problem-based learning (PBL), self-directed learning and self-reflection, and potentially online and blended learning “flipped classroom” models, as well as classroom teaching. One of the main features of the medical program that we offer at CMED is

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its unique student-centered approach using a blend of teaching and learning approaches that reflect best practices in medical education such as PBL, case-based learning (CBL), teambased learning, task-based learning and virtual patient learning. The study program is divided into three phases: The first phase (Year 1) or “The Transition” (Basic Medical Sciences) is the interface between high school education and the integrated medical program. It introduces the students to foundations in Human Anatomy, Physiology, Cell Biology, Biochemistry, IT, Medical English and Terminology and Core Curriculum courses. As an important component throughout a doctor’s career, a “Medical Education” course that focuses on lifelong learning is also offered in this phase. In the second phase (following 2.5 years) or Pre-clerkship phase (Integrated Organ Systems), the focus shifts to the foundations of medical sciences and its application to patients and population care. Clinical skills are mainly acquired in the clinical skills center, using simulated patients and high fidelity simulators for clinical training. In the third phase (last 2.5 years), or “Clerkship phase” (Hospital Training), students rotate in clerkships in order to ensure exposure to clinical situations, patients and population care. During this phase, the students follow 7 major rotations in pediatrics, and gynecology and obstetrics at Hamad Medical Corporation (HMC) and Sidra

Medical and Research Center (Sidra); and in surgery medicine, emergency medicine, and mental health at HMC; and family medicine at Primary Health Care Corporation (PHCC).

The College established partnerships with healthcare providers in Qatar especially those under HMC and PHCC, covering the area of research collaboration and aiming to further contribute to enhancing Qatar’s health research.

The colleges of Health Sciences (CHS) and Pharmacy (CPH) are also developing a learning strategy that involves CBL and PBL techniques. These techniques have been also implemented across all QU colleges. How does CMED’s learning methodology contribute to shaping the generation of future doctors? CMED puts the quality of education and its impact at the top of its priorities with the aim of making medical education with all its components and elements reach a level of international standards, and in order to graduate doctors who are able to achieve the best performance in the medical profession, whether inside or outside Qatar. The College’s learning strategy aligns with The Ministry of Public Health and HMC. It is oriented towards preparing students for clinical practice, with early exposure to the clinical environment to ensure that the students gain practical exposure and a deep understanding of real patient care settings throughout the program. In this context, students from the second to the sixth year of the medical

program follow clinical placements complementing their learning within a clinical setting. Such early exposure to the clinical environment is not common. Medical students normally have their first clinical contact in year 3. These opportunities help the students make sense of the knowledge they have acquired from studying at the university, allowing them to combine theoretical and experiential learning and to develop solid knowledge attainment skills that are rooted in experiential learning and based on a patient-centered approach. Can you tell us about the research strategy at CMED? How does it align with the needs of the healthcare sector in Qatar? The College focuses on research, especially in areas of national priority, covering the full translational pathway from basic science to applied health research with the aim to advance the healthcare sector in Qatar. CMED’s research agenda sits within the broader university-wide health research strategy, and aligns with both the QU 5-year research roadmap and the National Health Strategy. The College established partnerships with health care providers in Qatar especially those under HMC and PHCC, covering the area of research collaboration and aiming to further contribute to enhancing Qatar’s health research. One of my main goals is to unite CMED researchers, faculty and students with all departments and stakeholders in

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As part of its vision to be a driving force for innovation across the national healthcare sector, the College has recruited an impressive number of international faculty members and researchers, as well as experts from leading healthcare organizations in Qatar, which are strong role models and inspirational mentors for Qatar’s future doctors.

Qatar to conduct world-class research in medical health, and to contribute to the growing healthcare sector. Towards that end, we identified four pillars for medical research at CMED -molecular medicine, clinical research, medical education and public health. The College’s molecular medicine research aims to improve patient care by combining basic research excellence with innovations in clinical practice. According to the College’s research strategy, the objective is to shift to translational medicine in addressing major diseases such as diabetes, cancer, inflammatory, metabolic and neurodegenerative diseases, as well as clinical infections such as enteric pathogens causing diarrhea (e.g. Campylobacter), ulcer forming bacteria (e.g. Helicopacter) and several respiratory infections. In clinical research, researchers

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and biomedical scientists from QU Health are working closely with researchers across QU health programs and from HMC to combine basic research excellence with innovations in clinical practice. One of the College’s research focus areas is in medical education research, with a special interest in developing agreed standards of professional competence and ethics, and also the use of technology to enhance learning and teaching especially simulation technology in medical education. In the area of public health research, the College is focusing on 5 inter-disciplinary themes -- epidemiological studies on chronic diseases, health promotion and healthy lifestyle, healthcare delivery systems, evidence-based healthcare and health informatics. What are the College’s key achievements since its establishment in 2014?

In Fall 2016, the College has enrolled 93 new students to its Class of 2022, which began its journey towards the MD degree last September. This is an increase of 16% of the number of students who enrolled last year. At a rate of 62%, the majority (58) of the new admits are Qatari nationals. The College also adopted an interactive and engaging pedagogy, incorporating technology-based learning, which contributes to preparing students for the future and to shaping doctors for tomorrow. The College is also registered in the WHO’s international directory for medical schools, this registration strengthens its reputation and credibility. What are the College’s future plans? The College will continue in its efforts to advance quality medical education and research in Qatar and in so doing, support national approaches to provide an optimum health care sector for the society. In this context, the College aims to liaise with the Ministry of Public Health, Sidra and HMC in order to promote a learning environment that aligns with the needs of the health care sector in Qatar. At a regional level, discussions were also initiated by the College towards establishing a system for the accreditation of medical schools in the region.

Use this special code to get 10% discount on registration fees. Book using code MEPC17ARBH10

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2017 Top Speakers

Dr Abu Baker Al Madani Consultant Neurologist, Head of Neurology Department Rashid Hospital, UAE

Dr Azza Hassan Head of Palliative Care Unit National Centre for Cancer Research, Hamad Medical Corporation, Qatar

Dr Hassan Jabbar Shaikh Consultant Pain Medicine Dubai Mediclinic City Hospital, UAE

Dr Mona Tareen Consultant Internal Medicine, Geriatric Medicine, Hospice and Palliative Care Medicine American Hospital Dubai, UAE

Dr Reda Samuel Rezkallah Head of Palliative and Hospice Home Based Care Children's Cancer Hospital, Egypt

Dr Zafar Javed Consultant & Chair of Palliative Medicine Tawam Hospital, UAE

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• Discuss the best ways to advance the field of palliative medicine • Learn how to improve the quality of life in patients with malignant and non-malignant diseases • Understand the outcomes of homecare and palliative services in special age group like geriatrics and paediatrics • Address the role of interventional nutrition in terminally ill patients • Assess the different symptoms management techniques in neurological disorders • Evaluate pain management techniques in patients with cancer and non-malignant diseases • Describe the best approaches to counteract the side effects of the different cancer therapies Supporter:

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Lateral Ankle Instability in Adults

Dr. Ahmed Kamhawy GP/ORTHOPEDICS Al Ahli Hospital

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nkle sprain are the most common injuries sustained following sporting activities. They account for up to 40% of all athletic injuries. When eliciting the history from a patient with ankle instability, the main complaint usually includes intermittent â&#x20AC;&#x153;giving way of the ankleâ&#x20AC;? with a past history of at least two or three severe lateral ankle sprains. The patient often complains of difficulty and apprehension on uneven surfaces. Even a mild exacerbation can lead to short-term dysfunction; however, these patients are normally without pain or dysfunction between episodes.

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Bracing or taping may provide only partial relief or improvement. The physical examination confirms a diagnosis made on the basis of the patientâ&#x20AC;&#x2122;s history and differentiates an ankle sprain from a fracture. The examiner should look for areas of tenderness and swelling. The maximal points of tenderness for a lateral ankle sprain should be at the Anterior Talo-Fibular Ligament and/or Calcaneo-Fibular Ligament areas. Plain radiographs should be taken and are useful to exclude bony injury or degenerative changes. Ultrasound can be used to assess ankle instability. MRI is more useful in the setting of chronic

ankle instability than in the acute setting. Investigators are advocating arthroscopy because several intra-articular conditions associated with ankle instability can contribute to pain and dysfunction. These include Osteochondral (OCD) lesions of the talus, impingement, loose bodies, painful ossicles, adhesions, chondromalacia, and osteophytes. Numerous surgical procedures have been described for the treatment of lateral ankle instability beginning with Elmslie (1934), who first reported using fascia lata graft to reconstruct the lateral ankle ligaments. Today, surgical treatment of ankle instability can be divided into anatomic repair, non-anatomic and anatomic reconstruction.

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One of the world’s most innovative hearing systems

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an is a highly precise air conduction hearing aid that can be integrated into any pair of glasses. The experts at Austrian hearing device manufacturer BHM have come up with an innovative new product that stands out for its reliability, practicality and individual design.

See better, understand better Hearing is the key to the world. And there are as many different ways to perceive it – both with our eyes and with our ears – as there are people. This is why it is vital to provide reliable hearing systems for those with a hearing impairment. Hearing glasses are a great solution for those who need a little help not only with their hearing but also with their vision. Such solutions include the innovative models by BHM, Austria’s only manufacturer of hearing devices.

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pan – maximum choice, maximum satisfaction These days a pair of glasses is much more than simply a vision aid: besides the obvious requirements of fitting well and aiding sight, they can also serve as a fashion accessory that expresses your personality and lifestyle. So it’s just as well that in pan, BHM has crafted an inconspicuous hearing aid that provides optimum hearing quality, regardless of whether you wish to keep your existing glasses or opt for a completely new pair.

pan can do more pan immediately provides a reassuring feeling of safety in multiple ways. A small, discreet button on the frame meets the highest technical standards. Direct, clear communication becomes possible once again: for example, the ability to focus entirely on each respective conversation partner.

pan automatically adapts to the noise level of the environment. Thanks to its adaptive directional sensitivity, you can even clearly differentiate whispering against a loud background – but without the ambient noise disappearing from your own auditory range. This also goes for telephone calls. You hear the person you are talking to without isolating yourself acoustically from your environment. Nights out at the opera or theatre are once again transformed into unforgettable experiences, as pan features an inductive signal input that lets sound ring out in all its glory. Innovative technology is, of course, behind all of this.

pan – outstanding hearing quality thanks to state-of-the-art technology pan is a highly precise air conduction hearing system that captures sound via two directional microphones, and

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transfers it into the ear by means of a small speaker. This precise directional sensitivity enables pan to provide clear and interference-free hearing, thus setting completely new standards in relaxed, comprehensible hearing. Cutting-edge technology and the advantage of being able to attach pan easily and comfortably into any pair of glasses make this model one of the world’s most innovative hearing systems, combining excellent hearing quality with the highest degree of comfort!

The perfect hearing experience even in ambient noise With two microphones positioned in front of the ear, pan guarantees outstanding directional sensitivity. This means that pan wearers can also follow conversations in noisy environments such as parties or restaurants. Upon request, your acoustician can angle the microphones in such a way that they capture sound predominantly coming in from the front. This enables each respective wearer to hear their conversation partner perfectly, even at a greater distance – or even when watching TV, at the theatre or wherever you might wish to watch and listen at the same time. In comparison, customary behind-the-ear and mini behind-the-ear devices have microphones that sit above the ear, or behind it if there are two microphones.

See and hear safely and comfortably Compared to the usual mini behindthe-ear and normal behind-the-ear devices that are also attached to the ear by means of a frame, pan offers optimum comfort as the device cannot slip when the glasses are removed. Awkward situations are thus easily avoided.

Glasses wearers have it easy – simply switch pan is a flexible device that can be attached to any pair of glasses. Wearers themselves can attach the model easily, quickly and discreetly. Removing the device is just as straightforward. And remember: to enjoy this advantage, there’s no need to buy new glasses. Your optician or acoustician will affix pan to your existing pair.

Sound in all its glory Thanks to the inductive signal input, pan reveals sound experiences in all their glory. It also achieves excellent results in tinnitus treatment, whether by means of the traditional “masking” technique or by playing a supporting role.

pan-CROS for secure sound transmission For single-sided deafness or severe hearing loss, BHM experts recommend pan-CROS – contralateral routing of signals – a version that guarantees secure sound transfer from the impaired ear to the healthy ear. Thanks to adjusted signal differences, the direction of the sound can be determined, giving each particular wearer a wholly unlimited spatial orientation.

Quality Made in Austria Quality manufactory BHM develops high-quality hearing systems based on bone and air conduction technology.

Their products are manufactured exclusively in Austria and distributed around the world. BHM has set itself a challenging goal: to help those with a hearing impairment regain a significant quality of life by using innovative hearing systems that ensure outstanding performance in aesthetics, quality and reliability.

Contact: BHM-Tech Produktionsgesellschaft Grafenschachen 242 7423 Grafenschachen Phone: +43 (0)3359 200 78 0 Email: nice_2_hear_u@bhm-tech.at Web: www.bhm-tech.at

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Orthodontics AT THE RIGHT TIME: PARENTS ROLE!

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rthodontic treatment to align the teeth and correct the bite via a number of removable and fixed orthodontic techniques is becoming very common nowadays. These treatments could vary from few months up to few years and some of them still need some surgical intervention to achieve acceptable results. Although Orthodontics are good treatment modalities in most cases, it is always better to avoid the establishment of orthodontic problems if at all possible or at least to spot them before they are fully established in order to improve treatment outcomes and reduce any morbidity or even mortality associated with Orthodontic-Orthognathic (surgical) treatments.

Parents can play a very important role in detecting early signs of some malocclusions and below is a brief summary of some of them that if reported to the dentist/ orthodontist early, a small interventional procedure might avoid lengthy and complicated future treatment and improve the outcome. Upon losing a posterior baby tooth (baby molar tooth), the neighbor permanent teeth temp to tilt sideways and the opposite teeth try to over erupt in order to try to reduce the available gap. In most cases this will prevent the successor permanent tooth from erupting due to shortage of space and this might lead for a lengthy and complex future orthodontic treatment with potential use of head gears, surgical exposure of impacted tooth, extraction of teeth etc. If parents, however, were able to report that to the dentist/ orthodontics early, small and simple solutions

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such as a space maintainer or removable appliance could be used to preserve the space for the future to erupt into and maybe this will avoid the need for any future treatment at all.

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Similar permanent teeth should usually erupt almost at the same time, so for example if one permanent front incisor tooth has erupted and the opposite tooth in the same arch stayed un-erupted for a while, parents should draw the dentist/ orthodontist attention for this so that a small x-ray could be taken to assess the case and simple treatment could be provided then in order to avoid potential surgical exposure and lengthy orthodontic retraction in the future. Permanent canines should be felt in the buccal sulcus (in the gums above the baby canines) around the age 9-10. Parents should try to feel for them under the lip high up in the gums around that time and report any problem to the dentist/ orthodontist in order to check them up and maybe a simple x-ray and simple extraction of the existing baby canines could help avoiding impaction of the permanent canines and lengthy future treatment for such cases. Thumb or lip sucking habits among other habits should stop when the first permanent tooth in the mouth erupt in order to avoid complicated future problems. Parents should report such habits to the dentist/ orthodontist well ahead of time in order to help them stopping these habits via educational methods as well as simple fixed or removable appliances and stabilizing the malocclusion and possibly avoiding the need for any future complex treatments. In the early mixed dentition stage when only few permanent teeth in the mouth or even earlier when no perma-

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nent teeth shown in the mouth, parents are advised to look for any front teeth in cross-bites (meaning biting in the opposite way to normal - such as upper teeth are biting behind of the opposite lower teeth) and to report those findings to the dentist/ orthodontist who might be able to interfere conservably and correct the bite early and try to avoid or reduce the need for any future surgical intervention and lengthy orthodontic treatment. Parents should look for any extra (supernumerary) teeth or teeth erupting not in their usual position or of different shape and size and report this to the dentist/ orthodontist early in order to avoid future complications associated with such problems such as failure of permanent teeth eruption and malocclusion. Usually children above 10 years of age, should have the gap in between the upper front two incisor teeth closed. In case the gap is still large and the area becomes blanched white upon retracting the lip, parents should report that to their dentist/ orthodontic in order to exclude the presence of any abnormalities in the bone between those teeth such as large fraenum or a supernumerary tooth etc. and avoid further future problems or reduce the time of any future orthodontic treatment if still need be. Anterior or lateral open bites (meaning upon biting gaps will still be present between the upper and lower teeth that are usually filled up by the tongue in order to achieve an oral seal upon swallowing) should not be present in the normal occlusion. Parents should look for the signs of these open bites as early as possible in order to try to reduce their extent or even have them treated early in life in order to avoid major future complications

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whether this to do with mouth breathing, speech difficulties, malocclusions etc. Early signs of joint problems and any association with cross-bites of the posterior teeth (such as biting the other way around such as the lower jaw is tilted to one side upon biting the upper teeth occlude behind of the lower teeth posteriorly) should be detected by parents as early as possible and reported so that simple solutions such as the use of a simple fixed or removable expander could suffice to reduce or even eliminate future orthodontic problems. If one side of the face is growing in a different rate than the other half leading to a slight mismatch, this should be reported as well so that simple measures could be followed in order to reduce or avoid future compli-

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cations and restore the facial harmony and future confidence etc. The above-mentioned scenarios are only few examples in which parents could play a major role in avoiding future complications and reduce the time and possibly the need for any future orthodontic or surgical interventions on their children. Treating the developing orthodontic abnormalities during the active-growth period is priceless as when children are older more limitations would be introduced to the outcomes. Routine visits to the dentists should be followed so that he/ she would look for these early signs of malocclusion and refer to the orthodontist for early interceptive treatments that might avoid plenty of future complications and morbidities. The golden rules in orthodontics are similar to those in the other medical and dental special-

Dr Hani Dalati Consultant Orthodontist Healthpoint -UAE

ties, and the main one on the top of all of them is:

Prevention is always better than Cure

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by Dr Prem Jagyasi

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he ever dynamic Global Healthcare industry is continuously evolving with newer trends setting in at very short intervals. This brings a bucket full of opportunities and challenges in equal proportions both to the healthcare professionals and marketers. Though newer trends evolve, it is imperative to watch for those with long standing as these ultimately turn out to be the permanent key behaviors of the consumers. It is interesting to observe that today decision-making ability while availing healthcare has largely shifted towards the customers from the doctors. Therefore, the consumersâ&#x20AC;&#x2122; behavior pattern will always be at the focal point. Medical expenses touching the roof and with fewer doctors available to attend the booming ailing population, it would be interesting to watch the healthcare trends riding mostly on social media and digitalization.

1. Wider dominance of social

media platforms

Their popularity is unbeatable. Facebook and Twitter have been already engaging a lot of consumers in finding out proper information about healthcare. The ever mounting popularity of the social media apps like Watsapp, Telegram, Snapchat and Messenger would lead the consumer behavior. In many developed countries, these apps

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are providing real-time interactions with the customer and the caregiver building a reliable relationship quite of a different sort. Watch out for more exciting marketing and advertising strategies with these apps.

2. Live videos to gain more prominence

Another convenient and user-friendly mode to build a loyal customer base. While seeking the most reliable health-

care brand, live videos based on real-time feeds from branded healthcare providers would win the customer confidence faster. Customers armed with fast connections and quick feedback system can decide their choice very fast. 2017 Healthcare marketing would focus more on creative strategies in producing customer engaging video content.

3. Smart content to win more customers

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Loads of information is hitting millions of brains through the internet, which is also the main gateway of the healthcare marketers. Content sharing is a rising trend among the customers who is constantly surfing for relevant cost saving options. Increasing number of shares builds the trustworthiness of the healthcare brand. Therefore, amid the tough competitive market, the trend would be to create smarter readable content easy to understand and easier to share.

4. Mobile Optimization to

be the key tool for successful marketing

The number of smartphone users is swelling and therefore, if you are planning for an effective marketing strategy, you need to optimize for the mobile. People have the tendency to connect through smartphones faster than any other device. The smartphone is most used for information searching, sharing and decision making. Therefore, make sure your marketing content is compatible with the mobile screens and the website loads faster.

5. Create personalized messages

Among all services, healthcare demands more personalized care. Therefore, the trend is to deviate from conventional advertising and marketing and focus on delivering personalized messages based on individual’s requirement. It indeed demands sophisticated strategies to deliver the content on one-to-one basis. The need is to use digital marketing automation tools to track the profiles of users and visitors and send personalized message to generate a better response.

6. Reaching out to customers

as per their location

Proximity matters most while availing healthcare services. With smartphones

offering the location identifier tool to the marketers, it is a great opportunity for the latter to connect the customers and send the relevant information based on his/her location. Alerting the customer about the nearby facilities is highly beneficial. Moreover, the location based marketing also helps in identifying the preferences and likely choices of the customers.

7. Buying of programmatic marketing to take the upper hand

A huge chunk of digital marketing spend would be directed towards programmatic buying including programmatic video that would deliver the right message to the right customer at the right time. Programmatic buying is the automated buying of ad space of a webpage. While a customer is searching for relevant information on the net, programmatic video delivers the most relevant message at that particular time diverting the customer’s choice in the marketer’s favor.

8. Monetization of

telemedicine to grow

The advent of telemedicine is a great breakthrough in medical treatment technology and with less number of specialists/doctors available for each patient its use would be of more relevance in the coming years. Convenience in connectivity from any remote location for required medical care and support has popularized telemedicine that would see more innovations. Connecting with the patients through emails and text messages and online real-time doctor patient consultation will increase office efficiency and profitability.

9. Growing number of informed patients

Thanks to the great penetration of

Dr Prem Jagyasi A globally acclaimed, award winning strategic leader and speaker, Dr Prem Jagyasi is world renowned medical tourism consultant. He has authored Medical Tourism Guidebook and Wellness Tourism Guidebook. He has also delivered numerous keynote speeches and focused corporate workshops in 45+ countries. More than 150 international organizations have benefited from his expertise through conferences, expert training, consultancy and brand management services. http://drprem.com

internet and ubiquitous use of smart phones that helps to get connected easily. Patients/customers are now better informed and are taking their own decisions while selecting a healthcare provider. They gather dozens of information before making the first appointment call to the healthcare provider. Today patients remain more engaged while availing healthcare services and are unhesitatingly posting their ratings, feedback and their experiences.

10. Customers’ time will be valued as the doctor’s

Patients waiting for hours in doc’s chambers or clinics would soon be a thing of the past. New age healthcare marketing will seriously value the patient’s time by providing convenient time-saving options. Prolonged waiting time adds to the woes of the patients. On the other hand, real-time information of the patients helps a doc better in time management. Therefore, effective time management would dominate the show in healthcare marketing.

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Dr. Nicandro

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Dr. Khaled Faraj

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team of neuro spinal specialists at Medcare Orthopaedics and Spine Hospital have initiated a School Screening Program for Spinal Deformity (SSPSS) for boys and girls aged 10-14 years, to detect early cases of Scoliosis and Kyphosis. • The most common form of spine deformity is Adolescent Idiopathic Scoliosis (AIS), involving abnormal sideways curving of the spine. Approximately 3% of children under the age of 16 years are affected with the condition and it has a genetic predisposition. • If left untreated, progression of the disorder can lead to serious problems in adulthood such as breathing difficulties, chronic back pain and physical changes including uneven shoulders, prominent ribs, uneven hips, and a shift of the waist and trunk to the side. Dubai, United Arab Emirates, 26 February 2017: In the last two years, doctors at Medcare have treated over 200 patients with varying degrees of spinal abnormalities. In many cases, the diagnosis was delayed due to lack of awareness and information, with experts linking the start of the condition to adolescence. Recognizing the need to prevent, detect and raise awareness on common, yet little known about spinal deformities affecting people in the UAE, leading neuro spinal experts are implementing screening programs for school children, to facilitate early diagnosis and treatment. Scoliosis and hyper Kyphosis are the most common types of spinal deformity. Scoliosis involves a sideways curvature of the spine that occurs most often during the growth spurt in children just before hitting puberty.

Kyphosis is a forward rounding of the back. Some rounding is normal, but the term ‘kyphosis’ refers to an exaggerated rounding of the back.

cause any harm, but those cases which progress without treatment can affect the internal organs causing significant spinal problems.

“Not many people realize that they have Scoliosis or Kyphosis, until the curve in the spine gets severe. In this region, the problem often goes undetected due to loose clothing worn by both men and women, concealing any unnatural curve.

They also have a negative psychological and cosmetic impact on a patient. Curve progression is related to the age of the child and the magnitude of the deformity. The most common problem associated with scoliosis is pain, usually more in the lumbar (lower spine) than in the thoracic (upper spine).

Recognizing early symptoms is essential to enable proper assessment and treatment, while minimizing the risk of further progression, and undesired consequences for the patient. As the condition starts in adolescence and teenage years, we believe school screening for early detection of spinal deformities can prevent back problems and long-term degeneration. This test should be included in the annual health check programs for children in all schools.” expressed Dr. Nicandro Figueiredo, Spinal Neurosurgeon, Medcare Orthopaedics and Spine Hospital. The School Screening Program for Spinal Deformity (SSPSS) aims to offer a fast, free of charge, and through screening for spinal deformiies among school children in the UAE. These are being undertaken for boys and girls (10-14 years-old), to ensure timely detection and refer diagnosed cases for a more detailed assessment in a specialized center. The Medcare team will be reaching out to over 100 students in 2 schools. To complement the effort, school nurses and parents will also be educated about the spinal conditions that can affect children. Mild Scoliosis (10-25°) usually does not

Prevention of severe Scoliosis is a major commitment of physicians caring for spinal deformities. Studies have established that non-operative treatment with bracing and exercises may reduce the need for a surgery. To be effective, these treatments need to be applied to smaller back curves prior to skeletal maturity in children. “Children who have mild Scoliosis are monitored closely, usually with X-rays, to see if the curve is getting worse. In many cases, no treatment is necessary. Some children will need to wear a brace to stop the curve from worsening. Others may need surgery to keep the Scoliosis from worsening and to straighten severe cases of Scoliosis.” said Dr. Khaled Mabruk Faraj, Senior Consultant Orthopedic and Spine Surgeon. If the deformity is severe or still progresses, the child can be referred to the surgery at an appropriate phase of the deformity, with better chance of achieving success of the treatment. Screening examinations for spine deformities involve various techniques including a visual examination, a physical examination, Scoliometer reading, and surface topographic measures during an annual health services examination.

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ARTICLE FEATURES . 3D and 4D Imaging

3D & 4D IMAGING

Added Value to the Medical Imaging World

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D/4D ultrasound is a three-dimensional image by scanning the studied object in three dimensions.

A distinctive feature of the 4D study is to obtain an ultrasound image in real time. Although a number of diagnosticians believe these methods are only suitable for the creation of fetal portrait of a baby, they have a strong place in prenatal diagnosis. Ultrasound imaging (sonography) uses high-frequency sound waves to view inside the body. Because ultrasound images are captured in real-time, they can also show movement of the bodyâ&#x20AC;&#x2122;s internal organs as well as blood flowing through the blood vessels. Unlike X-ray imaging, there is no ionizing radiation exposure associated with ultrasound imaging. The ultrasound image is produced

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based on the reflection of the waves off of the body structures. The strength (amplitude) of the sound signal and the time it takes for the wave to travel through the body provide the information necessary to produce an image. Ultrasound is the most widely used medical imaging method for viewing the fetus during pregnancy. Routine examinations are performed to assess and monitor the health status of the fetus and mother. Ultrasound examinations provide parents with a valuable opportunity to view and hear the heartbeat of the fetus, bond with the unborn baby, and capture images to share with family and friends.

Ultrasound during pregnancy In fetal ultrasound, three-dimensional (3D) ultrasound allows the visualization of some facial features and possibly

other parts such as fingers and toes of the fetus. Four-dimensional (4D) ultrasound is 3D ultrasound in motion. While ultrasound is generally considered to be safe with very low risks, the risks may increase with unnecessary prolonged exposure to ultrasound energy, or when untrained users operate the device. Surface rendering of 3D ultrasound images allows physicians to view the features of a babyâ&#x20AC;&#x2122;s face or hands or other surface details that allow them to search for genetic syndromes. Tools like maximum intensity projection let doctors better visualize fetal bony structures such as the skull or vertebra, while 3D inversion mode gives them the ability to examine fluid-filled structures, such as the fetal stomach

ARTICLE FEATURES . 3D and 4D Imaging

or brain ventricles that ordinarily appear black in ultrasound. Thick slice scanning provides physicians a better look at fingers and toes, and anomalies like cleft palate.

A biopsy from the embryo in the mother’s womb Medicine has significantly evolved in this field as the physician can now take a biopsy from the embryo through the 4D ultrasound, in addition to withdrawing a small sample of the fetal blood from the umbilical cord (percutaneous umbilical blood sampling) and a sample of the amniotic fluid (fluid surrounding the fetus). We can also identify genetic diseases related to the nervous and muscle system of the fetus as well as fetal activity and muscle contraction.

Breast Disease Breast ultrasound is a noninvasive diagnostic exam that produces images, which are used to assess breast tissue. Ultrasound may also be used to assess blood flow to areas inside the breasts. The examination is often used along with mammography. Ultrasound uses a transducer that sends out ultrasound waves at a frequency too high to be heard. The ultrasound transducer is placed on the skin, and the ultrasound waves move through the body to the organs and structures within. The sound waves bounce off the organs like an echo and return to the transducer. The transducer processes the reflected waves, which are then converted by a computer into an image of the organs or tissues being examined. The sound waves travel at different speeds depending on the type of tissue encountered - fastest through bone tissue and slowest through air. The speed at which the sound waves are returned to the transducer, as well as how much of the sound wave returns, is translated by the transducer as different types of tissue. An ultrasound gel is placed on the transducer and the skin to allow for smooth movement of the transducer over the skin and to eliminate air between the skin and the transducer for the best sound conduction. Ultrasound may be safely used during pregnancy or in the presence of allergies to contrast dye, because no radiation or contrast is used.

3D imaging also allows easy identification of cranial bones. 3D and 4D imaging helps evaluate fetal heart quickly and effectively. The doctor can also diagnose congenital defects in the fetal heart inside the womb and assess the situation in preparation for the required treatment at birth.

Ultrasound in Obstetrics & Gynecology Gynecology has greatly benefited from 3D and 4D imaging that represent a quantum leap in the treatment of gynecological diseases. The gynecologist can now accurately assess the lining of the uterus and determine the cells’ size and activity through 3D imaging. Physicians can now treat uterine and ovarian tumors in a better way given the diagnostic accuracy that allows him to determine the exact location of the existing tumors in the uterus and ovaries. They can also monitor gynecological tumors after treatment to determine the treatment’s effectiveness and follow up on the tumor post-treatment.

Internal Diseases Internal medicine is one of the medical fields that benefited from advanced imaging techniques, as it is now possible to accurately assess acute abdominal symptoms, etc. We can also take a biopsy from the liver and kidney with the 4D imaging technique. 3D and 4D imaging tools can assess the nature of the tissues and size of the tumor as well as appendicitis while determining its location using 3D imaging device. Ultrasound can be used as a diagnostic or screening tool to confirm medical disorders or to assist in performing medical procedures. It is also used as a therapeutic tool in treating musculoskeletal problems, renal stones (kidney stones), and gallstones.

Urinary Tract Transrectal ultrasound is most often used to examine the prostate. The ultrasound image shows the size of the prostate and any abnormal-looking areas, such as tumors. Transrectal ultrasound cannot be used to definitively diagnose prostate cancer. Through this technology, the doctor will can better assess the prostate gland tissue; he can also evaluate the size of the bladder, prostate, polyps or tumors in the urinary tract.

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Adverse drug reactions constitute a major health hazard but can be often prevented by evidence-based decision support tools Adverse drug reactions as a clinical problem Prescription of medicine is the most common therapeutic intervention that a doctor does in his clinical work. However, the choice of drug, adjusting the dose in relation to other medications and e.g. renal or hepatic function of the patient as well as proper monitoring of both the efficacy and safety of the medication remain a big clinical challenge. Accordingly, adverse effects caused by drugs remain a major factor increasing morbidity and mortality (1). A 1999 meta-analysis of 39 prospective studies estimated that over 100.000 patients in the U.S. die annually as a result of adverse drug reaction (ADR) and over 2.000.000 patients suffer from serious adverse drug reaction leading to admission to hospital or prolonging the hospitalization. This rate of mortality due to adverse drug reactions was estimated to be the 4th to 6th leading cause of death in the U.S. (1). The medical problems caused by adverse drug reactions also cause a major financial burden to the healthcare system; in the Lazarou et al. study the cost was estimated to be 1.5 to 4 billion USD annually (1). In light of this evidence, it is fair to say that because of both humane and cost reasons the healthcare providers should put effort in preventing ADRs. There are two types of adverse drug reactions; type A represents a reaction that can be expected and, thus, usually prevented, whereas type B (‘bizarre’) reaction, such as hypersensitivity reactions are mostly unexpected and impossible predict. Type A reactions cover over 90% of ADRs. Type A reactions typically arise from different sources, non-adjustment of drug dose in relation to renal function (glomerular

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filtration rate) and drug interactions being the most important reasons (2). A Norwegian study indicated that 25% of patients admitted to general regional hospital suffered from reduced renal function (GFR<60 ml/min) and they were using on average of 10 drugs (3). Yet, 40% of the medications were either potentially harmful for kidneys or required dose adjustment, 5% being fully contra-indicated (3). Accordingly, the authors could describe drug toxicity in 62% of the patients exposed to inappropriate medications and/or doses (3). Similarly, drug interactions are a known major cause of preventable drug toxicity. In a study examining the population of Sweden from national prescription register indicated that about 1 million inhabitants were exposed to potentially significant drug interaction, 10% of these being potentially serious (4). Interestingly, about half of the D-classified (contra-indicated) drug pairs were such that would potentially interact in a way, which leads to therapeutic failure rather than a distinctive adverse drug reaction (4). This finding is very important and indicates that drug interactions cause medical harm in both ways, both being preventable by e.g. correct choice of medication. Typical examples of interactions causing therapeutic failure are chelation interactions by e.g. iron or magnesium/aluminum –containing antacids preventing the absorption of fluoroquinolone or tetracycline antibiotics or prescription of drug metabolic enzyme-inducing antiepileptics (e.g. carbamazepine) to patients on other therapies, which therapeutic effect is hampered due to the lowered drug exposure (4). Whether the clinical result of a drug interaction

is adverse drug reaction or therapeutic failure, they can be prevented almost always by correct choice of drug or dose or by monitoring the potential harm by sufficient measures.

How can we handle the vast amount of evidence? Considering only drug interactions, there are about 1000 studies published every year, which change our understanding on the clinical relevance and consequences of drug interactions. Importantly when new drugs are nowadays granted marketing authorization, they are quite well studied with regard to their safety, including the dosing in renal/hepatic impairment and potential drug interactions. It is not possible for a clinician to follow all this new evidence that, though, would significantly benefit his clinical practice. A good example (among many) is the drug interaction between warfarin and metronidazole. In this interaction the metabolic (CYP2C9) clearance of warfarin is inhibited leading to over-anticoagulation and, potentially, bleeding. I have personally witnessed over the years cases where patients on warfarin get life-threatening bleedings after being prescribed metronidazole. Yet, this interaction has been well-described in medical literature already in the mid1970s’ (5, 6). This specific case serves as an example how poorly the scientific medical evidence penetrates to clinical reality – especially as the amount of medical knowledge is tremendously increasing. The only solution to tackle this problem is to create medical IT-solutions where this information has been analyzed by experts to give short, but concise, clinical advice what the potential problem can be, but also how to avoid or monitor the clinical risk includ-

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ing suggestions for proper therapeutic alternatives. Indeed, there is evidence that drug therapy is amongst the areas of clinical medicine that would most potentially benefit from such solutions (7).

Whose job is it to prevent ADRs? The healthcare system is for the patient and not the other way around and this of course means that all parts of the healthcare system should make an effort to make the drug treatment safe and effective. Medical doctors are the most responsible and capable to prevent drug related harm and analyzing the possibility to consider alternative choices of medications in situations where the standard solutions are not applicable. As explained above this is an impossible challenge without proper tools and for this there are prerequisites:

a. The medical information needs to be available for the doctor in a concise and user-friendly format (i.e. readable in 15-30 seconds) and it should cover the areas from which ADRs arise. b. The prescription of drugs in hospital needs to be safeguarded by high-quality, evidence-based decision support tools that warn the doctors in real time on potential problems and ALSO provide medical expert given suggestions how to circumvent the problems.

c. The healthcare administration needs to provide the medical doctors enough time and proper tools to fulfill the task of safe prescribing – it is as important prerequisite as having a sufficient sterility in the operating room. d. Clinicians are sufficiently supported by clinical pharmacologists, clinical pharmacists and nursing staff to guarantee that the right patient gets the right drug at right time in a right dose. If these prerequisites are met and the prescribing doctors acknowledge the

magnitude and clinical importance of the problem and respect it, then we have good chance to significantly reduce drug-related harm. Importantly, a clinician must not and cannot give this responsibility to anyone else. In addition, it is important that laboratory provides ready calculation of GFR (with CKD-EPI formula) each time that patient’s plasma/serum creatinine value is measured as this increases the awareness and importance of dose adjustment in patients with reduced renal function. In specialized care in hospital environment most challenges arise from the fact specialists know well their own area of therapeutics, but rather little about the drugs used for other diseases. Some say that specialist treats diseases and general practitioner treats patients. If neurologist starts the patient on carbamazepine, he compromises the efficacy of most other medications that the patient is on. Similarly, when designing proper antipsychotic treatment or pain medication to a HIV-positive patient that is on HAART therapy is rather challenging as the protease inhibitors (e.g. ritonavir) causes tremendous increase of most drugs used for these indications. Basically, all the information needed to solve these problems are available in evidence based decision support databases. A basic requirement for this information is that they are fully referenced and frequently updated and thus reliable. Naturally, this information is just a part of clinicians’ decision making process; the doctor still needs to make the final decision whether the medical scientific information can be directly applied to his specific patient. Yet, the automatic reminders at the time of prescription are extremely effective way to bring the up-to-date evidence based knowledge to the lap of the doctor when he needs to make the decision how to treat the patient. They do not only prevent potential harm, but also work against

‘urban legends’ in medicine such as that sulfonamide non-antibiotics (e.g. thiazides or sulfonylureas) cannot be used in patients with hypersensitivity to sulfonamide antibiotics. Another major benefit of use of decision support for drug therapy is that the need of consultation between doctors or between doctors and clinical pharmacists is reduced (or focused to more complicated issues), which allows more time with the patients, more rapid decision making and reduced cost for the healthcare organization. Finally, we’d like to remind all colleagues on the most important principle of medicine: ‘Primum non nocere’ – first of all do no harm.

References

1. Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA. 1998;279:1200-5. 2. Adverse drug effect as cause of hospital admission. Common drugs are the major part according to the cross-sectional study. Odar-Cederlöf I, Oskarsson P, Ohlén G, Tesfa Y, Bergendal A, Helldén A, Bergman U. Lakartidningen (Swedish). 2008;105:890-3. 3. Blix HS, Viktil KK, Moger TA, Reikvam A. Use of renal risk drugs in hospitalized patients with impaired renal function--an underestimated problem? Nephrol Dial Transplant. 2006;21:3164-71. 4. Holm J, Eiermann B, Eliasson E, Mannheimer B.A limited number of prescribed drugs account for the great majority of drug-drug interactions. Eur J Clin Pharmacol. 2014;70:1375-83. 5. Kazmier FJ. A significant interaction between metronidazole and warfarin. Mayo Clin Proc. 1976;51:782-4. 6. O’Reilly RA. The stereoselective interaction of warfarin and metronidazole in man. N Engl J Med. 1976;295:354-7. 7. Mangalmurti SS, Murtagh L, Mello MM. Medical malpractice liability in the age of electronic health records. N Engl J Med. 2010;363:2060-7.

Samer Ellahham MD, CPHQ, CMQ,FACC, FAHA, FACP, Chief Quality officer, Senior Cardiovascular Consultant, Sheikh Khalifa Medical City Abu Dhabi, U.A.E. E-mail: samerellahham@yahoo.com Tel. +971 508113142 Kari Laine, MD, PhD, Associate Professor, Consultant in Clinical Pharmacology and Therapeutics Department of Pharmacology, Drug Development and Therapeutics University of Turku, Turku, Finland and Medbase Ltd Turku, Finland E-mail: kari@medbase.fi Tel. +358 400 548237

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NEWS

Hamad Medical Corporation Wins Top Hospital Award at Arab Hospitals Federation Forum

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amad Medical Corporation (HMC) has won the prestigious Top Hospital Award in Quality Improvement and Patient Safety during the awards ceremony of the 18th annual forum of the Arab Hospitals Federation (AHF) – MEDHEALTH - which was held in Cairo from 28 February to 1 March. The award was received on behalf of HMC by Mr. Ali Abdulla Al Khater, Chief Communications Officer at HMC; and Mr. Mohamad Mubarak Al Noimi, HMC’s Chief of Staff and Chief of the Managing Director’s Office as well as a member of the Executive Board of the Arab Hospitals Federation. The award was presented by the Egyptian Minister of Health, H.E. Dr. Ahmed Emad Al Din Rady, and the Arab Hospital Federation General Secretary Prof. Tawfik Khoja. During the forum, the Ministry of Public Health in Qatar was also awarded the Excellence Award for Health Awareness in 2017. The award was received on behalf of the Ministry by Dr. Saleh Ali Al Marri, Assistant Secretary General for Medical Affairs at the Ministry of Public Health and Mr. Mohamad Mubarak Al Noimi in his capacity as the Chief of the Health Minister’s Office. By awarding HMC with this prestigious quality improvement and patient safety award, the AHF recognized HMC’s commitment to ensuring the highest international standards in healthcare delivery in Qatar, as well as its continuous efforts to improve patient safety across its network of hospitals and healthcare facilities.

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Mr. Ali Abdullah Al Khater, who was also the Chairman of HMC’s delegation to MEDHEALTH, said the award came as an acknowledgement of HMC’s efforts to ensure patient safety and improve the quality of its services. “We are honored to have received this award by the Arab Health Federation, being the official body that includes all Arab hospitals under the umbrella of the Arab League. The award reflects HMC’s regional leadership in the important field of quality improvement in healthcare,” Mr. Al Khater said. Mr. Al Khater thanked the Arab Hospitals Federation for the award and recognition and reaffirmed HMC’s commitment to delivering the safest, most effective and most compassionate care to each and every one of its patients.

NEWS

HMC Organizes First Pediatric Medical Nutrition Symposium

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he Dietetics Department in collaboration with the Pediatrics Department at Hamad Medical Corporation (HMC) recently organized the ‘First Pediatric Medical Nutrition Symposium’ to raise awareness amongst dietitians and pediatricians of the importance of dietetics, the diseases and disorders associated with pediatric nutrition, and appropriate feeding methodologies. More than 120 participants comprising dietitians, pediatricians and dietetics experts from HMC, Primary Health Care Corporation, Sidra Medical and Research Center, private sector hospitals and clinics, and Qatar University, took part in the one-day event held at the Doha Sheraton hotel. A dietetics expert from the United Kingdom was also present. Ms. Reem Al Saadi, Head of HMC’s Dietetics Department, stated that the symposium featured a training workshop and some case study activities. “Topics such as allergies to cow’s milk and esophageal reflux in pediatric patients were discussed. The symposium also focused on the percutaneous endoscopic gastrostomy (PEG) feeding tube method used for children with special needs who suffer muscle atrophies and swallowing difficulties,” she said. “Behavioral issues in children with nutritional risks were also discussed. Speakers at the symposium reiterated the importance of teamwork through the collaborative efforts of dietitians, doctors, nurses, and other healthcare professionals as central to the success of nutritional care plans,” Ms. Al Saadi added. Dr. Ahmad Al Hammadi, Senior Consultant

and Chairman of HMC’s Pediatrics Department indicated that allergies to cow’s milk are common among infants and toddlers with a prevalence rate of two to four percent in children younger than one year of age. He stressed the importance of an early diagnosis of an allergy to cow’s milk, which is characterized by symptoms such as a rash, vomiting, diarrhea, and chest wheezing. “These symptoms may appear immediately after ingesting cow’s milk or 72 hours after ingestion. This disorder may recede once the allergic child reaches the age of five,” he explained. “A cows’ milk or baby formula allergy is sometimes accompanied by other types of allergies such as gluten, cereal and nut allergies. Results of allergy tests, body weight and height, and family history must also be taken into account to reach a precise diagnosis,” Dr. Al Hammadi pointed out. Children diagnosed with a formula allergy are put on medicated formula at Hamad General Hospital. Dietitians at the hospital place these children under observation and follow-up, and prescribe the appropriate diet for them. Dr. Al Hammadi advised parents to watch their children’s weight as a low body mass index, especially within the first two years of age, may sometimes be a sign of health problems such as cardiovascular disease, metabolic disorders, or malnutrition. He called on parents to ensure they provide their children with balanced diets. However, he said parents should never force their children to eat but rather encourage them.

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HMC Successfully Performs Qatar’s First Liver Transplant from a Living Donor for the donor include motivation to donate the organ for altruistic reasons, verification of the relation of donor to the recipient, compatibility of blood type with the recipient and being between the ages of 18 and 45 and free from chronic diseases.” “Following these criteria being verified, a series of preoperative tests are performed to determine if a donor is medically suitable for the procedure. These tests include x-rays and ultrasound imaging to assess the size of the liver, and a liver biopsy (sample of tissue taken from the body in order to examine it more closely). A psychosocial and social evaluation of the donor are also conducted by a competent committee from Hiba,” said Dr. Khalaf.

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he Organ Transplant Team at Hamad Medical Corporation’s (HMC) Hamad General Hospital has successfully performed Qatar’s first ever liver transplant from a living donor. The latest transplant, which took place in November, makes a total of 17 liver transplants from living donors performed since the commencement of the transplant program at HMC. Each year, between 20 and 25 patients are added to the waiting list for organ transplantation in Qatar. Dr. Yousef Al Maslamani, Medical Director of Hamad General Hospital and Head of the Organ Transplant Committee at HMC, said: “The transplant was planned and performed by HMC’s highly qualified team of liver transplant surgeons, anesthetists, nurses and technicians. The procedure consisted of the partial resection of the donor’s liver, which took eight hours to complete, and the removal of the

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recipient’s liver. Implanting the donated portion of the liver in the recipient’s body who suffered from liver cirrhosis took 12 hours to complete. This successful transplant procedure also saw the participation of a team of visiting Korean organ transplant surgeons.” “There are future plans to increase liver transplants in Qatar from live and brain-dead donors. HMC’s Qatar Center for Organ Transplantation and the Qatar Organ Donation Center (Hiba) are relentless in their efforts to encourage new organ donors to enroll in the donor registry, with the ultimate goal of helping patients who are currently awaiting a lifesaving transplant,” added Dr. Al Maslamani. Dr. Hatem Khalaf, Senior Consultant and Clinical Lead of HMC’s HPB and Liver Transplant Services, who led the local transplant team, stated: “There are certain criteria that both a donor and recipient should meet before a procedure can be done. The criteria

“In the case of this recent transplant, the right lobe of the donor’s liver, totaling 65 percent of the liver mass, was resected and implanted in the recipient’s body, following the removal of the cirrhosis-ridden liver. The donor recovered and was discharged from hospital one week after the procedure. The recipient remained under the care of HMC for two weeks and was then discharged,” explained Dr. Khalaf. The organ recipient, 58-yearold Ashraf Zaid, expressed gratitude to the leadership of Qatar and HMC’s team of surgeons for their compassion and the exceptional care provided to him. Reflecting on his journey with the illness, Mr. Zaid stated: “My journey with this illness started when I was diagnosed with liver cirrhosis in 2014. I was immediately provided with the necessary treatment at Hamad General Hospital. In 2016, I developed a liver tumor and needed to undergo

NEWS

chemotherapy. However, my healthcare team concluded that a liver transplant was the only way to save my life. Therefore, doctors started with the required preoperative tests with the hope of finding a donor in my household. Unfortunately, organ donation by my son was not possible due to blood-type incompatibility so I went back home to Egypt in search of a possible donor. While in Egypt, I received a call from Hamad General Hospital advising that a donor was found and I had to return to Doha. Upon arrival in Doha, I was surprised to find out that the donor was my nephew. The donor, Usama Taher Zaid, 26 years old, said: “The love and compassion bestowed on me by my uncle following

the death of my father prompted me to give him the gift of life. Dr. Hatem Khalaf explained all aspects of the procedure to me and gave me ample time to think about it before I made my final decision. Soon after that, the necessary tests and laboratory

work were done and the procedure took place.” “I am grateful to HMC’s team of surgeons for saving my uncle’s life and for ensuring that I am also well. We are both fully recovered and are each leading a normal life,” Mr. Zaid added.

HMC’s Communicable Diseases Center Home

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ravelers visiting overseas countries where vaccinations and other preventive measures are required will be able to visit the Travel Clinic at Hamad Medical Corporation’s (HMC) Communicable Diseases Center (CDC).

Opening on Monday, 20 February, 2017 the clinic provides travelers with counselling, vaccinations and other preventative measures. It also provides assessment and medical care for travelers returning with travel-related infections. The clinic will operate on an appointment basis and patients will be able to call and book ahead of time. Those accessing the clinic’s services will be able to attain a certificate of vaccination (required for travel to some countries) as well as disease prevention advice for the countries they will visit. These include recommended vaccines for measles-mumps-rubella (MMR), diphtheria-tetanus-pertussis, polio, hepatitis A and B and the yearly flu shot. Some additional vaccines for

to Hamad’s First Travel Clinic yellow fever, rabies, and diptheria may also be required for travel, depending on the country being visited. Vaccinations will be free for all, unless the medication required is specialized (for example Japanese Encephalitis). Travelers can now make appointments at the clinic by calling 40254003 from 7 am to 7 pm. The clinic will operate only Mondays in the interim, with a view to expand as demand grows. The clinic, the first of its kind in Qatar, will provide highly specialized advice and treatment for those returning from overseas trips who suspect they may have a travel-related illness such as persistent diarrhea, rash, and fever. “Our aim is to protect the health of travelers by providing exemplary clinical care along with specific advice and information for each traveler,” said Dr. Muna Al Maslamani, Medical Director of the CDC. “It is important for travelers to be up to date with their vaccination and have their medical care optimized before they travel, particularly

when there is a heightened risk of becoming sick in the country they are visiting. By providing all the necessary advice and preventive measures including vaccinations, our clinic will be a “One Stop Shop” for travelers in Qatar.” “We recommend travelers consult with Hamad’s CDC Travel Clinic doctors about what vaccines and medicines are needed based on travel destination, trip duration and activities,” she said. Vaccinations that will be available at the Travel Clinic include: • Meningococcal vaccine • Rabies vaccine • Typhoid vaccine • MMR vaccine • Haemophilus Influenza type B • Diphtheria, Tetanus , acellular Pertussis (TdaP) vaccine • Tetanus vaccine • Yellow Fever vaccine • Hepatitis A vaccine • Hepatitis B vaccine • Pneumococcal vaccine • Seasonal Flu vaccine • Polio vaccine

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Pioneering Home Healthcare in the Middle East

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ome Care Lebanon S.A.L. (HCL) pioneered the Home Health concept in the Middle East back in 1997 (www. homecarelebanon.com) when it started operations in Beirut, Lebanon, using state-of-the-art technology, well documented policies and procedures and on-going training for its staff. Led by a team of dedicated professionals, HCL works with private payers, health insurance companies and international pharmaceutical corporations. It is the only agency that has had years of presence inside leading university hospitals. HCL aims to help develop Home Care companies across the Middle East by sharing more than 20 years of clinical, managerial and marketing experience with interested parties.

scheduling, quality control and remote access of nurses, resulting in an extremely efficient business that increases your profits & margins.

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• CRM to manage the sales force & incoming phone calls • Billing/Invoicing • Scheduling • Remote access Sales app for the sales force • Remote access Sales app for Quality Control • Remote access app for field registered nurses • Remote access app for field Home Health Aides • Electronic Health Records (EHR) • Full stock management module for supplies & equipment • Electronic Purchase Orders • Full Payroll module • Link to the client’s accounting s oftware • An enterprise model to manage multiple locations, branches and franchises • An easy and secure interface to turn on/off specific modules • A very powerful reporting system

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HomeCareMaker consists of the main solution and multiple apps that connect to it via the internet. Whether via the software’s platform on a desktop and/or any iOS device or via any web browser such as Chrome, Explorer and Safari… HomeCareMaker can be accessed at anytime from anywhere. HCM handles Home Infusion Services, Home Health Care and Medical Equipment Rental/ Sales. It is backed by powerful tools such as a CRM to boost sales and is designed by Home Care people for Home Care people.

THE IT solution- HomeCareMaker Passionate about delivering worldclass home healthcare services and dwelling into over 20 years of experience in the field, HCL has invested in the development of a state of the art webbased IT solution –HomeCareMaker(HCM) that manages in a specific way of the business, the workflow from marketing to purchasing, invoicing,

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HomeCareMaker’s modules include:

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