HOSPITALS Magazine issue 36 by The Arab Hospital Magazine

Issue 36 / 132 Sep / Oct 2017 www.tahmag.com

Epidemics Global public health threats of the 21st century

Where are we in the fight against

AIDS?

Diabetes

New treatments to control blood sugar levels

Vaccinations

The most effective way to protect against infectious diseases

Breast Cancer Early detection is key

NEWS

29 JAN – 1 FEB 2018 DWTC, Dubai, UAE

Where the healthcare world comes to do business

103,000+ Healthcare & Trade Professionals 159 Countries Represented 19 Medical Conferences JOIN THE REGION’S LARGEST HEALTHCARE EVENT 3 easy ways to book your stand:

arabhealth@informa.com

+971 4 407 2797

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life sciences exhibitions

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Publisher Arab Health Media Communication General Manager Simon Chammas E: schammas@tahmag.com Creative Department Roula Haddad - Georges Habka Creative Director: Jessy Chlela Photographer Hanna Nehme

The healthcare and disease control sector is on the agenda of the Mohammed Bin Rashid Al Maktoum Global Initiatives by addressing the health problems of underserved communities and providing the most basic forms of healthcare to those in greatest need. In this context, total spending on humanitarian and relief initiatives totaled 252 million dirhams in 2016, benefiting 22.6 million people around the world, while healthcare and disease control initiatives recorded AED 224 million. 10 million people around the world have benefited from these programs, initiatives and health and preventive health campaigns. His Highness Sheikh Mohammed bin Rashid Al Maktoum announced the annual results of the Foundation’s work during a Board of Trustees meeting held under his chairmanship and in the presence of officials. Mohammed Bin Rashid Al Maktoum’s total global spending was AED 1.5 billion in 2016; AED 791 million was invested in building three sustainable monuments including the Al Jalila Research Center, which will be officially inaugurated in 2018. To support medical research and develop remedial solutions for a number of incurable diseases, the Al Jalila Research Center in 2016 funded more than 55 local research studies. The Center, the multidisciplinary future research center for biomedical research in the UAE, has invested 16.3 million AED million in medical research, scholarships, scholarship programs, and fellowships. On the basis of the above, we can only praise these efforts and results achieved, which have been greater than expected and can rest assured that health in the Arab world and in Dubai specifically, is doing very well. Greetings to every initiator and blessed are those who have contributed to saving the lives of many.

Copy Editor Jessica Achkar Editors Aline Debes, Mark Steven, Don Karn, Andrew Weichert, Colette Semaan, Abbas Moussa Advertising & Marketing advertising@tahmag.com Mirna Khayrallah mirna@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

SEPTEMBER . OCTOBER 2017

52 36

36 60

46 76

NEWS

34 New partnership between Ile-de

6 Cerner Middle East Unveils

France & ESA

46 88 80 Sleep apnea and obesity 88 Breast Cancer

2017 Achievement & Innovation

68 Sheikh Hamdan bin Rashid

Award Winners

Al Maktoum Award for Medical

14 Empower contributes to Dubai

Sciences participates in the national

30 Obesity & Metabolic

Blood Donation Centre through its

outreach seminar on UAE technical

disorders centre

blood donation drive

cooperation with IAEA

44 BHM – the specialist in

18 U.S. Cleveland Clinic ranked #1

94 Dubai hosts the Second Middle

bone-conduction hearing systems

hospital for heart care

East Conference on Dermatology

96 What is the role of healthcare

22 High-ranking Kuwait Officials

and Aesthetic Medicine

supply chain to overcome

visit American Hospital Dubai

24 Takeda and Hikma announce a new licensing agreement

28 Bellevue Medical Center Launches The “Chemo Care kit” in collaboration with Diakonia

32 NMC Health to Operate and Manage Emirates Healthcare Assets

32 Julphar’s Board of Directors appoints Jerome Carle as General Manager

FEATURES

36 Organ Transplant 48 Diabetes 54 Hemophilia 58 Electroencephalogram 60 Epidemics 64 AIDS 70 Rheumatic heart 72 Teenagers’ health 76 Vaccinations

ARTICLES

healthcare crises?

98 Vitamin-D deficiency

MEDICAL FAIRS

10 Wearables are revolutionizing classic medicine

20 Boehringer Ingelheim brings together Egypt’s Top Experts

84 Statement on MEDICA 2017

TECHNOLGIES

16 Advancing lives with Cerner health technology

26 Saudi Arabia Approves Oncothermia the Latest Technology in Cancer Treatment

SEPT.OCT 2017

NEWS

Cerner Middle East

Unveils 2017 Achievement and Innovation Award Winners vaccinations as well as increased revenues for nurse medication administrations.As of October 2016, SEHA AHS utilizes evidence-based order sets for almost 90 percent of well child visits. That achievement greatly surpasses organizational goals and international benchmarks of 70 percent, leading to better patient outcomes.

erner Middle East& Africa celebrated the sixth edition of its annual Achievement and Innovation Awards by recognizing clients across the Middle East for their most rewarding healthcare technology adoptions across five categories. Cerner created the Achievement and Innovation Awards to honor clients that have effectively increased quality and value for their organizations and patients through health IT. The five categories cover various areas that have used innovative technology over the past 12 months: Patient Experience, Support Services, Population Health Management, Clinical Decision Support and User Experience. “Our esteemed client organizations from across the Middle East have worked tirelessly with their caregiver and IT teams to help their communities have a world-class care experience and advance health care in their respective countries,” said Michael Pomerance, vice president and managing director, Cerner Middle East & Africa. “I am truly honored to be able to highlight their achievements and wish them continued success.”

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During the annual Cerner Middle East Collaboration Forum, at the Address Dubai Marina hotel in Dubai, United Arab Emirates, finalists presented their submissions. The audience voted to select their preferred winner in each category. Finalists and winners were announced during the forum’s awards ceremony. The Achievement and Innovation in Support Services were granted to Abu Dhabi Health Services Company (SEHA) for its pharmacy benefits management (PBM) innovation which allows for PBM management within its Malaffi (Cerner Millennium®) system. Prior-authorizations response time has been reduced to less than three minutes in 92 percent of transactions. As a result, Pharmacy Benefits Management at SEHA now prevents millions of dirhams in insurance denials each year compared to past experience SEHA Ambulatory Health Services(AHS) received the Achievement and Innovation in Population Health Managementforits holistic approach to better child care. This program provided for more timely and complete

UAE Ministry of Health & Prevention was recognized with the Achievement and Innovation in Clinical Decision Support award for its work in enhancing antimicrobial surveillance. With the complete interface and solution optimization, the estimated time saved for 2,000-panel tests per month in a single laboratory is approximately 6,000 minutes per month per laboratory which equates to 1,200 hours or 168 working days per year. The Achievement and Innovation in the User Experience award were granted to King Saud University in Saudi Arabia for its advancement in end-stage renal therapy. Its innovation has automated the workflow in the Renal Dialysis Unit and allowed physicians to spend more time working toward increased quality and outcomes for the 15,000 patient sessions performed annually. The annual Cerner Middle East Collaboration Forum is a three-day knowledge-sharing event designed for Cerner Middle East & Africa client health care leaders, clinicians, and IT professionals. The event highlights the latest developments in regional health care. More than 250 senior health care representatives from various organizations, hospitals, and ministries attended.

MEDICAL FAIR

Wearables are revolutionizing classic medicine

MEDICA 2017 to focus on current trends and show concrete applications The resounding success of health-promoting smart gadgets for private use has been outshone by another no less important development: Wearables are steadily advancing into many fields of professional healthcare. They are essential to the digital revolution that is also changing the field of medicine. A development that visitors to the world’s largest medical trade fair – the MEDICA in Düsseldorf with more than 5,000 exhibitors – will be able to experience for themselves in November (13 – 16 November 2017, from Monday to Thursday). The MEDICA CONNECTED HEALTHCARE FORUM in Hall 15, which will be dedicating special sessions to the field of wearables is going to be the hotspot for everybody who is interested in the topic, specifically on Monday, 13 November, from 11.00 a.m. to 2.00 p.m., and Tuesday, 14 November, from 2.00 to 5.00 p.m. The Wearable Technologies Show (also in Hall 15) will be additionally offering an overview of exciting new developments. This is where both prototypes and research projects are going to be presented in addition to products that are already heading for the market. “Wearables represent one of the major enablers of digitization in healthcare,” says Christian Stammel, Founder, and CEO of WT Wearable Technologies Group. The wearables

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that are finding employment in the health sector are more than just fitness trackers strapped to the wrist. There are many applications that have been very successful for decades – even if they were not previously called wearables: “We define all electronic components that are worn on the body, close to the body or in the body as wearables,” explains Stammel. It is a definition that also covers pacemakers and hearing aids as well as smart implants. Wearables are already having an impact on new treatment methods and are creating new methods of diagnosis, monitoring, and medication across all aspects of medical care – from prevention and inpatient and outpatient care to rehabilitation. The spectrum ranges from intelligent plasters for

measuring blood-sugar levels, such as the product already implemented by Abbott, through patches that deliver the individually required quantity of drugs to intelligent pills that are able to monitor the correct drug administration. A sensor in the form of a pill by Proteus Medical, for instance, enables physicians to track when patients have taken their medicines. Adherence to required therapies is one of the factors that are decisive to the success of drug treatments. The ‘mylife OmniPod’ insulin-management system also represents a new type of insulin-pump therapy. The eponymous pod is applied directly to the skin – without annoying tubes between the pod and the ‘personal diabetes manager’. This provides the people using it with more freedom in their everyday lives.

MEDICAL FAIR

The wide range of different applications demonstrates that: Wearables have become an everyday item Stammel says that wearables are available for cardiovascular diseases, diabetes and asthma and that they make life much easier for patients and provide physicians with lots more information about their conditions than conventional methods.

will help restore mobility to people suffering from temporary or chronic restrictions to movement. The monitoring of vital data is central to helping people who are suffering from chronic and acute illnesses. This is where wearables can deliver optimum solutions for monitoring almost any type of complaint at home or in clinics.

The session that will be taking place at the MEDICA CONNECTED HEALTHCARE FORUM from 2.00 to 5.00 p.m. on Tuesday (14 November) will be focusing on wearables to help with chronic illnesses and to support people facing special mobility challenges (e.g. people who have suffered strokes). Bioservo will be taking this opportunity that the Wearable Technologies Show will be presenting to demonstrate its training glove for stroke patients.

The Biovotion start-up, for example, has created an arm cuff that continuously captures medically relevant data and makes it available to the treating physicians through a ‘cloud’ solution. Precisely tailored wearables are also available for specific diseases including Alzheimer’s, Parkinson’s, asthma, cardiovascular diseases and diabetes as are new options for monitoring newborns and pregnant women.

The glove uses motion sensors and robotic support to amplify the wearer’s movement impulses. Wearing the glove regularly will not only improve the perception of touch stimuli but also voluntary motility, e.g. grasping. It is not far from robotic gloves to exoskeletons that promise even greater benefits in mobilization therapy. FreeBionics, for instance, is hoping that its ‘Free Walk’ system

The scope of application options that the MEDICA 2017 will be focusing on and that is to be presented there also constitutes an indication of the continuously growing demand. “The market for wearables is growing rapidly. More than 150 million wearable products were sold across the world last year,” says Stammel. It is a market that will have doubled by 2020. Initial forecasts are assuming that

The market for medical wearables is growing rapidly

400 million wearables will be sold in 2020. A good 50% of this figure will be medical wearables. The market for smart patches, in particular, will probably make up a very high share of the market. Gerd Bueschel, the OEM Manager at Covestro, will be presenting insights into the topic during his talk at the MEDICA CONNECTED HEALTHCARE FORUM on 14 November, which will be entitled: “Soft Embedding of Electronics and Skin Friendly Fixation of Materials & Technology”. Advancing miniaturization is also going to deliver solutions for medical monitoring that are increasingly small and more pleasant for patients to use. “Medical wearables are being increasingly developed in the form of smart patches and will so enable patients to use long-term monitoring products and even receive medication in such a way that is almost invisible to others,” says Christian Stammel looking forward. This means that wearables could make treatment significantly easier and less stigmatic for patients.

Wearables - a challenge for licensing authorities So wearables are opening up prospects that are highly promising for both users and suppliers. But they are also presenting many challenges that need to be tackled before their introduction to the market. These include medical licensing, interfacing

MEDICAL FAIR

aspects, data interoperability, and data protection. This requires: “Medical licensing authorities across the world will need to respond to increasing demands and are indeed gradually adapting to their new tasks,” Stammel reports. Digitisation represents a great overall challenge for licensing authorities, Stammel continues: “Just for the sheer size of its health market, Germany is a country that is attracting lots of attention from manufacturers of medical products here.”

Wearables for inpatients “There are many innovations in the field of wearables for inpatients,” says Stammel. The bandwidth of applications ranges from the monitoring of bed sores through patch sensors to the tracking of vital data. But wearables would initially play a more subordinate role from the point of view of a clinic: ”The existing medical infrastructure will slow down the introduction of wearables here. But wearables would probably deliver great benefits to outpatient care following hospital treatment.”

Wearables for outpatient care It would be particularly advantageous for doctors’ practices to start thinking about the topic of improving patient assessments with the help of wearables. Stammel explains: “The first health-monitoring devices that have also been officially certified – e.g. ‘Philips Health Watch’ – have simplified the use of wearables as reliable indicators.” The device captures such vital data as heart frequencies and will also track movement, sitting and sleeping behavior and does so without the need for an additional chest strap. The data are stored in the cloud in

SEPT.OCT 2017

compliance with data-protection guidelines and may then be shared with physicians and medical experts if necessary. Stammel thinks that the use of wearables will in the near future become a performance feature for high-quality medical practices: “Physicians should be familiar with the products that are already available today for diabetes patients and be aware of the benefits of medical treatment and the patients’ quality of life so that they can prescribe such products.”

Start-ups are facilitating digitization in healthcare Creative start-ups are playing an important role in the digitization of healthcare and particularly in the field of wearables. A special ‘platform’ is going to be dedicated to such players for the first time at the MEDICA 2017 with the new MEDICA START-UP PARK. Up to 40 start-ups are going to laying out their wares over a total area of 500 square meters in Hall 15. “The company founders and their small teams of developers are simply bubbling with ideas. What they need is a boost. That is why the MEDICA will be matching them up with potential business partners, investors and sales partners from around the world,” says Dr. Claudio Bucchi, the MEDICA team’s trend scout and the project manager responsible for the MEDICA START-UP PARK.

Everybody must pull together to succeed So there are many innovations with the potential to advance the digitization of healthcare for the good of patients. And proper information for all those involved is essential to ensuring that patients do actually benefit from progress being made in the fields of medicine. Patients are already embracing the digital revolution. A recent survey by Deloitte and Bitkom revealed that more than 90% of respondents are sharing their health data from their mobile devices with their physicians. And how are physicians responding? “It is up to the medical profession to openly explore the new opportunities that are being opened up by digital innovations and to indicate their interest to the established suppliers of medical infrastructure solutions for practices and clinics,“ says Christian Stammel clearly. The MEDICA 2017 will be the place for all professionals working in the health sector to bring themselves up to date. The international MEDICA CONNECTED HEALTHCARE FORUM in Hall 15 will throughout the day be providing insights into the full range of relevant digital developments that are destined to fundamentally change the world of healthcare across all its sectors. Here, wearables will not only become an important aspect of the Internet of things but also and especially of medical care in general.

NEWS

Empower contributes to Dubai Blood Donation Centre through its blood donation drive

“There is a need for further awareness among the residents of the country on blood donation, particularly among the youth. While we will continue this life saving mission in hopes to create more awareness, we believe that our simple contribution of donating blood will save the lives of many” Ahmad Bin Shafar Empower CEO

mirates Central Cooling Systems Corporation (Empower), the world’s largest district cooling services provider organised a blood donation drive at its headquarters in collaboration with Dubai Blood Donation Centre on 28 August 2017. The blood donation drive was conducted in line with the UN’s Global goals for sustainable development and 2021 Dubai Plan, reflecting the principles of the social responsibilities of the company in donating the blood as humanitarian action. “At Empower, we’re keen on spreading the culture of dedicated social service and giving, which targets all members of the society. The blood donation drive is a part of our Corporate Social Responsibility activities that help spread a positive message about the importance of donating blood and wholehearted support to meet emergency blood requirement,” said Ahmad Bin Shafar, CEO of Empower. Experts suggest that blood donation is good for health, helping reduce heart attack rates, cholesterol levels and the risk of cancer. Blood is distributed weekly to hospitals for regular usage on patients with

SEPT.OCT 2017

ongoing conditions not forgetting the emergency supplies needed for specific cases and unforeseen accidents. “There is a need for further awareness among the residents of the country on blood donation, particularly among the youth. While we will continue this life-saving mission in hopes to create more awareness, we believe that our simple contribution of donating blood will save the lives of many” added Ahmad Bin Shafar. Empower constantly strives to organise such humanitarian campaigns, which are essential and necessary for the upliftment of the society, and the recent drive fosters social solidarity and cooperation among community members. Empower encouraged its employees and members of the society to donate blood by informing about the importance of blood donation, the role of blood donation in rescuing patients and alleviating their suffering and benefits to donors’ health. “Supporting and helping members of the community is a characteristic we’ve learnt from our wise leadership, His Highness Sheikh Khalifa Bin Zayed Al Nahyan, President of the UAE and His Highness Sheikh Moham-

mad Bin Rashid Al Maktoum, Vice President and Prime Minister of the UAE and Ruler of Dubai, as well as the Rulers of the Emirates of the UAE. The blood donation campaign not only offers the patients a new ray of hope, but the joy and happiness experienced in contributing to the society are beyond words. Taking this as an opportunity I would like to extend my heartfelt gratitude to all community members for their support in making this campaign a success,” concluded Ahmad Bin Shafar. With 86 numbers of total donors participating in the campaign, Empower witnessed a significant turnout and remarkable participation of employees and members of the community. Empower currently operates more than 1.250 Million RT, providing environmentally responsible district cooling services to large-scale real estate developments such as Jumeirah Group, Business Bay, Jumeirah Beach Residence, Dubai International Financial Centre, Palm Jumeirah, Jumeirah Lake Towers, Ibn Battuta Mall, Discovery Gardens, Dubai Healthcare City, Dubai World Trade Centre Residences, Dubai Design District, among others.

NEWS

TECHNOLOGIES

ADVANCING LIVES WITH

Cerner health technology Better patient care is increasingly dependent upon the best healthcare technology “We want to support the work flow, reduce human errors and minimize the administrative burden. This gives a better healthcare experience for patients and creates satisfaction for caregivers.” Michael Schelper General Manager – UAE and Kuwait, Cerner Middle East

erner has specialized in healthcare technology since its founding in the US in 1979. Cerner Middle East dates to 1991 and they now have clients in Egypt, Kuwait, Saudi Arabia, Qatar and the UAE. Empowering the healthcare professionals with the best healthcare technologies will help create the best experience for their patients. “Nurses might spend 60 per cent of their time on administrative tasks,” says Michael Schelper, General Manager – UAE and Kuwait, Cerner Middle East. “We want to support the work flow, reduce human errors and minimize the administrative burden. This gives a better healthcare experience for patients and creates satisfaction for caregivers.” Cerner’s Millennium® solution is one example. Electronic medical records reduce paperwork and provide a seamless data flow. If a patient is

SEPT.OCT 2017

moved from an emergency unit to a hospital ward, the healthcare professionals will have unified access to the patient’s data. Other major innovations include medicine dispensation and smart documentation. Medicine can be dispensed with the scan of a badge, while reports can be generated using a template of predefined text. The goal is improved efficiency and increased safety so patients enjoy better health. In addition, Cerner’s holistic offering is optimised for Middle Eastern countries. The system can adjust medicine schedules based upon Ramadan hours or prayer times, and the patient portal is available in Arabic. “The patient portal is a great tool that allows patients to communicate with their care providers,” adds Schelper. “It gives them access to their medical records, which are updated in near real time, allows them to make med-

ical appointments, and send messages to their doctor.” Cerner has also introduced population health management analytics solutions, which is about making sure the patient data is proactively being used appropriately along with preventive medicine to effectively manage health. Cerner is guided by its motto “Know, Engage, Manage.” Ensuring a population’s health is managed effectively involves knowing the people afflicted with hypertension, for example, and being able to recall and treat them. Once those patients are engaged, you want to keep them healthy by working with them so their conditions can be managed. “Cerner has been working with visionary leadership in the GCC for the creation of a unified medical record – data that can be shared among and accessed by multiple health organizations so they can better manage a population’s health,” Schelper concludes.

NEWS

Cleveland Clinic Abu Dhabi’s Heart and Vascular Institute was the first in the Middle East to introduce transcatheter aortic valve replacement (TAVR) as an alternative to traditional open-heart valve replacement surgery

U.S. Cleveland Clinic

ranked #1 hospital for heart care for 23rd consecutive year

leveland Clinic Abu Dhabi Extends Reputation for Cardiology and Heart Surgery Excellence to Region with Heart and Vascular Institute. For the second year in a row, Cleveland Clinic is ranked the No. 2 hospital in the United States by U.S. News & World Report, retaining its position as the No. 1 hospital for cardiology and heart surgery for the 23rd successive year. “I am incredibly proud of this organization and everyone who works here,” said Toby Cosgrove, M.D., Cleveland Clinic president, and CEO. “These rankings are a reflection of our caregivers’ unwavering commitment to providing the very best care to the patients we are privileged to serve.” Cleveland Clinic Abu Dhabi, which opened in 2015, is a unique and unparalleled extension of US-based Cleve-

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land Clinic’s model of care, designed to address a range of complex and critical care requirements in support of the region’s specific healthcare needs. The hospital provides patients direct access to the world’s best healthcare providers with more than 30 medical and surgical specialties represented through 13 institutes. Cleveland Clinic Abu Dhabi’s Heart and Vascular Institute was the first in the Middle East to introduce transcatheter aortic valve replacement (TAVR) as an alternative to traditional openheart valve replacement surgery. It offers a wide spectrum of services, from diagnostic to cutting-edge treatments, such as hybrid coronary revascularization, and minimally invasive and robotic cardiac surgery. Tomislav Mihaljevic, M.D., Cleveland Clinic Abu Dhabi CEO, said: “We are

proud to play a significant role in the expanding international story of Cleveland Clinic. Every day, our dedicated physicians and nurses deliver Cleveland Clinic’s commitment to excellence in complex and critical heart care to the people of the Middle East.” In compiling its rankings, U.S. News studied objective data, such as risk-adjusted survival, readmission rates, volume, patient experience, patient safety, quality of nursing care and other care-related indicators. According to U.S. News, these rankings recognize hospitals that excel in treating patients who need an especially high level of care. The rankings are available at http:// health.usnews.com/best-hospitals and will appear in the U.S. News “Best Hospitals 2018” guidebook, available on newsstands Sept. 12, 2017.

NEWS

MEDICAL FAIRS

Boehringer Ingelheim brings together Egypt’s Top Experts to address cardiovascular risk and type 2 diabetes management

oehringer Ingelheim, one of the world’s leading pharmaceutical companies, has brought together top endocrinologists, experts in internal medicine and primary care physicians under the theme ‘Control your Diabetes - Care for your Heart’ to highlight new solutions in type 2 diabetes management. Cardiovascular disease, the primary cause of death in Type 2 diabetes, can cause up to 46 per cent of deaths in Egypt. During the session, doctors presented the latest findings of the EMPA-REG OUTCOME® Trial, a dedicated cardiovascular outcomes trial in people with type 2 diabetes and established cardiovascular disease. The trial took place at 590 clinical sites in 42 countries with 7,020 participants and was observed for a median duration of 3.1 years. A new drug to manage risk factors associated with type 2 diabetes was also launched at the event. Empagliflozin is the only oral type 2 diabetes medicine approved for type 2 diabetes management with additional benefit to prevent cardiovascular death in adults with type 2 diabetes. The drug was shown to reduce the relative risk of cardiovascular deaths by 38 percent in the EMPA-REG OUTCOME® trial. New approaches to reduce blood sugar levels were amongst topics discussed by the experts during the panel

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discussion. Blood sugar, if uncontrolled affects the body’s circulatory system, leading to complications such as coronary artery disease, peripheral arterial disease, and stroke in the case of large blood vessels and diabetic nephropathy, neuropathy, and retinopathy when smaller vessels are damaged. The landmark EMPA-REG OUTCOME® trial is a long-term cardiovascular outcome trial assessing the effect of adding an oral, once daily, highly selective Sodium glucose cotransporter 2 (SGLT2) inhibitor that works by blocking the reabsorption of blood sugar by the kidney, and supports standard of care compared with placebo added to standard of care in adults with type 2 diabetes and established cardiovascular disease. The trial showed that adding the inhibitor reduced initiation of kidney replacement therapy, such as dialysis by 55 percent, a 44 percent reduction in doubling of creatinine (a waste product usually filtered by the kidneys) in the blood, and progression to macroalbuminuria (very high levels of a protein called albumin in the urine) by 38 percent. Prof. Dr. Ibrahim Naguib Elebrashy, Professor of Internal Medicine at Cairo University said: “Reducing cardiovascular risk is just as essential to diabetes management. The EMPA-REG OUTCOME® trial investigates long-term clinical

MEDICAL FAIRS

cardiovascular outcomes. SGLT2 inhibition has been shown to be an effective way of lowering blood glucose in the management of type 2 diabetes with a positive effect on body weight and blood pressure.” “SGLT2 reabsorbs sugar filtered by the kidneys back into the bloodstream. This reabsorption continues the cycle of high blood sugar in people with type 2 diabetes since the amount of filtered sugar is directly related to the concentration of sugar in the blood. SGLT2 inhibition reduces reabsorption of sugar into the bloodstream, allowing excess glucose to pass through the urine,” added Dr. Professor Yehia. M. Ghanem, Head of Internal Medicine and Diabetes, Alexandria University Hospitals. The WHO predicts that the number of those expected to suffer from diabetes in Egypt will rise to 6,726,000 by 2030. The prevalence of diabetes and risk factors is as much as 14.2 per cent in males and 18.2 per cent in females. Moreover, Prof. Dr. Hesham El Hefnawy, Dean of Egypt National Institute for Diabetes & Endocrinology noted: “Diabetes is on the rise in Egypt, representing a major threat to people’s lifestyles and overall health conditions. At the same time, cardiovascular incidences are have also increased over the last few decades in Egyptians due to the high prevalence of major lifestyle risk factors including stress, smoking, and poor diet. Completing the annual cycle of care can help achieve better outcomes for people with diabetes. Regular assessments can prevent complications and other adverse outcomes associated with the disease.” Prof. Dr. Ibrahim Naguib Elebrashy, Professor of Internal Medicine at Cairo University also said that: “Despite advances in care, cardiovascular disease is still the number one cause of death among people with type 2 diabetes. Even after receiving standard care treatments, people with type 2 diabetes and established cardiovascular disease are still at risk and need additional cardioprotection. Diabetes affects more than 415 million people worldwide. The EMPA-REG OUTCOME® trial showed that Empagliflozin significantly reduced the risk of the combined endpoint of cardiovascular death, non-fatal heart attack or non-fatal stroke by 14 percent when added to standard of care in adults with Type 2 Diabetes and established cardiovascular disease.” Mohamed El Dababy, Boehringer Ingelheim’s Head of Human Pharma and General Manager Near East

Middle East and Africa (NEMEA) said, “With an increasing section of the population diagnosed with diabetes, the need for ongoing clinical research has never been more important. In Boehringer Ingelheim, our focus is to provide an innovative approach to managing T2D, and we are building upon our commitment to meeting the diverse needs of people with diabetes and those who care for them. Through research and collaboration, our efforts reflect a growing range of product portfolios and a continued determination to provide sustainable solutions. We will keep on working to ensure innovative treatment options and approaches are available to help more patients. We are also committed to serving the medical community, with studies and product information to help address the needs of those living with diabetes.” By 2040, the number of people with diabetes is expected to increase and reach 642 million (the equivalent of one adult in 10). It has been estimated that every six seconds a person dies of diabetes, which translates to over five million deaths a year worldwide. Life expectancy of people with type 2 diabetes at high cardiovascular risk is, on average, decreased by up to twelve years with approximately 50 percent of deaths in people with type 2 diabetes caused by cardiovascular disease.

NEWS

High-ranking Kuwait Officials visit American Hospital Dubai AHD Vice Chairman Buti Almulla & DXH Head Dr. Layla AlMarzouqi welcome delegates from Kuwait Medical Committee at Armed Forces Chief of Internal Medicine; and Dr. Carmelo Barbaccia, Chief of Surgery. Dr. Safar gave an overview of the hospital’s services, after which the visitors were given a tour of the Presidential Suite, VIP and Standard Rooms, the OR, the Rehab Center, and other major facilities. The group also spent time with patients referred by the Kuwait Embassy to AHD.

merican Hospital Dubai (AHD), has received a high-ranking delegation comprising representatives of the Kuwait Medical Committee at Armed Forces who visited the multi-specialty hospital until July 26, 2017. The Kuwait contingent led by Brigadier General Emad Sultan Aman, Colonel Dr. Rashid Fahad Aldowaila, Lieutenant Colonel Dr. Hisham Mohammed Alasaosi, and Lieutenant Colonel Dr. Mohamed Alghanim. They met the hospital’s department heads and observed its world-class medical services and technologies

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throughout their extensive four-day tour. The agenda included a meet and greet with AHD CEO Peter Makowski and Chief Administrative Officer Firas Al Attili. The guests were also introduced to Buti Almulla, Vice Chairman; Dr. Layla Mohamed AlMarzouqi, Head of Dubai Health Experience (DXH); Dr. Robert Courteney-Harris, Chief Medical Officer; Dr. Ammar Safar, President of Medical Staff; Dr. Tarek Dufan, Director of Radiation Oncology and Chief of Medical Imaging; Dr. Thomas Nau, Orthopedic Surgeon; Dr. Khaldoun Taha, Director of Heart Center, Cardiologist; Dr. Fahad Kouli,

Makowski said: “We are honored to welcome such an esteemed delegation from Kuwait and give them an exclusive tour around the hospital, introduce our key people, and facilitate interactions with the many Kuwaitis we treat. The next couple of days will provide an excellent opportunity for us to learn more about how we can best serve the citizens of Kuwait and at the same time assure some of Kuwait’s top officials that their people who live and work in Dubai and the other emirates are enjoying superior medical services at American Hospital Dubai.” The Kuwait delegates continued to tour American Hospital Dubai’s various departments and discuss avenues for cooperation with the medical facility over the next three days.

NEWS

Research cooperation with India for better wound management

Takeda and Hikma

announce a new licensing agreement for marketed products

I F

raunhofer ENAs shows the project MIDARDI together with BiFlow systems GmbH at cOmPAmED 2017 from November 13 until 16 in Duesseldorf, Ger- many. Within the project, a pointof-care test to determine pathogens and their antibiotic resistances were developed. Europe and India face a steady increase in type 2 diabetes. Besides the actual symptoms, several associated diseases like diabetic foot ulcer (DFU) may occur. The damage of nerve cells leads to the reduction of pain sensation and thus to an increased number of ulcers and delayed wound healing at the feet. The wounds are often rapidly colonized by bacteria and the severe infection delays the wound healing even further. For a proper wound management, the fast determination of pathogens and their antibiotic resistances in the wound is needed. In the project MIDARDI, funded by BMBF (Federal Ministry of Education and Research) and IGSTC (Indo-German Science & Technology Centre), experts from India and Germany develop a new tool for rapid Point-of-Care diagnostics. Using molecular diagnostic procedure the determination of pathogen species and antibiotic resistances is much faster (<1 hour) than the established microbiological testing by cell culture. In order to use the complex procedures of molecular biology for the Point-of-Care testing, the procedures need to be automated and miniaturized. The Fraunhofer Institute for Electronic Nanosystems ENAS is developing micro uidic systems which are capable to transfer macroscopic liquid handling steps into small integrated systems. By simplifying the handling of these systems and eliminating work intensive manual handling steps the tests can be even run by less qualified personnel. In cooperation with experts in biochemistry (Fraunhofer IZI-BB in Potsdam-Golm, Germany, and Manipal University in Manipal, India), medical product developers (BiFlow Systems GmbH in Chemnitz, Germany, and Achira Labs, Ltd. in Bangalore, India) and surgeons from the Manipal University Hospital (India) a robust diagnostic device is being developed for the clinical routine.

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n an endeavour to facilitate good patient care, Takeda Pharmaceuticals International AG (Takeda), a global research and development-driven pharmaceutical company, and Hikma Pharmaceuticals LLC (Hikma), a fast growing multinational pharmaceutical group, announced that they have agreed to a new licensing agreement, giving patients further access to Takeda’s portfolio of products in certain markets within the Middle East and North Africa (MENA) region. “At Takeda, we put patients at the center of everything we do. As such, our partnership with Hikma is a testament to our commitment to offering patients world-class cardiovascular and metabolism (CVM) medicines while keeping the focus on our core therapeutic areas of oncology and gastroenterology,” said Danilo Cassani, Takeda’s Vice President and Area Head Near East, Middle East & Africa. “This will help better serve the unmet medical needs of patients.” “Our large sales and marketing teams, with particular expertise in promoting cardiovascular and diabetes treatments, are well positioned to drive strong patient access to Takeda’s products. We are pleased to be building on our long history of partnering with Takeda to bring important medicines to the MENA region. This supports our strategy of working with global partners to strengthen our product portfolio in growing therapeutic areas and our commitment to improving patient access to quality medicines,” said Mazen Darwazah, Vice Chairman and CEO of Hikma MENA and Emerging Markets. The new agreement builds on a long-standing strategic partnership between Hikma and Takeda. The relationship leverages Hikma’s substantial sales and manufacturing presence in MENA and extensive experience of building brands in the region. This agreement is effective immediately for all markets.

NEWS

TECHNOLOGIES

Saudi Arabia Approves Oncothermia the Latest Technology in Cancer Treatment

dvanced technology to provide better and pain-free life with cancer and treat incurable tumors. After being approved in over 30 countries, the Saudi Food and Drug Authority (SFDA) approved the use of Oncothermia (modulated electro-hyperthermia, mEHT), the latest complementary cancer treatment technology. The treatment gives cancer patients enhanced the quality of life, improved survival rates, and comfort during the various stages of treatment as well as promotes their physical and psychological well-being.

cells temperature to 43⁰ C, while keeping the surrounding healthy tissues at core body temperature, or slightly higher, unlike conventional hyperthermia methods,” he said.

“Oncothermiais basically developed from the traditional oncological hyperthermia method, one of the oldest methods in fighting diseases,” said Eng. Hani Mohammed Saeed Yamani, General Manager of HYE, Exclusive Agents of Oncothermia devices in GCC. “Oncothermia does not raise the body temperature. It raises tumor

Unlike the traditional hyperthermia, Oncothermia targets only the tumor area, leaving the surrounding tissue unaffected. Conductivity in malignant cells is higher than that of normal cells, which means that the electric field applied will reach all malignant cells, increasing their temperature. Yamani pointed out that the treat-

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“The new technology uses a modulated electric field of 150 W, with a carrier frequency of 13.56MHz that is generated by electrodes,” Yamani explained. “The moving electrode is positioned in accordance with the body area being treated, while a second, stationary electrode always remains in a fixed position below the patient.”

ment is safe and nonpoisonous as it uses low energy levels and frequency fields. It provides various treatment options using Oncothermia for advanced incurable tumors, whether or not they can be surgically removed, as well as recurrent and metastatic cancers and prostate cancer. Oncothermia is not a stand-alone cancer treatment; it is provided as a complementary treatment. Studies have shown that applying Oncothermia together with radiation therapy or chemotherapy, can be highly effective, and can strongly enhance the effectiveness of other treatments. Consultants in the Saudi Arabia are currently being introduced to this new technology and its benefits, as well as the research conducted by Prof. AndrásSzász, the inventor of the treatment, to help ease the pain of cancer patients and assist in their healing process.

NEWS

Bellevue Medical Center Launches The “Chemo Care kit” in collaboration with Diakonia

s part of its ongoing cooperation with Diakonia, which aims at easing the burden of chronic illnesses on patients, their families, and involved staff, the Bellevue Medical Center launched the “Chemo Care Kit” initiative, the first of its kind in Lebanon and the soothing partner of patients during their chemotherapy journey. The launch event was held on Tuesday, July 11, in the presence of media professionals, healthcare specialists, and members of the organization. Knowing that this disease touches most families and leaves its negative and psychological impact on both the patients and their loved ones, it was

deemed necessary to seek a way that eases the long and hard journey of chemotherapy by providing simple and necessary requirements in the “Chemo Care kit” accompanying the patient to reduce the effects of treatment and thus ease the pain. The Bellevue Medical Center chose to offer a small bag that includes a collection of simple items that no one could imagine being this useful like creams for the lips and body to fight the dehydration caused by the treatment, notes books, snacks, crosswords to pass the time while waiting

and to keep the memory effective as the treatment can cause brain confusion and other items needed at this difficult stage. Commenting on the initiative, the President and CEO the hospital Dr. Dia Hassan said: “A simple gesture towards those we love can make a big difference during hard times and our support will help them to challenge the disease and alleviate its effects. We are proud to be working with the Diakonia organization as a special care provider to improve the patients’ quality of life as one cannot deny the importance of giving the necessary emotional and social care and its active contribution to the healing process.” The idea is part of a series of initiatives undertaken by the hospital in cooperation with Diakonia and its volunteers, which are available every week to provide emotional support for patients with difficult medical conditions and their families through individual meetings, gatherings and art therapy sessions such as music, theater, and other methods.

Thumbay Hospital organized a free health camp

humbay Hospital Day Care – University City Road, Sharjah, the multispecialty day care center operated by Thumbay Group’s healthcare division, organized a free health camp for the staff of Centro Sharjah Hotel, on 16th August 2017. More than 60 members of the hotel’s staff availed the free services offered by the camp including dental consultation, general practitioner consultation, blood sugar, blood pressure and BMI checkups. Located at University City Road, Muwaila, Sharjah, Thumbay Hospital Day Care offers treatment and procedures as day-cases, meaning no overnight stay in the hospital is required, and patients can rest and recuperate in their own homes. This day care hospital is a stateof-the-art multi-specialty facilities envisioned as a center housing all major specialties under one roof. Fully-equipped laboratory, advanced radiology services with ultrasound and x-ray facility and trained personnel to ensure optimum patient safety and satisfaction are some of the highlights of the hospital. The hospital uses the latest healthcare technology, which combined with excellent postoperative care and effective pain relief enable patients to recover in just a few hours. This also ensures minimal risk of hospital infections.

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NEWS

ARTICLE

Dr A. Azeem A. Wahab H. Abdulwahab Al-Ahli Hospital offers a holistic approach to guests with overweight and obesity by providing them the most realistic and effective opportunity to lose weight and lead a healthy life. It provides advanced treatment plans include counselling, nutritional advice and laparoscopic surgical procedures.

l-Ahli Hospitalâ€™s Dietary Department under the Obesity and Metabolic Disorders Centre is committed to providing quality and healthy food to its guests that meet the nutritional standards and different nationality food preferences. It provides standardized therapeutic diets as an intervention in the treatment process to assess the nutritional status of guests and as a part of the well-being services.

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The Dietary Department helps inhouse and visiting guests carry out dietary prescriptions according to the principles of therapeutic nutrition and dietary management through the Dietary Clinic at the Obesity and Metabolic Disorders Centre. Upon visits, experts will use educational visual aids as well as analyze body of guests composition before conducting nutritional and diet counseling for medical conditions such as obesity for

all hypertension, dyslipidemia, digestive diseases and metabolic disorders. They also emphasize on the importance of overall mental and physical wellbeing and natural free-of-toxins lifestyle. If needed assess and provide proper dietary guidelines for the bariatric procedures. Dr A. Azeem A. Wahab H. Abdulwahab, Senior Consultant Surgeon, Chief of Medical Staff and Director of General

ARTICLE

Surgery Department at Al-Ahli Hospital says, “We have a team of experts including physicians, dietitians, surgeons, endocrinologists and psychiatrists. When a guest comes we look at the exact need of the person, if they only need a dietitian, or a dietitian and psychiatrist or if the person is obsessed with a BMI above 40 and need a surgery. If the guest needs a bariatric surgery then they will need to consult a physician, endocrinologist, anesthetist and psychiatrist. But a surgery will be conducted only if the guests meet the required criteria.” Al-Ahli Hospital conducts endoscopic and laparoscopic surgical procedures to manage overweight and obesity. “We will decide either to do an Endoscopic Intragastric Balloon, Primary Obesity Surgery Endoluminal (POSE), gastric bypass surgery or sleeve gastrectomy procedure upon the person’s body mass index, age and health condition,” says Dr Abdulwahab. The balloon partially fills the stomach and limits food intake. Patients report that they have an enduring feeling of satiety. The procedure does not require surgery and is done in a daycare setting. Gastric bypass surgery makes the stomach smaller and reroutes the intestines. The sleeve gastrectomy is a weight loss procedure that removes part of the stomach and restricts the amount of food that can be eaten. POSE is a new technique introduced at Al-Ahli Hospital. The procedure is performed endoscopically through the mouth and inside the stomach, rather than through incisions in the abdomen. Special instruments are used to create folds in the stomach wall, reducing the overall capacity of the stomach and so the amount of

food that can be eaten. It means that patients can expect to feel fuller for longer on smaller portions. Between two to three weight loss procedures are performed at Al-Ahli Hospital, however Dr Abdulwahab encourages people to adopt healthy lifestyle practices and maintain their weight and health. “A surgical procedure should be considered as the last option for weight loss,” he said. In Qatar, more than 70 percent of the population are either overweight or obese and nearly half of all men (48%) are found obese, shows the Qatar Biobank 2016 report. The report also revealed that 83% of the population do little or no physical exercise, and 41 % are not participating in any physical exercise. Also more than 45% of participants consume fast food more than three times a week. The findings of the report are based on an analysis of biological samples and information collected from voluntary participants at the Qatar Biobank. It includes a comprehensive health profile of more than 5,000 Qataris and long-term residents. With an aim to combat and reduce the burden of obesity in the country, Al-Ahli Hospital will soon start a new initiative supplying healthy food for people intend to lose weight. The first of its kind initiative will give people a choice of more than 100 healthy cuisines carefully prepared under the supervision of expert dietitians. The initiative ‘Diet to Go’ by Al-Ahli Hospital will prepare food within the hospital campus under the strict monitoring of dietitians on calories and other factors which contribute to a

healthy meal. ‘Diet to Go’ will be commercialised and anyone would be able to order food through subscription. “Everyone can be part of ‘Diet to Go’ who wants to maintain their weight or intend to lose weight. To be more effective, it will be better if the guest meets our dietitians and get the exact specific diet. Because ‘Diet to Go’ is about calorie counted diet. So according to the person’s body mass index the dietitians will give the perfect menu and calorie intake per day. If you are on your own and just want to try us, you will be able to come to our shop and try our breakfast, lunch or dinner as you want, but each dish will indicate the amount of calories and ingredient content. But if you register with us, we will give you a program for one to three months as per your needs and deliver to you on daily basis,” says Dominique Richard, Catering Manager at Al-Ahli Hospital. “Every day we will have seven different menus and the menu will be changed every month. So if anyone wants to go on a special diet or lose weight, they don’t need to go for the usual boring food every day, but choose from a wide selection,” he added. Also according to Richard, guests registered with the hospital will be able to have mobile application, so they can log in with a password and username. Each guest will have a caloric intake designed to suit their health condition and needs. Guests will be able to select from the menu, but if they exceeded the designated calorie intake they will not be able to submit the order. The menu of ‘Diet to Go’ will be diversified to cater people of all nationalities. The ingredients will be selected fresh from local farms and the staff have been trained to make healthy meals based on calories.

NEWS

NMC Health

to Operate and Manage Emirates Healthcare Assets

mirates Healthcare, a leading healthcare provider owned by Abu Dhabi investment group KBBO, has announced signing an operating and management contract with NMC Health, the leading integrated healthcare provider operating across the United Arab Emirates, for the management of Emirates Healthcare assets. Yazen Abu Gulal, CEO of KBBO Group and Emirates Hospital Chairman commented, “We are particularly pleased to have NMC Health, a prestigious and recognized brand, handle the operations and management of Emirates Healthcare’s assets. Our expansion strategy and vision is to provide the

highest level of care for our customers and the expertise of NMC Health in operations and management has made them an ideal partner to provide a world-class experience.” Emirates Healthcare assets that fall under this agreement include recognizable brands such as CosmeSurge, which provides cosmetic medical services in the UAE and the UK, as well as Emirates Hospitals and Clinics which provide medical services across six emirates in the UAE. It also includes Emirates Rehab and Homecare Services, a division that provides home nursing, rehabilitation, therapeutic care and home-based care with a presence in the UAE, Slovakia and Oman. “Top international bodies responsible for regulating and governing healthcare provided positive feedback on NMC Health’s track record in all aspects of managing the operations of major medical institutions. The phenomenal reputation of NMC Health

informed our decision to sign over the management of Emirates Hospitals and Clinics, CosmeSurge and Emirates Rehab & Homecare Services. With this signing, we look forward to the future of these assets with great anticipation,” added Abu Gulal. CEO of NMC Health, Prasanth Manghat, stated, “The brands under Emirates Healthcare are among the most well-known in this market, and NMC Health is delighted to help bolster that reputation by streamlining their operations. We take great pride in the signing of this contract as it signifies NMC Health is rightfully recognized as a leader in the healthcare industry for its innovative management solutions and outstanding customer service. We look forward to working with Emirates Healthcare to help them achieve the vision of their management team and that of KBBO Group, setting the standard for the entire healthcare industry within the UAE.”

Julphar’s Board of Directors

appoints Jerome Carle as General Manager

Jerome Carle General Manager of Julphar

he regional leading pharmaceutical company Julphar announced that its Board of Directors has appointed Jerome Carle as General Manager – effective immediately. The Board expressed confidence in Jerome’s aptitude and SEPT.OCT 2017

competence to make an immediate impact to the business, to lead the management team and to execute the company’s strategic objectives. The Julphar roadmap – Vision 2020 – will be a key pillar to drive Julphar to the top of the MENA markets. Commenting on his appointment, General Manager Jerome Carle said: “I am very pleased, honored and humbled to have been appointed to this role, and I would like to thank the members of the Board for their trust. I am thrilled to serve a company that makes a real difference in patients and consumers’ quality of life. Julphar is uniquely positioned in the Middle East and African

markets to improve the healthcare system and I am proud to play a role in achieving our company’s mission.” Jerome Carle joined Julphar in January 2017 as Chief Financial Officer. He has over 20 years of financial expertise in emerging markets and his broad experience has shown his ability to deliver results in challenging environments. He has a proven track-record in the pharmaceutical industry, having served in the most reputable multi-national companies, with a full hand responsibility for the business operations, financials, and administration.

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NEWS

New partnership between Ile-de France & ESA

on strategic development projects, in collaboration with the CCIR Paris Ile-de-France declared that “These three projects are fully in line with the International cooperation strategy of the Region Ile de France which aims to reinforce the French speaking community, add a sparkle to French enterprises and digital expertise in Lebanon and promote the Region Ile de France as a fertile economic field’.

SA Campus & its Managing Director Mr. Stephane Attali welcomed Mrs. Valerie Pecresse, President of the Ile de France Region who announced her intention to seal a partnership between the Ile de France region and ESA with the collaboration of the CCIR (Chamber of Commerce and Industry) of Paris ile de France Region represented by its chairman, Didier Kling, and its vice chairman and financial secretary Bruno Didier. The French Ambassador to Lebanon Mr. Bruno Foucher and the President of the Chamber of Commerce, Industry and Agriculture of Beirut and Mount Lebanon Mr. Mohamad Choucair and Mr. Gaby Tamer President of the Franco-Lebanese Chamber of Commerce were also present. Mrs. Pecresse seized the opportunity to visit ESA incubator and accelerator, developed with the support of the French Embassy in Beirut and the Lebanese Central Bank, where she exchanged a few views with the creators of start-ups and the students of ESA as well as with Lebanese business leaders and economic representatives. President Pecresse has also shared the Region’s ambition to develop the entrepreneurial and innovative spirit

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among the young generation. This partnership between The Ile de France Region and ESA will be focused on three strategic development themes in ESA: Smart ESA incubator/accelerator, The Charles de Gaulle Institute of Lebanon and the Sports Complex.

“ESA is a privileged platform for the development of French Leadership in Lebanon and the region. This partnership will allow us in the framework of our mission to develop three new expertise centers where people will be offered the opportunity to gather around French excellence.” Mr. Stephan Attali, managing director of ESA has further declared.

Ile-de France Region will contribute to the purchase of technical equipment for the incubator/accelerator, educational digital equipment for the Charles de Gaulle Institute of Lebanon, and sports equipment for the sports complex. This contribution will be done with the assistance of the CCIR Paris Ile de France and will cover as well the launching and funding events for the Charles de Gaulle Institute and the sports complex expected in 2018. In her address, Mrs Vaelrie Percreese

“The Charles de Gaulle Institute and the Incubator/Accelerator projects are in line with CCI’s ambition to promote the digital by placing it at the heart of the training and coaching professional processes. I am glad to be part of this project’s realization, which bears a bunch of promises and meanings for the young generation, the development, the French speaking community and the economic ties that link our two countries, stated Didier Kling, president of the CCI Paris Ile de France.

H.O: Sami el Solh Av. - Ghorayeb Bldg l T: +961 1 389067 l F: + 961 1 389379 P.O.Box: 166 - 116 AshraďŹ eh, Beirut 1100 - 2100 Lebanon l marketing@victoire.com.lb

ARTICLE FEATURES . Organ Transplant

Scientific miracle and medical development that end the suffering of hopeless patients With the spread of the concept and culture of organ and tissue donation and transplantation, every donor, whether alive or dead, contributes to saving the life of a person who would face death one day. One or more organs are taken from a living or dead donor to replace another organ that is failing to function properly. This is the real scientific miracle that ends the suffering of patients who have lost their hope in life.

edical development has been manifested today in the transfer of organs such as the heart, kidneys, liver and pancreas and implanted in the body of someone else; this opens new horizons in the world of organ transplantation within modern treatments so that the damaged organ is replaced with a healthy one.

Kidney Transplant

The ideal option to save the lives of patients with renal failure Renal transplantation has entered the world of medicine to make a medical revolution in the world of organ transplantation after providing the optimal solution and treatment for acute renal failure that ended in sessions of dialysis. When the patient gets to the very advanced stages of his illness, his life is threatened until he finds a donor either alive or dead, giving him a kidney and making it the best option to save his life. Many tests and exams are performed to make sure that the

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tissues are compatible and it is usually best to have a related donor. A kidney transplant is a surgical procedure to place a kidney from a live or deceased donor into a person whose kidneys no longer function properly. Your kidneys remove excess fluid and waste from your blood. When your kidneys lose their filtering ability, dangerous levels of fluid and waste accumulate in your body â€” a condition known as kidney failure or end-stage kidney disease. A kidney transplant is often the best treatment for kidney failure. Only one donated kidney is needed to replace two failed kidneys, making living-donor kidney transplantation an option. If a compatible living donor isnâ€™t available for a kidney transplant, your name may be placed on a kidney transplant waiting list to receive a kidney from a deceased donor. The

ARTICLE FEATURES . Organ Transplant

wait is usually a few years. Unlike many other types of organ donation, it’s possible to donate a kidney while you’re alive because you only need one kidney to survive. This is known as a living donation. People who want to be considered as a kidney donor are tested very carefully to ensure they are a suitable donor and are fit for the operation needed to remove a kidney. Ideally, living donations will come from a close relative because they are more likely to share the same tissue type and blood group as the recipient, which reduces the risk of the body rejecting the kidney. Kidney donations are also possible from people who have recently died. This is known as deceased kidney donation. However, this type of kidney donation has a slightly lower chance of long-term success. If you receive a kidney from a living donor, this will be a carefully planned operation. If you’re waiting for a deceased donor kidney, the transplant

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centre will contact you when a suitable kidney becomes available. Staff at the centre will check you don’t have any new medical problems and will ask you to go to the centre, where final checks will be performed to be sure the transplant should go ahead. You’ll then have surgery to insert the new kidney and connect it to your blood vessels and bladder. The new kidney will be placed in the lower part of your abdomen. Your own kidneys will usually be left in place.

for the rest of their life. After your kidney transplant, you can expect to spend several days to a week in the hospital. Doctors and nurses monitor your condition in the hospital’s transplant recovery area to watch for signs of complications. Your new kidney will make urine like your own kidneys did when they were healthy. Often this starts immediately. In other cases it takes several days. Expect soreness or pain around the incision site while you’re healing.

A kidney transplant is a major surgical procedure with a wide range of potential risks. In the short term, these risks include blood clots and infection. Longer-term problems, which include diabetes and an increased risk of infections, are usually related to the medication you need to take to reduce the chance of rejection. Because of the risk of further problems, people who have had a kidney transplant require regular check-ups

After you leave the hospital, close monitoring is necessary for a few weeks. Your transplant team will develop a checkup schedule for you. You’ll take a number of medications after your kidney transplant. Drugs called immunosuppressants help keep your immune system from attacking your new kidney. Additional drugs help reduce the risk of other complications, such as infection, after your transplant.

ARTICLE FEATURES . Organ Transplant

Liver Transplant

The last resort for patients with end-stage liver disease A liver transplant is a surgical procedure to remove a diseased liver and replace it with a healthy liver from a donor. Most liver transplant operations use livers from deceased donors, though a liver may also come from a living donor. The number of people waiting for new livers is much larger than the number of available livers, so liver transplant is reserved for people who are critically ill. Some people receive a liver transplant right away, while others spend many months waiting for a liver transplant. Liver transplant is a treatment option for people who have end-stage liver failure that can’t be controlled using other treatments and for some people with liver cancer. Liver failure can occur rapidly, in a matter of weeks (acute liver failure), or it can occur

slowly over months and years (chronic liver failure). Liver failure has many causes, including liver cirrhosis, alcoholic liver disease, non-alcoholic fatty liver disease, early-stage liver cancer, hemochromatosis, primary biliary cirrhosis, Wilson’s disease, biliary duct atresia or cystic fibrosis. Liver transplant surgery can take up to 12 hours, depending on your situation. Once a suitable deceased donor liver has been found, the patient is called to the hospital. Donor livers function best if they are transplanted within 8 hours, although they can be used for up to 24 hours. Presurgical studies, including blood tests, urine tests, chest X-rays, and an ECG, are performed. Before surgery, a number of IV lines are started. The patient also receives a dose of steroids-one of the medicines to prevent rejection of the new liver-and a dose of antibiotics to prevent infection. The liver transplantation procedure takes about 6-8 hours.

After your liver transplant, you can expect to possibly stay in the intensive care unit for a few days. Doctors and nurses will monitor your condition to watch for signs of complications. They’ll also test your liver function frequently for signs that your new liver is working. You will have to spend 5-10 days in the hospital. Once you’re stable, you’re taken to a transplant recovery area to continue recuperating. Have frequent checkups as you continue recovering at home. Your transplant team designs a checkup schedule for you. You may undergo blood tests a few times each week at first and then less often over time. You’ll take a number of medications after your liver transplant, many for the rest of your life. Drugs called immunosuppressants help keep your immune system from attacking your new liver. Other drugs help reduce the risk of other complications after your transplant.

ARTICLE FEATURES . Organ Transplant

Heart Transplant

Giving the patient a chance to live longer A heart transplant is an operation in which a failing, diseased heart is replaced with a healthier, donor heart. Heart transplant is a treatment that’s usually reserved for people who have tried medications or other surgeries, but their conditions haven’t improved sufficiently. While a heart transplant is a major operation, your chance of survival is good, with appropriate follow-up care. Heart transplants are performed when other treatments for heart problems haven’t worked, leading to heart failure. In adults, heart failure can be caused by coronary artery disease, a weakening of the heart muscle (cardiomyopathy), valvular heart disease, a heart problem you’re born with (congenital heart defect) or failure of a previous heart transplant. Heart transplant surgery usually takes about four hours — longer if you’ve had previous heart surgeries or if there are complications during the procedure. The surgeons will open your chest and connect you to a heartlung machine to keep oxygen-rich blood flowing throughout your body. In this procedure, your surgeon will make an incision in your chest. Your surgeon will separate your chest bone and open your rib cage so that he or she can operate on your heart. Your surgeon then removes the diseased heart and sews the donor heart into place. He or she then attaches the major blood vessels to the donor heart. The new heart often starts beating when blood flow is restored. Sometimes an electric shock is needed to make the donor heart beat properly. You’ll be given medication to help with pain after the

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surgery. You’ll also have a ventilator to help you breathe and tubes in your chest to drain fluids from around your lungs and heart. After surgery, you’ll also receive fluids and medications through intravenous (IV) tubes. After you’ve had surgery to place your donor heart, you’ll likely remain in the hospital for a week or two, and then you’ll be closely monitored at your outpatient transplant center for about three months. While at the transplant center, you’ll have regular tests, including blood work, lung function tests, echocardiograms, electrocardiograms and heart biopsies. To determine whether your body is rejecting the new heart, you’ll have frequent heart biopsies in the first few months after heart transplantation, when rejection is most likely to occur. The frequency of necessary biopsies decreases over time. After the surgery, you will need to take immunosuppressants; these medications decrease the activity of your immune system to prevent it from attacking your donated heart. Because your immune system will most likely never completely accept the new organ, you’ll take some of these medications for the rest of your life. Most people who receive a heart transplant enjoy a high quality of life. They can return to work within three to six months of a heart transplant and have few activity restrictions.

Arterial Transplant

Restores heart efficiency and improves its functional capacity Not all heart diseases require a heart transplant; some cases require replacement of the arteries and the implant of others. Arterial transplant is an operation to connect and supply blood and oxygen to the heart muscle,

since those arteries are responsible for the blood flow to the muscle. Arteries and veins from the arm and leg veins are taken as needed as they do not cause the body any harm. Arterial transplant has been a remarkable success and has become the ultimate treatment for heart disease thanks to the technological development in the field of medicine and surgery, in addition to modern and sophisticated equipment. Arteries are damaged by the inability to allow blood flow to the heart muscle due to the narrowing of arteries and veins because of high cholesterol levels, which are deposited in the arterial wall, increasing the number of heart attacks that can lead to the death of part of the heart muscle. Arterial transplant is common among heart surgeries, and takes about 5 hours; the arterial transplantation process reduces the patient risk, and arteries can be used from anywhere inside or outside the body so that blood flow nourishes the heart muscle, as arterial transplant restores heart efficiency and improve its functional capacity. Doctors perform arterial transplant if the arteries are obstructed or narrowed and are unable to supply the heart muscle with blood and oxygen, due to the accumulation of fat and deposits inside the arteries causing atherosclerosis due to unhealthy eating habits, smoking, laziness, lack of physical activity and psychological stress, as the arteries are unable to provide proper blood flow for the nutrition of the heart muscle. This impedes blood flow and oxygen to reach the heart muscle, causing pain and narrowness in the chest area; thus, the patient is not benefiting from his medications intake which causes hypertension and leads to the loss of part of the heart and stroke.

ARTICLE FEATURES . Organ Transplant

Corneal Transplant

Modern & sophisticated methods that guarantee surgery success The cornea is the clear, front window of the eye. It helps focus light into the eye so that you can see. The cornea is made of layers of cells. These layers work together to protect your eye and provide clear vision. Your cornea must be clear, smooth and healthy for good vision. If it is scarred, swollen, or damaged, light is not focused properly into the eye. As a result, your vision is blurry or you see glare. If your cornea cannot be healed or repaired, your ophthalmologist may recommend a corneal transplant. This is when the diseased cornea is replaced with a clear, healthy cornea from a human donor. A human donor is someone who chooses to donate his or her corneas after their death to people who need them. All donated corneas are carefully tested to make sure they are healthy and safe to use. Eye disease and injuries can damage the cornea.

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Here are some common eye problems that can lead to a damaged cornea: • Keratoconus, where the cornea is coneshaped rather than dome-shaped. • Fuchs’ dystrophy, where cells in the inner layer of the cornea are not working effectively. • Eye infections or injuries that scar the cornea. • Previous corneal surgery or other eye surgery that damaged the cornea. There are different types of corneal transplants. In some cases, only the front and middle layers of the cornea are replaced. In others, only the inner layer is removed. Sometimes, the entire cornea needs to be replaced. Before your operation, your doctor will probably do an exam and some lab tests to check that you’re in good general health. You may have to stop taking certain medicines, such as aspirin, a couple of weeks before the procedure. Usually, you’ll have to use antibiotic drops in your eye the day before your transplant to help pre-

vent an infection. Most of the time, these surgeries are done as outpatient procedures under local anesthesia. This means you’ll be awake but woozy, the area is numb, and you’ll be able to go home the same day. Your doctor will do the entire surgery while looking through a microscope. It typically takes 30 minutes to an hour. Afterward, you’ll probably wear an eye patch for at least a day, maybe 4, until the top layer of your cornea heals. Your eye will most likely be red and sensitive to light. It might hurt or feel sore for a few days, but some people don’t feel any discomfort. Your doctor will prescribe eye drops to bring down inflammation and lower the chances of infection. He may prescribe other medicines to help with pain. He’ll want to check your eye the day after surgery, several times during the following couple of weeks, and then a few more times during the first year. You’ll have to protect your eye from injury after your surgery. Follow your doctor’s instructions carefully.

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What is bone conduction? The sound is perceived by means of both air and bone conduction. Sound waves conducted by air pass through the ear from the outside and reach the eardrum through the auditory canal. Bone conduction is the transmission of tones, sounds and other noises in the form of vibrations that pass through the cranial bone directly to the cochlea of the inner ear and its auditory hair cells, circumventing the outer and middle ear.

Useful applications for bone conduction Numerous benefits and, consequently, useful applications can be derived from this form of conduction. Bone-conduction hearing systems circumvent the outer and middle ear and therefore offer appropriate support in the event of damage to the middle and outer ear (conductive hearing loss). The ear remains unobstructed, meaning that awareness of the surrounding environment remains intact.

Generally, hearing loss can be divided into three categories: • • •

The loss of hearing caused by the two forms is compounded. In such cases, it is necessary to determine whether the use of a bone-conduction hearing system would be a suitable approach. This depends on the severity of the CHL and SHL.

CORRESPONDING EXAMPLES OF AUDIOGRAMS:

Conductive hearing loss (CHL) Stiffness type

In this case, the chain of ossicles in the middle ear stiffens, or tube dysfunction accompanied by negative pressure in the tympanic space occurs. Air-conduction hearing loss may be observed. This affects mainly the low and mid-frequency range. Possible pathological causes: • Stiff ossicular chain. • Tube obstruction and negative pressure in the tympanic space • Onset of otosclerosis. • Stiff eardrum from scarring.

Conductive hearing loss (CHL). Sensorineural hearing loss (SHL). Combined hearing loss.

Conductive hearing loss is the term used to describe impaired sound conduction in the outer ear or the middle ear. Air conduction is therefore disrupted. With the aid of bone conduction, it is possible to compensate for the conductive hearing loss. A distinction is made between three types: stiffness, attenuation and summation/obstruction. Sensorineural hearing loss implies damage to the inner ear and the cochlea, respectively. The vibrations can no longer be correctly absorbed by the auditory nerves and transmitted to the brain. In special cases, bone conduction is an appropriate solution. A distinction is made between high-frequency, mid-frequency, low-frequency and pantonal hearing loss. The combined hearing loss is a combination of CHL and SHL. Both air and bone conduction are thereby impaired.

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Attenuation type In this case, there is a loss of high frequency from air conduction due to e.g. a possible effusion in the middle ear. High frequencies are attenuated whilst the low-frequency range is affected to a lesser degree. Possible pathological causes: • Middle ear effusion. • Flaccid eardrum from scarring. • Fibrotic ossicular chain. • Cerumen plug.

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Combined hearing loss This is a combination of bone-conduction and air-conduction hearing loss, where air conduction is lower than that of the bone-conduction threshold. •

•

Summation/obstruction type

If the difference between the air and bone-conduction hearing loss is 25 to 40 dB, then air and bone-conduction hearing systems are suitable. If the difference between the air and bone-conduction hearing loss is > 40 dB, then bone-conduction hearing systems are most suitable.

This involves a combination of stiffness and attenuation in the middle ear. A blockage of the middle ear (e.g. advanced otosclerosis) can result in a conductive hearing disorder (pantonal conduction component) which is not dependent on frequency. Possible pathological causes: • Advanced otosclerosis. • Interruption of the ossicular chain.

Indications for bone-conduction hearing systems

Carhart’s notch A Carhart’s notch can develop in the presence of otosclerosis. This also involves a deterioration in the bone-conduction threshold in case of middle ear hearing loss alone, namely in the mid-frequency range at approx. 2 kHz. It occurs if the mobility of the stirrup has been completely negated by the otosclerotic changes.

In general, bone-conduction hearing systems are the treatment of choice for the following conditions: Congenital aural atresia, microtia (outer ear deformity), otosclerosis, deformed auditory canal, chronic otitis media (middle ear inflammation), allergic reaction to otoplasty, after surgery to the middle ear, chronic inflammation of the auditory canal, ear discharge, single-sided deafness. However, bone-conduction hearing systems are also beneficial in diverse cosmetic situations, e.g. if an ear mould or “blocking” of the auditory canal is undesirable. In addition, there is no irritation to the auditory canal as is the case with air-conduction hearing aids, for instance. Ultimately, it is also possible to combine hearing and visual aids in one pair of hearing glasses.

How bone-conduction hearing systems work

Carhart’s notch in the presence of stiffness

Bone-conduction systems receive and amplify sound waves, transforming them into vibrations that are forwarded directly to the cranial bone. The vibrations are perceived by the cochlea (the portion of the inner ear shaped like a snail shell) as tones, with any obstructions in the middle or outer ear being circumvented. Bone-conduction hearing systems are mainly worn behind the ear near the mastoid.

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Types of bone-conduction hearing system: These systems are available on the one hand as implants, and on the other hand as non-implantable devices combined with glasses or integrated into headgear, hairbands, etc. The major advantage of these hearing systems is that any risk in relation to surgery can be avoided. This is where BHM, the Austrian hearing aid developer, and manufacturer, comes in.

Bone-conduction hearing systems by BHM BHM is a specialist in non-surgical solutions using bone-conduction technology. In addition to bone-conduction hearing glasses, the Austrian specialist manufacturer also offers a miniature bone-conduction hearing system and a pocket hearing device that can be adapted â€“ due to being extremely flexible â€“ to the individual needs of each wearer.

Hearing glasses

Miniature bone-conduction hearing system and pocket hearing system based on bone conduction Bone-conduction hearing glasses are a combined visual and hearing aid in which the arms of the spectacles transmit vibrations to the inner ear. Bone-conduction glasses by BHM are not only extremely comfortable to wear but also, above all, reliable and technologically innovative, whilst offering all-round listening enjoyment â€“ wholly adapted to the individual needs of the wearer.

Contact mini

Developed especially for children contact mini was developed especially for children with mild to moderate hearing loss. The compact device consists of two interconnected units: an electronic compartment and a tiny miniature receiver, that can be easily and invisibly integrated into various types of headwear, hair bands or head jewelry. Children, therefore, benefit from total freedom of movement and are not restricted in any way. More and more adults are also discovering the benefits of contact mini. Sports enthusiasts, in particular, find that contact mini is a practical companion when running or skiing, for example,

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seeing that it can be integrated into sports caps and ski helmets, among others.

Apollon

Getting safely and swiftly through the day! Apollon is a modern, high-performance hearing aid that can deal with a wide range of demands and can be used both for bone and air conduction. The deliberate decision to keep its handling simple means it is especially suitable for those who are dependent on nursing care and have impaired motor skills. In addition, apollon is a reliable pocket hearing device. Its value lies in its compact size, making it the perfect companion in any environment.

Quality made in Austria BHM develops sophisticated hearing systems that are manufactured exclusively in Austria and marketed worldwide. Its wealth of experience and commitment to perfection make BHM a globally respected specialist in bone and air-conduction hearing devices.

ARTICLE FEATURES . Diabetes

Medical developments that have been spreading in recent years have led to the emergence of new generations of drugs that control blood sugar levels, and have had a significant impact on facilitating the life of patients with diabetes so that they are able to have a peaceful life with this chronic disease. Every year, we hear about a new drug with new specifications aimed at certain types of diabetes, thanks to medical research and studies around the world. As time and years have passed, we have seen fewer cases of sudden increases or decreases in blood sugar levels in patients. The development in the pharmaceutical field is accompanied by great awareness on how to live with diabetes and what methods should be followed, in terms of food consumption, medicine intake or lifestyle as a whole, in order to control diabetes and delay its complications.

etabolic diseases are rapidly increasing their prevalence and becoming one of the most important and costly problems affecting the worldâ€™s population and health care systems. Diabetes and its associated compli-

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cations have become a worldwide epidemic, with estimates of 382 million sufferers and 592 million people by 2,035. The strongest predictor of the development of this pathology is obesity, which is rapidly increasing worldwide mainly due

ARTICLE FEATURES . Diabetes

to an unbalanced diet and reduced physical exercise. WHO projects that diabetes will be the seventh leading cause of death in 2030. Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Type 1 diabetes is characterized by deficient insulin production and requires daily administration of insulin. The cause of type 1 diabetes is not known and it is not preventable with current knowledge.

TODAY, PATIENTS WITH DIABETES CAN LIVE A RELATIVELY NORMAL LIFE FREE OF COMPLICATIONS IN LIGHT OF THE MODERN THERAPEUTIC DEVELOPMENTS AS WELL AS LEADING A HEALTHY LIFESTYLE. Type 2 diabetes results from the body’s ineffective use of insulin. Type 2 diabetes comprises the majority of people with diabetes around the world, and is largely the result of excess body weight and physical inactivity. Symptoms of type 1 diabetes include excessive excretion of urine (polyuria), thirst (polydipsia), constant hunger, weight loss, vision changes, and fatigue. These symptoms may occur suddenly. Symptoms of type 2 diabetes may be similar to those of type 1, but are often less marked. As a result, the disease may be diagnosed several years after onset, once complications have already arisen. Gestational diabetes is hyperglycaemia with blood glucose values above normal but below those diagnostic of diabetes, occurring during pregnancy. Women with gestational diabetes are at an increased risk of complications during pregnancy and at delivery. They and their children are also at increased risk of type 2 diabetes in the future.

Culture of diabetic patients… for a better life

The patient’s understanding of the nature of his illness and the ways to deal with the disease allows him to control his blood sugar levels because he has become fully aware of the foods and exercises that are beneficial and harmful for his health; although in some cases, he may be unable to control the sudden rise or fall of his blood sugar levels, but maintaining these levels at a steady rate for a long time contributes to the reduction of sudden attacks and complications. Educating patients with diabetes is a necessary requirement today to protect them and reduce their suffering. Hence, educational and awareness programs as well as medical centers dedicated to this purpose have been established; their aim is to follow up with the patients on their case from the moment of diagnosis of the disease to giving them the necessary guidance and advice on how to adjust their blood sugar levels and keep it within the normal range. The most important step that a diabetic should follow in order to have a successful treatment is to maintain normal weight according to his body mass index depending on his height and weight; he should also do some exercise with the need to stick to the list of foods allowed or prohibited. In addition to that, the diabetic patient should always keep the diabetes screening machine handy in order to monitor his blood sugar levels at specific times and make sure that he takes the drugs or insulin injections at the right time determined by the doctor while staying away as much as possible from everything that can cause him tension and anxiety because of its major role in significantly increasing blood sugar levels to the extent that can cause a coma. The patient’s culture and awareness is an important factor that should be accompanied by the awareness of family members and everyone around the patient, such as preparing healthy food for him and learning about the symptoms of sudden increase or decrease of blood sugar levels in order for them to know how to deal with that and help him quickly and most importantly provide him with psychological support, encourage him and treat him as a normal person.

ARTICLE FEATURES . Diabetes

Type 1 diabetes…

Type 2 diabetes…

Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin. Insulin is a hormone needed to allow sugar (glucose) to enter cells to produce energy. Different factors, including genetics and some viruses, may contribute to type 1 diabetes. Although type 1 diabetes usually appears during childhood or adolescence, it can develop in adults.

Type 2 diabetes develops over a long period of time. During this period of time insulin resistance starts, this is where the insulin is increasingly ineffective at managing the blood glucose levels. As a result of this insulin resistance, the pancreas responds by producing greater and greater amounts of insulin, to try and achieve some degree of management of the blood glucose levels.

pancreatic dysfunction

insulin resistance

As insulin overproduction occurs over a very long period of time, the insulin producing cells in the pancreas wear themselves out, so that by the time someone is diagnosed with type 2 diabetes, they have lost 50 – 70% of their insulin producing cells. This means type 2 diabetes is a combination of ineffective insulin and not enough insulin. Initially, type 2 diabetes can often be managed with healthy eating and regular physical activity.

Treatment of type 1 diabetes focuses on managing blood sugar levels with insulin, diet and lifestyle to prevent complications. The doses of insulin injections that are currently available are of 2 types: long-acting insulin that lasts for 3-6 hours and intermediate-acting insulin that lasts for 12 hours. Insulin must be injected twice daily; the doctor must specify the number of doses that must be injected. Usually, four doses of insulin should be given daily and they consist of three rapid-acting insulin before meals and one intermediate-acting insulin before going to sleep. It is also possible to give a mixture of rapid and intermediate-acting insulin in the morning before breakfast and a similar injection before dinner; doses must be prescribed by a doctor. Insulin pumps may be an alternative to injections for some people with Type 1 diabetes. A pump is a small device, about the size of a small mobile phone. It delivers a steady flow of short-acting insulin around the clock. In most pumps, insulin is sent through a fine plastic tube that runs from the pump to a cannula (a very thin and flexible plastic tube) inserted just under the skin. But some pumps sit directly on your skin; they are called “patch pumps”.

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Over time most people with type 2 diabetes will also need tablets and many will eventually require insulin. It is important to note that this is the natural progression of the condition, and taking tablets or insulin as soon as they are required can result in fewer long-term complications.

Glucose

Glut-4

Insulin

Insulin receptor

Diabetes runs in the family. If you have a family member with diabetes, you have a genetic disposition to the condition. While people may have a strong genetic disposition towards type 2 diabetes, the risk is greatly increased if people display a number of modifiable lifestyle factors including high blood pressure, overweight or obesity, insufficient physical activity, poor diet and the classic ‘apple shape’ body where extra weight is carried around the waist.

ARTICLE FEATURES . Diabetes

Complications Long-term complications of diabetes develop gradually. The longer you have diabetes â€” and the less controlled your blood sugar â€” the higher the risk of complications. Eventually, diabetes complications may be disabling or even life-threatening. Diabetes dramatically increases the risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke and narrowing of arteries (atherosclerosis). If you have diabetes, you are more likely to have heart disease or stroke. Excess sugar can injure the walls of the tiny blood vessels (capillar-

ies) that nourish your nerves, especially in your legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward. Left untreated, you could lose all sense of feeling in the affected limbs. Kidney damage (nephropathy) is another complication caused by diabetes. The kidneys contain millions of tiny blood vessel clusters (glomeruli) that filter waste from your blood. Diabetes can damage this delicate filtering system. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, which may require dialysis or a kidney transplant. Diabetes can

damage the blood vessels of the retina (diabetic retinopathy), potentially leading to blindness. Diabetes also increases the risk of other serious vision conditions, such as cataracts and glaucoma. Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. Left untreated, cuts and blisters can develop serious infections, which often heal poorly. These infections may ultimately require toe, foot or leg amputation. Diabetes may leave you more susceptible to skin problems, including bacterial and fungal infections. Hearing problems are more common in people with diabetes.

ARTICLE FEATURES . Diabetes

Advanced Treatments

The evolution of insulin therapies Insulin injections are part of the basic treatments for some diabetics. The patient should inject himself daily and several times with insulin injections, which have developed significantly as they work to compensate for the shortfall caused by the pancreas when it stopped producing insulin. In this context, pharmaceutical companies have developed insulin pumps that have proven to be highly effective in controlling blood sugar levels, and significantly reducing the risk of hypoglycemia while eliminating the need for patients to inject themselves during the day and providing greater ability to control blood sugar levels. According to studies, using insulin pumps helps reduce episodes of extreme increase or decrease of blood sugar levels. It is continuously pumping insulin to the body on a 24-hour basis with doses programmed by the treating physician and this is called the pumping of insulin pump. Insulin pump is a small electronic device, about the size of a mobile phone. It can be easily carried on a belt, inside a pocket, or even attached to a bra thus becoming virtually invisible to others and allowing a very discreet therapy. The pump can help you more closely mimic the way a healthy pancreas functions. The pump, through a Continuous Subcutaneous Insulin Infusion (CSII), replaces the need for frequent injections by delivering precise doses of rapid-acting insulin 24 hours a day to closely match your bodyâ€™s needs. A programmed insulin rate made of small amounts of insulin delivered continuously mimics the basal insulin production by the pancreas for normal functions of the body (not including food). The programmed rate is determined by your healthcare professional based on your personal needs. This basal rate delivery can also be customized according to your specific daily needs. Additional insulin can be delivered â€œon demandâ€? to match the food you are going to eat or to correct high blood sugar. Insulin pumps have bolus calculators that help you calculate your bolus amount based on settings that are pre-determined by your healthcare professional and again based on your special needs.

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The long years of medical research and scientific studies have played an active role in understanding the nature of diabetes. Although no cure has been found, patients with diabetes today have a wide range of treatments that have helped control the rate of diabetes more than ever before. The doctor is able to determine the type of diabetes for each patient in order to prescribe a treatment suitable for his condition in the presence of several oral treatments, injections and insulin pumps. Hence, the treatment of diabetics varies among other groups of patients. There are drugs that increase the secretion of insulin from the pancreas, and other drugs that increase the function of insulin in the body in different ways. In some cases, the patient may need more than one drug to control his blood sugar levels.

Drug Therapy The treatment of diabetes in the past was based on limited types of traditional oral treatments, but in the past years new drugs that are more effective have emerged and contribute to effectively and safely reducing blood sugar levels. Previous treatments have always focused on reducing blood sugar levels through affecting the function of pancreas, liver and mechanisms that increases insulin hormone and its effectiveness, while the new generation of modern treatments affects the function of kidneys and intestines. Some groups of oral diabetes medications help lose weight which increases the control of blood sugar levels. GLP-1 Diabetes Drug Treatment: GLP-1 (glucagon-like peptide 1 receptor agonists) are incretin mimetics which have several benefits for diabetes management. They suppress post-prandial glucagon release, delay stomach emptying, and increase insulin sensitivity.

ARTICLE FEATURES . Hemophilia

Hemophilia is a rare inherited disorder in which your blood doesnâ€™t clot normally because it lacks sufficient blood-clotting proteins (clotting factors). If you have hemophilia, you may bleed for a longer time after an injury than you would if your blood clotted normally.

hen most people get a cut, the body naturally protects itself. Sticky cells in the blood called platelets go to where the bleeding is and plug up the hole. This is the first step in the clotting process. When the platelets plug the hole, they release chemicals that attract more sticky platelets and also activate various proteins in the blood known as clotting factors. These proteins mix with the platelets to form fibers, and these fibers make the clot stronger and stop the bleeding.

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Normal blood vessel

Haemorrhage

Inability to clot

ARTICLE FEATURES . Hemophilia

Our bodies have 13 clotting factors that work together in this process. Having too little of factors VIII (8) or IX (9) is what causes hemophilia. A person with hemophilia will only lack one factor, either factor VIII or factor IX, but not both. Internal bleeding caused by hemophilia can damage your organs and tissues, and may be life-threatening. There’s no cure for hemophilia yet, but with proper treatment and self-care, most people with hemophilia can maintain an active, productive lifestyle. Gestational diabetes is hyperglycaemia with blood glucose values above normal but below those diagnostic of diabetes, occurring during pregnancy. Women with gestational diabetes are at an increased risk of complications during pregnancy and at delivery. They and their children are also at increased risk of type 2 diabetes in the future.

There are two major kinds of hemophilia: 1.

Hemophilia A, which accounts for about 80% of cases, is when factor VIII is lacking. Females can be seriously affected only if the father has hemophilia and the mother is a carrier. Hemophilia A

Hemophilia B

2. Hemophilia B is when factor IX is lacking, symptoms for both cases are the same and the type of hemophilia can be only detected through a blood test. Signs and symptoms of hemophilia vary, depending on your level of

clotting factors. If your clotting-factor level is mildly reduced, you may bleed only after surgery or trauma. If your deficiency is severe, you may experience spontaneous bleeding. Symptoms of spontaneous bleeding include unexplained and excessive bleeding from cuts or injuries, or after surgery or dental work, many large or deep bruises, unusual bleeding after vaccinations, pain, swelling or tightness in your joints, blood in your urine or stool, nosebleeds without a known cause and unexplained irritability in infants. Hemophilia and other bleeding disorders don’t make you more prone to dental problems. However, avoiding proper preventive care of your teeth and gums can lead to more complicated and costly procedures in the future. Children and adults with hemophilia and other bleeding disorders need an aggressive, prevention-oriented program to maintain optimal oral health and minimize the risk of complications if dental problems arise. Making dental care part of your family’s daily routine takes only a few minutes. Add a couple of annual dentist visits to your brushing and flossing regimen, and your preventive care can pay off in the long haul. Hemophilia cannot be cured, however, patients who start prophylaxis early (by age 3) show a better musculoskeletal outcome and fewer joint bleeds. People with hemophilia should avoid taking aspirin and non

steroidal anti-inflammatory drugs (NSAIDs), get vaccinated (including infants) with the hepatitis B vaccine, administer factor VIII or IX on a regular basis, to help prevent bleeding and joint damage, avoid circumcising male infants of women known to be carriers until the baby has been tested for hemophilia and carry information at all times identifying the person as someone with hemophilia. While there’s no cure for hemophilia, most people with the disease can lead fairly normal lives. Your doctor may recommend having regular infusions of DDAVP or clotting factor, the infusions can help prevent bleeding. Taking clot-preserving medications (antifibrinolytics) that help prevent clots from breaking down as well as fibrin sealants that can be applied directly to wound sites to promote clotting and healing. Fibrin sealants are especially useful in dental therapy. Physical therapy can ease signs and symptoms if internal bleeding has damaged your joints. If internal bleeding has caused severe damage, you may need surgery. Using pressure and a bandage will generally take care of the bleeding. For small areas of bleeding beneath the skin, use an ice pack. Ice pops can be used to slow down minor bleeding in the mouth. Although blood products are screened, it’s still possible for people who rely on them to contract diseases. If you have hemophilia, consider receiving immunization against hepatitis A and B.

ARTICLE FEATURES . Hemophilia

Marrow Transplantation (BMT) from compatible donor. A bone marrow transplant is a medical procedure performed to replace bone marrow that has been damaged or destroyed by disease, infection, or chemotherapy. This procedure involves transplanting blood stem cells, which travel to the bone marrow where they produce new blood cells and promote growth of new marrow. Bone marrow also contains immature blood-forming stem cells known as hematopoietic stem cells, or HSCs. Most cells are already differentiated and can only make copies of themselves.

Thalassemia

Bone marrow transplantation… new hope for patients Thalassemia is an inherited blood disorder in which the body makes an abnormal form of hemoglobin - the protein molecule in red blood cells that carries oxygen. The disorder results in excessive destruction of red blood cells, which leads to anemia. Anemia is a condition in which your body doesn’t have enough normal, healthy red blood cells. Thalassemia is inherited, meaning that at least one of your parents must be a carrier of the disease. It’s caused by either a genetic mutation or a deletion of certain key gene fragments. There are two major types of thalassemia that are classified based on the severity of symptoms: minor and major. Children with thalassemia minor or trait, and those that are silent carriers do not experience symptoms or require treatment, while children with thalassemia major need ongoing medical care, including blood transfusions to alleviate severe anemia and chelation therapy to remove excess iron

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from the blood. Thalassemia major is the most severe form of beta thalassemia. It develops when beta globin genes are missing. The symptoms of thalassemia major generally appear before a child’s second birthday. The severe anemia related to this condition can be life-threatening. Other signs and symptoms include fussiness, paleness, frequent infections, a poor appetite, failure to thrive, jaundice and enlarged organs. This form of thalassemia is usually so severe that it requires regular blood transfusions. Symptoms of thalassemia begin during the first year of life, so 3-6 months after the birth of the baby, symptoms will appear and they include fatigue, weakness, pale appearance, facial bone deformities, slow growth, jaundice, irritability and abdominal swelling. Regular blood transfusions provide thalassemia patients with the red blood cells they need to survive. Once these red blood cells are broken down, however, the body is left with an excess of iron. The main cure available today for Thalassemia is Bone

THERE ARE TWO MAJOR TYPES OF THALASSEMIA THAT ARE CLASSIFIED BASED ON THE SEVERITY OF SYMPTOMS: MINOR AND MAJOR. CHILDREN WITH THALASSEMIA MINOR OR TRAIT, AND THOSE THAT ARE SILENT CARRIERS DO NOT EXPERIENCE SYMPTOMS OR REQUIRE TREATMENT. However, these stem cells are unspecialized, meaning they have the potential to multiply through cell division and either remain stem cells or differentiate and mature into many different kinds of blood cells. The HSC found in the bone marrow will make new blood cells throughout your lifespan. A bone marrow transplant replaces your damaged stem cells with healthy cells. This helps your body make enough white blood cells, platelets, or red blood cells to avoid infections, bleeding disorders, or anemia. Healthy stem cells can come from a donor, or they can come from your own body. In such cases, stem cells can be harvested, or grown, before you start chemotherapy or radiation treatment. Those healthy cells are then stored and used in transplantation.

ARTICLE FEATURES . Hemophilia

Sickle cell anemia

Blocks blood flow to the limbs and organs Sickle cell disease is a disorder that affects the red blood cells, which use a protein called hemoglobin to transport oxygen from the lungs to the rest of the body. Normally, red blood cells are round and flexible so they can travel freely through the narrow blood vessels. The hemoglobin molecule has two parts: an alpha and a beta. Patients with sickle cell disease have a mutation in a gene on chromosome 11 that codes for the beta subunit of the hemoglobin protein. As a result, hemoglobin molecules donâ€™t form properly, causing red blood cells to be rigid and have a concave shape. These irregularly shaped cells get stuck in the blood vessels and are unable to transport oxygen effectively, causing pain and damage to the organs. Sickle cell disease is inherited in an autosomal recessive pattern. This means that a child will not inherit the disease unless both parents pass down a defective copy of the gene. People who inherit one good copy of the gene and one mutated copy are carriers. They are clinically normal, but can still pass the defective gene to their children.

Normal red blood cells can live for 120 days in the bloodstream and then die. They carry oxygen and remove carbon dioxide from the body. In sickle cell anemia, the abnormal sickle cells usually die after only about 10 to 20 days. The bone marrow canâ€™t make new red blood cells fast enough to replace the dying ones. Sickle cell disease prevents oxygen from reaching the spleen, liver, kidneys, lungs, heart, or other organs, causing a lot of damage. Without oxygen, the cells that make up these organs will begin to die. For example, the spleen is often destroyed in these patients resulting in some loss of immune function. As a result, these patients often experience frequent infections. When sickle-shaped red blood cells get stuck in blood vessels this can cause episodes of pain called crises. Other symptoms include: delayed growth, strokes, and jaundice. A blood test can check for hemoglobin S, the defective form of hemoglobin that underlies sickle cell anemia. Diagnosing sickle cell anemia is very important especially in families that could be carrying the beta-thalassemia gene. Both defected genes along with beta globin can cause a

Abnormal hemoglobin

dangerous disease in grandchildren. A DNA testing before birth can be done to check if the fetus is at risk of having this dangerous disease. Doctors can provide treatments that help prevent complications from the disease. Folic acid, a vitamin that helps the body produce new red blood cells, is often prescribed for teens with sickle cell anemia. Pain medications help relieve the symptoms of crises. Kids and teens who have sickle cell disease should take penicillin or other antibiotics to help prevent infections. Drinking lots of fluids and avoiding extreme cold or heat can help prevent crises. But if a crisis is especially intense, they may need to go to the hospital for intravenous fluids and stronger pain medications. Many patients with sickle cell anemia occasionally need to get transfusions of healthy red blood cells to help carry oxygen to the tissues of their bodies more effectively and treat complications. Several new treatments, such as the drug hydroxyurea, have helped reduce painful crises. Hydroxyurea may not be appropriate for all patients with sickle cell anemia. It is a cytotoxic agent, and has the potential to cause life-threatening cytopenia.

normal hemoglobin

Sickle cells blocking blood flow

ARTICLE FEATURES . Electroencephalogram

An electroencephalogram (EEG) is a test that measures and records the electrical activity of your brain. Special sensors called electrodes are attached to your head. Theyâ€™re hooked by wires to a computer. The computer records your brainâ€™s electrical activity on the screen. Or it may record the activity on paper as wavy lines. Changes from the normal pattern of electrical activity can show certain conditions, such as seizures.

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ARTICLE FEATURES . Electroencephalogram

n EEG may be done to check for epilepsy and see what type of seizures is occurring. EEG is the most useful and important test for checking if someone has epilepsy. Check for problems with loss of consciousness or dementia, help find out a person’s chance of getting better after a change in consciousness, find out if a person who is in a coma is brain-dead.

It is also done to study sleep disorders, such as narcolepsy, watch brain activity while a person is getting general anesthesia for brain surgery. Help find out if a person has a physical problem or a mental health problem. Physical problems include problems in the brain, spinal cord, or nervous system. An EEG may be done in a hospital or in a doctor’s office. An EEG technologist does the test. The EEG record is read by a doctor who is trained to diagnose and treat problems that affect the nervous system. The EEG technologist will attach several flat metal discs (electrodes) to different places on your head. A sticky paste is used to hold them in place. In rare cases, the electrodes may be attached to the scalp with tiny needles. The electrodes are hooked by wires to a computer that records the electrical activity in the brain. A machine can show the activity as a series of wavy lines on a piece of paper. Or the activity may be shown as an image on the computer screen. An EEG takes 1 to 2 hours. After the test, you may do your normal activities. But if you had little or no sleep or were given a sleep medicine, have someone drive you home after the test.

Epilepsy patients and EEG EEG is an important test for diagnosing epilepsy because it records the electrical activity of the brain. The EEG shows patterns of normal or abnormal brain electrical activity. Some abnormal patterns may occur with a number of different conditions, not just seizures. For example, certain types of waves may be seen after head trauma, stroke, brain tumor, or seizures. A common example of this type is called “slowing,” in which the rhythm of the brain waves is slower than would be expected for the patient’s age and level of alertness. Certain other patterns indicate a tendency toward seizures. Your doctor may refer to these waves as “epileptiform abnormalities” or “epilepsy waves.” They can look like spikes, sharp waves, and spike-and-wave discharges. If you have partial seizures, spikes and sharp waves on the EEG in a specific area of the brain, such as the temporal lobe, can show where the seizures are coming from. Generalized epilepsy is suggested by spike-and-wave discharges that are widely spread over both side of the brain, especially if they begin in both sides at the same time.

ARTICLE FEATURES . Epidemics

The spread of pandemics is a real threat to the population, which may be greater than the risk of war because they spread rapidly among people before finding appropriate treatment or vaccine. The spread of epidemics has increased in recent years. From time to time we hear about a new virus that causes a real threat to the entire world and there is no clear treatment for it. Viruses include Zika, Ebola, swine flu (H1N1) and many other epidemics that have killed so many people in the past few years as they are transboundary and cannot be confined to a specific geographical area, especially in light of the openness between countries and the abundance of travel among humans.

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n epidemic is therefore a disease that affects a very large number of people in a society at the same time; there are some factors that have contributed to the expansion and spread of epidemics among people; population growth and frequent mixing among people is one of the most important factors that increased the spread of diseases, in addition to unclean water or mosquitoes. On the other hand, climate change and global warming are an ideal environment for disease growth and transmission, as global travel increases. International tourist arrivals grew by 4.4% in 2015 to reach a total of 1,184 million in 2015, according to the latest UNWTO World Tourism Barometer. Some 50 million more tourists travelled to international destinations around the world last year as compared to 2014.Â

ARTICLE FEATURES . Epidemics

Swine flu

One of the most difficult viruses for its ability to change rapidly It has been reported that the 2009 swine H1N1 flu pandemic, responsible for more than 17,000 deaths worldwide, originated in pigs from a very small region in central Mexico. The scientists say their findings represent the first time that the origin of an influenza pandemic virus has been determined in such detail.

The symptoms of swine flu are very much like those of regular influenza. They include: • • • • • • • • • •

Chills. Fever. Coughing. Sore throat. Runny or stuffy nose. Body aches. Fatigue. Diarrhea. Nausea. Vomiting.

The best way to prevent swine flu is to get a yearly flu vaccination. Other easy ways to prevent swine flu include: • •

• •

Frequently washing hands with soap or hand sanitizer. Not touching your nose, mouth, or eyes (The virus can survive on surfaces like telephones & tabletops). Staying home from work or school if you’re ill. Avoiding large gatherings when swine flu is in season.

When it first emerged, swine flu was most common in children 5 years and older and young adults. This was unusual because most flu virus infections are a higher risk for complications in older adults or the very young. Today, risk factors for getting swine flu are the same as for any other strain of the flu. You’re most at risk if you spend time in an area with a large number of people who are infected with swine flu. Swine flu is now considered another human flu virus that can be prevented with the yearly flu vaccine. It has similar symptoms and treatments and is transmitted in the same ways as the regular flu virus. Like other strains of the flu, H1N1 is highly contagious, allowing it to spread quickly from person to person. A simple sneeze can cause thousands of germs to spread through the air. The virus can linger on tables and surface areas like door knobs, waiting to be picked up. The best means of dealing with swine flu is to prevent it. Hand sanitization is important to stop the spread of the virus. Staying away from infected people will help stop person-to-person transmission.

It’s important to follow any public health recommendations regarding school closures or avoiding crowds during the flu season. These recommendations may come from the CDC, WHO, National Institutes of Health, or other governmental public health institutions.

ARTICLE FEATURES . Epidemics

Ebola Virus Disease A fast-moving epidemic

Between December 2013 and April 2016, the largest epidemic of Ebola virus disease (EVD) to date generated more than 28,000 cases and more than 11,000 deaths in the large, mobile populations of Guinea, Liberia, and Sierra Leone. Tracking the rapid rise and slower decline of the West African epidemic has reinforced some common understandings about the epidemiology and control of EVD but has also generated new insights. Ebola is a rare but deadly virus that causes fever, body aches, and diarrhea, and sometimes bleeding inside and outside the body. As the virus spreads through the body, it damages the immune system and organs. Ultimately, it causes levels of blood-clot-

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ting cells to drop. This leads to severe, uncontrollable bleeding. It kills up to 90% of people who are infected. Ebola isn’t as contagious as more common viruses like colds, influenza, or measles. It spreads to people by contact with the skin or bodily fluids of an infected animal, like a monkey, chimp, or fruit bat. Then it moves from person to person the same way. Those who care for a sick person or bury someone who has died from the disease often get it. Other ways to get Ebola include touching contaminated needles or surfaces. You can’t get Ebola from air, water, or food. A person who has Ebola but has no symptoms can’t spread the disease, either. Early on, Ebola can feel like the flu or other illnesses. Symptoms show up 2 to 21 days after infection and usually

include high fever, headache, joint and muscle aches, sore throat, weakness, stomach pain and lack of appetite. As the disease gets worse, it causes bleeding inside the body, as well as from the eyes, ears, and nose. Some people will vomit or cough up blood, have bloody diarrhea, and get a rash. Since there is no cure for Ebola, prevention focuses on avoiding contact with the viruses.

The following precautions can help prevent infection and spread of Ebola: • • • • • •

Avoid areas of known outbreaks. Wash your hands frequently. Avoid bush meat. Avoid contact with infected people. Follow infection-control procedures. Don’t handle remains

ARTICLE FEATURES . Epidemics

Zika Virus Infection and Congenital Abnormalities Zika virus disease is caused by a virus transmitted primarily by Aedes mosquitoes, the same type of mosquito that carries dengue fever, yellow fever, and chikungunya virus. People with Zika virus disease can have symptoms including mild fever, skin rash, conjunctivitis, muscle and joint pain, malaise or headache. The virus causes birth defects in babies born to some infected pregnant women, including microcephaly, where babies are born with underdeveloped heads and brain damage. Zika has also been linked to Guillain-Barre syndrome, a condition in which the immune system attacks the nerves. It’s mainly spread through mosquitoes, although some cases of sexual transmission have been reported. The Zika virus, first identified in Uganda in 1947; a mosquito bites an infected person and then passes those viruses to other people it bites. Outbreaks did not occur outside of Africa until 2007, when it spread to the South Pacific. The disease can cause fever, rash, joint pain, and redness in the whites of the

eye (conjunctivitis, or pinkeye). But most people won’t know they have it. Symptoms can appear anywhere from 3 to 14 days after a bite from an infected mosquito, according to the CDC. They can last from several days to about a week. There’s no treatment for Zika virus but most people with symptoms do well with over-the-counter medications for aches and pains. The disease usually runs its course within a week or so. It is recommended that infected people get plenty of rest, drink fluids to prevent dehydration, and take acetaminophen for fever and pain. Aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) should not be taken until dengue is ruled out, to reduce bleeding risk, the agency says. There is no vaccine against Zika, but the National Institutes of Health is testing one in humans. If you plan to travel in affected areas, avoid mosquito bites by using repellent throughout the day. Also, wear long-sleeved shirts and long pants, indoors and out. Around your home, use screens on windows and doors, and get rid of standing water -- in

tires, buckets, planters, and flowerpots, for example -- as mosquitoes lay eggs near water. Even those who don’t know they have Zika can spread the disease. People who have traveled to affected regions should be extremely vigilant against mosquito bites when they return home. The CDC also recommends using condoms or abstaining from sex for 8 weeks for women or 6 months for men to avoid sexual transmission. The best way to reduce mosquitoes is to eliminate the places where the mosquito lays her eggs, like artificial containers that hold water in and around the home. In urban areas, Aedes mosquitos breed on water collections in artificial containers such as plastic cups, used tires, broken bottles, flower pots, etc.

THERE’S NO TREATMENT FOR ZIKA VIRUS BUT MOST PEOPLE WITH SYMPTOMS DO WELL WITH OVERTHE-COUNTER MEDICATIONS FOR ACHES AND PAINS. Periodic draining or removal of artificial containers is the most effective way of reducing the breeding grounds for mosquitos. Larvicide treatment is another effective way to control the vector larvae but the larvicide chosen should be long-lasting and preferably. There are some very effective insect growth regulators (IGRs) available which are both safe and long-lasting (e.g. pyriproxyfen). For reducing the adult mosquito load, fogging with insecticide is somewhat effective.

ARTICLE FEATURES . AIDS

The scales have tipped in the fight against AIDS, with AIDS-related deaths almost halving since 2005 and more than half of people infected with HIV now getting treatment, the United Nations has said.

mong the most significant impacts of a vast scale-up of HIV testing, treatment and prevention programs has been in the reduction of AIDS-related deaths, which have dropped by almost half since 2005. As a result, more people are now living longer in what had been some of the worst affected countries.

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It is possible to say today that the disease has started to decline to some extent now, especially after the World Health Organization has set some goals and recommendations for this purpose and began to implement them, including the adoption of new innovative policies to combat the disease, with the need to urge countries and local communities to deploy highly effective services to prevent the virus and continue to expand treatments, as well as address the geographical differences without neglecting anyone while following methods specially designed to meet the diverse needs of people.

200 are at high risk of developing serious illnesses. HIV treatment is recommended for all people living with HIV. It is especially important for people with low CD4 counts.

AIDS is therefore a chronic disease caused by a virus called HIV that affects and destroys CD4 cells, a type of white blood cell responsible for the immune system. People living with HIV who have a CD4 cell count below

Many people have no symptoms when they first become infected with HIV. Some people may have a flu-like illness (including fever, headache, tiredness and enlarged lymph nodes) within a month or two after expo-

Transmission HIV can be transmitted via the exchange of a variety of body fluids from infected individuals, such as blood, breast milk, semen and vaginal secretions. Individuals cannot become infected through ordinary day-to-day contact such as kissing, hugging, shaking hands, or sharing personal objects, food or water.

Symptoms

ARTICLE FEATURES . AIDS

sure to the virus. These symptoms usually disappear within a week to a month and are often mistaken for those of another viral infection. More severe symptoms may not appear for 10 years or more. Even during the asymptomatic period, the virus is active inside a person’s body and can be passed to another person. As the immune system worsens, a variety of complications start to occur. For many people, the first signs of infection are large lymph nodes or “swollen glands” that may be enlarged for more than three months. Other symptoms often experienced months to years before the onset of AIDS include: •

Lack of energy or fatigue: The inflammatory response generated by your besieged immune system also can cause you to feel tired and lethargic. Fatigue can be both an early and later sign of HIV.

•

Frequent low-grade fevers: One of the first signs of ARS can be a mild fever. The fever, if it occurs at all, is often accompanied by other usually mild symptoms, such as fatigue, swollen lymph glands, and a sore throat.

•

Achy muscles, joint pain, swollen lymph nodes: ARS is often mistaken for the flu, mononucleosis, or another viral infection, even syphilis or hepatitis. That’s not surprising: Many of the symptoms are the same, including pain in the joints and muscles and swollen lymph glands.

•

Sore throat and headache: As with other symptoms, sore throat and headache can often be recognized as ARS.

•

Skin rashes or flaky skin that is hard to heal: It may appear in

the early or advanced stages and shows pink areas on the arms that cause itching. •

•

Nausea, vomiting, and diarrhea: Anywhere from 30 to 60% of people have short-term nausea, vomiting, or diarrhea in the early stages of HIV. These symptoms may also occur as a result of antiretroviral therapy, and later in the infection, usually as the result of an opportunistic infection. Weight loss: It is a sign of more advanced illness and could be due in part to severe diarrhea. A person is considered to have wasting syndrome if they lose 10% or more of their body weight and have had diarrhea or weakness and fever for more than 30 days. Dry cough: This symptom, an insidious cough that could be going on for weeks that doesn’t seem to resolve is typical in very ill HIV patients.

•

Pneumonia: The cough and the weight loss may also presage a serious infection caused by a germ that wouldn’t bother you if your immune system was working properly.

•

Night sweats: About half of people get night sweats during the early stages of HIV infection.

•

Menstrual irregularities: Advanced HIV disease appears to increase the risk of having menstrual irregularities, such as fewer and lighter periods.

Today, in the absence of any HIV cure, the solution is to prevent and avoid getting infected and follow the guidelines in this field. People with HIV can only live with the disease and adhere to treatment, which includes antiretroviral drugs that slow down the virus inside the body in a way that almost stops its activity.

NEWS

Ophthalmologists in Abu Dhabi

successfully restore vision of an elderly emirati woman who has not been able to see her children for 8 years

team of ophtalmologists from Moorfields Eye Hospital in Abu Dhabi successfully restored the vision of an 80-year-old Emirati woman, Bakheeta Al Mansouri, after eight years of suffering from a very poor vision where she could only differentiate between light and dark, and see some shadows. The woman had very dense cataracts in both eyes and one eye had long-standing retinal detachment, which was detected with ultrasound of her eyes. In addition, she had inward turn of the eye lid, in-growing

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eye lashes and abnormal blood vessels over her corneas. Majd Abu Zant, Chief Operating Officer of United Eastern Medical Services (UEMedical), said “the patient visited Moorfields Eye Hospital Center in Abu Dhabi, a joint partnership between UEMedical and Moorfields Eye Hospital in London, early this year. Staffed with top-notch ophthalmologists most of whom trained or worked in Moorfields Eye Hospital in London, the patient was put on a treatment plan to restore her vision by multiple specialized physicians

and surgeons in Abu Dhabi’s facility.” Dr. Syed Mohammed Asad Ali, the Consultant Ophthalmologist at Moorfields Eye Hospital in Abu Dhabi who performed several surgical procedures for the patient, said “for the last 2 years, the patient was not walking alone, as she couldn’t see her way. She was chairbound and needed help in her everyday activities. At the beginning of the treatment plan, Dr. Yassir Abou-Rayyah, Consultant Ophthalmologist Surgeon at Moorfields Eye Hospital, conducted a surgical operation to improve her eyelid position.”

NEWS

He added, “The patient had severe sight impairment due to scared corneal due to in growing eye lashes. She also had very dense cataracts in both eyes and long-standing retinal detachment in one eye. At first, we removed her ingrowing eyelashes with a technique called electro epilation which reduces the chances of re-growth of ingrowing eyelashes. This procedure improved her cornea status and reduced the risk of infection. At the second stage, a cataract surgery with phacoemulsification (using ultrasound) with lens implantation under anesthesia by eye drops only was performed. This procedure was very challenging due to the status of the cataract and the general health of the patient.” “Due to her heart condition, she was not fit for general anesthesia, as she was on high dose blood thinner and high risk of bleeding, so an injection of anesthesia over the eye was not ideal. Also, the type of cataract could have been treated by older techniques but due to her other medical

Majd Abu Zant Chief Operating Officer of United Eastern Medical Services conditions, this was not the best option. Next day after surgery, the patient noticed a great improvement in vision and started reading half of the eye test chart. She started crying with joy for seeing her son and family after many years.” Dr. Syed Ali added. “Restoring our patient’s vision and improving their quality of life is truly

Dr. Syed Mohammed Asad Ali the Consultant Ophthalmologist at Moorfields Eye Hospital in Abu Dhabi rewarding for us all,” Dr. Syed concluded. Her son, Mr. Saif Al Mansouri said, “We are grateful for Dr. Syed and the team of Moorfields Eye Hospital Abu Dhabi who have changed my mother’s life. She can walk now, independently finding her way, and planning to go on holidays.”

NEWS

Sheikh Hamdan bin Rashid Al Maktoum Award

for Medical Sciences participates in the national outreach seminar on UAE technical cooperation with IAEA

heikh Hamdan bin Rashid Al Maktoum Award for Medical Sciences participated in a workshop on the national outreach seminar on UAE technical cooperation with the International Atomic Energy Agency (IAEA), which was held at Khalifa University of Science and Technology in Abu Dhabi from 20th to 22nd of August, in the presence of H.E Abdullah bin Souqat, Executive Director of the Award. The workshop aimed at highlighting the concept of peaceful nuclear energy applications and the IAEA’s

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ability to provide support to national stakeholders through technical cooperation programs. These programs are aimed at enhancing collaboration among local entities and engaging new stake holders and potential partners who can participate and support the program, both in terms of expertise and financial capacity. The Award’s participation in the workshop was through its support for scientific activities in the field of radiation medicine as a peaceful application of nuclear energy since 2014. Close to 24 scientific activities in-

volving the implementation of IAEA’s projects at the regional or national levels have been carried out by health authorities such as the Dubai Health Authority and the Health Authority of Abu Dhabi with the support of the Award. The Award assists these projects with financial and/or logistical support based on the requirements of each individual activity. Examples include the IAEA regional projects on Strengthening Nuclear Medicine Applications through Education and Training to help Fighting Non-Communicable Diseases as on-

NEWS

cology and Cardiology, IAEA National Project on Strengthening the National Program on Patient Radiation Safety and Dosimetry and Referral guidelines in Radiology and Nuclear Medicine for referral physicians, the national program for Cancer management and control in the UAE. During the workshop, H.E Abdulla bin Souqat stressed on the necessity of strengthening cooperation with competent international organizations in order to support sustainable development within the UAE and beyond.

the best practices. The workshop was attended by several national entities interested in technical cooperation projects with the Agency such as Dubai Health Authority, Abu Dhabi Health Authority, Federal Authority for Nuclear Regulation, Emirates Nuclear Energy Corporation, Nawaat Energy Company and Khalifa Uni-

versity. The Agency, in an exchange with officials of national institutions, focused on the peaceful uses of nuclear energy in the fields of health, agriculture, water purification and air pollution, with a strategy for future projects and reviewing many previous success stories resulting from cooperation with the Agency.

He added that the technical cooperation projects of IAEA are supported by the Award, given their vital role in promoting peaceful uses of atomic energy in the UAE, especially in the medical field, and strengthening the global status of the UAE in applying

ARTICLE FEATURES . Rheumatic heart

Rheumatic Heart Disease Affects and damages the heart valves

Rheumatic heart disease is the most serious manifestation of acute rheumatic fever and is the most common cause of death in acute rheumatic fever. It describes a group of short-term (acute) and long-term (chronic) heart disorders that can occur as a result of rheumatic fever. One common result of rheumatic fever is heart valve damage. This damage to the heart valves may lead to a valve disorder.

tudies indicate that very few parents know that there is a connection between a sore throat and heart disease in children. All children with a sore throat, and who do not have a runny nose are advised to see a doctor as soon as possible. Prompt and effective treatment of streptococcal infection with antibiotics will usually prevent rheumatic fever developing, and also reduces the risk of streptococcus being transmitted to other people.

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People who have already had rheumatic fever are more susceptible to further attacks. Such people need long-term antibiotic treatment to prevent rheumatic heart disease.

out the body, especially in the heart, joints, brain and skin. Although rheumatic fever can strike people of all ages, it is most common in children between 5 and 15 years old.

Symptoms

The best way to prevent rheumatic fever is to treat strep throat with antibiotics. The symptoms of rheumatic heart disease vary and damage to the heart often is not readily noticeable. When symptoms do appear, they may depend on the extent and

Rheumatic heart disease is a complication of rheumatic fever in which the heart valves are damaged. Rheumatic fever is an inflammatory disease that begins with strep throat. It can affect connective tissue through-

ARTICLE FEATURES . Rheumatic heart

location of the heart damage. Typically, symptoms of rheumatic fever appear about two weeks after the onset of an untreated strep throat infection. Apart from the sore throat caused by the strep infection, children have a fever and feel ill. Commonly, the child will have a very painful, swollen and red joint — usually a large joint like a knee, ankle, elbow or shoulder — that goes away after a day or two only to be replaced by the same problem in another joint. Short-lived skin rashes may occur, but are not common. Even if the heart is affected, it is usually not severe enough to cause symptoms, although occasionally the child may be short of breath. Symptoms of heart valve problems, which are often the result of rheumatic heart disease, can include: chest pain, excessive fatigue, heart palpitations (when the heart flutters or misses beats), a thumping sensation in the chest, shortness of breath, and swollen ankles, wrists or stomach. The causes of infection may be caused by extreme poverty, overcrowding, lack of healthcare, especially in poor countries, or chronic rheumatic fever.

symptoms of a strep infection. The doctor will do a physical examination and check your child for signs of rheumatic fever, including joint pain and inflammation. The doctor also will listen to your child’s heart to check for abnormal rhythms or murmurs that may signify that the heart has been strained. In addition, there are a couple of tests that may be used to check the heart and assess damage, including: •

Chest X-ray to check the size of the heart and to see if there is excess fluid in the heart or lungs.

•

Echocardiogram, a non-invasive test that uses sound waves to create a moving image of the heart and to measure its size and shape.

•

Blood tests, C reactive protein (CRP) – which tests the level of C reactive protein (CRP) in your blood, Erythrocyte sedimentation rate (ESR) – in an ESR test, a sample of your red blood cells is placed into a test tube of liquid. If the blood is “sticky” due to various substances produced during the immune response, the red blood cells will settle higher

up the tube. If these substances aren’t present, the blood cells will be lower down the tube.

Treatment Rheumatic fever requires treatment with antibiotics. After initial treatment, preventative medicines (prophylactic antibiotics) are needed to make sure the strep infection doesn’t come back. Your doctor may also prescribe anti-inflammatory medicine to treat the joint pain and swelling. Bed rest may be recommended, and this can range from 2 to 12 weeks, depending on the seriousness of the illness. If diagnosed with rheumatic fever, your child will need follow-up care with a heart doctor (pediatric cardiologist) to check for long-term damage to the heart (rheumatic heart disease). Once a child gets rheumatic heart disease from a strep infection, they may have to take medicine (antibiotics) for decades to prevent a return of rheumatic fever that can cause more damage to their heart valves. If your child has a damaged heart valve that is narrow or leaks enough blood to strain their heart, they may need surgery to repair or replace the valve.

Diagnosis The first step in diagnosing rheumatic heart disease is establishing that your child recently had a strep infection. The doctor may order a throat culture, a blood test, or both to check for the presence of strep antibodies. However, it is likely that signs of the strep infection may be gone by the time you take your child to the doctor. In that case, the doctor will need you to try to remember if your child recently had a sore throat or other

normal heart

rheumatic valve 71

ARTICLE FEATURES . Teenagers’ health

ADOLESCENCE

AND THE MENTAL DISORDERS associated with it Several health problems due to physical and sexual maturity Adolescence typically describes the years between ages 13 and 19 and can be considered the transitional stage from childhood to adulthood. However, the physical and psychological changes that occur in adolescence can start earlier, during the preteen or “tween” years (ages 9 through 12). Adolescence can be a time of both disorientation and discovery. This transitional period can bring up issues of independence and self-identity; many adolescents and their peers face tough choices regarding schoolwork, sexuality, drugs, alcohol, and social life. Peer groups, romantic interests, and appearance tend to naturally increase in importance for some time during a teen’s journey toward adulthood.

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ARTICLE FEATURES . Teenagers’ health

dolescence can be a risky time. Although all of the changes you experience in puberty are natural and healthy, teens don’t always react to these changes in a safe or healthy way. Teen hormones have an impact not only on their bodies and minds, but also on their behavior. Peer pressure, low self-esteem, and hormonal surges can lead teens to take chances and engage in risky behaviors that could have a negative effect on their future. As children enter their teenage years, it’s important for them to have a support system they can rely on. Parents, siblings, counselors, teachers, and good friends can provide strength and advice as teens navigate this challenging, exciting time in their lives.

Mental Disorders

egies useful for managing behavioral problems in children can also be used in children who have mental disorders. Furthermore, appropriate management of childhood behavioral problems may decrease the risk of temperamentally vulnerable children developing a full-blown disorder. Also, effective treatment of some disorders (eg, anxiety) during childhood may decrease the risk of mood disorders later in life. The most common mental disorders of childhood and adolescence fall into the following categories: anxiety disorders, stress-related disorders, mood disorders, obsessive-compulsive disorder and disruptive behavioral disorders, conduct disorder, and oppositional defiant disorder.

Acne

The result of hormonal imbalance in puberty

Acne is a skin condition that shows up as different types of bumps. They include whiteheads, blackheads, red bumps (pimples), and bumps that are filled with pus (called pustules). Your skin is covered with tiny holes called hair follicles, or pores. Pores contain sebaceous glands (also called oil glands) that make sebum, an oil that moistens your hair and skin. Most of the time, the glands make the right amount of sebum and the pores are fine. But sometimes a pore gets clogged up with too much sebum, dead skin cells, and germs called bacteria. This can cause acne. A lot of kids and teens get a type of acne called acne vulgaris. It usually appears on the face, neck, shoulders, upper back, and chest. Teens and kids get acne because of the hormone changes that come with puberty. As

The most common diseases in adolescents Although it is sometimes assumed that childhood and adolescence are times of carefree bliss, as many as 20% of children and adolescents have one or more diagnosable mental disorders. Most of these disorders may be viewed as exaggerations or distortions of normal behaviors and emotions. Like adults, children and adolescents vary in temperament. Some are shy and reticent; others are socially exuberant. Some are methodical and cautious; others are impulsive and careless. Whether a child is behaving like a typical child or has a disorder is determined by the presence of impairment and the degree of distress related to the symptoms. There is much overlap between the symptoms of many disorders and the challenging behaviors and emotions of normal children. Thus, many strat-

ARTICLE FEATURES . Teenagers’ health

you grow up and your body begins to develop, these hormones stimulate the sebaceous glands to make more sebum, and the glands can become overactive. When there is too much sebum, that oil clogs the pores and leads to acne. If your parent had acne as a teen, it’s likely that you will, too. Stress may make acne worse, because when you’re stressed, your pores may make more sebum. Luckily, for most people acne gets better by the time they’re in their twenties. Many lotions and creams are sold at drugstores to help prevent acne and clear it up. When you use a product for acne, be sure to follow the directions exactly. Don’t use more than you’re supposed to because this can make your skin very red and very dry. It’s also good to try just a little bit at first to be sure that you’re not allergic to the product. Don’t give up if you don’t see results the next day. Acne medicine can take weeks or months to work.

Malnutrition

Caused by not choosing the right food Eating a healthy, balanced diet plays a vital part in maintaining a good level of all-round health and fitness and will avoid malnutrition. An inadequate diet can lead to malnutrition, which is a condition caused by an imbalance between what a person eats and the nutrients that they need to maintain good health. Malnutrition commonly occurs when someone does not eat enough food (sub-nutrition). However, it can also occur if a person has a poor diet that provides them with an incorrect balance of the basic food groups listed

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above. An inadequate diet can also lead to a person having a deficiency of one, or more, vitamins, minerals, or other essential substances. People with malnutrition lack the nutrients necessary for their bodies to grow and stay healthy. Someone can be malnourished for a long or short period of time, and the condition may be mild or severe. Malnutrition can affect someone’s physical and mental health. People who are suffering from malnutrition are more likely to get sick; in very severe cases, they may even die from its effects. Malnourishment takes a toll on children’s health. In the short term, malnourished children will often present with weakened immune systems, as their bodies do not have the nutrients they need to maintain a strong defense against infections, cold, and flu. Additionally, they may struggle to maintain concentration, be irritable and experience mood swings.

Chronic malnourishment can have lasting negative effects on children’s physical and mental development. Typically, children’s obesity is not caused by a medical problem, but rather by excessive consumption of junk food and snack foods which are high in fat and refined sugar in combination with too little exercise. Parents of overweight or near-overweight children should carefully consider what their children are eating and how active (or inactive) they are, and make changes as necessary to provide their children with more nutritious meals and more incentives for physical activity. A weight management program or visit with a nutritionist may be useful to help put new eating and activity habits in place. The doctor or dietitian will recommend specific changes in the types and quantities of foods that a person eats, and might prescribe dietary supplements, such as vitamins and minerals.

ARTICLE FEATURES . Vaccinations

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ARTICLE FEATURES . Vaccinations

Vaccines have contributed to the elimination of many diseases that have affected humans in the past. Today, we don’t hear much about certain diseases such as polio, tuberculosis, chickenpox, viral hepatitis and many more because they entered the global vaccine agenda followed by all countries without exception, as they are obtained according to a specific timeframe. But vaccines are no longer confined to childhood, but older people also have their share.

accines have proved effective in all age groups, especially the elderly or those suffering from chronic diseases. The vaccine is a biological product that is usually made of viruses and bacteria in large quantities. It is given to humans to support the body’s defense mechanisms, which in time is able to cope with certain pathogens with an effective weapon. Vaccines contribute to building immunity against bacterial diseases, activate the immune system and form antibodies that quickly recognize the virus, such as the flu virus, poliomyelitis or smallpox and kill it. Vaccines that are part of national immunization programs in the developed world provide protection against these bacterial diseases among children. Some of these vaccines have had a role in the elimination of certain diseases; although the timing of doses varies from one country to another, yet all countries adhere to the recommendations of the World Health Organization and the international health authorities. Each vaccine has its own method; some oral vaccines are given in specific doses, including muscle injection or subcutaneous injection.

POLIO VACCINE Polio, also called infantile paralysis, acute viral infectious disease of the nervous system that usually begins with general symptoms and is sometimes followed by a more-serious and permanent paralysis of muscles in one or more limbs, the throat, or the chest. More than half of all cases of polio occur in children under the age of five. There are two types of vaccine that protect against polio: inactivated poliovirus vaccine (IPV) and oral poliovirus vaccine (OPV). IPV is given as an injection in the leg or arm, depending on the patient’s age. Polio vaccine may be given at the same time as other vaccines. Most people should get polio vaccine when they are children.

DIPHTHERIA, TETANUS, AND PERTUSSIS (DPT) Diphtheria, tetanus, and pertussis are three bacterial diseases that can be vaccinated against with a single shot. Diphtheria causes a thick covering in the back of the throat. It can lead to breathing problems, paralysis, heart failure, and even death. Tetanus (lockjaw) is a serious disease that causes painful tightening of the muscles, usually all over the body. It can lead to “locking” of the jaw so the victim cannot open their mouth or swallow. Tetanus leads to death in about 1 in 10 cases. Whooping cough — known medically as pertussis — is a highly contagious respiratory tract infection. Although it initially resembles an ordinary cold, whooping cough may eventually turn more serious, particularly in infants.

HEPATITIS A Hepatitis A is a serious disease of the liver that can cause death. It is caused by the hepatitis A virus (HAV), and is spread most often through infected food or water. Hepatitis A

may also be spread by close person-to-person contact with infected persons (such as between persons living in the same household). Although some infected persons do not appear to be sick, they are still able to spread the virus to others. The hepatitis A vaccine is given as two shots, six months apart. The hepatitis A vaccine also comes in a combination form, containing both hepatitis A and B vaccine, that can be given to persons 18 years or older. This form is given as three shots, over a period of six months or as three shots over one month and a booster shot at 12 months.

HEPATITIS B Hepatitis B is a potentially life-threatening liver infection caused by the hepatitis B virus (HBV). It is a major global health problem. It can cause chronic infection and puts people at high risk of death from cirrhosis and liver cancer. The vaccine is 95% effective in preventing infection and the development of chronic disease and liver cancer due to hepatitis B. In some people, the hepatitis B virus can also cause a chronic liver infection that can later develop into cirrhosis (a scarring of the liver) or liver cancer.

MEASLES, MUMPS, AND RUBELLA (MMR) Measles causes fever, rash, cough, runny nose, and red, watery eyes. Complications can include ear infection, diarrhea, pneumonia, brain damage, and death. Mumps causes fever, headache, muscle aches, tiredness, loss of appetite, and swollen salivary glands. Complications can include swelling of the testicles or ovaries, deafness, inflammation of the brain and/or tissue covering the brain and spinal cord (encephalitis/meningitis) and, rarely, death.

ARTICLE FEATURES . Vaccinations

Rubella, causes fever, sore throat, rash, headache, and red, itchy eyes. If a woman gets rubella while she is pregnant, she could have a miscarriage or her baby could be born with serious birth defects. You can protect against these diseases with safe, effective vaccination.

CHICKENPOX Chickenpox, also known as varicella, is a highly contagious disease caused by the initial infection with varicella zoster virus (VZV). The disease results in a characteristic skin rash that forms small, itchy blisters, which eventually scab over. It usually starts on the chest, back, and face then spreads to the rest of the body. Other symptoms may include fever, tiredness, and headaches. Complications may occasionally include pneumonia, inflammation of the brain, and bacterial skin infections. The disease is often more severe in adults than children. Symptoms begin 10 to 21 days after exposure to the virus.

ROTAVIRUS Rotavirus is the most common cause of inflammation of the stomach and intestines (gastroenteritis), leading to severe diarrhea in infants and children throughout the world. Most unvaccinated children become infected with rotavirus by age 3. There are different strains of rotavirus, and multiple infections by different strains may occur. Rotavirus causes the following symptoms and signs including fever, vomiting and watery diarrhea. Rotavirus infection is highly contagious. The incubation period is typically about two days. Rotavirus illness typically resolves on its own after three to nine days. Vaccines should be completed before an infant reaches 8 months of age.

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STREPTOCOCCUS PNEUMONIAE Pneumococcal disease is an infection caused by Streptococcus pneumoniae bacteria (“pneumococcus”). These bacteria can cause many types of illnesses, including: pneumonia, ear infections, sinus infections, meningitis and bacteremia (blood stream infection). Pneumococcus bacteria are spread through coughing, sneezing, and close contact with an infected person.

SALMONELLA TYPHI It is a dangerous disease that is transmitted by consumption of contaminated food or water and resulting in fever and fatigue and sometimes death. The incidence of this disease has declined in countries with modern health systems and typhoid continues to be a health problem in developing countries. There are two vaccines to prevent typhoid. One is an inactivated (killed) vaccine gotten as a shot. The other is a live, attenuated (weakened) vaccine which is taken orally (by mouth).

MENINGOCOCCAL MENINGITIS Meningococcal meningitis is a rare but serious infection. It causes the membranes that cover the brain and spinal cord to become inflamed. Meningococcal meningitis can be fatal or cause great harm without prompt treatment; as many as one out of five people who contract the infection have serious complications. The bacteria are transmitted from person-to-person through droplets of respiratory or throat secretions from carriers. Close and prolonged contact with an infected person (a carrier) facilitates the spread of the disease.

BCG BCG vaccine provides immunity or protection against tuberculosis (TB).

It is also used to treat bladder tumors or bladder cancer. The BCG vaccine is normally given to children as it has been shown to provide very good protection against the disseminated forms of TB in children, including TB meningitis. However the protection provided against pulmonary TB in adults is very variable. So the BCG vaccine is not generally given to adults. Signs and symptoms of active TB include coughing that lasts three or more weeks, coughing up blood, chest pain, or pain with breathing or coughing, unintentional weight loss, fatigue, fever and night sweats.

Vaccines for adults Immunizations are not just for children. Protection from some childhood vaccines can wear off over time. You may also be at risk for vaccine-preventable disease due to your age, job, lifestyle, travel, or health conditions. Vaccines recommended for adults may include:

SHINGLES (HERPES ZOSTER) The risk of shingles increases as a person gets older. It is recommended that people over age 50 get shingles vaccine to prevent shingles. They should get the vaccine whether or not they recall having had chickenpox, which is caused by the same virus as shingles. There is no maximum age for getting shingles vaccine.

PNEUMOCOCCAL VACCINES There are currently two types of pneumococcal vaccines, pneumococcal conjugate vaccine (PCV13) and pneumococcal polysaccharide vaccine (PPSV23). One dose of PCV13 is recommended for all adults 65 years or older who have not previously received the vaccine. A dose of PPSV23

ARTICLE FEATURES . Vaccinations

should be given at least one year later. For adults 65 years or older who have already received one or more doses of PPSV23, the dose of PCV13 should be given at least one year after receiving the most recent dose of PPSV23.

FLU VACCINE It has been recognized for many years that people 65 years and older are at greater risk of serious complications from the flu compared with young, healthy adults because human immune defenses become weaker with age. While flu seasons can vary in severity, during most seasons, people 65 years and older bear the greatest burden of severe flu disease. The seasonal flu shot protects against the three or four influenza viruses that research indicates will be most common during the upcoming season.

HEPATITIS A AND B Hepatitis A and hepatitis B are two types of hepatitis. You get them from a viral infection. Each of those viruses is different. But the diseases they cause are similar. Hepatitis brings liver inflammation, and it can be serious or even life-threatening. There are safe and effective vaccines that can prevent hepatitis A and B. There is also a combination vaccine that protects against hepatitis A and B.

TETANUS, DIPHTHERIA, AND PERTUSSIS These are very serious diseases. Tdap vaccine can protect us from these diseases.Â And, Tdap vaccine given to pregnant women can protect newborn babies against pertussis. Tdap vaccine can protect adolescents and adults from tetanus, diphtheria, and pertussis. One dose of Tdap is routinely given at age 11 or 12.Â People who did not get Tdap at that age should get it as soon as possible.

HUMAN PAPILLOMAVIRUS

TRAVEL VACCINES

It is for use in females ages 9 through 26 for the prevention of HPV-caused cervical cancer. They should be vaccinated according to the 3-dose schedule.

They are preventive vaccines given to travelers to a country where epidemics such as typhoid and gastroenteritis are common to travelers to India, Mexico, while yellow fever is common in Brazil and some African countries and rabies vaccine is given to travelers to Asia. It is recommended to take the vaccine four weeks prior to the trip, and this is the expected time for the overall effectiveness of vaccination.

MENINGITIS It is a bacterial infection that affects the meninges surrounding the brain and is important for pilgrims or those who serve them; vaccination is usually taken every three years.

ARTICLE FEATURES . Sleep apnea and obesity

Sleep apnea and obesity

Frequent starts and stops in breathing while asleep Obstructive sleep apnea is the most common form of sleep apnea. It is characterized by frequent starts and stops in breathing while asleep. This type of apnea occurs when the muscles in the back of the throat relax and block the airway.

hen the airway is either completely or partially blocked, there is usually 10

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to 20 seconds of breathing cessation, which can lower blood oxygen levels. The brain panics when this happens and rouses the body to restart breathing. Generally, this is a very brief awakening that most people do not even notice or remember. It can happen over 30 times an hour all throughout the night, which significantly disrupts restful sleep cycles. Individuals with decreased muscle

tone and increased soft tissue around the airway, and structural features that give rise to a narrowed airway are at high risk for OSA. Men, in which the anatomy is typified by increased mass in the torso and neck, are at increased risk of developing sleep apnea, especially through middle age and later. Women suffer typically less frequently and to a less-

ARTICLE FEATURES . Sleep apnea and obesity

include excessive sleepiness during the day, leading to difficulty with focus and concentration, waking up in the middle of the night short of breath, breathing cessation throughout the night, which is usually observed by someone else, dry mouth and sore throat in the morning, chest pain upon waking up, morning headaches, mood instability like frequent bouts of depression, anxiety, or excessive irritability, insomnia, problems staying asleep, and/or restless sleep and hypertension.

er degree than do men, owing partially to physiology, but possibly also to differential levels of progesterone. OSA causes severe symptoms, such as excessive daytime somnolence, and is associated with a significant cardiovascular morbidity and mortality. Different treatment options are now available for an effective management of this disease. The most obvious and common sign of this type of apnea is loud snoring.

INDIVIDUALS WITH DECREASED MUSCLE TONE AND INCREASED SOFT TISSUE AROUND THE AIRWAY, AND STRUCTURAL FEATURES THAT GIVE RISE TO A NARROWED AIRWAY ARE AT HIGH RISK FOR OBSTRUCTIVE SLEEP APNEA

For adults, causes of OSA may vary and include age, obesity, which may cause increased soft tissue around the airway, structural deformities that obstruct the airways and decrease in muscle tone, which can be caused by alcohol, substance abuse, neurological disorders, or some other underlying

Other signs and symptoms that may occur during sleep or in the daytime

Tongue Chin

Epiglottis

Upper lip

Uvula

health conditions. Sleep studies are tests that measure how well you sleep and how your body responds to sleep problems. These tests can help your doctor find out whether you have a sleep disorder and how severe it is. Sleep studies are the most accurate tests for diagnosing sleep apnea. There are different kinds of sleep studies. If your doctor thinks you have sleep apnea, he or she may recommend a polysomnogram (also called a PSG) or a home-based portable monitor. A PSG is the most common sleep study for diagnosing sleep apnea. This study records brain activity, eye movements, heart rate, and blood pressure. A PSG also records the amount of oxygen in your blood, air movement through your nose while you breathe, snoring, and chest movements. The chest movements show whether

Nazal cavity

Soft palate

Open airway during sleep

Obstruction Sleep apnea present with obstruction 81

ARTICLE FEATURES . Sleep apnea and obesity

you’re making an effort to breathe. Treatment of OSA varies depending on the severity of the disease and the age/weight of the patient or other chronic diseases. One of the main things that reduce the burden of the situation is losing weight, refraining from smoking, having regular sleep wake schedules to improve the patient’s condition. The treatment of choice for obstructive sleep apnea is continuous positive airway pressure device (CPAP). CPAP is a mask that fits over the nose and/or mouth, and gently blows air into the airway to help keep it open during sleep. This method of treatment is highly effective. Using the CPAP as recommended by your doctor is very important.

Health of heart and hypertension

Good night’s sleep protects heart from diseases The connection between sleep apnea and heart disease is evolving very rapidly. People with cardiovascular problems such as high blood pressure, heart failure, and stroke have a high prevalence of sleep apnea. Whether sleep apnea actually causes heart disease is still unclear, but we do know that if you have sleep apnea today, the chance that you will develop hypertension in the future increases significantly.

SLEEP APNEA DUE TO OBSTRUCTION OF THE UPPER RESPIRATORY TRACT LEADS TO ELEVATED ARTERIAL BLOOD PRESSURE. One of the problems in defining the relationship between sleep apnea and heart disease is that people with sleep apnea often have other co-existing diseases as well. If you treat people with high blood pressure and sleep apnea,

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or heart failure and sleep apnea, the measures of blood pressure or heart failure are significantly improved. There is good evidence to think there is a cause-and-effect relationship between hypertension and sleep apnea. Your blood pressure will go up when your sleep is disrupted by sleep apnea because when you’re not breathing, the oxygen level in your body falls and excites receptors that alert the brain. In response, the brain sends signals through the nervous system and essentially tells the blood vessels to “tighten up” in order to increase the flow of oxygen to the heart and the brain, because they have priority. Plain old snoring can get a little annoying, especially for someone listening to it. But when a snorer repeatedly stops breathing for brief moments, it can lead to cardiovascular problems and potentially be life-threatening. Episodes of sleep apnea wake the

sleeper as he or she gasps for air. It prevents restful sleep and is associated with high blood pressure, arrhythmia, stroke and heart failure. Obstructive sleep apnea, the most common form of sleep apnea, is caused when the upper airway collapses or becomes blocked during sleep. People who are obese or overweight have excess fat in their throats that can contribute to the problem, but some people with OSA are slender. Over time, OSA exposes the heart and circulation to harmful stimuli that may cause or contribute to the progression of most cardiovascular diseases. When you stop breathing, your oxygen level drops. The body responds by releasing epinephrine (also called adrenaline), a stress hormone. When this happens over and over, adrenaline levels remain high. This can lead to high blood pressure.

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life sciences exhibitions

MEDICAL FAIRS

Statement on MEDICA 2017

by Joachim Schäfer, Managing Director of Messe Düsseldorf GmbH

hose wishing to reduce the German economy, its potential for development, the value it creates or the number of people it employs to its most important common denominator have for years drawn on the following adage: ‘Germany is a car nation.’ And it is true and still true that Germany is a car nation. But, it is a saying that more than ever needs something decisive added to it – which is: ‘Germany is a car nation as well as a healthy nation.’ That is because, over the last 10 years, the health economy has grown significantly faster than the economy in general. The number of people in Germany who work in the health sector increased to more than seven million

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for the first time in 2016. The health industry’s industrial segment alone now provides jobs for a good 900,000 people and therefore 100,000 more than the automotive industry does (sources: BMWi/ GGR, VDA). Irrespective of any discussion about financing and the costs for modern healthcare provisions, the health sector is a stability factor and driver of growth not only in Germany but across the world. Europe and the USA are still the main export markets for medical-equipment companies, large numbers of which will be represented at the world’s No. 1 leading trade fair – MEDICA – which will be taking place in Düsseldorf from 13 to 16 November 2017. The registrations to

date lead us to expect that more than 5,000 exhibitors from 68 countries will be taking part. Besides the ‘classic’ target markets of Europe, North America and Japan, suppliers are also increasingly focusing on emerging economies in spite of some uncertainties. That is because people’s willingness to spend on health is increasing with rising incomes in these markets. More and more prosperity-related diseases and greater life expectancies in these countries are additionally driving up demand for medical products and modern treatments. The large number of people who will be attending MEDICA from other countries, particularly from Asia, is indicative of these

MEDICAL FAIRS

increasing needs. Of the 120,000 to 130,000 trade visitors that MEDICA has regularly welcomed over the past, a good 60% of these traveled to the event from countries other than Germany. The significantly increased popularity with visitors and exhibitors that the Messe Düsseldorf Group’s medical trade fairs are enjoying in opportunity-rich continental markets – for example, the MEDICAL FAIR INDIA and MEDICAL FAIR ASIA – also show how attractive these markets for medical-equipment suppliers are and demonstrates that a great potential to do business exists there. This applies in particular to the highly innovation-oriented privately funded areas of inpatient and outpatient care.

Rapid change - MEDICA in step with the times But, just like the automotive industry, the healthcare sector is also experiencing rapid change. Digitisation is affecting all aspects of supply and such buzzwords as ‘networking’ and ‘artificial intelligence’ are characterizing the technical discussions and are already affecting production in particular. MEDICA 2017 will provide professionals with the opportunity of gaining insights into all the developments – during the presentations and talks at the MEDICA CONNECTED HEALTHCARE FORUM, during the MEDICA HEALTH IT FORUM and even with the help of the exhibitors’ new products as well as the exciting MEDICA APP COMPETITION. More and more health applications for smartphones, tablet PCs and ‘wearables’ – applications that are already enjoying increasing acceptance in the practical world – are going to be presented, for instance, within the appropriately relevant contexts. 45% of German smartphone owners are

already using health apps and another 45% can see themselves using them. A further 60% of people in Germany approve of the concept of an electronic patient file that could be used to store their medical data centrally (Source: Bitkom/ Bayerische TelemedAllianz BTA). That is why one of the leading German health insurance providers has taken the initiative and commissioned the development of an electronic patient file for its more than 10 million clients. The plan is for customers to be able to access their health and treatment data on a central server with the help of a security code and an app or Internet browser. Standardised interfaces are to be implemented to enable the data to be exchanged between IT systems in doctors’ practices and clinics. The project will certainly constitute a topic for controversial discussion at the MEDICA ECON FORUM (platform for political dialogue on health issues / Hall 15), which is being organized at MEDICA 2017 by the Techniker Krankenkasse. That is because the IT infrastructure for electronic patient data, which has been on hold for years, was to provide comparable functions for all people covered by health insurance. Artificial intelligence is another challenge that the healthcare sector is facing. A robot that is able to automatically set up needles for infusions and biopsies was already presented to an amazed expert audience at MEDICA 2016. It is therefore not surprising that artificial intelligence is on the agenda for this year’s MEDICA HEALTH IT FORUM. Because what previously seemed like ‘science fiction’ is currently on the threshold of becoming reality in concrete and plausible applications. IBM’s ‘Watson’ cognitive

assist system, for example, is already helping to diagnose rare diseases at the University Clinic of Marburg. It is doing so by analyzing patient data and comparing it with huge quantities of information about successfully solved previous cases and searching for documented symptoms and the drugs administered accordingly. The analysis also takes digitized medical knowledge sourced from databases, publications, and even Wikipedia into account. It is then able to generate a list of probable diagnoses. Developments in the field of medical imaging appear just as revolutionary. The first applications to use artificial intelligence for the automated detection of possible tumors on the basis of digitally generated image data from CRT or MRT systems are about to be launched on the market. The above examples demonstrate the dynamic that the healthcare sector is currently experiencing. For the ‘market players’ in the field of medical technology, this means: Only those who use their creativity and power of development to consistently align themselves with customer interests and market developments will be able to succeed. This applies equally to the world’s No. 1 trade fair – MEDICA – as well as the COMPAMED trade fair for suppliers, which will be taking place at the same time. It is also a market leader in its market segment.

New program highlights for topical subjects With the aim of meeting the needs of the international professional public even into the future, the programme for the accompanying conferences and the forums integrated into the trade fair have, over recent years, been radically restructured and aligned at a more international

MEDICAL FAIRS

level with many highlights also being presented in English and rounded off by ever-new formats that focus on topical subjects. The dynamic that characterizes eHealth applications and the digital networking of those involved in the health sector is producing interesting business options, for example, particularly for creative start-ups – be it in innovative services, smart products or software applications. That is why the new MEDICA START-UP PARK has been created in Hall 15 with the intention of matching founders of innovative businesses up with potential business partners, investors and distribution partners. With the aim of complementing the contents that are going to be presented at MEDICA CONNECTED HEALTHCARE FORUM and the MEDICA HEALTH IT FORUM (both also in Hall 15), up to 40 startups will be presenting themselves and their ideas to an audience of experts on a total area of 500 square metres in direct proximity to these events. The MEDICA LABMED FORUM is also new this year. Under the key heading of “The Interdisciplinary Fascination”, laboratory medicine, molecular pathology, microbiology, medical technology and life sciences will be presenting themselves as drivers of innovation and generating new impulses for the entire medical sector. Four themed days will be offering a range of exciting presentations and panel discussions that will be focusing on the following highlights: Preventive screening tests for cancer, cardiac and circulatory conditions, innovative diabetes diagnostic tools, infection, and migration. The events will all be taking place between 11.00 a.m. and 4.00 p.m. and are free for trade fair visitors with MEDICA tickets. The co-

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operation partner for the content for the MEDICA LABMED FORUM in Hall 18 is the medical publisher Trillium.

The trade fair is ‘smartening’ itself up Hall 18 is a modern structure that has been built with lightweight materials and that is located centrally between Halls 10 and 16. This temporary structure was specifically constructed for exhibitors who are presenting products within the MEDICA’s laboratory-technology and diagnostics sections, which were previously located in Halls 1 and 2. Background information: The South Entrance to the Messe Düsseldorf trade fair center is being completely renovated, due for completion in summer 2019. The old Halls 1 and 2 are at the same time going to be replaced with a newly built hall. The new Hall 1, measuring 158 meters in length and 77 meters in width, with over 12,000 square meters of floor space, will be around the same size as Halls 8a and 8b once it is completed.

The new and the triedand-tested – conferences by professionals for professionals One highlight of the conference program – the MEDICA ACADEMY – will be celebrating its launch at this year’s MEDICA. It will be the venue for two workshops that are going to be devoted to ‘blockbuster’ subjects related to medical practice and that are going to be held on each of the four days of the fair. These will include, for example, ‘updates’ about imaging procedures, modern surgery procedures and even an ultrasound ‘refresher’ course. The MEDICA ACADEMY will also be discussing the ‘hand over of practices’ as a highly topical subject in a seminar aimed at both young physicians looking for practices and physicians wishing to pass on their

practices. In addition to the MEDICA ACADEMY, additional items on the MEDICA’s conference program will bridge the gap to the new products being presented at the trade fair through presentations with relevance to highly topical subjects and by focusing on the interests of the MEDICA’s important target groups. The 40th German Hospital Conference deserves mention here as a leading event for the management of German hospitals. The bandwidth in this regard ranges from political health questions through aspects of financing and controlling for hospital services to the presentation of best-practice projects for hospital IT. These will additionally be presented at the same time by the ENTSCHEIDERFABRIK IT (IT DECISION-MAKERS) initiative at a large joint stand in Hall 15. This year, the German Hospital Conference is to be complemented by the European Hospital Conference, which takes place every two years as a gathering that allows top decision-makers from European hospitals to swap notes. Other highlights include the DiMiMED conference for disaster and military medicine and the MEDICA MEDICINE + SPORTS CONFERENCE (respectively on 14 + 15 November 2017 / Congress Center Düsseldorf South) that will be focusing on prevention and sports medical treatment concepts. The conferences will be held in English and are geared towards an international audience. Its great reception from participants has meant that the MEDICA PHYSIO CONFERENCE, which was launched in 2014 and organized by the Thieme publishing house, has established itself firmly within the conference program. With its treatment-oriented presentations, it is directed towards professional physiotherapists, sports

MEDICAL FAIRS

medicine specialists and orthopedists and is taking place this year on 15 + 16 November (Congress Center Düsseldorf South).

Globally unique – varied presentations Now, and in the future, a central strength of the MEDICA continues to be that it does not just deal with solutions for one individual medical specialist discipline, but that it offers solutions for the complete workflow of patient treatment in one place at one time. The more than 5,000 exhibitors from a good 70 countries will use MEDICA 2017 to present their entire range of new products, services, and processes for inpatient and outpatient care. No other event worldwide comes even close to this wealth of innovations. Being clearly structured by halls, the MEDICA trade fair will be focusing on the following subjects: Electromedicine / medical technology (approx. 2,500 exhibitors), laboratory technology/diagnostics, physiotherapy / orthopedic technology, commodities and consumables, information and communication technology, medical furniture and specialist furnishings for hospitals and practices.

COMPAMED – suppliers as creative partners COMPAMED 2017 will be taking place in Halls 8a and 8b alongside the MEDICA trade fair on all four days (13 to 16 November). With more than 750 exhibitors, it is the driving force and internationally leading market

platform for suppliers to the medical technology industry. The high levels of creativity and development knowhow that characterizes the supplier sector mean that, over its 25 years of its existence, COMPAMED has become the place to see what the future of medical progress looks like. Be it product development, production, and marketing or the desire for comprehensive solutions: COMPAMED constitutes the starting point for close collaborations between suppliers and their customers. This is something that may be demonstrated by the example of diagnostic applications for so-called ‘Point-ofCare Testing’. These are analytical procedures for patient-proximate and rapid while favorably priced and uncomplicated laboratory diagnostics. The equipment used in diagnostics and treatment must operate reliably and automatically for the benefits to be properly utilized. Samples must be directed towards analysis in precisely defined quantities and then processed and tested. Drugs must be adapted and dosed according to the individual disease patterns presented by the patients. And it is here that microfluidic systems play an important role. The development of smallest components and parts to this end has turned out to be highly complex but does provide the necessary basis for great progress in the field of ‘lab-on-a-chip’ technology, for example. So if an increasing number of illnesses which, just a few years ago, could only be diagnosed

with the aid of complex laboratory analyses and that now can be detected with the help of cheque-card-sized mini laboratories, it is the exhibitors at the COMPAMED trade fair and their competence who are driving these developments. Other innovations that also deserve mention here are those that are being employed in so-called ‘wearables’ that are used to monitor important vital parameters and the functioning of implants. Be it suitable wireless modules for sharing data, the most delicate of sensors, body-compatible materials, and coatings or powerful energy supplies that are associated with the smallest of footprints – the latest solutions are going to be presented at the COMPAMED trade fair with the most important aspects also being discussed at the two integrated specialist forums. This globally unique combination means that both MEDICA and COMPAMED will be reflecting the entire process chain and presenting a comprehensive range of medical products, devices, and instruments. Together, they occupy the entire space at Düsseldorf’s exhibition center. Of the 127,800 specialist visitors who attended MEDICA + COMPAMED in 2016, a good 17,000 were particularly interested in the topics covered within the COMPAMED event. As in previous years, it will be possible to visit both events with a single ticket.

ARTICLE FEATURES . Breast Cancer

Despite the high recovery rates and survival of breast cancer patients, in addition to the long life expectancy of breast cancer survivors, the rate of new cases of breast cancer continues to rise significantly to remain the most common cancer affecting women. Comprehensive cancer control involves prevention, early detection, diagnosis and treatment, rehabilitation and palliative care. Raising general public awareness on the breast cancer problem and the mechanisms to control are key strategies of population-based breast cancer control.

reast cancers can start from different parts of the breast. Most breast cancers begin in the ducts that carry milk to the nipple (ductal cancers). Some start in the glands that make breast milk (lobular cancers). There are also other types of breast cancer that are less common. Although many types of breast cancer can cause a lump in the breast, not all do. There are other symptoms of breast cancer you should watch for and report to a healthcare provider.

Early detection is necessary for survival

A study has found that adding 3-D mammography or breast ultrasound to regular screening mammograms can detect more cancers in dense breasts. Ultrasound was slightly better at detecting cancers in dense breasts than 3-D mammography and both screening methods had similar false-positive rates.

Besides a lump, signs of breast cancer can include breast pain, thickening of the skin of the breast, nipple discharge, or a change in breast size or shape; however, these signs may also be signs of benign conditions. A diagnostic mammogram can also be used to evaluate changes found during a screening mammogram or to view breast tissue when it is difficult to obtain a screening mammogram because of special circumstances, such as the presence of breast implants.

WOMEN ARE LESS TERRORIZED BY THIS DISEASE DUE TO THE HIGH RECOVERY RATES

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Screening mammography is the preferred examination for breast cancer. It is a low-dose x-ray examination of the breast that is performed on women with no complaints or symptoms of breast cancer (asymptomatic). The goal of screening mammography is to detect breast cancer when it is still too small to be felt by a physician or the patient. Research has shown that the early detection of small breast cancers by screening mammography greatly improves a womanâ€™s chances for successful treatment. Diagnostic mammograms are used to check for breast cancer after a lump or other sign of the disease has been found. Mammograms can also be used to check for breast cancer after a lump or other sign or symptom of the disease has been found. This type of mammogram is called a diagnostic mammogram.

The National Cancer Institute (NCI) advises women who have had breast cancer and those who are at increased risk due to a family history of breast cancer to seek expert medical advice about the frequency of screening and whether they should begin screening before age 40. According to American Cancer Society guidelines, most women at high risk should begin screening with MRI and mammography at age 30 and continue for as long they are in good health.

ARTICLE FEATURES . Breast Cancer

3D Mammography

Breast self-exam

3D mammography (also known as digital breast tomosynthesis), is a revolutionary new screening and diagnostic breast imaging tool to improve the early detection of breast cancer. During the 3D part of the exam, an x-ray arm sweeps over the breast, taking multiple images in seconds. Images are displayed as a series of thin slices that can be viewed by our radiologists as individual images or in a dynamic interactive animation. Approved as an imaging modality by the FDA in early 2011, 3D mammography is used in combination with 2D digital mammography. Prepare yourself before your mammography examination. You can take some simple steps to help your exam go smoothly, and even improve the quality of the images. You should avoid using deodorants, antiperspirants, powders, lotions, creams or perfumes under your arms or on your breasts before your mammogram. Metallic particles in powders and deodorants could be visible on your mammogram and cause confusion.

Beginning in their 20s, women should be told about the benefits and limitations of breast self-exam. Women should be aware of how their breasts normally look and feel and report any new breast changes to a health professional as soon as they are found. Finding a breast change does not necessarily mean there is a cancer. This test should be done 7 - 10 days after your period starts. Your breasts are not as tender or lumpy at this time in your monthly cycle. However, by doing the exam regularly, you get to know how your breasts normally look and feel and you can more readily detect any signs or symptoms if a change occurs, such as development of a lump or swelling, skin irritation or dimpling, nipple pain or retraction (turning inward), redness or scaliness of the nipple or breast skin, or a discharge other than breast milk.

Taking an over-the-counter pain medication, such as aspirin, acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others), about an hour before your mammogram might ease the discomfort of the test. Wear a two-piece outfit (skirt or pants and a top) for ease and comfort. You will be given a gown before the exam, but you only need to remove your clothes from the waist up. If your most recent mammography examination was performed at a different facility, bring the films with you to the appointment. The most subtle abnormalities are often detected because they represent a change from a previous mammogram. Also, extra pictures to clarify a questionable finding may not be necessary if the radiologist notes a similar appearance on a previous mammogram.

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Should you notice any changes you should see your healthcare provider as soon as possible for evaluation. Begin by looking at your breasts in the mirror with your shoulders straight and your arms on your hips. You should look for breasts that are their usual size, shape, and color and are evenly shaped without visible distortion or swelling. If you see any of the following changes, bring them to your doctor’s attention: Dimpling, puckering, or bulging of the skin, a nipple that has changed position or an inverted nipple (pushed inward instead of sticking out), redness, soreness, rash, or swelling. Now, raise your arms and look for the same changes. While you’re at the mirror, look for any signs of fluid coming out of one or both nipples (this could be a watery, milky, or yellow fluid or blood). Next, feel your breasts while lying down, using your right hand to feel your left breast and then your left hand to feel your right breast. Use a firm, smooth touch with the first few finger pads of your hand, keeping the fingers flat and together. Use a circular motion, about the size of a quarter. Cover the entire breast from top to bottom, side to side — from your collarbone to the top of your abdomen, and from your armpit to your cleavage. Follow a pattern to be sure that you cover the whole breast. You can begin at the nipple, moving in larger and larger circles until you reach the outer edge of the breast. You can also move your fingers up and down vertically, in rows, as if you were mowing a lawn. This up-and-down approach seems to work best for most women. Be sure to feel all the tissue from the front to the back of your breasts: for the skin and tissue just beneath, use light pressure; use medium pressure for tissue in the middle of your breasts; use firm pressure for the deep tissue in the back. When you’ve reached the deep tissue, you should be able to feel down to your ribcage.

ARTICLE FEATURES . Breast Cancer

What are the risk factors? There are certain factors that can be controlled such as obesity, quality of foods and physical activity, but there are also factors that cannot be changed such as sex, age and others. A breast cancer risk factor is anything that makes it more likely you’ll get breast cancer. But having one or even several breast cancer risk factors doesn’t necessarily mean you’ll develop breast cancer. Many women who develop breast cancer have no known risk factors other than simply being women. Factors that are associated with an increased risk of breast cancer include:

BEING FEMALE

can be passed from parents to children. The most common gene mutations are referred to as BRCA1 and BRCA2. These genes can greatly increase your risk of breast cancer and other cancers, but they don’t make cancer inevitable.

HAVING YOUR FIRST CHILD AT AN OLDER AGE

A PERSONAL HISTORY OF BREAST CANCER

RADIATION EXPOSURE

If you’ve had breast cancer in one breast, you have an increased risk of developing cancer in the other breast.

If you received radiation treatments to your chest as a child or young adult, your risk of breast cancer is increased.

Women who have never been pregnant have a greater risk of breast cancer than do women who have had one or more pregnancies.

A FAMILY HISTORY OF BREAST CANCER

OBESITY

Women are much more likely than men are to develop breast cancer.

AGE Your risk of breast cancer increases as you age.

If your mother, sister or daughter was diagnosed with breast cancer, particularly at a young age, your risk of breast cancer is increased. Still, the majority of people diagnosed with breast cancer have no family history of the disease.

INHERITED GENES THAT INCREASE CANCER RISK Certain gene mutations that increase the risk of breast cancer

Being obese increases your risk of breast cancer.

BEGINNING YOUR PERIOD AT A YOUNGER AGE Beginning your period before age 12 increases your risk of breast cancer.

BEGINNING MENOPAUSE AT AN OLDER AGE If you began menopause at an older age, you’re more likely to develop breast cancer.

Women who give birth to their first child after age 30 may have an increased risk of breast cancer.

HAVING NEVER BEEN PREGNANT

POSTMENOPAUSAL HORMONE THERAPY Women who take hormone therapy medications that combine estrogen and progesterone to treat the signs and symptoms of menopause have an increased risk of breast cancer. The risk of breast cancer decreases when women stop taking these medications.

DRINKING ALCOHOL Drinking alcohol increases the risk of breast cancer.

ARTICLE FEATURES . Breast Cancer

BRCA1 and BRCA2 and their association with breast cancer BRCA1 and BRCA2 are the best-known genes linked to breast cancer risk. Everyone has these genes, but some people have an inherited mutation in one or both that increases the risk of breast cancer. BRCA1/2 mutations can be passed to you from either parent and can affect the risk of cancers in both women and men. Breast cancers in women with BRCA1 abnormalities are more likely to be estrogen-receptor-negative — meaning that the cancer’s growth is not fueled by the hormone estrogen — and to have high-grade cell growth. Both of these characteristics mean that chemotherapy will be more effective than hormonal (anti-estrogen) therapy in treating these cancers. Everyone has BRCA1 and BRCA2 genes. The function of the BRCA genes is to repair cell damage and keep breast cells growing normally. But when these genes contain abnormalities or mutations that are passed from generation to generation, the genes don’t function normally and breast cancer risk increases. Abnormal BRCA1 and BRCA2 genes may account for up to 10% of all breast cancers, or 1 out of every 10 cases. Testing for abnormal BRCA1 and BRCA2 genes is usually done on a blood sample taken in your doctor’s office and sent to a commercial lab. During testing, the genes are separated from the rest of the DNA, and then they’re scanned for abnormalities. If you and/or some of your family members have been diagnosed with breast cancer, you may be interested in having genetic testing done.

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Developed treatments have yielded amazing results Your doctor determines your breast cancer treatment options based on your type of breast cancer, its stage and grade, size, and whether the cancer cells are sensitive to hormones. Your doctor also considers your overall health and your own preferences. Most women undergo surgery for breast cancer and also receive additional treatment before or after surgery, such as chemotherapy, hormone therapy or radiation. Operations used to treat breast cancer include removing the breast cancer (lumpectomy). During lumpectomy, which may be referred to as breast-sparing surgery or wide local excision, the surgeon removes the tumor and a small margin of surrounding healthy tissue. Lumpectomy is typically reserved for smaller tumors. Another operation is removing the entire breast (mastectomy). Most mastectomy procedures remove all of the breast tissue — the lobules, ducts, fatty tissue and some skin, including the nipple and areola.

In a skin-sparing mastectomy, the skin over the breast is left intact to improve reconstruction and appearance. Depending on the location and size of the tumor, the nipple also may be spared. A sentinel lymph node biopsy (SLNB) is a procedure in which the sentinel lymph node is identified, removed, and examined to determine whether cancer cells are present. A negative SLNB result suggests that cancer has not developed the ability to spread to nearby lymph nodes or other organs. A positive SLNB result indicates that cancer is present in the sentinel lymph node and may be present in other nearby lymph nodes and, possibly, other organs. This information can help a doctor determine the stage of the cancer and develop an appropriate treatment plan. A surgeon injects a radioactive substance, a blue dye, or both near the tumor to locate the position of the sentinel lymph node. The surgeon then uses a device that detects radioactivity to find the sentinel node or looks for lymph nodes that are stained with the blue dye. Once the sentinel

ARTICLE FEATURES . Breast Cancer

lymph node is located, the surgeon makes a small incision (about 1/2 inch) in the overlying skin and removes the node. The sentinel node is then checked for the presence of cancer cells by a pathologist. If cancer is found, the surgeon may remove additional lymph nodes, either during the same biopsy procedure or during a follow-up surgical procedure. SLNBs may be done on an outpatient basis or may require a short stay in the hospital. SLNB is usually done at the same time the primary tumor is

removed. However, the procedure can also be done either before or after removal of the tumor. Radiation therapy uses high-powered beams of energy, such as X-rays and protons, to kill cancer cells. Radiation therapy is typically done using a large machine that aims the energy beams at your body. But radiation can also be done by placing radioactive material inside your body. Chemotherapy uses drugs to destroy cancer cells. If your cancer has a high risk of returning or spreading to another part of your body, your doctor may recommend chemother-

apy to decrease the chance that the cancer will recur. This is known as adjuvant chemotherapy. Hormone therapy is often used to treat breast cancers that are sensitive to hormones. Doctors sometimes refer to these cancers as estrogen receptor positive (ER positive) and progesterone receptor positive (PR positive) cancers. Hormone therapy can be used before or after surgery or other treatments to decrease the chance of your cancer returning. If the cancer has already spread, hormone therapy may shrink and control it.

NEWS

Under the patronage of H.H Sheikh Hamdan Bin Rashid Al Maktoum and with participation of all Arab and international Associations

Dubai hosts the Second Middle East Conference on Dermatology and Aesthetic Medicine

nder the patronage of H.H Sheikh Hamdan Bin Rashid Al Maktoum, Deputy Ruler of Dubai, Minister of Finance, President of Dubai Health Authority, the events of the Second Middle East Conference on Dermatology and Aesthetic Medicine shall be held in Dubai Intercontinental Festival City Hotel between 21-23 of September.

and nail fungi treatment. Moreover, the conference shall discuss the most updated achievements of Aesthetic Medicine in the Botox and Fillers operations particularly with the annual growth of this sector in the countries of the region at the rate of 10-15 in accordance with the latest statistics issued by the last International Conference of Dermatology & Aesthetic Medicine held in Paris.

It is the first time that all associations meet whereby such a meeting would be an exceptional opportunity for Dermatology physicians and specialist from the region to gain and exchange experience with a large number of international physicians whose number is expected to be over 900 physicians and specialists from all over the world.

Dr. Khalid Al Nuaimi has explained that the work papers that will be discussed during the conference amount to 72 scientific papers which are in line with the particularities of Arab societies among hundreds of the papers already submitted to the scientific committee, in addition to 20 papers that will be discussed through the workshops that will be held one day prior to launching the conference activities.

Dr. Khalid Al Nuaimi , president of the conference, said that this event is considered to be the largest of its type at the regional level as it combines all dermatology and Aesthetic Medicine associations as well as the most understanding international aesthetic experts; particularly Dubai is considered to be a link between East and West for the development and enhancement of capabilities and potentials of those who are operating in this profession in various countries of the region. He pointed out that the participants of the conference look forward through this important medical event to come out with applicable recommendations and a clear agenda in the name of Dubai including practical tracks in order to achieve the best medical practices whether as regards dermatology or Aesthetic Medicine. Dr. Khalid further pointed out that Dubai this year shall be the focal point of the international medical community particularly the conference attracts the leading and best speakers and includes a rich scientific program through which the most updated attained dermatology treatments, such as psoriasis, alopecia and leukoderma as well as the treatment of senility and eczema biological treatment in addition to LAESER and its modern utilization in leukoderma, eczema

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He has also pointed out that the number of hours approved by Ministry of Health and community protection for the conference is considered to be a turning point of conferences as it amounted to 40.75 approved credit hours. The number of the international companies specialized in production of dermatology diseases systems and medicaments participating in the conference has amounted to 32 up to now, added Dr K. Al Nuaimi, pointing out that the conference shall be an arena through which companies shall compete to offer the most sophisticated products of medicine in the field of medicaments and systems related to Aesthetic Medicine the foremost of which come to the LAESER, Botox, and Fillers systems. On his part, Mr. Abdullah Bin Souaqat, CEO of Sheikh Hamdan Bin Rashid Al Maktoum Award for Medical Sciences, said that all thanks and appreciation are to go to H.H. Sheikh Hamdan Bin Rashid Al Maktoum, Deputy Ruler of Dubai, Minister of Finance , President of Dubai Health Authority for his valuable patronage of the conference and H.H continuous support to the development of professional performance of those who are entrusted with the local, regional and international healthcare

NEWS

sector which is considered to be one of the Award’s most important activities that enhance its efforts toward dedication of the principle of medical excellence. He further stated that the Award, ever since its establishment in 1999 up to now, has been keen to support whatever may upgrade health sector in UAE and abroad through the targeting medical conferences and honor healthcare personnel of excellence, to continuously support medical learning as well as scientific research in the medical field in

general and research on genetic diseases in particular. He further indicated that Sheikh Hamdan Bin Rashid Al Maktoum Award for Medical Sciences is proud of holding such excellent conferences in UAE whereby enhancing its appearance on the map of international medical conferences so as to meet the specialist’s needs in the medical field at the level of Middle East countries hence contributing to their acquaintance with the most updated technologies utilized in the field of specialization.

Dubai Pharmacy College and PRA launch Regulatory Affairs Certificate Course

care call for world-class processes and professionals who can consistently elevate standards in every domain of health and well-being,” Dr. Khan said. The course modules are so designed and structured to give attendees an overview of the industry and also to help them acquire expertise in best compliance practices and related documentation. By the end of the program, participants will have a better understanding of the important regulatory concepts, and RA documentation and processes.

Dr. Najiba Al Shezawy, General Manager of Professionals Regulatory Affairs, said those who complete the course will have a clear understanding of the history and evolution of the RA profession and their expected role as RA professionals in the region. They will also learn about the stages and processes as well as the players involved in the life cycle of a product.

The course will commence from the 8th of September 2017 and classes will be held at the Dubai Pharmacy College from 8 A.M. to 12 noon on all Fridays for the next 12 weeks. The course is conducted twice a year and starting this year, it will be available online too.

“The objective of the course is to develop competent, confident and consummate RA professionals and also enable them to continue their learning and development. Attendees will have the opportunity to learn from regulatory affairs experts in the region and gain a competitive edge while applying for RA-related positions in the public or private sectors,” said Dr Al Shezawy.

ubai Pharmacy College in collaboration with Professionals Regulatory Affairs (PRA) has launched the ‘Professional Regulatory Affairs Certificate Course,’ designed to help students and industry professionals build a successful career in pharmaceutical regulation and allied sectors.

Prof. Dr. Saeed Khan, Dean at Dubai Pharmacy College said the certificate course has gained recognition among aspiring professionals as a unique opportunity to develop up-to-date knowledge of regulatory affairs (RA) processes and legislation, especially in the UAE and the GCC region. “The ‘Professional Regulatory Affairs Certificate Course’ has received tremendous response from professionals and we have now decided to run an online program too. The projected growth and rising competition in the region’s health-

“The Certificate is a significant advantage in view of the growing demand for RA professionals among pharmaceutical companies and consultancies, manufacturers of medical devices, veterinary products and cosmetics, and regulators,” said Dr. Mona Al Moussli, CEO of Professionals Regulatory Affairs. Altogether there will be 12 modules in the course, with one or two modules delivered every week. Participants will be evaluated based on module assignments and those who successfully complete the course will receive certificates issued by the Dubai Pharmacy College.

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WHAT IS THE ROLE OF HEALTHCARE SUPPLY CHAIN to overcome healthcare crises? Today’s global population is on the brink of the severe healthcare crisis. This is by and large driven by the steady rise of pandemics as well as the healthcare cost often extending beyond the affordability of commoners. The swelling global population and a shortage of skilled and qualified healthcare professionals are further fuelling the crisis. •

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As per Global Healthcare Outlook 2017 released by Deloitte, global healthcare expenditure is projected to touch $8.7 trillion by 2020 from $7 trillion in 2015. WHO (World Health Organization) declares the world is going to face an acute shortage of healthcare force of 12.9 million by 2035 from the current figure of 7.2 million.

The leading healthcare organizations are under the compulsion of rigid cost-cutting and are seriously thinking of revamping the healthcare supply chain to add better service delivery to the patient at a controlled cost.

Hospital Supply Chain Excellence Conference It was an opportune moment for me to be a part of the honorary delegation to deliver a keynote speech in an international meet on Hospital Supply Chain Excellence recently conducted in Pullman, Bangkok. Many significant issues in SCM (Supply Chain Management) were brought into light working on which can make a huge difference in cost management and quality service delivery. Healthcare supply chain is the lifeline of any health organization and has lots to do in overcoming this looming global crisis. I am glad that my deliberation provided more

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enlightenment on this issue which can be high yielding in the long run.

Role of supply chain management in healthcare:

Improper healthcare supply chain management contributing to rising healthcare cost:

Supply chain management in healthcare implies effectively managing the upstream and downstream relations between the providers and customers generating the best customer value maintaining an optimal cost.

If we study the drivers (as per the research Willis Towers Watson) listed below contributing to the rising healthcare cost, we would find that supply chain has a crucial role in it. • • • • •

Hospital/inpatient services. Basic medical/outpatient services Provider and employee behavior New medical technology. Rising provider profits.

“The supply chain is the second largest and fastest growing expense for healthcare providers; with only labor costing most providers more.” – Bruce Johnson, CEO of Global Healthcare Exchange. In fact, healthcare supply chain accounts for 40-45% of the total operating cost in a hospital. [http:// hitconsultant.net] To provide timely care and service to the patients, the synergism of the healthcare supply chain is very crucial to the operation of each and every department of the hospital/ healthcare organization is linked with the chain. The traditional healthcare supply chain models running down since long without factoring in the developments in the global healthcare sector have made accessibility of quality healthcare difficult. This is evident from unprecedented long patient waiting times, treatment errors and compromised patient care often leading to death.

The process is complex given the involvement of a number of stakeholders in every macro and micro level of operations eager to protect their own interests. In line with this, the Global Healthcare Exchange (GHX), the 10-year-old collaborative group comprising of 20 manufacturers, Group Purchasing Organizations, distributors, hospitals aims to lessen the supply chain costs by more than $ 5 billion in the coming 5 years. In the $3 trillion market, it may appear to be a small drop in the ocean, but this is the best achievement so far better than the rest.

Prime factors affecting the cost and efficiency of the supply chain: •

Controlling the supply cost remains the prime challenge in the supply chain: The prime challenge of the healthcare supply chains is to control the cost of supply that is growing at an unprecedented rate raising the cost and affecting the operation efficiency of the system. “The reason why healthcare costs are so high is hospitals keep buying things they already have and waste money” – Mark Roberti, Editor, RFID Journal. 90% of the hospital linen in the US is lost before it reaches the end of its

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useful life – Healthcare Publication Mcknights. [http://www.logisticsbureau.com]. As per the CEO of ROi, Sisters of Mercy Health System, “Material should never exceed labor in the service industry”. •

Equating efficiency with activity is another factor affecting the efficiency of the supply chain: Skilled healthcare staffs waste a substantial paid time in managing other logistic activities which could be utilized for better patient care.

Maximizing speed & efficiency is crucial in healthcare supply chain management A customer (mainly the patient) prefers speedy service but concentrating more on speed enhancement shoots up the cost. Therefore, the optimal balance between speed and efficiency is required. This involves: •

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Having an improved end-to-end visibility of the supply- demand situation and aligning the organization accordingly. Proper stocking of products. Develop effective inventory management system. Ensure timely services and care to patients. Check the ready availability of life-saving tools/drugs. Proper dealing with the regulatory agencies safeguarding the patients’ interests. Careful management of contracts even if they are efficiently handled by GPOs. Ensure smooth operations with the right usage of technology and analytics. Understand the cost and set up an effective pricing system. Improve in order accuracy and order cycle times that would reduce cost.

Improvement in healthcare supply chain management has far-reaching consequences: As per the Gartner Research, a better planned and smartly analyzed supply chain can reduce its cost by 5-15%, which translates into a profit margin increased by 2-7%. Gartner has listed top 10 healthcare supply chain performers in 2016 whose efficient supply chain management has demonstrated improved patient care at sustained costs: • • • • • • • • • •

Intermountain Healthcare. Cardinal Health. Mayo Foundation. Mercy. McKesson. Owens & Minor. CVS Health. Johnson & Johnson. Amerisource Bergen. Cleveland Clinic.

How supply chain transformation can reduce healthcare costs significantly: The aim is to drive more efficiency that is to cost less and provide more value (service). The focus should be on centralization and patient centric thinking. Healthcare supply chain is not confined within the medical supplies but also involves technology, coordination, consolidation and partnership building within the community. To maintain an efficient and cost effective supply chain, the following 5 ways are important: • •

Reducing manual processes and introducing automation. Building efficient trading partner relationships with suppliers, partners, and customers through accurate and efficient e-business transactions.

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

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Reducing waste and checking excess build up. Capturing and sharing data for business requirements to drive more efficiency and better compliance. Enabling automation among regional care networks.

Supply chain forms the circulatory system of a healthcare organization where the speedy and efficient flow of goods and services to different points of use determines the quality and cost. Various transformed models in healthcare supply chain are generating appreciable cost benefits adding more value to the patient, and with this trend to continue it would have a great impact on the prevailing healthcare crises.

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VITAMIN-D DEFICIENCY

By Dr. Ahmad Al-Ajaj Internal Medicine /Al-Ahli Hospital Vitamin D is a fat soluble vitamin and it is important for calcium homeostasis and for optimal skeletal health. Vitamin D3 produced by the skin upon exposure to ultraviolet B (UVB) radiation.

Etiology Vitamin D deficiency can result from the following: • Inadequate exposure to sunlight; adults in nursing homes or healthcare institutions are at a particularly high risk. • Vitamin D malabsorption problems, resection of the small intestine, celiac sprue, short bowel syndrome, and cystic fibrosis. • Minimal amounts of vitamin D in human breast milk. • Medications: Dilantin, phenobarbital, and rifampin. • This was significantly more common in women than in men in the Middle East (reflects the cultural and religious practices leading to less skin exposure in women than in men). Darker skin people require 6 times the amount of UV radiation necessary to produce a serum vitamin D concentration similar to white skin, this explains the higher prevalence of vitamin D insufficiency among darker-skinned adults. Vitamin D production in the skin declines with advancing age, making elderly populations more dependent on dietary vitamin D.

Signs and symptoms

Vitamin D deficiency is often clinically silent. Manifestations are as follows: • •

Children are often found to have started walking late or prefer to sit down for prolonged periods. Adults can experience chronic muscle aches and pains, fatigue,tiredness, increased risk of infections, depression, impaired wound healing and hair loss.

Physical findings in severe vitamin D deficiency are as follows: • •

In children, bowing in the legs (rickets). In adults; bone tenderness (osteomalacia)

Diagnosis Measurement of serum 25-hydroxyvitamin D (25[OH] D) is the best test to determine vitamin D status. Screening for vitamin D deficiency is recommended only in those individuals who are at high risk for vitamin D deficiency, including the following. • Patients with osteoporosis. • Patients with a malabsorption syndrome. • Black and Hispanic individuals

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• •

Obese persons (body mass index >30 kg/m 2). Patients with disorders that affect the metabolism of vitamin D and phosphate (eg, chronic kidney disease).

Management Vitamin D–deficiency should be treated by the specialized doctor after confirming the deficiency with the appropriate tests, the excessive and unobserved use of vitamin – D supplements can lead to vitamin-D toxicity. Advised to spend (10 minutes for fair skin and 30 minutes for brown skin and 1 hour for black skin) in the sun with your arms and legs exposed (not your face) between the hours of 11 a.m. and 3 p.m. two to three times a week from March through May and September through October but only 15-20 minutes in July and August when the sun in strongest. If you remain outdoors longer than the specified time, apply sunscreen.

Recommended dietary intake of vitamin D for patients at risk of vitamin D deficiency is as follows: •

In infants and children up to 1 year old, at least 400 IU/day. • In children and adolescents 1-18 years of age, at least 600 IU/day. • In adults 19-70years of age, at least 600 IU/day . • In adults > 70 years of age, at least 800 IU/day. • Raising the serum 25(OH)D level consistently above 30 ng/mL may require vitamin D intake of at least 1000 IU/day. Most dietary sources of vitamin D do not contain sufficient amounts of the vitamin to satisfy daily requirements.

The following foods contain the indicated amounts of vitamin D: • • • • • • • • • •

Fortified milk (8 oz.) - 100 IU. Fortified orange juice (8 oz.) - 100 IU. Fortified cereal (1 serving) - 40-80 IU. Pickled herring (100 g) - 680 IU Canned salmon with bones (100 g) - 841 IU. Mackerel ( salted (100 g) - 1006 IU. Canned sardines (100 g) - 332 IU. Codfish liver oil (100 g) –10000 IU. Mushrooms (Portobello Exposed to Sunlight) 100g – 1136 IU. Most multivitamins (1 tab) - 400 IU.