HOSPITALS Magazine issue 37 by The Arab Hospital Magazine

Issue 37 / 134 Nov / Dec 2017 www.tahmag.com

PETER MAKOWSKI Chief Executive Officer, American Hospital Dubai

AMERICAN HOSPITAL DUBAI NEWS

CANCER CARE CENTER

HEALING HANDS. CARING HEARTS.

Fighting cancer is a team effort. With treatment approaches constantly evolving and providing a growing array of medical tools to diagnose and attack the disease, it is essential to turn to skilled physicians trained in cancer care when deciding on an appropriate treatment plan. At the American Hospital Dubai Cancer Care Center, treating cancer is what we do. From diagnosis and treatment to side-effect management and survivorship, our oncologists treat every stage. Through advanced tools and state-of-the-art technology, we provide fast and accurate diagnosis and develop thorough treatment plans, supporting patients with therapies to reduce side-effects and improve quality of life.

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Medical Oncology and Hematology

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Pediatric Oncology and Hematology

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Radiation Oncology with most Advanced Technology available

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Surgical Oncology for all specialties

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Cancer Diagnostic Department with PET scans capabilities

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Palliative Care

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Cancer Ablation Therapy for Thyroid Cancer

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Multidisciplinary approach with E-consults with Mayo Clinic Care Network

To book an appointment, please call +971 4 377 6369 or visit www.ahdubai.com

American Hospital Dubai accepts most major health insurance plans, please call (+971) 800 - 5500

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OUR CANCER CARE SERVICES:

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 conflict between the spread of diseases and the medical quest to overcome them has continued since the dawn of history. But recent scientific experiments and discoveries have been making significant progress in this regard. Diabetics, for instance, will receive greater attention with the latest research in the United States, especially in terms of blood glucose monitoring devices. Abbott Diabetes Care Division has recently announced that it has reached a revolutionary new glucose sensing technology that will be available in the market by the end of the year; it eliminates the need for routine finger sticks and is the only personal continuous glucose monitor (CGM) that does not require finger stick calibration. The new device reads glucose levels through a sensor that is worn on the back of the upper arm for up to 10 days, it is also water-resistant, and can be worn in the shower and during swimming. It also gives patients and their doctors the ability to make treatment decisions based on more accurate information, and at a fraction of the cost of traditional systems. This good news for diabetics is not the only one among the medical discoveries, while diabetics are not the only ones who will enjoy more health security, as long as there are people who strive to achieve better health with fewer diseases. The Publisher

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 All rights reserved by the hospitals mag. No part of this publication can be reproduced in any form without prior permission in writting from the publisher

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NOVEMBER . DECEMBER 2017

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60 36

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COVER STORY

8 Peter Makowski, CEO at American Hospital Dubai

NEWS

14 LAU Medical Center-Rizk Hospital announces the Breast Cancer awareness and Call to Action campaign 16 Qatar University College of Pharmacy held its 11th annual White Coat Ceremony 17 Boehringer Ingelheim and Dicerna Announce Collaboration to Develop Novel Treatments for Chronic Liver Diseases including Nonalcoholic Steatohepatitis (NASH) 19 AUBMC Dr. Souha Kanj Sharara Honored with the BAbdul Hameed Shoman Award for Arab Researchers 20 KSMC’s one-stop clinic speeds up access to obesity treatment

34 The Center for Arab Genomic Studies Published the 5th edition of The Genetics Made Easy Series 36 Aster DM Healthcare bags Gulf Business Awards-2017 for the “Healthcare Company of the Year” category 40 ‘Inside Out’, Psoriasis Awareness Day in Beirut launched by Novartis 48 Qatar University hosts Fourth International Congress on Pathogens at the Human-Animal Interface (ICOPHAI) 2017 52 Abbott Launches Region’s First Diabetes Training Academy to Improve Diabetes Management 54 Dubai is in the process of launching the latest trend in the biological therapies for the treatment of Psoriasis in the Middle East

70 46 FEATURES

60 Autism 64 Gallbladder Diseases 70 Gout 74 UAE occupies first position in number of healthcare facilities 82 Parkinson’s disease

ARTICLES

44 pan by BHM 56 How old is your Heart? What can we do to keep it Young? 68 Save a tooth - Save the Smile 86 Heart Healthy Eating 98 Losing 5-10% of Body Weight Greatly reduces risk of Comorbidities Linked to the Disease of Obesity

MEDICAL FAIRS

10 The first MEDICA ACADEMY

INTERVIEWS

86 Dr. Samer El-Ali , Medical Director, Gilead Sciences Eastern Europe and Middle East 90 Dr. Fuad Hasan, Professor at the Department of Medicine, Kuwait University

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COVER STORY

“AHD has gained tremendous benefits after joining Mayo Clinic Care Network”

eter Makowski, CEO at American Hospital Dubai, is a highly experienced hospital leader having held a range of senior positions and led with distinction a number of healthcare institutions in the USA. “Hospitals” magazine met with Mr. Peter Makowski to talk about the latest medical services at AHD, how the hospital has benefited from joining the renowned Mayo Clinic Care Network, how much the country contributes to developing the health sector among other things. Below is the full interview:

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COVER STORY

The hospital’s administration is keen to keep abreast of international events and medical developments in order to provide the finest medical services in accordance with patients’ needs. What are the latest medical services and departments at American Hospital Dubai today? We recently expanded our intensive care unit (ICU) - from nine to 19 beds - to accommodate and extend high-quality critical care to more patients. This move is the result of our constant efforts to look for ways to enhance our services and capabilities to the community. Over the past year, AHD has added a number of new services to better meet the needs of our patients. These include; bariatric surgery to help people with morbid obesity and those whose quality of life is seriously compromised due to weight related complications; Cardiac Electrophysiology, a diagnostic procedure to look more closely at the electrical function of your heart, AHD has the only EP Lab in Dubai; a 640 slice CT scanner with a 85% reduction in radiation dose to patients; Stereotactic Radiosurgery to deliver the radiosurgery treatments for patients diagnosed with brain and lung cancer, this is a highly focused treatment that significantly reduces side effects.

More than a year after joining the Mayo Clinic Care Network, how do you assess the situation today? How much have you benefited from that and exchanged experiences? The patients of the American Hospital Dubai have benefited tremendously a year after joining the renowned Mayo Clinic Care Network. For over a year, we have gained relevant insights on various cases, including complex medical conditions. We consult our prominent partner about

various challenging cases to ensure that our patients are receiving the best of care.

How did the patients at the American Hospital Dubai benefit from this affiliation? Through our affiliation with Mayo Clinic, our physicians are given access to the institution’s renowned expertise. They can consult and collaborate regarding treatment and drug options for various diseases. Such exchanges of expertise assure our patients that leading experts are looking into and discussing their cases to provide exceptional medical treatments. If a patient’s condition requires a consultation, then this is done at no expense to the patient.

We must talk about the role of the state in supporting the health sector and its efforts to overcome obstacles to provide the best medical services. How do you assess the health situation in the UAE today? How much is the country contributing to developing this sector? The UAE Government has established preventive health measures and offers integrated and advanced healthcare services delivered in innovative and sustainable ways. Health education is gaining ground in the country and there is a strong promotion for Public / Private Partnerships. It is encouraging that all local stakeholders are working as one to provide the best healthcare solutions in line with global standards and according to the goals of UAE Vision 2021. Private hospitals play a pivotal role in the realization of the country’s goal to build a world-class health system. At American Hospital Dubai, we recognize the significance of formulating policies, forging relevant partnerships, and implementing programs that will

contribute to the growth of the UAE health community. As we aim to provide high-quality, excellent, cost-effective and innovative patient care, we have embarked on key endeavors to ensure that we fulfill our commitment to our patients. Our partnership with Mayo Clinic is a concrete demonstration of this. Additionally, we are continuously working towards enhancing our systems and processes according to the standards of international institutions to gain accreditation and recognition for our various centers of excellence. We have also put in place a host of packages of medical services to attract international patients in line with the objective of Dubai and the rest of the UAE to intensify their health tourism industries. We have, in fact, established a division dedicated to addressing the unique needs of global health travelers. We will continuously offer the best services to help strengthen the local health system.

We would like to discuss the Service Excellence Program and its role in providing the best possible healthcare. What is this program? What is its importance in reaching this major level of high-quality medical services? Our Service Excellence Program utilizes an effective tool to measure patient satisfaction in all of our services. We designed this program as part of our bid to exceed the expectations of our patients, provide the best experience, and offer excellent services to help our patients recover and lead a quality life. Through the program, our patients can give their feedback in real time and rate their experience with our staff and services. From our end, we will evaluate their feedback daily for further improvement of the processes of the entire hospital.

COVER STORY

“WE AIM TO PROVIDE HIGH QUALITY, COST-EFFECTIVE AND INNOVATIVE PATIENT CARE”

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COVER STORY

“MEETING THE HIGHEST STANDARDS OF EXCELLENCE AND QUALITY”

COVER STORY

After this success, how do you assess this new chapter in the treatment of cancer patients at the regional level today?

Your hospital offers “healthcare packages.” What are these packages? Who are the target groups?

Following globally recognized protocols for handling cancer cases, acquiring state-of-the-art equipment, embarking on continuous scientific research activities, and promoting efficient doctor collaboration have made the region even more capable of treating cancer patients. In the case of American Hospital Dubai, our partnership with the Mayo Clinic, has helped further strengthen our competencies and capabilities in handling such serious conditions.

Our host of healthcare packages caters to different age groups and targets common health concerns. Each package offers a series of comprehensive medical tests for accurate diagnosis of the diseases and effective treatment to help our patients lead a healthy life. Some of these include bariatric; well man and well women screening; screening colonoscopy; cardiology; knee replacement; dermatology; breast cancer; and maternity services.

To what extent will this contribute to the growth of hospital admissions for treatment locally and regionally, especially through the hospital’s International Patients Department?

What about the awareness programs that you offer and their role in spreading cultural awareness in the community?

This demonstrates the country’s commitment to meeting the highest standards of excellence and quality. This has led to increased patient trust and confidence in our proven capabilities to deliver excellent healthcare solutions and which in turn contribute to the growth of hospital admissions. The American Hospital Dubai collaborates closely with the Dubai Health Authority to reach out not only to local and regional patients but individuals from other parts of the world.We visit various countries to highlight the quality and affordability of our services. Going beyond providing worldclass healthcare services, the men and women behind our dedicated International Patient Relations Department are also trained to provide the right information to assist our patients in booking their flights and hotels, among others.

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We recognize the value of public awareness and education in nurturing a healthy population. Private health institutions are vital to empowering society when it comes to their health. The American Hospital Dubai has been active in this regard. We have launched the breast cancer awareness campaign, for instance, in which we give special discounts on our mammogram and breast ultrasound tests. Stress management awareness is another important initiative implemented in coordination with Dubai Police in which we conduct medical missions in various underserved areas. We also celebrate nutrition month to promote mindful eating, which involves awareness of internal and external cues influencing the desire to eat, food choice, quantity of consumption, and the manner in which the food is consumed. We will continue to create similar campaigns to serve the community and raise the level of health awareness in our society.

COVER STORY

“LEADING EXPERTS TO PROVIDE EXCEPTIONAL MEDICAL TREATMENTS”

NEWS

LAU Medical Center-Rizk Hospital announces the Breast Cancer awareness and Call to Action campaign

AU Medical Center-Rizk Hospital launched its Breast Cancer Awareness Campaign under the title “Awareness is Good; Screening is Better” during its conference led by the multidisciplinary team of a physician at the medical center. The conference highlighted the importance of radiography and early detection of breast cancer for women. Dr. Daniel Mahfoud, Head of Diagnostic and Interventional Radiology department at LAU Medical Center-Rizk Hospital, announced: “We joined the Ministry of Public Health’s yearly Breast Cancer special screening tariffs campaign that started on October 1st till the end of January. We aim at having the majority of women do the mammography on a yearly basis as a preventive action, as we agree that screening is the best tool for early detection”. The lecture discussed the main phases of breast cancer starting with radiology, screening, diagnosis and finally the treatment. The LAU Medical Center-Rizk Hospital is known for its medical staff that follows up with patients throughout their treatment to help them overcome their illness and recover. The medical staff is divided into different sections including radiology, gynecology, surgery, chemotherapy, and radiotherapy that work together to evaluate the patient’s case. Each doctor had the chance to elaborate and explain the tasks each department handle in order to provide patients with the best treatment, as follows: Dr. Tamina Elias-Rizk, Mammography Specialist – Imaging department, Dr. Michel Samaha, Gynecologist, Dr. Ziad Zakaria, General and Breast Cancer Surgeon, Dr.

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Hady Ghanem, Head of Hematology and Oncology department, and Dr. Salim Chammas, BSc, Radiotherapy Oncologist. Physicians, residents of LAU Medical Center-Rizk Hospital and students of the LAU Gilbert and Rose-Marie Chagoury School of Medicine had the honor to participate in the conference along with patients and selected media. The conference aimed at raising awareness and encouraging women to early detection. At the end, we all have to cooperate

in order to overcome this disease. The conference was preceded by a halfday open door interactive exposition where visitors were invited to pass by the 2 stations showing recorded advanced topics on screens and doctors were available at each station for further explanation. Pink ribbons and informational leaflets were distributed to raise awareness about the importance of the yearly screening and to create more engagement between physicians and the attendees.

NEWS

Qatar University College of Pharmacy held its 11th annual White Coat Ceremony

atar University College of Pharmacy (QU-CPH) held on September 25 its 11TH annual White Coat Ceremony in which thirty-one new pharmacy students took the Oath of a Pharmacist, signed the pledge of professionalism and received the pharmacist’s White Coat in front of an audience of more than 300 invited guests and well-wishers. The event was attended by QU Vice President for Medical and Health Sciences and Dean of the College of Medicine (CMED) Dr Egon Toft, CPH Dean Dr Mohammad Diab, CPH Assistant Dean for Student Affairs Dr Alla El-Awaisi, First Secretary for Public and Political Affairs at the Canadian Embassy Diana Tan, and pharmacy directors as well as CPH partners, students and their families, faculty, alumni and staff. This year’s batch is the largest class to be cloaked since the inception of the Pharmacy Program in 2007. It is a testament to the increasing demand for a career in pharmacy in Qatar. The event also featured the distribution of Ebn Sina Medical Scholarship Awards to the students who achieved a high GPA. PharmD student Nawal Bensmail (3.93), MSc student Dana El-Khalifa (3.68), 4th-year student Dima Kawas (3.75), 3rd-year student Aya Maklad (3.79), and 2ndyear student Soumaya Koraysh (3.97).

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Dr. Egon Toft said: “CPH continues to accomplish numerous achievements among which its accreditation success. The college is committed to equipping its students with high-quality skills that enable them to compete at the international level. Today, the new students are entering a new phase in their academic journey towards becoming the pharmacists of the future. We are proud of you and you should be proud of yourself.” Dr. Mohammad Diab said: “Today we are welcoming the newest class of students and their families to the 11th annual White Coat Ceremony. The White Coat Ceremony is a ritual of passage to the College of Pharmacy, welcoming new student pharmacists into our professional program, and helps prepare them for the responsibilities and privileges that await them. As a college, we are committed to preparing future healthcare leaders in an environment of interdisciplinary education, scholarship and service meeting the goals of Qatar National Vision 2030. The College of Pharmacy at Qatar University truly demonstrates excellence and is recognized nationally and internationally in professional and graduate education.” Dr. Alla El-Awaisi said: “Today,

our CPH students are hard workers and I am confident that in their journey at CPH they will be outstanding students and pioneering graduates who will provide optimal healthcare services in the field of pharmacy. I would like to confirm here that once you put on your white coat, you will be QU and CPH ambassadors. We are sure that you will be up to the responsibilities and we will always be proud of all of you. Today, we also celebrate the International World Pharmacists Day under the theme of “Research for medical care” to focus on the advantages of pharmacy in the field of exploration, conducting research, and providing best services up to highest international standards.” 1st-year pharmacy student Hissa Al Mannai said: “I am delighted to have you all here today to share with us this momentum in which we take the first steps towards achieving our ultimate goal. We have chosen CPH for its fundamental contribution in the field of healthcare in Qatar and the region. Today, we are starting an important academic phase that requires hard work, commitment, and dedication. Qatar expects a lot from all of us and we have to do our best to pay back the country in the best way possible.”

NEWS

Boehringer Ingelheim and Dicerna Announce Collaboration to Develop Novel Treatments for Chronic Liver Diseases including Nonalcoholic Steatohepatitis (NASH)

oehringer Ingelheim and Dicerna Pharmaceuticals (NASDQ: DRNA), a leading developer of investigational RNA interference (RNAi) therapeutics, announced a research collaboration and license agreement to discover and develop novel GalXC™ RNAi therapeutics for the treatment of chronic liver diseases. The partnership will initially focus on nonalcoholic steatohepatitis (NASH), a devastating, chronic liver disease for which there is no approved treatment option. NASH is caused by the buildup of fat in the liver, potentially leading to liver fibrosis and cirrhosis. It has an especially high prevalence among obese and diabetic patients and is an area of high unmet medical need. NASH is expected to soon become the most common cause of advanced liver disorders, and it often necessitates liver transplantation.

Dicerna to receive up to $201 million in upfront and successbased development and commercialization milestones, excluding royalties, for an undisclosed target Dicerna’s GalXC technology platform uses RNAi to inhibit the expression of disease-causing genes by destroying the messenger RNAs (mRNAs) of those genes. This new approach has the potential to treat diseases by silencing previously inaccessible drug targets. It adds a

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further breakthrough therapy opportunity to Boehringer Ingelheim’s cardiometabolic pipeline and provides additional combination options. “We believe that Dicerna’s GalXC technology platform is ideally suited for the development of novel RNAi therapies for nonalcoholic steatohepatitis and other chronic liver diseases,” said Douglas M. Fambrough, President and Chief Executive Officer of Dicerna. “With strong capabilities in drug discovery, deep expertise in the cardiometabolic space, and proven commercial experience, Boehringer Ingelheim is a natural partner to speed the development of the first GalXC RNAi program targeting chronic liver disease. The collaboration combines the strong capabilities of both companies to pursue the full potential of Dicerna’s GalXC technology to bring valuable and differentiated RNAi therapies to patients with liver diseases and their healthcare teams, and reflects both the promise of the GalXC technology and the strength of its underlying intellectual property.” “At Boehringer Ingelheim, our research team is diligently working to discover effective new therapies for NASH and other chronic liver diseases, which is a priority area for us,” said Clive R. Wood, Ph.D., Corporate Senior Vice President Discovery Research at Boehringer Ingelheim. “This partnership complements our existing research efforts and expertise and offers distinct advan-

tages in developing exciting new therapy options,” added Wood. Boehringer Ingelheim has a long history of excellence in the discovery and development of medicines for cardiometabolic disease patients. It has established a broad portfolio of marketed products for thromboembolic diseases, type 2 diabetes, acute myocardial infarction, hypertension, and cardio-renal risk reduction. The cardiometabolic diseases pipeline extends beyond type 2 diabetes and anticoagulation with a focus on innovative drugs for the treatment of the devastating consequences of diabetes as well as contributing factors like obesity.

The collaboration will investigate a new therapeutic approach that enables addressing previously inaccessible drug targets to protect and restore liver functionality in NASH Dicerna is building a portfolio of research and development programs to advance the treatment of diseases involving the liver, including chronic liver diseases, viral infectious diseases, cardiovascular diseases and rare diseases. The company aims to leverage its proprietary GalXC technology to develop innovative RNAi therapeutics to positively transform the lives of individuals living with these diseases. Under the terms of the agreement, Dicerna may re-

NEWS

ceive more than $200 million from Boehringer Ingelheim, including an upfront payment, development and commercial milestone payments, and research and development reimbursement for a GalXC candidate product addressing an undisclosed NASH target. Dicerna is also eligible to receive royalties staggered up to double-digits on worldwide net sales.

Cautionary Note on Forward-Looking Statements This press release includes forward-looking statements. Such forward-looking statements are subject to risks and uncertainties that could cause actual results to differ materially from those expressed or implied by such statements. Examples of forward-looking statements include, among others, statements we make regarding: (i) the therapeutic and commercial potential of GalXC™; (ii) research and development plans related to GalXC; and (iii) the potential of our technology and drug candidates in our research and development pipeline. The process by which an early stage platform such as GalXC could potentially lead to an approved product is long and subject to highly significant risks, particularly with respect to a pre-clinical research collaboration. Applicable risks and uncertainties include those relating to our preclinical research and other risks identified under the heading “Risk Factors” included in our most recent Form 10-Q filing and in other future filings with the SEC. The forward-looking statements contained in this press release reflect Dicerna’s current views with respect to future events, and Dicerna does not undertake and specifically disclaims any obligation to update any forward-looking statements.

AUBMC Dr. Souha Kanj Sharara Honored with the BAbdul Hameed Shoman Award for Arab Researchers

rofessor of Medicine and Head of the Division of Infectious Diseases at the American University Medical Center (AUBMC), Dr. Souha Kanj Sharara, received the Abdul Hameed Shoman Award for Arab Researchers for her outstanding research in the medical and health sciences category. In that regard, AUB President, Dr. Fadlo R. Khuri, addressed the University community with the message below: “It gives me great pleasure to announce that Dr. Souha Kanj Sharara, Professor of Medicine and Head of the Division of Infectious Diseases, has been presented with the prestigious Abdul Hameed Shoman Award for Arab Researchers”. “Now in its 35th year, this award is presented annually to outstanding Arab men and women conducting scientific research in order to encourage young researchers. Dr. Kanj was selected out of more than 150 nominations in the medical and health sciences category,” he said. Khuri added: “A recognized expert in the field of infectious diseases, Dr. Kanj has conducted important research and published on numerous topics in this field, but her main research focus has concentrated on hospital-acquired infection (HAI) and she is considered a global authority on Gram negative resistant pathogens. Despite limited resources, Dr. Kanj’s work has been of

significant impact, tackling the problem of HAI from many angles, from understanding the epidemiology and risk factors to prevention, and treatment”. “Under her leadership, AUBMC has witnessed the development of a state-of-the-art Infection Control and Prevention Program (ICPP) operating in accordance with international standards. The ICPP at AUBMC has focused on protecting patients and healthcare workers from healthcare-associated infections, including ventilator associated pneumonia, central line associated bloodstream infections, catheter associated urinary tract infections, Clostridium difficile colitis, and surgical site infections”. Khuri said: “Her research in infection prevention and control has proved to decrease hospital mortality, hospital stay, and cost of hospitalization. Such findings promise to increase the quality of medical care and improve patient satisfaction while decreasing the impact on the overburdened medical system. She was also asked to lead the work on the susceptibility of new antibiotics against multi-drug resistant pathogens in the Middle East and North Africa region, the results of which were published in the International Journal of Antimicrobial Agents.” “Dr. Kanj has published more than 124 papers in international peer-reviewed journals and several papers in local journals. She presented more than 70 abstracts at international conferences and was invited to more than 200 national, regional, and international conferences as a keynote speaker”. President Khuri concluded in congratulating Dr. Kanj on this well-deserved recognition.

NEWS

KSMC’s one-stop clinic speeds up access to obesity treatment

ing Saud Medical City (KSMC)

launched an integrated onestop obesity screening service as part of the hospital’s ongoing efforts to offer patients the highest standards of care. The service also aims to offer patients an effective and efficient pathway that provides timely access to comprehensive care, including diagnosis, treatment, and follow-up. More than 200 patients from various regions in the Kingdom suffering from obesity were screened by a multidisciplinary team, including dieticians, physicians, and psychologists, and conducted diagnostic tests during the two-day service that was launched on Sept. 25 outside regular clinic hours. Patients were able to complete the process, which normally takes multiple visits over several months, in less than five hours, providing faster access to treatment, including metabolic surgery.

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“We are working on finding effective solutions that have a direct impact on patients primarily and the healthcare system in general. There is a substantial number of patients who are facing challenges because their disease requires a multidisciplinary approach, and obesity is one such disease that has become a serious public health challenge,” said KSMC Chief Executive Officer Dr. Haitham Alfalah. According to the World Health Organization, Saudi Arabia has one of the highest obesity (33 percent) and diabetes (17 percent) rates in the world. Obese patients are at an increased risk of developing multiple medical problems including type 2 diabetes, hypertension, cardiovascular disease, and osteoarthritis. “At King Saud Medical City we felt it was our duty to find an effective solution that significantly reduces the length of time to get access to all the specialists involved in treating the disease, in addition to ensuring patient satisfaction by providing care that exceeds their expectations,” said Dr. Alfalah. “It is our culture at King Saud Medical City to continuously strive for

innovative solutions based on proven methodologies with the primary aim of uniting our cadres and capabilities in the service of our patients,” he added. Dr. Alfalah said the obesity screening service, modeled on global best practice methodologies, has proven to be successful with preliminary results from a patient satisfaction survey showing a 96 percent rate of satisfaction. KSMC’s efforts to combat obesity are aligned with the Ministry of Health’s drive to address the burden of obesity through preventive and therapeutic initiatives and to improve access to care in line with the National Transformation Program, which aims to reduce the prevalence of obesity in the Kingdom to 1 percent by 2020. KSMC is recognized as a Center of Excellence in Bariatric & Metabolic Surgery by the International Federation for the Surgery of Obesity & Metabolic Disorders (IFSO) and Surgical Review Corporation (SRC), USA. The KSMC center is the first in the Middle East to be recognized as a Center of Excellence with back-to-back international accreditation in 2017.

NEWS

Breast Cancer and Fertility preservation IVI Fertility Middle East helps patients diagnosed with breast cancer as well as the survivors to get pregnant again

ccording to a 2011 report released by the Department of Health - Abu Dhabi, the top five cancers in females are breast, leukemia, colorectal, thyroid and uterus. Breast cancer is an abnormal growth of cells that normally line the ducts and the lobules. Most breast cancer begins in the ducts (ductal), some in the lobules (lobular), and the rest in other breast tissues. Lymph is a clear fluid that has tissue waste products and immune system cells. Most lymphatic vessels of the breast lead to underarm (axillary) lymph nodes. Some lead to lymph nodes above the collarbone (called supraclavicular) and others to internal mammary nodes which are next to the breastbone (or sternum). Cancer cells may enter lymph vessels and spread along these vessels to reach lymph nodes. Cancer cells may also enter blood vessels and spread through the bloodstream and other parts of the body. Breast cancer is classified by whether cancer started in the ducts or lobules, whether the cells have grown or spread through the duct or lobule (invasive) or not (in situ carcinoma) and the way the cancer cells look under a microscope. There are different stages of cancer and each stage is treated differently. Most common types of cancer treatment are surgery, chemotherapy, radiation therapy, and many others. Cancer treatments and the drugs for breast cancer may affect a woman’s fertility. For example, chemotherapy for breast cancer might damage the ovaries, which sometimes lead to instant or delayed infertility. Yet, many women are able to become pregnant after treatment. Therefore, it is highly recommended to visit a

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fertility specialist before undergoing cancer treatments for fertility preservation. At IVI fertility Oocyte Vitrification/ cryopreservation (Egg Freezing) is performed for patients that are diagnosed with different types of cancers. Oocyte Vitrification is a technique used to extract a woman’s eggs (oocytes), freeze and store them (oocyte bank). Those eggs can be used later on when the woman is ready to become pregnant, the eggs can be thawed, fertilized, and then transferred to the uterus as embryos. “We always advise our patients to vitrification the oocytes before chemotherapy treatment begins as the patient has an acceptable ovarian reserve” mentioned Dr. Barbara Lawrenz IVF Consultant at IVI Fertility Clinic. Mariam, 32 was diagnosed with breast cancer, said “I survived and I am perfectly fine today because it was on one of my regular screenings that my cancer was discovered, I’m also pleased to still be able to have a baby after the struggle with chemotherapy especially that I had a low egg reserve before the treatment started”. In this respect, Dr. Barbara Law-

renz considers that: “Egg freezing can also be useful for women who, for the purpose of education, career or other reasons, desire to postpone motherhood. Freezing eggs at an early age may ensure a chance for a future pregnancy. Additionally, women with a family history of early menopause have an interest in fertility preservation. With egg freezing, they will have a frozen store of eggs, in the likelihood that their eggs are depleted at an early age”. Mariam also added “it is great that science and technology can still help us reach our dreams no matter what the circumstances are, now I try to raise awareness about breast cancer as well as the importance of fertility preservation. IVI Middle East Fertility Clinic is the world leader in delivering fertility treatments with 71 clinics and 160,000 babies born worldwide. It offers a comprehensive range of infertility treatments, including genetic testing, backed by world’s most advanced technology and a team of highly experienced specialists. The friendly patient care staff ensures that couples seeking IVF treatments are walked through all possible details on their treatment and expected results.

NEWS

29 JAN – 1 FEB 2018 DWTC, Dubai, UAE

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AMERICAN HOSPITAL DUBAI PLASTIC, RECONSTRUCTIVE AND COSMETIC SURGERY

LOOK BETTER, FEEL BETTER, BE BETTER.

American Hospital Dubai’s new Plastic Surgery Department thrives on the same high standards as the hospital and prides itself on integrity, quality and safety. We offer a comprehensive plastic, reconstructive, and cosmetic surgery services: •

Hand Surgery (Trauma & Elective)

•

Burn Repair Surgery

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Breast Reconstruction (following mastectomy)

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Skin Cancer Management

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Cosmetic Surgery (Body, Breast, & Face)

To book an appointment, please call +971 4 377 5500 or visit www.ahdubai.com

American Hospital Dubai accepts most major health insurance plans, please call (+971) 800 - 5500

MOHAP - OQ40104 - 26/02/2018

Please visit our website for the complete list of procedures

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The University of Manchester inducts first Middle East student cohort for new MSc International Healthcare Leadership

he University of Manchester Middle East Centre has inducted the first student cohort for the new MSc International Healthcare Leadership – the first of a series of new industry-led Masters programmes introduced into the region by the University. 21 senior healthcare professionals in clinical to administrative roles came together in Dubai for a session by programme leader, Dr. Stephen Brookes, senior fellow in public leadership at The University of Manchester. The first cohort for the MSc International Healthcare Leadership started with 21 students enrolling on the new industry-led part-time programme, following a recruitment campaign across the Arabian Gulf region. Of the new students, 9 are female; 12 students are resident in the United Arab Emirates, six reside in Saudi Arabia, together with students from Kuwait, Lebanon, and Bahrain. The face-to-face induction session at the Middle East Centre comprised an introduction to the programme elements, and an invitation to complete a ‘Personal Pledge’ towards improving the healthcare system in which they work. The Middle East healthcare sector remains very active with continued public and private sector investment (the number of private healthcare facilities in Dubai alone grew 4% in Q2 2017) to meet rising patient demand, greater emphasis on wellness and prevention, privatization and some consolidation taking place, alongside digital transformation with increasing automation and Electronic Health Records, and man-

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datory health insurance programmes being rolled out. All of this is placing a premium on high-quality leadership across healthcare systems, institutions, and individual departments. The new MSc International Healthcare Leadership is delivered in a part-time blended learning format for experienced clinicians and managers already in general management or leaders in healthcare who need to enhance their leadership skills and those managers who need practical preparation before moving into clinical, project, specialist or business leadership positions. It is designed to equip leaders and managers with the latest knowledge and global healthcare best practice and to help facilitate experienced managers transfer their skills into the healthcare economy, while they continue to work. The flexible study programme can be completed in two years (with further options to accelerate studies), starting from September 2017. The programme also includes regular face-to-face workshops in Dubai.

Randa Bessiso, Director of The University of Manchester Middle East Centre, comments: “Attracting, retaining and developing talent is a major challenge for many industries in the region; the regional healthcare sector is very dynamic, benefiting from investment, growth and with consolidation as the industry model transforms. Leadership is an essential component for success across healthcare systems, individual institutions and at every level, clinical and administrative, with a focus on the patient. Wellness and prevention are also rising priorities, with the challenge of improving productivity and cost efficiency in meeting the healthcare needs of a growing regional population.” The MSc International Healthcare Leadership programme is one of a range of new industry-led specialist Masters programmes to be introduced to the region by the university, alongside a growing series of shorter executive education programmes.

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FocalSpec’s UULA answers the demand for automated quality control in fast-growing medical device markets fect of destroying the inspected package. With UULA, the inspection is quick and accurate, and the product doesn’t suffer in the process, a result that saves resources as well as reduces waste.

Medical device markets growing – quality control is key to ensuring safety

ocalSpec, the Finnish expert in high-precision quality control devices, will launch their first 3D imaging and metrology system UULA at MEDICA Trade Fair in Düsseldorf, Germany. UULA can be used both in at-line quality control and in laboratories. It works especially well in measuring 3D topography and dimensions in medical device manufacturing as well as studying seal integrity of medical packages. As people live longer and companies continually work to improve the quality of their lives, new medical devices will be developed. Through constant innovation in product development, these devices will increasingly incorporate smaller components and more challenging materials. UULA can be used to inspect a variety of medical devices and components where the parts must be designed on a micron scale to ensure the devices’ operational reliability. Chips used in the microfluidic analysis can also be inspected, as well as biosensors. The former can be used in detecting the outbreak of cancer and the latter in measuring blood sugar or drug concentration in the human body. The research made in the field of medical devices, as well as product development and quality control processes, can be made more efficient and safe through automatization. As an example, the seal quality of sterile packages in operating rooms has traditionally been inspected manually. This has also had the ef-

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The market for medical devices is growing at an accelerating pace. According to the latest market analysis, it will cross the $400 billion line at the turn of the next decade. One source for the growth will be the proliferation of wearable medical devices. To ensure their functionality and safety, quality control standards will be set at a very high level. Through launching UULA, FocalSpec aims to answer these strict demands in a fast-growing market segment. LCI enables customers to model even the most demanding surfaces and shapes, from multi-layered to transparent surfaces. The technology detects millions of 3D points per second and detects irregularities of even one micron. This makes it superior in both speed and accuracy to other quality control methods on the market. “We are very proud of the product, as it allows us to answer our client’s demands even better. UULA is the embodiment of our development so far, and it opens up opportunities for us to act even in the most cutting-edge and fast-growing industry sectors,” states Sauli Törmälä, CEO, FocalSpec. As well as medical devices, UULA can be utilized in a variety of industrial processes, including consumer electronics, automotive industry, in steel manufacturing, as well as in plastics and containers. FocalSpec is a privately held Finnish high-tech company offering laboratory level measurement precision for online quality control and manufacturing line process optimization. The company operates globally through its subsidiaries in Atlanta, USA and Ratingen, Germany as well as a skilled network of integrators and distribution partners.

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Women Age 45 & Above at Greatest Risk of Breast Cancer

ccording to the Qatar National Cancer Registry at the Ministry of Public Health, 16.2 percent of breast cancer cases diagnosed in Qatar are in women aged between 45 and 49 years old. Breast cancer is the most common cancer among women in Qatar and the second leading cause of death in women worldwide. Professor Karl Alexander Knuth, Medical Director at the National Center for Cancer Care and Research (NCCCR) stated: “At HMC, we strongly believe in the link between awareness and reducing the incidence of breast cancer. We encourage women of any age to seek medical advice if they notice changes in their breasts or any unusual symptoms. Time is of the essence, and without doubt, breast cancer is most treatable when detected early.” October is Breast Cancer Awareness Month and Hamad Medical Corporation (HMC) is joining global efforts to increase public awareness of breast cancer, and specifically the disease’s signs and symptoms. The most common symptom of breast cancer is a new lump or mass. Other possible symptoms can include swelling of all or part of a breast, skin irritation or dimpling, breast or nipple pain, nipple retraction (turning inward), redness or thickening of the nipple or breast skin, and nipple discharge (other than breast milk). In recent years, the discovery of new therapies and technol-

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ogies has provided an almost overwhelming menu of treatment choices for breast cancer, bringing new hope for patients. According to Professor Knuth, while there have been many advancements in breast cancer treatment, particularly in the area of drug therapies, regular breast screenings are essential for reducing one’s risk of breast cancer. “There has been a lot of good news about breast cancer recently; treatments keep getting better and people know more than ever before about ways to protect themselves against this disease. When combined together, technology advancements, research developments, and awareness programs greatly help to improve

all cancer services and reduce the impact and extent of breast cancer,” Professor Knuth concluded. The Executive Director of Nursing at NCCCR, Ms. Catherine Gillespie, echoed his sentiment, adding that while HMC has adopted cutting-edge technologies, including operating the first PET CT scanner in the region, the focus remains on improving cancer services and patient outcomes. “Our focus on improving cancer services – one of the objectives of the National Cancer Strategy (2011-2016) – has seen advancements in cancer diagnostics and treatment options year on year. As a result, the number of people who have survived cancer has greatly increased.”

HMC’s National Newborn Screening Unit Relocates to Women’s Wellness and Research Center

amad Medical Corporation’s (HMC) National Newborn Screening Unit relocated to the Outpatient Department at the Women’s Wellness and Research Center. The Unit, which opened at Women’s Hospital in 2003, provides screening for all babies born in Qatar. To date, the newborn heel prick test has been administered to over 250,000 babies across the country. The screening quickly identifies specific harmful or potentially fatal disorders that aren’t otherwise apparent at birth. Dr. Hilal Al Rifai, Director of the Qatar Newborn Screening Program and Medical Director of Women’s Hospital stressed the importance of parents consenting to the newborn heel prick test that is routinely performed at every birthing facility in Qatar 36 to 72 hours after a baby’s birth. “Although a baby testing positive for a potentially fatal or disabling metabolic and endocrine diseases is not that common, it does occur. Recently, one of our babies screened positive for Primary Congenital Hypothyroidism (CH), a condition that affects the body’s thyroid gland,” said Dr. Al Rifai. According to Dr. Ghassan Abdoh, Senior Consultant of Pediatric Neonatology and Head of HMC’s Newborn Screening Unit, since its opening, the Qatar Newborn Screening Unit has provided early diagnosis and treatment for over 700 babies that have tested positive for a disease or disorder. The unit has reported a 98 percent survival rate of babies successfully treated for potentially fatal or disabling diseases. “Once we are certain a baby has tested positive, we initiate contact with his or her parents so we can explain the process for their baby’s care,” said Dr. Abdoh. “We know that hearing this news will be very difficult for a parent, so we ensure follow-up care involves multiple face-to-face visits in the clinic.”

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The Center for Arab Genomic Studies Published the 5th edition of The Genetics Made Easy Series “Four previous booklets have been published by CAGS that discuss a number of genetic disease topics including blood disorders, multifactorial disorders, cancers, as well as neonatal screening.” H.E Abdullah Bin Souqat Executive Director of Sheikh Hamdan Bin Rashid Al Maktoum Award for Medical Sciences

he Centre for Arab Genomic Studies, a division of Sheikh Hamdan Bin Rashid Al Maktoum Award for Medical Sciences, published the 5th edition of the Genetics Made Easy series entitled “Genetics Brain Disorders”. The booklet provides an overview of the symptoms, risk factors, genetic basis and impact on the Arab World of five common neurological brain disorders, namely Alzheimer Disease, ADHD, Intellectual Disability, Schizophrenia, and Tourette syndrome. H.E Abdullah Bin Souqat, the Executive Director of Sheikh Hamdan Bin Rashid Al Maktoum Award for Medical Sciences said: “This topic was specifically selected to raise public awareness on certain neurological brain disorders. These disorders are generally viewed negatively, especially in the Arab World. Additionally, there is a lack of awareness about where and how to treat these disorders, so the booklet also provides a list of local and regional facilities and resources in order to direct the public to the specialized centers in the Arab world.” H.E Added that “four previous booklets have been published by CAGS that discuss a number of genetic disease topics including blood disorders, multifactorial disorders, cancers, as well as neonatal screening. These booklets provide an overview of the risk factors, diagnosis and management, and the extent of spread of these disorders in the Arab World”. The genetics made easy series that was edited by a group of distinguished researchers under the supervision of Dr. Mahmoud Taleb Al Ali, the director of CAGS. This series aims to achieve the desired objectives of raising public awareness on the importance of genetic disease in the Arab World and to facilitate cooperation with other research and medical institutions to ensure global access to

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new findings and technical developments. The booklet will be distributed in hospitals, clinks, and healthcare centers; soft copies will be made available on the CAGS website. It should be noted that the 7TH Pan Arab Human Genetics Conference will be held from 18 to 20 January 2018 at Conrad hotel in Dubai, and will discuss the Omics Era through 4 main topics: precision medicine, big data in human genetics, genomics of multifactorial disorders, and the current trend in human genetics sciences.

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The

Omics Era

18th - 20th January Conrad Hotel

Conference Themes Big Data in Human Genetics Precision Medicine Genomics of Multifactorial Disorders Current Trends in Human Genetics

Keynote Speakers

R NOW REGISTE arly bird rates to avail E

Fowzan Alkuraya King Faisal Specialist Hospital & Research Centre, KSA Karsten Suhre Weill Cornell Medical College, Qatar

Plenary Speakers Andrew Morris, University of Liverpool Emma Baple, Genomics England Jacques Beckmann, University of Lusanne Khalid Fakhro, Sidra Medical Research Centre

Michael Pellini, Foundation Medicine Owen Rennert, NICHD Pierre Zalloua, Lebanese American University Raif Geha, Harvard Medical School

Genetic Counselling for Arab Populations Ensembl Workshop on Genetic Variation and Gene Regulation 35

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Aster DM Healthcare bags Gulf Business Awards-2017 for the “Healthcare Company of the Year” category on our ‘30th Anniversary Year’ - a landmark year of our journey towards the excellence in healthcare. We are happy that we could shoulder and add value to the healthcare infrastructure developments and a quality healthcare eco-system development in those region we operate. We believe this is an honour to our entire workforce of about 20,000 staff engaged in catering to the need and services of about 50,000 people per day through our facilities spread across 9 countries. Such recognition further motivate us to continue to work ceaselessly for ensuring Quality Healthcare at Affordable Cost to the Patients, as part of a ‘Caring Mission with a Global Vision’, while we constantly trying to deliver our brand promise ‘We’ll Treat You Well’ “.

ster DM Healthcare won the prestigious annual ‘Gulf Business Award 2017’ for the ‘Healthcare Company of the Year’ category. Ms. Alisha Moopen, Executive Director & CEO - Hospital & Clinics in GCC, Aster DM Healthcare, received the Award in a in a dazzling award ceremony held at Fairmont The Palm Hotel in Dubai on 10th September 2017, in the presence of the region’s prominent business leaders and top executives . The awards instituted by Motivate – judged by an independent panel and public voting – sought to celebrate excellence in the corporate world and recognize leaders across nine industries. Speaking on the occasion Dr. Azad Moopen, Founder Chairman & Managing Director of Aster DM Healthcare said “We are proud to receive this honour from the gulf region

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The sixth edition of the event saw a total of 27 awards given away during the evening in various categories. The

Gulf Business Awards cover a wide spectrum of economic sectors, from energy to real estate. Each year, the Awards celebrates regional titans of industry, government officials, small and medium-sized enterprises as well as entrepreneurs. Professionally, Gulf Business Awards attendees are at the top of their game. Not only do they drive forward the corporate agenda, but they also drive the national and international agendas and the audience consists of those who have contributed in raising the Gulf’s profile, both regionally and internationally. In each sector, a company and business leader of the year will be recognised. More Information on Gulf Business Awards Categories and 2017 Winners are available on http://gulfbusiness.com/revealedwinners-gulf-business-awards-2017/ http://gulfbusiness.com/countdownbegins-gulf-business-awards-2017/

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

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SunTech Medical Receives Third-Party Validation of CT40 BP Spot-Check Device

he CT40 spot-check device from BP monitoring specialist SunTech Medical has received third-party validation for blood pres-

sure performance as specified by the British Hypertension Society and the Association for the Advancement of Medical Instrumentation/ International Organisation for Standardisation. The SunTech CT40 provides clinical-grade, automated spot-check measurements of blood pressure and other vital signs for patients in hospitals, clinics, ambulatory care, long-term care and low-acuity hospital departments. A modular design allows clinicians to easily customise the device in the field; adding thermometry, Sp02, and Wi-Fi based on the unique needs of the patient and facility. The study conducted inde-

pendently by Dr. Hernan Polo Fritz and the staff at Vimercate Hospital (Vimercate, Italy) determined that the CT40 achieved an A/A grade according to the 1993 BHS protocol, and fulfilled requirements set by the AAMI/ ISO standard 81060-2:2013. The study confirmed the accuracy of oscillometric BP measurements taken by the CT40, and recommend it for BP measurement in adults. “This study validates the accuracy and reliability of our BP technology,” said SunTech Medical president Rob Sweitzer. “We are proud that our CT40 has received a third-party validation for both BHS and AAMI/ ISO standards.”

The Netherlands Cancer Institute Awarded Funding to Apply Molecular Imaging Technology to Prostate Cancer Surgery

he Netherlands Cancer Institute (NKI) announced that it has received funding from the Dutch Cancer Society (KWF Kankerbestrijding) to test whether a novel molecular imaging technology can guide prostate cancer surgery. The project will evaluate the imaging technology’s ability to detect prostate cancer during surgery, with the aim of performing more accurate removal of cancerous tissue. Prostate cancer is the most common cancer among men in Europe with over 350,000 diagnosed in Europe every year. Complete removal of malignant tissue during prostate cancer surgery can be challenging, especially in later-stage disease, as it can be difficult to distinguish between cancerous and non-cancerous tissue. Accordingly,

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there is a crucial need for new technologies to help surgeons visualize cancer in real time during an operation to ensure that cancer has been completely removed. In the joint research project, the Netherlands Cancer Institute, the University of Twente and industry partners, Lightpoint Medical and Philips will evaluate a novel molecular imaging technology to image the prostate cancer biomarker Prostate Specific Membrane Antigen (PSMA) during surgery. If successful, the technology will be tested in larger clinical trials with the aim of sparing healthy tissue and reducing recurrence rates in prostate cancer surgery. Dr. Marcel Stokkel, Nuclear Medicine Physician at NKI, commented, “If this technique is successful, we will be able to guide the urologist in

the most optimal way by combining pre-operative staging with pre-operative imaging using the same tracer. If the resection margins can be assessed with the highest accuracy during surgery, we might become able to improve recurrence and survival rates. The collaboration with Lightpoint Medical, Philips and the University of Twente is the most optimal setting to reach this goal and to complete this study.” “We are delighted to embark on this collaboration with the NKI and Philips. Intraoperative molecular imaging holds enormous potential in prostate cancer surgery. This project will bring the technology a step closer to the patients in need of better treatment options” commented Dr. David Tuch, CEO of Lightpoint Medical.

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‘Inside Out’, Psoriasis Awareness Day in Beirut launched by Novartis

n the occasion of the World Psoriasis Day, Novartis Pharma Services Inc., in collaboration with the Lebanese Order of Physicians and the Lebanese Society of Dermatology, organized an awareness day on “psoriasis Inside Out”, at the Beyt el-Tabib Auditorium, Furn el Chebbak, with a host of healthcare professionals, Psoriasis patients and members of the media present. Psoriasis is a common skin condition that speeds up the life cycle of skin cells and causes these cells to build up rapidly on the surface of the skin, resulting in scales and red patches that are itchy and sometimes painful. A panel of discussion was moderated by Jacqueline Chehwan, a media figure at ANB TV, with a ‘Question and Answer’ session held for the press as well as live testimonials of patients living with the disease and the effects it has on their lives. “Our goal on World Psoriasis day is to increase public and patient awareness on psoriasis. The Lebanese Order of Physicians welcomes all efforts done by different societies to leverage better communication between doctors and patients,” stated Dr. Marwan Zoghbi representing Professor Raymond Sayegh, President of the Lebanese Order of Physicians. “Our aim today is to provide information on psoriasis as a disease and to highlight the impact it has on the patients’ psychological, physical and social state,” explained Dr. Dany Touma, the President of the Lebanese Society of Dermatology. “We also want to increase the perception of psoriasis by healthcare professionals, in order to fully understand the negative impact it has on suffering patients.”

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Dr. Fouad El Sayed, President-Elect of the Lebanese Society of Dermatology and Professor of Dermatology emphasized on the fact that “Psoriasis is a systemic disease and is associated with multiple comorbidities including Diabetes, Hypertension and Cardio-vascular diseases.’ “Psoriasis is not a contagious disease, it is a systemic one. So clear skin is achievable and patients should be encouraged to consult their dermatologists for better guidance and understanding.” Anyone can develop psoriasis but factors can increase the risk of developing this disease such as family history, viral and bacterial infections, stress, obesity, and smoking. “psoriasis arthritis can affect up to 30% of patients with Psoriasis and has a major impact on joint movements and Quality of Life of patients” added Dr. Kamel Mroueh, President-Elect of the Lebanese Society of Rheumatology.

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The Lebanese Breast Cancer Foundation and Breast Center of Excellence at AUBMC spread hope and courage amongst the survivors of breast cancer through a guidance workshop

ou never know how strong you are until being strong is your only choice. In this same context, the Lebanese Breast Cancer Foundation and Breast Center of Excellence at the American University of Beirut chose to spread hope and courage amongst women with an advanced stage of breast cancer, through a workshop entitled “Patient Empowerment Workshop”, organized at Rotana Gefinor Hotel in Beirut on October 13, 2016. October, known as the official month for awareness on breast cancer, witnessed the start of a singular and pioneer initiative in the Middle East, translated into a workshop organized by the Lebanese Breast Cancer Foundation aiming to help breast cancer patients. A great number of experts in the field and media representatives were present during this day to support and give a glance of hope to the breast cancer patients and their families.The program of this workshop was organized to guide and entertain the participant women. It included sessions on nutrition, sexology, psychology, oncology, meditation, and beauty. After lunch, the participants attended a photo-shoot that will serve as a social awareness instrument on breast cancer.

at empowering women with education and courage in order to ensure better living while getting the most advanced and best cancer treatment, and that with full dignity and support. The workshop provided information on the different symptoms, solutions, and ways of coping with the disease. The support of the patient’s family, as well as friends, volunteers, staff, nurses, and doctors is key to hope, perseverance and standing up against cancer. We are gathered here today to encourage and spread awareness on the different means that allow patients to keep on fighting to cope with breast cancer and survive.”

Commenting on the workshop, Dr. Nagi El Saghir, President of the Lebanese Breast Cancer Foundation, said: “This pioneering initiative in the Middle East, for the second year in a row, underlines the importance of not only screening and early diagnosis, but also pays more attention and care to women who have advanced breast cancer as well. This workshop aims

Mirna Sabbah Hoballah, Vice-President of the Lebanese Breast Cancer Foundation, expressed great relief and happiness for the success of this workshop and for having a positive impact on the lives of patients with breast cancer. The Lebanese Breast Cancer Foundation is known for its role in social health awareness, medical and psychological support of

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patients, as well as fundraising and financial support of breast cancer patients, in partnership with the Breast Center of Excellence of the Naef K. Basile Cancer Institute at American University of Beirut Medical Center. Awareness and fundraising activities are organized at municipalities, schools, institutions, banks, and workplaces in all parts of Lebanon throughout the year. This patient empowerment workshop was supported by an unrestricted grant from Novartis. LBCF also thanks, Malia Group for their support, as well as Malia Group who sponsored the event’s “Beauty and Personal Care Section” by offering valuable giveaways to all attendees, patients, and their family members, from Cosmaline and Catrice products. Patients and their immediate families present at the workshop expressed great satisfaction, gratitude, and happiness for the education, care, and especially for getting together and talking openly about their disease and treatment journey.

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Graduation Ceremony in ESA for the students of the “Cercle des Dirigeants”

O Photo: Shutterstock

n Friday 15th of September at 18:30 in the gardens of ESA, Clemenceau Street, ESA Business School organized a graduation ceremony for the students of the “Cercle des Dirigeants”, Doctorate in

Business Administration, Executive MBA, MBA, Master in Marketing, Master in Management, Master in healthcare management and Executive Master in Financial Management. Students received their diplomas

by Mr. Bruno Foucher, French Ambassador to Lebanon, Dr. Saad Andary, Vice-Governor of the Central Bank of Lebanon, Mr. Jean-Paul VERMES, delegated Vice President of the Chamber of Commerce and Industry of Paris Ile-de-France and Mr. Stephan ATTALI, General Director of ESA. All graduates received two diplomas: the ESA diploma and the equivalent diploma of ESA partners such as ESCP Europe, to which ESA is affiliated, SDA Bocconi, School of Management, Paris Diderot University, etc. Such partnerships with the leading European management schools guarantee a label of quality of ESA’s academic programs and allow international recognition of its degrees. The ceremony was followed by a cocktail at the Villa Rose bringing together graduates with their families, friends and ESA partners.

With BHM, I’m taking back my freedom!

Whatever freedom means to people, our senses play a vital role in it. Freedom also means quality of life. BHM has set itself a challenging goal: To help those with a hearing impairment regain a significant quality of life, thus restoring their freedom. Innovative hearing systems by BHM – the new dimension in aesthetics, quality and reliability. www.bhm-tech.at

BHM-Tech Produktionsgesellschaft mbH . 7423 Grafenschachen . Austria

ARTICLE

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

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

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include the innovative models by BHM, Austria’s only manufacturer of hearing devices.

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

pan can do more pan immediately provides a reassuring feeling of safety in multiple

ways. A small, discreet button on the frame meets the highest technical standards. Direct, clear communication becomes possible once again: for example, the ability to focus entirely on each respective conversation partner. pan automatically adapts to the noise level of the environment. Thanks to its adaptive directional sensitivity, you can even clearly differentiate whispering against a loud background – but without the ambient noise disappearing from your own auditory range. This also goes for telephone calls. You hear the person you are talking to without isolating yourself acoustically from your environment. Nights out at the opera or theatre are once again transformed into unforgettable experiences, as pan features an inductive signal input that lets sound ring out in all its glory. Innovative technology is, of course, behind all of this.

pan – outstanding hearing quality thanks to state-of-the-art technology pan is a highly precise air conduction hearing system that captures sound via two directional microphones, and transfers it into the ear by means of a small speaker. Precise directional sensitivity enables pan to provide clear and interference-free hearing, thus setting completely new standards in relaxed, comprehensible hearing. Cutting-edge technology and the advantage of being able to attach pan easily and comfortably into any pair of glasses make this model one of the world’s most innovative hearing systems, combining excellent hearing quality with the highest degree of comfort!

ARTICLE

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

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

The perfect hearing experience even in ambient noise With two microphones positioned in front of the ear, pan guarantees outstanding directional sensitivity. This means that pan wearers can also

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

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

antees secure sound transfer from the impaired ear to the healthy ear. Thanks to adjusted signal differences, the direction of the sound can be determined, giving each particular wearer a wholly unlimited spatial orientation.

Quality Made in Austria Quality manufactory BHM develops high-quality hearing systems based on bone and air conduction technology. Their products are manufactured exclusively in Austria and distributed around the world. BHM has set itself a challenging goal: to help those with a hearing impairment regain a significant quality of life by using innovative hearing systems that ensure outstanding performance in aesthetics, quality and reliability.

pan-CROS for secure sound transmission For single-sided deafness or severe hearing loss, BHM experts recommend pan-CROS – contralateral routing of signals – a version that guar-

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Qatar University hosts Fourth International Congress on Pathogens at the Human-Animal Interface (ICOPHAI) 2017

Prof Rustin Moore

Dr Hamad Al Romaihi

ver 200 health experts and researchers in Doha, the region and beyond attended the Fourth International Congress on Pathogens at the Human-Animal Interface (ICOPHAI) 2017, the first-ever conference on communicable diseases in the region. Themed “Environmental Challenges and Impact on Global Health”, the 3-day conference (November 7-9) was organized and sponsored by Qatar University (QU), Hamad Medical Corporation (HMC), Ministry of Public Health (MoPH), Weill Cornell Medicine - Qatar (WCM-Q), Hamad Bin Khalifa University (HBKU), Qatar National Research Fund (QNRF), The Ohio State University (OSU), Université de Montréal, Universidade Federal da Paraíba, The John E. Fogarty International Center (FIC), Phytobiotics, Solar Cool Technologies Inc., Biotechnology and Biological Sciences Research Council (BBSRC), and University of Gondar.

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The event brought together a large number of health, agriculture and environment scientists and policymakers from many countries such as Bangladesh, Brazil, Cameroon, Canada, Ethiopia, India, Italy, Kenya, Mexico, Qatar, Rwanda, Somalia, South Africa, Sudan, Tanzania, The Netherlands, Uganda, United Arab Emirates, and the USA. They discussed the “One Health” concept and exchanged information on infectious and non-communicable disease risk factors, complex issues such as antimicrobial resistance, current technological advances in diagnosis, and vaccine development, as well as the limitations and gaps in knowledge on pathogens at the animal-human interface. The opening ceremony was attended by QU President Dr. Hassan Al Derham, QU College of Health Sciences (CHS) Dean and Biomedical

Research Center (BRC) Director and ICOPHAI 2017 Co-chair Dr Asma AlThani, MoPH Health Protection and Communicable Diseases Manager Dr Hamad Al Romaihi, OSU College of Veterinary Medicine (CVM) Dean Prof Rustin Moore, and ICOPHAI 2017 Chair Prof Wondwossen Gebreyes, as well as a large number of officials from QU. The Day One featured a keynote address by MoPH Advisor Dr. Roberto Bertollini, in which he discussed the “Environmental changes and their impact on global health”, a special session on “Zika Virus, Emerging and Re-emerging Infectious Diseases” led by Texas Biomedical Research Institute President and CEO Dr Larry Schlesinger, and two plenary sessions on “Parasitic and Environmental Zoonoses” and “One health and impact on climate change”, as well as a panel discussion on “Environmental Chal-

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lenges and Impact on Global Health”. It also included many presentations on a wide range of topics such as “Crimean Congo Hemorrhagic Fever among the One-Humped Camel (Camelus dromedaries) in Central Sudan”, “Dengue and Chikungunya in the Middle East and North Africa: A Systematic Review”, “Challenges to Control Ebola in West Africa: A Review”, “Coronaviruses detected in bats of Rwanda: diversity at human-wildlife interfaces and a call for one health approach”, and “Molecular characterization of Echinococcus granulosus s.l. cysts from cattle, camels, goats, and pigs in Ethiopia”, among many others. The Day Two comprised three plenary sessions titled “Innovative Capacity Building, e-Learning and Outreach approaches”, “Antimicrobial Resistance and Drug-Related Issues” and “Biosecurity, Biodefense, and Disaster Response”. It also included many presentations on “Bovine Tuberculosis infection in pastoral cattle and wildlife at livestock-wildlife interface of the Greater Ruaha ecosystem, Tanzania”, “Gastro-intestinal parasites infections in mountain gorillas (Gorilla beringei beringei) of Rwanda Volcanoes National Park: One Health Implications”, “In vitro antimycobacterial activity and cytotoxicity of selected medicinal plants against pathogenic and non-pathogenic mycobacterial strains”, “Diversity and antibiotic resistance profiles of Escherichia coli strains from migratory bird (Branta leucopis) and Reindeer (Rangifer tarandus) reveals dissemination of multidrug resistant (MDR) E. coli to pristine arctic environment”, and many more. The Day Three featured two

plenary sessions titled “Pathogenesis, Vaccine Development and metagenomic Technologies” and “Food-borne and Water-borne Diseases”. Discussions focused on a wide range of topics such as “Point-of-Care Lionex and Lipoarabinomannan (LAM) antigen tests and rapid Tuberculosis detection in cattle using non-invasive samples”, “Characterization of diverse novel porcine astroviruses in East African smallholder piglets”, “Tumor Necrosis factor -308 gene polymorphism and risk of Plasmodium Falcifarum malaria infection among people living in Denbia wereda, Northwest Ethiopia”, “Detection and Phylogenetic Genotyping of Epstein Barr Virus (EBV) Among Blood Donors in Qatar”, and more. Also on the event’s program were poster discussions on “Food-borne and Water-borne Diseases”, “Zika Virus, Emerging and Re-emerging Infectious Diseases”, “Parasitic and Environmental Zoonoses/One health and impact on climate change”, “Innovative Capacity Building”, “Antimicrobial resistance and Drug Related Issues”, and “Biosecurity and Biodefense and Pathogenesis, Vaccine Development and metagenomic Technologies”. In his remarks, Dr. Hassan Al Derham said: “In a world with a growing population of 1.1% annually, there is a tremendous increase in environmental stress, and accordingly, it is mandatory for nations and communities to come together to address sustainability issues. In part, international scientific collaboration has become a must to find solutions for many challenges facing the humanity such as providing energy, food, and clean water for people around the globe. With this notion comes our responsibility as academics, research-

ers, and policymakers to meet discuss, and promote sustained international cooperation for effectively dealing with world’s growing crises.” He added: “In Qatar, we invest about 3.5% of nation’s GDP to support research and build a knowledge-based economy that not only benefits our nation but also all mankind worldwide. Despite the unfortunate situations that we are facing in this region including the blockade on Qatar, which in the first place weaken the interaction between scientists, we are all here to work together and reinforce our commitment to providing a peaceful and healthy environment for many generations to come. We welcome you to this meeting and we look forward to fruitful and informative discussions over the next few days.” Dr. Asma Al-Thani gave a short brief on QU, CHS, and BRC. She said: “Qatar is the first nation in the region to host such a big event on “One Health”. The “One Health” concept is increasingly embraced by the World Health Organization (WHO), the Food and Agriculture Organization (FAO) and the World Organisation for Animal Health (OIE), as well as regional academic and policy-making bodies. This holistic view of health and capacity allows the improvement of public health and the implementation of sustainable programs for control and prevention of zoonotic diseases and environmental hazards of public health significance. We will continue to work with our national partners for the great advancement of this nation and to fulfill the goals of Qatar National Vision 2030.” Dr. Hamad Al Romaihi congratulated QU for hosting the Fourth In-

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ternational Congress on Pathogens at the Human-Animal Interface (ICOPHAI) 2017. He said: “Climate change, water security, and nuclear weapons are key threads that require multidisciplinary solutions. The highly pathogenic flu is the most overwhelming thread in the world. This event is important because it urges each individual to take part in the preparedness and response to such kind of threads through research and the translation of knowledge into control measures. It is our responsibility to seek areas of collaboration and to support each other. We look forward to the informative, engaging and inspiring discussions that will emanate from this conference.” Prof Rustin Moore said: “The Ohio State University recognizes the interconnectedness between animal health, human health, and the environment, as well as the importance of collaborative work across many years and around the globe towards a one health approach.”

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Prof Wondwossen Gebreyes Prof Wondwossen Gebreyes pointed to the world’s growing population and the global factors that are affecting health such as urbanization, industrialization and climate change.

He noted that the goal of ICOPHAI 2017 is to bring together scientists from developing and industrialized countries and to stimulate interactions using the “One Health” concept.

The Pioneers in healthcare specialty training and career development

Optimisation of treatment for major cardiac syndromes 24th - 25th November 2017 | Dubai, United Arab Emirates

COURSE OVERVIEW The course aims to update and standardise the optimal treatment in the different cardiac conditions both chronic and acute. The course will summarise the key pathophysiological components to promote a better understanding of the pharmacological targets. Treatment strategies will be principally focused on medical treatment whilst indicators for specialty and super-specialty strategies will be illustrated. These indicators will help attending physicians in the decision to refer patient to a hospital setting or to a specialty tertiary level institution in a prompt and appropriate way. Emphasis will also be put into optimising the “standard” treatment to each individual needs and clinical conditions in order to provide to the patients the most benefits in terms of care, symptom relief, quality of life and prognosis. Treatment strategies and flow charts will be illustrated starting from international guidelines and results of most recent major trials.

Training organized by:

COURSE TRAINER:

Domenico Cianflone

MD FESC MIHHS, Director Cardiovascular Prevention & Rehabilitation San Raffaele Hospital

WHO SHOULD ATTEND:

• General practitioners • Internal medicine specialists • Cardiologists

Certified and Recognized by:

Media Partners:

Sign up now to secure your seats for the training. Limited slots are available, Register Today! Email us on info@gsdhealthcare.ae for more information or call us on +971 4 568 3374

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Prof. Alawi Alsheikh Ali, Dean – College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU) Dr. Amer Al Zarooni, Chief Executive Officer, Dubai Healthcare City Authority – Medical Dr. Ramadan Alblooshi, Chief Executive Officer, Dubai Healthcare City Authority – Regulations

Abbott Launches Region’s First Diabetes Training Academy to Improve Diabetes Management Abbott, a global player in diabetes care, is celebrating the opening of the region’s first dedicated training academy for healthcare professionals

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working with diabetes patients. The Abbott Diabetes Academy, which opened in Dubai Healthcare City, will offer theoretical and practical training on new diabetes technologies to help

support healthcare providers improve diabetes management. The Abbott Diabetes Academy opening comes at a time when diabetes levels are high, with 415 million people currently live

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with diabetes across the globe, according to the IDF Diabetes Atlas. In the UAE, there are approximately one million people with type one and type two diabetes, with approximately 450,000 of those cases being undiagnosed, making it more of an issue now than ever before. With its mission to act as a center of excellence and education and training partner for the regional public and private healthcare and diabetes community, the Abbott Diabetes Academy will provide practical tools which can be applied by endocrinologists, diabetologists and educators to improve the region’s management of diabetes. Amer Haddadin, Regional Director – Greece, Middle East, Africa, Turkey and Pakistan Region at Diabetes Care, Abbott comments “The mission of the Abbott Diabetes Academy is to lead the paradigm shift in diabetes management. The opening of this academy represents our commitment towards supporting healthcare professionals specializing in diabetes. We are proud to further help these professionals in addressing the challenges in diabetes management as a result of the revolutionary advancements in the way we are viewing information”. Dr. Abdulrazzaq Al Madani, President of the Emirates Diabetes Society comments “The number of cases of diabetes in the nation is on the rise, and it is crucial to support and provide healthcare professionals with the tools required to ensure patients are living their lives to the

fullest potential. The Abbott Diabetes Academy will equip physicians and diabetes experts to use advanced technologies to develop new and improved medical care for diabetics. Abbott’s effort in this space, specifically through the introduction of the Academy, will help both improve and save the lives of people affected with diabetes, filling an important gap in the region”. Opening in association with the Emirates Diabetes Society and in collaboration with Dubai Healthcare City, the Abbott Diabetes Academy is in the heart of the medical community, with a presence in Dubai Healthcare City amongst some of the known healthcare institutions in the Middle East. Also inaugurating the opening was Her Excellency Barbara A. Leaf, U.S. Ambassador to the UAE. Added Dr. Amer Ahmad Sharif, Chief Executive Officer, Dubai Healthcare City Authority – Education Sector and Vice Chancellor of the Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU) “Given the ever growing burden of diabetes within the region, we commend Abbott for its efforts in addressing this challenge, and we are proud that Dubai Healthcare City has been chosen as the location for the Abbott Diabetes Academy. Our association with Abbot embodies our vision to provide high quality healthcare solutions that positively impact society, and the academy will play an important role in advancing the

educational resources and training available to healthcare professionals in the region”. The Abbott Diabetes Academy program is built based on the need to challenge the status-quo in the current approach to diabetes monitoring, introducing the latest practical methods and innovative tools for effective management of diabetes. The program will be made up of learning modules which will include workshop sessions, practice sessions with new technologies and tools, and hands-on experience, all of which will be delivered by a faculty with expertise in the current challenges and solutions in providing diabetes care. Whilst the main focus of the academy will be on training around new innovative technologies such as flash glucose monitoring and ambulatory glucose profile reporting systems, it will also open the floor to an exchange of experience and clinical perspectives amongst regional experts and healthcare professionals. With so many new innovations and technologies in the diabetes monitoring and management space, this type of dialogue is a crucial part of the path to a better lifestyle for the patients of healthcare providers. The Abbott Diabetes Academy will be open to eight trainees per course, ensuring the focus and attention in addressing participants’ needs. Attendees can register at www. abbottdiabetescarepro-me.com.

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Dubai is in the process of launching the latest trend in the biological therapies for the treatment of

Psoriasis in the Middle East THE THERAPY ATTAINED REMARKABLE SUCCESS RATE AT 90% AND IS APPLIED IV BY PATIENTS.

he Second Middle East International Dermatology & Aesthetic Medicine Conference & Exhibition â€“ MEIDAM, intended to be held in Dubai on the 21ST of Sep, under the kind patronage of His Highness Sheikh Hamdan Bin Rashid Al Maktoum, Deputy Ruler of Dubai, Minister of Finance and Chairman of Dubai Health Authority, shall launch the first treatment for psoriasis in the Middle East, having applied and launched in the United States and Europe. Dr. Khalid Al-Nuaimi, chairman of the conference pointed out that the new treatment, which shall be launched in the UAE for the first time after obtaining the official approval of the Ministry of Health and society, shall be one of the up-to-date series of new biological therapies that realized a notable rate of success in the treatment of psoriasis at 90%. Dr. Al-Nuaimi clarified that the new drug that has been approved by the US Food and Drug Administration is produced by the International Company Eli Lilly and deems as a new and significant addition for the treatment of psoriasis and is applied IV by the patients. He further stated that the Swiss company Novartis shall also display and offer the up-to-the-minute products of biological medicine for

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treating psoriasis in the presence of international speakers who shall shed more light on the massive progress and advancement attained in the treatment of psoriasis. He explained that the psoriasis is an immune genetic disease of unknown cause, and one of the most common chronic dermatology diseases, and has been called by that name,due to the fact that the symptoms of the disease appears in the form of thick red spots with bright silver flakes resembling shells, and demonstrated with hyperactivity in the external layer of skin, with higher renovation rate than normal, and thus the psoriasis cells accumulate on the skin surface. However, psoriasis can occur in any part of the body but particularly affecting the elbows, the knees, and the scalp. He clarified that psoriasis affects 2% populations worldwide and typically at the age of 40, referring to the significance of genetic factor in the appearance of the disease. Whereas, the international studies suggest the probability of infection by 6% in case of one of the brothers was infected, rising to 14% in case of one of the parents was infected, and shall go up to 41% if both parents were infected with the disease, nevertheless this percentage shall increase from 30%70% in the twins in the case of one of them was infected.

Dr. Al-Nuaimi added that there are several factors contribute to the emergence of the disease, such as the psychological factor and some types of drugs, smoking, obesity, as well as leading an unhealthy lifestyle. It is noteworthy that psoriasis is not restricted to the skin only due to the fact that 30% of psoriasis patients are susceptible to psoriatic arthritis, particularly if psoriasis affected the nails, head, and genitals, the symptoms of psoriatic arthritis demonstrated in joint pain and low back pain. Moreover, psoriasis may associate with other diseases, such hypertension, diabetes, heart disease, depression and thus the patients need to lead a healthy lifestyle, particularly the obese category in order to attain effective response to the therapy, referring to the significance of practicing sport activities and exercise by that category of patients for 45 minutes daily for five days at least. The social and psychological effects of the disease, and the heavy burden on patients, such as depression and social isolation, affirming that the patient mood is a vital role in the aggravation of disease. The Dermatology Center of Dubai Health Authority (DHA) received 20,753 patients last year, including 1765 of them with psoriasis at 8.5% of the Center patients.

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ARTICLE

How old is your Heart?

What can we do to keep it Young? Dr. Sunil Roy T.N., MD, DM, FESC, FACC / Consultant Interventional Cardiologist / Belhoul Speciality Hospital If your vascular age is greater than your chronological age, you may be at more risk of developing cardiovascular disease (CVD) later in life. If your real age is 45 and your vascular age is 55, your blood vessels are more like those of a healthy 55-year-old.

As a consequence, you are at a higher risk for developing CVD than that based on your age. Having a high heart age increases the risk of serious health issues including heart attack, stroke, chronic kidney disease and dementia. Making simple changes, like doing more activity or quitting smoking, can reduce this risk and it is recommended to lower the heart age before it is too late.

What is Heart Age? One of the cornerstones of the prevention of cardiovascular disease is identification of individuals at higher risk of developing this condition. Absolute cardiovascular risk is a statistical and epidemiological concept that many patients may find difficult to understand. However, the concept of vascular age as the age of the arteries is a concept related to risk that might be more easily understood by all.

Why is Heart Age Important? Heart Age shows how many years people can expect to live healthily without a heart attack or stroke. Studies have shown that 1 in 10 men aged 50 taking Heart Age Test have a heart age at least ten years older than they are. Approximately 4 in 5 (79.2%) people over 30 have a heart age older than their chronological age, making them more likely to have a potentially fatal heart attack or stroke. Significant proportion of the public is unaware of their own cardiovascular risk factors. 4 in 5 people (78.8%) did not know what their cholesterol levels, almost half (49.5%) did not know their blood pressure. Factors like high blood pressure and high cholesterol, as well as smoking, diet and a lack of

exercise, can increase someone’s risk of developing CVD. Telling people their heart is older than it should be is shown to be a more effective way to get them to change behavior and improve cardiovascular health. Knowing your heart age is vital to taking control of your health. Armed with this knowledge, you can start to make changes to help protect yourself against cruel and life-changing events such as heart attack and stroke. The younger you start making small but significant changes, the greater the return on your investment in your health. Research has shown that high blood pressure, high cholesterol, smoking, poor diet and a lack of exercise all contribute to increasing your risk of developing cardiovascular disease. Many on-

CVD risk factors The main risk factors for CVD are:

The use of vascular age may thus help the physician to explain the risk status of the patient and therefore improve patient compliance with therapeutic decisions. This age is calculated as the age a person would be with the same calculated cardiovascular risk but whose risk factors were all within normal ranges. The Heart Age Test is really important as it gives an idea of heart attack and stroke risk.

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• • • • • • • • • •

• high blood pressure smoking high cholesterol • diabetes inactivity being overweight or obese • family history of CVD ethnic background other risk factors age: CVD is most common in people

over 50 and your risk of developing it increases as you get older gender: men are more likely to develop CVD at an earlier age than women diet: an unhealthy diet can lead to high cholesterol and high blood pressure alcohol: excessive alcohol consumption can also increase your cholesterol and blood pressure levels, and contribute to weight gain BOX 1

line tools are available at find out your heart age, and I will recommend British Heart Foundation website (https:bhf. org.uk) or NHS website (https:nhs.uk) for the same. Why not take action and make the first steps to improve the health of your heart by logging on and using this simple and quick heart age online tool. Even though you may not have symptoms, having a heart age higher than your own age indicates an increased risk of developing serious illness in future.

How Heart Age can be determined? Your arteries age more slowly when nurtured with daily exercise, a healthful diet, and good relationships with family and friends. They age faster when they are constantly assaulted by cigarette smoke, foods laden with saturated and trans fats, chronic stress, and other traumas. Data accumulated in the Framingham Heart Study has helped researchers create a general cardiovascular risk profile. Similarly, the SCORE system developed by European Society of Cardiology, has been used to develop a scoring system to calculate the cardiac risk. With answers to a few questions in Box 2, the online tools can estimate your vascular age which is easiest and cheap method to find out your Heart Age. The Heart Age Tool gives an immediate indication of a person’s potential risk and what they can start doing to reduce the risk. Each heartbeat sends a wave of blood through the body’s network of arteries. Measuring the speed of the pulse wave provides information about how stiff or flexible the arteries are. The speed of the wave can be used to calculate the vascular age by some spe-

cial devices. The innermost layer of an artery’s wall is called the intima; it provides a smooth surface for blood to flow through. The thicker the intima and the media, the more likely the artery is choked with cholesterol-filled atherosclerotic plaque. Using ultrasound, a doctor can easily measure the intima-media thickness in the carotid arteries in the neck. This measurement can be also used to estimate vascular age. With the use of cardiac CT scan we can found out the level of calcium in heart arteries, and we can use this information to find out the Heart Age from this value as well. Since most insurance companies don’t pay for these tests, and not very widely available, the online tool to estimate the Heart Age is a good place to start unless you don’t mind paying extra bill for this information.

The Heart Age Calculator will ask you questions about • • •

• • • •

Your age and gender. Your ethnicity and where you live Your health status including heart health, diabetes and kidney disease. Smoking status. Your weight and height (to work out your BMI or body mass index) Family history. Cholesterol and blood pressure levels. BOX 2

What can we do to prevent Heart from ageing? Heart health depends on things like blood pressure, cholesterol, blood sugar, body mass index (BMI), and waist circumference. Your Heart Age is likely to be more, if your body mass

index (BMI) is 25 or above, waist measurement of 94 cm (about 37 inches) or more, (woman 80 cm (about 31.5 inches) or more). CVD prevention guidelines advises at least 150 minutes of moderate aerobic activity a week such as cycling or brisk walking, to decrease your risk of cardiovascular diseases. Excess dietary salt is one of the biggest risk factors for high blood pressure, and one that can be easily modified. A balanced diet has been proven to improve heart health. Another modifiable factor is cholesterol. It can be reduced by reducing the amount of saturated fat in your diet, eating foods that contain unsaturated fat, eating plenty of high fibre foods. Smoking is the single most significant factor in increasing a person’s risk of cardiovascular disease and quitting smoking is the single best thing you can do for your heart health. Being educated on your numbers like blood pressure, BMI, Waist measurement, blood sugar and cholesterol levels and using these information to know your risk and understanding what they mean is the first step to leading a healthy life. Ten lifestyle interventions for keeping the Heart Age young are given in Box 3.

Lifestyle changes to keep Heart Young 1. Get more physically active. 2. Tackle obesity. 3. Check your blood pressure and keep it normal. 4. Lower salt consumption. 5. Improve your diet. 6. Lower cholesterol. 7. Stop smoking. 8. De-stress. 9. Drink less alcohol. 10. Fresh air.

BOX 3

MOH No:PS28493/30/10/29/12/2017

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Ministry of Health and Prevention launches awareness campaign on seasonal flu

he Ministry of Health and Prevention (MOHAP), Health Clinics and Centers Sector Preventive Medicine Department launched an awareness campaign on seasonal flu which will last until December 8, 2017. The campaign targets the healthcare professionals in the ministry and the private sector in the northern Emirates. The activities of the campaign include lectures and training on updated clinical information of the influenza virus, highlighting its risks, and ensuring the importance and effectiveness of the available vaccine. During the campaign’s launch, H.E. Dr. Hussein Abdel-Rahman Al Rand, Assistant Undersecretary for Health Clinics and Centers Sector, said that the initiative is in line with the ministry’s strategy to protect the community from communicable

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diseases and provide universal health coverage and develop the skills of healthcare workers according to the latest international guidelines and increase their knowledge with the latest information of the disease: symptoms, transmission, detection methods, treatment, reporting and preventive steps. He added that raising awareness will enable the community to be aware of the latest updates on diseases and the prevention methods. Additionally, the ministry will enhance awareness among the public as part of its education initiative in cooperation with the preventive medicine centers in medical districts. Dr. Nada Al-Marzooqi, Director of Preventive Medicine Department, said that the launch of the campaign coincided with the start of the flu season and will help raise awareness

about the available vaccine. Vaccination is considered to be the best and most effective medical interventions to protect against vaccine-preventable diseases. Studies have indicated that influenza vaccination limits the spread of infection within the community and reduces the likelihood of serious complications. “Vaccine is recommended for healthcare professionals especially those who are in emergency and outpatient clinics, primary healthcare centers, and intensive care units as part of their protection. Also, it is recommended for all people in the community especially pregnant women, patients with chronic diseases such as diabetes and heart disease, as well as the elderly and children under five years old; because they are more susceptible to complications from the flu virus,” said Dr. Al-Marzooqi.

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ARTICLE FEATURES . Autism

AUTISM

Verbal and non-verbal communication are central to autism

utism is a neurodevelopmental disorder characterized by impaired social interaction, impaired verbal and non-verbal communication, and restricted and repetitive behavior. Parents usually notice signs in the first two years of their childâ€™s life. These signs often develop gradually, though some children with autism reach their developmental milestones at a normal pace and then regress. The diagnostic criteria require that symptoms become apparent in early childhood, typically before age three. Boys are nearly five times more likely than girls to have autism. Autism is caused by a combination of genetic and environmental factors. Autism affects information processing in the brain by altering how nerve cells and their synapses connect and organize; how this occurs is not well understood. Autism spectrum disorder has

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no single known cause. Given the complexity of the disorder, and the fact that symptoms and severity vary, there are probably many causes. Both genetics and environment may play a role. Several different genes appear to be involved in autism spectrum disorder. For some children, autism spectrum disorder can be associated with a genetic disorder, such as Rett syndrome or fragile X syndrome. For other children, genetic changes (mutations) may increase the risk of

autism spectrum disorder. Still other genes may affect brain development or the way that brain cells communicate, or they may determine the severity of symptoms. Some genetic mutations seem to be inherited, while others occur spontaneously. Researchers are currently exploring whether factors such as viral infections, medications or complications during pregnancy, or air pollutants play a role in triggering autism spectrum disorder.

ARTICLE FEATURES . Autism

Isolation & repetitive behavior are the most common symptoms Autism spectrum disorders (ASD) are characterized by social-interaction difficulties, communication challenges and a tendency to engage in repetitive behaviors. However, symptoms and their severity vary widely across these three core areas. Taken together, they may result in relatively mild challenges for someone on the high functioning end of the autism spectrum. For others, symptoms may be more severe, as when repetitive behaviors and lack of spoken language interfere with everyday life. While autism is usually a life-long condition, all children and adults benefit from interventions, or therapies, that can reduce symptoms and increase skills and abilities. Some children show signs of autism spectrum disorder in early infancy, such as reduced eye contact, lack of response to their name or indifference to caregivers. Other children may develop normally for the first few months or years of life, but then suddenly become withdrawn or aggressive or lose language skills they’ve already acquired. Signs usually are seen by age 2 years. Each child with autism spectrum disorder is likely to have a unique pattern of behavior and level of severity — from low functioning to high functioning. Some children with autism spectrum disorder have difficulty learning, and some have signs of lower than normal intelligence. Other children with the disorder have normal to high intelligence — they learn quickly, yet have trouble communicating and applying what they know in everyday life and adjusting to social situations. Because of the unique mixture of symptoms in each child, severity can

sometimes be difficult to determine. It’s generally based on the level of impairments and how they impact the ability to function.

Symptoms of autism can be identified as follows: • • • • • • • • •

• •

Weak social interaction. Weak communication. Limited activities, actions and interests. Failure to respond to the normal means of education. Aggression and self-injury. A significant increase or decrease in efficiency and activity. Sudden outbursts of rage and anger. Lack of attention. Abnormal sleeping and eating patterns and the child may only eat certain types of food. Playing in unusual ways. Abnormal association with things

How is autism diagnosed? Your child’s doctor will look for signs of developmental delays at regular checkups. If your child shows any symptoms of autism spectrum disorder, you’ll likely be referred to a specialist who treats children with

autism spectrum disorder, such as a child psychiatrist or psychologist, pediatric neurologist, or developmental pediatrician, for an evaluation. Because autism spectrum disorder varies widely in symptoms and severity, making a diagnosis may be difficult. There isn’t a specific medical test to determine the disorder. Instead, a specialist may observe your child and ask how your child’s social interactions, communication skills and behavior have developed and changed over time, give your child tests covering hearing, speech, language, developmental level, and social and behavioral issues, present structured social and communication interactions to your child and score the performance, include other specialists in determining a diagnosis and recommend genetic testing to identify whether your child has a genetic disorder such as Rett syndrome or fragile X syndrome.

Behavioral therapies No cure exists for autism spectrum disorder, and there is no onesize-fits-all treatment. The goal of treatment is to maximize your child’s ability to function by reducing autism

ARTICLE FEATURES . Autism

spectrum disorder symptoms and supporting development and learning. Early intervention during the preschool years can help your child learn critical social, communication, functional and behavioral skills. The range of home-based and school-based treatments and interventions for autism spectrum disorder can be overwhelming, and your child’s needs may change over time. Your healthcare provider can recommend options and help identify resources in your area. If your child is diagnosed with autism spectrum disorder, talk to experts about creating a treatment strategy and build a team of professionals to meet your child’s needs. Treatment options may include behavioral and communication therapies, educational therapies and family therapies. Many programs address the range of social, language and behavioral difficulties associated with autism spectrum disorder. Some programs focus on reducing problem behaviors and teaching new skills. Other programs focus on teaching children how to act in social situations or communicate better with others. Applied behavior analysis (ABA) can help children learn new skills and generalize these skills to multiple situations through a reward-based motivation system.

Children with autism spectrum disorder often respond well to highly structured educational programs. Successful programs typically include a team of specialists and a variety of activities to improve social skills, communication and behavior. Preschool children who receive intensive, individualized behavioral interventions often show good progress. Parents and other family members can learn how to play and interact

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with their children in ways that promote social interaction skills, manage problem behaviors, and teach daily living skills and communication.

How to deal with an autistic child Learning all you can about autism and getting involved in treatment will go a long way toward helping your child. Children with ASD have a hard time applying what they’ve learned in one setting to others, including the home. For example, your child may use sign language at school to communicate, but never think to do so at home. Creating consistency in your child’s environment is the best way to reinforce learning. Explore the possibility of having therapy take place in more than one place in order to encourage your child to transfer what he or she has learned from one environment to another. Children with ASD tend to do best when they

have a highly-structured schedule or routine. Again, this goes back to the consistency they both need and crave. Set up a schedule for your child, with regular times for meals, therapy, school, and bedtime. Try to keep disruptions to this routine to a minimum. Positive reinforcement can go a long way with children with ASD, so praise them when they act appropriately or learn a new skill, being very specific about what behavior they’re being praised for. Also look for other ways to reward them for good behavior. Teaching independence is a baby steps process that starts at an early age. When working with children with autism on any skill, you have to think it forward. There are small, gradual ways to build independence. Teaching the concept of time fosters independence. Letting children see there is a beginning, end and time limit for activities is a good way to teach patience and transitioning.

ARTICLE FEATURES . Autism

ARTICLE FEATURES . Gallbladder Diseases

Gallstones and inflammation are the most common diseases

he gallbladder, a pear-shaped organ, is located under the liver. Your gallbladderâ€™s main function is to store the bile produced by your liver and pass it along through a duct that empties into the small intestine. Bile helps you digest fats in your small intestine. Your gallbladder is most likely to cause problems if something blocks the flow of bile through the bile ducts. That is usually gallstones that form when substances in bile harden.

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Rarely, you can also get cancer in your gallbladder. Many gallbladder problems get better with removal of the gallbladder. Fortunately, you can live without a gallbladder. Bile has other ways of reaching your small intestine.

Cholecystitis Cholecystitis is the most common type of gallbladder disease. It presents itself as either an acute or chronic inflammation of the gallbladder. Acute cholecystitis is generally

caused by gallstones. But it may also be the result of tumors or various other illnesses. It may present with pain in the upper right side or upper middle part of the abdomen. The pain tends to occur right after a meal and ranges from sharp pangs to dull aches that can radiate to your right shoulder. After several attacks of acute cholecystitis, the gallbladder can shrink and lose its ability to store and release bile. Abdominal pain, nausea, and vomiting may occur. Surgery is of-

ARTICLE FEATURES . Gallbladder Diseases

ten the needed treatment for chronic cholecystitis. Signs and symptoms of cholecystitis may include severe pain in your upper right abdomen, pain radiating to your right shoulder or back, tenderness over your abdomen when it’s touched, nausea, vomiting and fever. Cholecystitis signs and symptoms often occur after a meal, particularly a large or fatty meal. The main symptom of acute cholecystitis is a sudden sharp pain in the upper right-hand side of your tummy (abdomen). This pain spreads towards your right shoulder. The affected part of the abdomen is usually very tender, and breathing deeply can make the pain worse. Unlike other types of abdominal pain, the pain of acute cholecystitis is usually persistent and doesn’t go away within a few hours. Some people may have additional symptoms, such as fever, nausea and vomiting, sweating, loss of appetite, yellowing of the skin and the whites of the eyes (jaundice) and a bulge in the abdomen. The causes of acute cholecystitis can be grouped into two main categories: calculous cholecystitis and acalculous cholecystitis. Calculous cholecystitis is the most common, and usually less serious, type of acute cholecystitis. It accounts for around 95% of all cases. Calculous cholecystitis develops when the main opening to the gallbladder, called the cystic duct, gets blocked by a gallstone or a substance known as biliary sludge. Biliary sludge is a mixture of bile, a liquid produced by the liver that helps digest fats, and small cholesterol and salt crystals. The blockage in the cystic duct causes bile to build up in the gallbladder, increasing the pressure inside it and causing it to become inflamed. In around one in every five cases, the inflamed gallbladder also becomes infected by bacteria. Acalculous cholecystitis

ARTICLE FEATURES . Gallbladder Diseases

• • • • •

•

Being pregnant Eating a high-fat, highcholesterol, low-fiber diet Having a family history of gallstones Having diabetes Taking medications that contain estrogen, such as oral contraceptives or hormone therapy drugs Losing weight very quickly

Laparoscopic cholecystectomy is a less common, but usually more serious, type of acute cholecystitis. It usually develops as a complication of a serious illness, infection or injury that damages the gallbladder. Acalculous cholecystitis can be caused by accidental damage to the gallbladder during major surgery, serious injuries or burns, blood poisoning (sepsis), severe malnutrition or AIDS.

Gallstones Gallstones accumulate in the gallbladder without causing any symptoms at first, but it usually gets worse when a gallstone causes a blockage in the ducts that connect the gallbladder, the liver and the small intestine, resulting in severe pain. Gallstones form when substances in the bile form crystal-like particles. They can range from the size of a grain of sand to the size of a golf ball. The presence of gallstones causes pressure, irritation, and may cause infection. The walls of the gallbladder begin to thicken over time. Eventually, the gallbladder starts to shrink. These changes make it harder for the gallbladder to function properly.

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The gallbladder’s main purpose is to store and concentrate bile. The liver produces bile, a liquid that helps digest fats and carries toxins excreted by the liver. Bile is passed from the liver through a series of channels called bile ducts into the gallbladder, where it’s stored. Over time bile becomes more concentrated, which makes it more effective at digesting fats. The gallbladder releases bile into the digestive system when it’s needed. Gallstones may cause no signs or symptoms. If a gallstone lodges in a duct and causes a blockage, the resulting signs and symptoms may include sudden and rapidly intensifying pain in the upper right portion of your abdomen, sudden and rapidly intensifying pain in the center of your abdomen, just below your breastbone, back pain between your shoulder blades, pain in your right shoulder, nausea or vomiting.

Factors that may increase your risk of gallstones include: • •

Being female Being overweight or obese

Laparoscopic cholecystectomy is increasingly being used for detection and removal of common duct stones. The surgeon makes a number of small incisions into your abdomen, so that slender instruments can reach into the abdominal cavity. A tube blowing a gentle stream of carbon dioxide gas is inserted. This separates the abdominal wall from the underlying organs, the surgeon views the gallbladder on a TV monitor by using a tiny camera attached to the laparoscope. With laparoscopic cholecystectomy, you may return to work sooner, have less pain after surgery, and have a shorter hospital stay and a shorter recovery time. Surgery to remove the gallbladder with a laparoscope does not require that the muscles of your abdomen be cut, as they are in open surgery. After the surgery, the patient may feel nausea and vomiting but can only have fluids at first. Feeling pain may be normal after the operation but will soon disappear after taking painkillers. The most important thing to start with is to avoid fatty foods while drinking fluids and consuming healthy food for at least two months after the surgery.

ARTICLE

Save a tooth - Save the Smile

Parent / Teacher Guide for knocked out tooth Dr. Smitha Bhagavathi Kandi Dental Gen. Practitioner Al-Ahli Hospital Smiles are the building blocks of any healthy relationship. Unforeseen circumstances like accidents causing Dental trauma almost always involves the upper front teeth and therefore can have a considerable effect on oneâ€™s looks.

Etiology This is frequently seen in children and adolescents and can have a significant impact on their quality of life. So it is very important to restore the missing teeth to maintain a healthy smile. Dental trauma is an extremely stressful condition as it causes pain for the child and continuous worries for the parents. Accidents within and around the home are the major sources of injury to the milk teeth, while accidents at home, swimming pool and school accounted for most of the injuries to the permanent teeth.

Dental Emergency Knocked out (completely dislodged /avulsed) permanent teeth due to trauma is a dental emergency. It is a treatable condition if we can replant the tooth as soon as possible. Dentists are always prepared to manage this condition and awareness through mass media is an easy way to spread this information to the public. Re-implantation of the knocked out tooth into the socket is the immedi-

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ate treatment. The amount of time that the avulsed tooth stays out of the mouth before re-implantation (slipping the tooth back into its socket) has a significant effect on the success of treatment. It is most important to re-implant the tooth as soon as possible. The sooner the tooth is replaced, the greater the chance it will survive. The parents, teacher or any responsible adult can take an important role to re-implant the tooth in time.

First- Aid Following are the steps to improve the chances of saving the knocked out permanent tooth before attending a dentist. 1. Keep the child calm. 2. Find out the tooth. Pick it up by holding the crown (the part that was outside the gum) of the tooth. Handle the tooth carefully. Try not to touch the root (the part of the tooth that was under the gum). It can be damaged easily. 3. If the tooth is dirty, rinse the root gently under cold running water for a maximum of 10 seconds to remove dirt from the root surface. 4. Try to re-implant (replace) the tooth straight away. The tooth should be placed back in the socket with firm gentle pressure until it is at the same level as the adjacent incisor. It is advised to

bite on a tissue paper to keep it in position. 5. If the tooth cannot be re-implanted, keep the avulsed tooth in a cup of cold fresh milk. If you donâ€™t have milk you can use saliva. Put the tooth in a cup and keep tooth moist with childâ€™s saliva (spit). Storage in tap water is undesirable, as it reduces the vitality of ligament adhering to the root. 6. Attend emergency dental care as soon as possible. The tooth needs to be stabilized for a short duration by splinting and might need further treatments and follow-up.

Note: No attempt should be made to re-implant avulsed milk tooth (baby tooth)

ARTICLE FEATURES . Gout

Diet is the most important & effective way to manage the disease

out is a kind of arthritis caused by a buildup of uric acid crystals in the joints. Uric acid is a breakdown product of purines that are part of many foods we eat. An abnormality in handling uric acid and crystallization of these compounds in joints can cause attacks of painful arthritis, kidney stones, and blockage of the kidney filtering tubules with uric acid crystals, leading to kidney failure. Gout has the unique distinction of being one of the most frequently recorded medical illnesses throughout history. According to global statistics, one in four people with gout has a family history. Men are more likely to

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suffer from gout than women, while postmenopausal women are more likely to develop gout. A gout diet may help decrease uric acid levels in the blood. While a gout diet is not a cure, it may lower the risk of recurring painful gout attacks and slow the progression of joint damage. How does gout develop? Uric acid is normally cleaned out of the blood by the kidneys, and passes out of the body along with urine. However, high levels of uric acid can accumulate in the body, either when the kidneys excrete too little uric acid or when the body produces too much uric acid. This condition is known as hyper-

uricemia, according to the NIH. The high concentration of uric acid in the blood will eventually convert the acid into urate crystals, which can then accumulate around the joints and soft tissues. Deposits of the needle-like urate crystals are responsible for the inflammation and the painful symptoms of gout. Youâ€™re more likely to develop gout if you have high levels of uric acid in your body. Factors that increase the uric acid level in your body include eating a diet thatâ€™s high in meat and seafood and high in beverages sweetened with fruit sugar (fructose) promotes higher levels of uric acid, which increases your

ARTICLE FEATURES . Gout

risk of gout. Alcohol consumption, especially of beer, also increases the risk of gout. If you are overweight, your body produces more uric acid and your kidneys have a more difficult time eliminating uric acid, which greatly increases your risk of gout. Certain diseases and conditions make it more likely that you’ll develop gout. These include untreated high blood pressure and chronic conditions such as diabetes, metabolic syndrome, and heart and kidney diseases. If other members of your family have had gout, you’re more likely to develop the disease. Gout occurs more often in men, primarily because women tend to have lower uric acid levels.

Symptoms cholecystectomy The signs and symptoms of gout almost always occur suddenly - often at night - and without warning. They include: • Intense joint pain: Gout usually affects the large joint of your big toe, but it can occur in your feet, ankles, knees, hands and wrists. The pain is likely to be most severe within the first four to 12 hours after it begins. • Lingering discomfort: After the most severe pain subsides, some joint discomfort may last from a few days to a few weeks. Later attacks are likely to last longer and affect more joints. • Inflammation and redness: The affected joint or joints become swollen, tender, warm and red. • Limited range of motion: Decreased joint mobility may occur as gout progresses.

produced as a byproduct of the body breaking down chemicals called purines which are found in food. It can crystallize and form painful deposits in the joints, usually the big toe. Occasionally, gout is associated with other conditions such as high blood pressure, also called hypertension.

•

There are two reasons for this: •

•

Certain medications for high blood pressure are diuretics. Diuretics increase the body’s water and sodium excretion. This allows the blood vessel walls to relax, alleviating high blood pressure. However, this can also cause an increase in the blood uric acid concentration. High blood pressure, if left untreated, is a risk factor for developing gout.

Usually medications for high blood pressure will not cause gout, but they can exacerbate an existing gout condition.

•

Tips for avoiding gout and alleviating high blood pressure:

Lose weight: Many studies have shown that being overweight is very detrimental to your health. Excess weight exacerbates gout and high blood pressure. Talk to your health practitioner about designing a safe and effective weight loss program. Stop drinking alcohol: Alcohol, especially beer and wine, is high in purines, acts as a diuretic, and interferes with the body’s ability to excrete uric acid. Avoid foods high in purines: Red meats, organ meats, legumes, and shellfish are high in purines. Talk to your health practitioner about switching your medications for high blood pressure if they might cause gout. Stay hydrated: Drink at least 64 ounces of water each day. Dehydration allows a higher blood uric acid concentration. Follow a low-sodium diet: High levels of sodium contribute to high blood pressure. Quit smoking: Smoking also contributes to high blood pressure.

BONE EROSIONS

URATE CRYSTALS IN A TOPHUS

Gout and hypertension Gout is a very common form of arthritis. It is caused by elevated levels of uric acid in the blood. Uric acid is

SYNOVIUM 71

ARTICLE FEATURES . Gout

•

Eat a healthy diet: Avoid purine rich foods, and make sure to get plenty of fruits and vegetables. Avoid foods high in fat, saturated fat, and cholesterol. Take a multivitamin: Research shows that certain nutrients like potassium can help reduce blood pressure, and a restricted diet can leave out certain nutrients. Be sure to talk to your health practitioner to design a program for managing your hypertension and preventing gout. Do not stop taking any prescription medications without first consulting your health practitioner.

High uric acid level A high uric acid level, or hyperuricemia, is an excess of uric acid in your blood. Normal uric acid levels are less than 6.0 mg/dL (female) and less than 7.0 mg/dL (male). The patient’s lifelong nutrition contributes significantly to high uric acid levels in the blood; hence, the diet is the most important way to reduce the severe pain episodes that occur to patients with gout. Most of the time, a high uric acid level occurs when your kidneys don’t eliminate uric acid efficiently. Things that may cause this slow-down in the removal of uric acid include rich foods, being overweight, having diabetes, taking certain diuretics (sometimes called water pills) and drinking too much alcohol. Other less common causes are a diet high in purine-containing items or your body producing too much uric acid.

2. Drinking too much alcohol 3. Genetics (inherited tendencies) 4. Hypothyroidism (underactive thyroid) 5. Immune-suppressing drugs 6. Obesity 7. Psoriasis 8. Purine-rich diet — liver, game meat, anchovies, sardines, gravy, dried beans and peas, mushrooms, and other foods 9. Renal insufficiency — inability of the kidneys to filter waste 10. Tumor lysis syndrome — a rapid release of cells into the blood caused by certain cancers or by chemotherapy for those cancers

Tips and instructions

During symptom-free periods, these dietary guidelines may help protect against future gout attacks: •

•

Factors that may cause a high uric acid level in your blood include: 1. Diuretic medications (water pills)

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Also, you may be monitored for high uric acid levels when undergoing chemotherapy or radiation treatment for cancer.

Keep your fluid intake high: Stay well-hydrated, including plenty of water. Limit or avoid alcohol: Talk with your doctor about whether any amount or type of alcohol is safe for you. Get your protein from low-fat dairy products: Low-fat dairy products may actually have a protective effect against gout, so these are your best-bet protein sources. Limit your intake of meat, fish and poultry: A small amount may be tolerable, but pay close attention to what types - and how much - seem to cause

ARTICLE FEATURES . Gout

•

problems for you. Maintain a desirable body weight: Choose portions that allow you to maintain a healthy weight. Losing weight may decrease uric acid levels in your body. But avoid fasting or rapid weight loss, since doing so may temporarily raise uric acid levels.

A patient with gout should avoid the following foods: • • • • • •

Fatty foods and fats Lentils and legumes during severe attacks Meat, fish and chicken during severe attacks Liver, kidney, brain, salmon, sardines and oysters Meat and fish soups Eggplant, cauliflower, peas and spinach during severe attacks

• • •

Jam containing seeds Berries, strawberries and figs Spices and pickles during severe attacks

• • •

The patient with gout is allowed to eat:

•

• •

•

• • • • • • • •

Bread, toast and rice. Legumes such as lentils and others, while abstaining during gout attacks. Meat, fish, chicken and rabbits about 100 g of each. Eggs and milk products. Vegetable Soup. Vegetable salad. Cooked vegetables. Potatoes. Butter, oil and fat equivalent to two tablespoons per day. Sugars, jam, honey (avoiding jam containing seeds).

•

Fresh fruits except berries, strawberries and figs. Dried fruits and nuts. Spices in small quantities, while abstaining during gout attacks. Pickles while abstaining during gout attacks. Drinks such as tea and coffee with two or three glasses a day. Unlimited quantity of fluids.

There are some foods that help in treating patients with gout: •

• •

Lemon juice is effective in the treatment of gout, as it dissolves the salts deposited in the joints. Pineapple is very useful in cases of obesity and arthritis. Grape juice works to reduce the uric acid levels in the blood.

ARTICLE FEATURES . UAE Healthcare

UAE occupies first position in number of healthcare facilities New hospitals, clinics and medical centers across the UAE

he UAE has always been an example for giving a lot of attention to the health sector and its excellent performance, both in terms of high expenditure to achieve adequate healthcare for patients or in terms of management and drawing future plans and strategies. As a result, the UAE has occupied the first position globally for the fourth consecutive year in terms of the number of accredited healthcare providers in

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the country, according to the Joint Committee International, JCI, an organization that provides accreditation for healthcare facilities and the UAE’s health sector has led in terms of the percentage of internationally accredited hospitals in the country with 76 percent, above some of the best healthcare systems in the world. The UAE has also occupied the first position on an international level in terms of the number of accredited

specialized centers and medical labs within the country’s unified health network system, as well as in the number of accredited primary healthcare providers and home healthcare providers. The Ministry of Health and Community Prevention announced that the numbers of internationally accredited healthcare providers in the UAE has reached 178 hospitals, medical centres and health facilities. The JCI revealed the UAE’s

ARTICLE FEATURES . UAE Healthcare

success during an exhibition on the sidelines of the 34th International Scientific Meeting on Quality and Safety in Healthcare, ISQua 2017, which was held from 1st to 4th October, 2017, in London, United Kingdom. Dr. Abdul Rahman bin Mohammad bin Nasser Al Owais, Minister of Health and Prevention, stated that other countries with the best health sectors have not achieved the same level of international success in the field of quality and patient safety as the UAE, which represents an international recognition of the quality of the countryâ€™s health sector and medical services, in line with the directives of the wise leadership stating that all hospitals and health centres should obtain an international accreditation certificate by 2021, to create a healthy, efficient, sustainable and happy community. He also pointed out that they will seek other summits and bigger challenges that will consolidate their leadership in the Global Competitiveness Index by competing with the best health systems in the world.

Implementing the highest international standards The UAE is committed to providing the best potential and resources to build a health system based on the highest international standards so that the UAE becomes one of the best countries in the quality of healthcare while achieving sustainability in health services and health security, in accordance with the objectives of UAE Vision 2021 National Agenda. Receiving international accreditation will play a major role in improving the results of Healthcare Quality Indicators through the development of the medical and technical staff performance and the use of health information systems to improve the performance of health facilities in

order to achieve the strategy of the Ministry of Health and Community Prevention in promoting community health through the provision of comprehensive, innovative and sustainable health services that exceed expectations for a happy society. Figures indicate a positive and rapid development of this indicator, as there was 11 internationally accredited health facilities in 2008 and the number has rapidly increased to reach 178 internationally accredited health facilities in 2017; the number is expected to increase by the end of the year, which confirms the importance of this indicator and the seriousness of the health sector in dealing with it because of its positive impact on improving health services and their quality in the country. The UAE has occupied the first position in terms of the number of its internationally accredited medical facilities since 2014 while achieving advanced results in the application of JCI standards on leadership and innovative solutions. It is worth mentioning that the governmentâ€™s approach aims to make all UAE health facilities receive international accreditation in 2021. UAE Vision 2021 National Agenda aims to achieve a world-class healthcare system. In 2016, the UAE government allocated 7.9% of its budget, equivalent to AED 3.83 billion for the healthcare sector alone. In 2017, it allocated 8.6% of the federal budget to the healthcare sector, in addition to the spending at the local level. According to the Sustainable Economic Development Assessment (SEDA) scores from the Boston Consulting Group (BCG), healthcare standards in the UAE outperform regional and worldwide averages on multiple dimensions such as wellbeing and education. Â The UAE is keen to develop its preventative healthcare system to maintain the

ARTICLE FEATURES . UAE Healthcare

health of the individual and society. The UAE is constantly developing its health system and increasing its efficiency, while its health facilities are achieving remarkable growth and further expansion and spread. In recent months, the UAE has established and opened many health centers and hospitals, including:

THE OPENING OF A MEDICAL CLINIC IN JEBEL ALI UAE-based Transguard Group, a top business support services firm, and UAE healthcare provider Al Tadawi Medical Centre have opened a fully equipped medical facility in Trans-

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guard’s employee accommodation facility in Jebel Ali last February. The partnership has cost the companies a combined Dh2.07 million for the construction, fit out and equipping the healthcare facility. Al Tadawi will staff and operate the centre with two doctors (in two shifts), three nurses, and support staff - receptionist, supervisor and cleaning. The new administrative process allows existing Transguard employees to use their current medical insurance and any mandatory costs not covered by the company’s corporate insurance, can be billed direct to Transguard, streamlining the

administrative process. In addition to medical consultations, the centre will have a fully equipped pharmacy and offer same day appointments. The clinic will also have an integrated information system minimizing lengthy referral processes.

OPENING OF TWO FACILITIES IN RAS AL KHAIMAH Emirates Hospitals Group, a leading healthcare services provider in the UAE, launched last April its two world-class brands — Emirates Hospitals Clinics and CosmeSurge Clinics in Ras Al Khaimah aimed at addressing the gap of quality care for

ARTICLE FEATURES . UAE Healthcare

residents in the emirate. Mr. Pramod Balakrishnan, CEO of Emirates Hospitals Group, explained that the Group has allocared $300 million for the opening of 6 new health facilities in Dubai, Ras El Khaimah and Al Fujeirah by the end of this year as part of its efforts to expand the provision of advanced medical services in the region, including the treatment of neurological diseases in children. The new hospital in Ras El Khaimah features fully equipped operating rooms with the latest advanced instrumentation and recovery rooms to meet the growing demand for treatment services. The Group stated that the opening of the two new branches in Ras Al Khaimah for Emirates Hospitals Clinics and CosmeSurge Clinics is part of its expansion plans in the UAE, adding that they provide primary care services and a range of specialties in family medicine and plastic surgery.

OPENING OF WOMEN AND CHILDREN’S HOSPITAL IN SHARJAH Last April, the Ministry of Health and Community Prevention inaugurated the Women and Children’s Hospital in Sharjah, which is considered an important and advanced medical building that was constructed according to the latest scientific methods in this field. The ministry confirmed that the work teams from the Ministry of Infrastructure Development and the Ministry of Health and Community Prevention have been working for some time on the modernization of medical devices and equipment in the building in coordination with the companies that supplied them, in order to ensure their efficiency and validity. The new hospital will include highly competent medical, nursing and technical staff, in addition to

state-of-the-art equipment in these specialties. It is a great addition to the treatment and important medical services provided in the UAE, whether in the provision of advanced treatments or in terms of decoration and the adoption of designs that suit the nature of these health and therapeutic facilities in accordance with a developed global system in this regard. The new Women and Children’s Hospital in Sharjah spans over 39,000 square meters and includes a ground floor, four-storey building with a capacity of 200 beds, including 72 maternity beds, 76 beds for women and 52 beds for women and children’s accidents, in addition to rooms and beds for preterm infants and intensive care. There are 30 single rooms and 70 double rooms will be built. The hospital also includes 4 operating rooms, 10 delivery rooms, an imaging department, a central laboratory, a blood bank, a central pharmacy, a sterilization department, changing rooms for medical staff and many auxiliary services. The total cost of the project is AED 350 million.

OPENING OF MEDCARE HOSPITAL SHARJAH Aster DM Healthcare has opened its largest hospital in the United Arab Emirates: a new 120-bed general hospital in Sharjah, located on King Faisal Street in the centre of Sharjah city. The new property, brings the group’s number of hospital beds in the UAE to 419, compared with 213 beds at the end of 2016. The JCI-accredited multi-speciality facility, Medcare Hospital Sharjah, offers a wide range of outpatient, day care, inpatient and 24/7 emergency care services to patients of all ages. According to Aster, the facility is equipped with a wide range of medical technology including latest MRI and ultrasound scanners, operation

theaters with advanced anaesthesia and intraoperative imaging facilities and Philips IntelliSpace Critical Care and Anaesthesia Intensive Care Units. In addition to the Medcare Hospital Sharjah, the group recently opened a 12,000 square foot Medcare Clinic Sharjah, adding to its four Aster Clinics and more than 20 Aster Pharmacies in the emirate.

OPENING OF TEDDY BEAR HOSPITAL FOR CHILDREN IN DUBAI The new hospital in Dubai has recently opened but not for treatment. The Mohammed Bin Rashid University of Medicine and Health Sciences, MBRU has launched a Teddy Bear Hospital, a first of its kind in Dubai and the UAE. The Teddy Bear Hospital is a program designed to teach school children hands-on about medical procedures, and to decrease any preconceived fears of doctor visits. The program will be run at MBRU’s Khalaf Ahmad Al Habtoor Medical Simulation Center. Teddy Bear Hospital is open to children aged 6 to 8; they checked their bears while being accompanied by a team of specialists and the bears underwent a CT scan, received intravenous therapy, then were led into the surgery ward to get anesthetics before their operation. At the end of the visit, children were provided with a detailed medical report on the bear’s medical situation.

OPENING OF BEVERLY HILLS MEDICAL CENTER OPENED IN ABU DHABI Reach Holding, one of the UAE’s leading investment groups, has opened Beverly Hills Medical Center, Abu Dhabi. Located in the heart of the capital city, Beverly Hills Medical Center is a multi-specialty facility providing round-the-clock comprehensive

ARTICLE FEATURES . UAE Healthcare

healthcare, dermatology and cosmetic services. Specializing in one-day care procedures, the state-of-the-art centre uses the latest technology and products from the U.S. and Europe to administer treatments. The Beverly Hills Medical Centre team is made up of world-class doctors and top specialists appointed from across the U.A.E., Europe and Canada. Boasting an array of up-to-theminute services including ENT, pediatrics, cardiology, dentistry, orthopaedic, gynaecology and obstetrics, urology, and internal medicine – the new center will also provide laboratory and radiology facilities. “Abu Dhabi has seen a strong focus on healthcare services recently especially with the government’s target for Abu Dhabi Vision 2030. Now is the perfect time to open Beverly Hills Medical Center and provide the finest medical facilities for the entire family. Our target is to make the center a gateway to good health in the capital,” said Malik Melhem, Chairman and Owner, Reach Holding.

OPENING OF A CLINIC FOR CHILDREN WITH EPILEPSY AT AL AIN HOSPITAL Last July, Al Ain Hospital, owned and operated by Abu Dhabi Health Services company (SEHA), opened a new specialized clinic for children with epilepsy that provides worldclass medical services to this important segment of the society. The opening of the clinic is part of Al Ain Hospital’s strategy to increase and diversify medical specialties in the Departments of Child Health in order to upgrade them to keep abreast of the world’s leading medical institutions.. T he clinic provides integrated medical services for children with epilepsy, including diagnosis, treatment and follow-up as well as guide

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and educate the family about the nature of the disease and related health problems, how to cope with it and encourage them to contribute to supporting school and community activities in order to raise awareness of the benefits of integrating their children into society. The Department of Child Health at the hospital receives 15 thousand children annually and includes clinics for kidney diseases, diabetes, respiratory system diseases, allergies, immune system, asthma, blood and heart diseases, psychological and epidemiological diseases in children, obesity, nutrition and diets and Clinic for Rheumatism in Children. There are 42 beds in the pediatric ward, 10 beds in the pediatric surgery ward, 6 beds in the emergency room, 6 beds in the medical counseling rooms and 22 beds for preterm infants in the neonatal intensive care unit.

Other developments and ambitious programs Of course, there are many other projects that have opened in the UAE, or are underway. In addition to that, there are also preparations and developments even within the existing hospitals in order to increase their efficiency and upgrade them. They include: •

Abu Dhabi Health Services company (SEHA) recruited 754 new nurses for their hospitals and outpatient care services. Their recruitment was completed after organizing one of the largest local recruitment campaigns in the Emirate of Abu Dhabi recently, which attracted more than 8,000 candidates. SEHA has attracted qualified nurses that provide a range of services with high levels of specialization. The

new nursing staff will provide the highest quality of services to patients and their families as well as their exceptional clinical skills. •

A comprehensive remote monitoring program for patients with cardiac implants was added by Cleveland Clinic Abu Dhabi to its equipment in order to save patients’ lives by monitoring their condition while enjoying home comfort without having to go to the hospital. The Heart & Vascular Institute at Cleveland Clinic Abu Dhabi, a subsidiary of Mubadala Investment Company and a pioneer in the field of cardiac care in the region, launched the first remote cardiac monitoring program in the UAE in August 2015 in addition to another program for kidney, heart and lung transplant.

•

Increasing inpatient capacity at Cleveland Clinic Abu Dhabi by adding 150 beds to its current capacity. The management department has announced that it will continue to expand the outpatient capacity as well, noting that the hospital aims to receive more than 2,000 patients a day unlike emergency patients.

This is in addition to other programs such as: early diagnosis of diabetes program, Travelers Health Clinics, Charity Clinics, registration and control of all types of pharmaceutical drugs and electronic consultations. These achievements come within the context of comprehensive and distinctive health services that the UAE provides and aims to provide in a sustainable health environment within ambitious initiatives and plans that have achieved many successes.

ARTICLE FEATURES . UAE Healthcare

NEWS

American Hospital Dubai launches American Heart Association’s Resuscitation Quality Improvement (RQI) Program to boost cardiac arrest survival

he American Hospital Dubai has announced it is going ahead with its plans to implement the Resuscitation Quality Improvement (RQI) Program of the American Heart Association (AHA). With the successful deployment of the system, the hospital will become the first healthcare facility in the Middle East to implement the AHA-branded version of the pioneering training program from the AHA for high-quality cardiopulmonary resuscitation (CPR) and improved patient outcomes. CPR may seem to be a basic skill for healthcare providers but research has shown that psychomotor skills related to resuscitation can decay within just three to six months – far before the two-year standard when basic and advanced life support skills

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are currently evaluated. American Hospital Dubai knows the importance of high-quality CPR in saving more lives and has implemented the RQI program to help staff maintain skill competency and achieve better patient outcomes through regular, low-dose/high-frequency high-quality CPR training. Peter Makowski, CEO, American Hospital Dubai, said: “The American Heart Association created RQI to teach healthcare providers high-quality CPR in a more effective, concise and convenient way that drives them to practice and retain these skills with confidence. The system will allow the American Hospital Dubai to ensure their healthcare providers regularly refresh CPR skills and perform with confidence during an emergency. We always strive to offer the best and most innovative healthcare solutions to our customers. The deployment of the RQI system is one more system in place to help ensure that our team of healthcare providers are prepared to handle cardiac arrest related emergencies at any time.” RQI is intended to improve Basic

Life Support (BLS) and Advanced Cardiovascular Life Support (ACLS) skills, while making training more convenient for healthcare providers. Students can take the cognitive components of testing online and then test their psychomotor skills with real-time feedback by performing CPR at mobile Simulation Stations equipped with adult and infant manikins. At each RQI Station, a tablet connects the student to training material and provides helpful audiovisual feedback for compressions and ventilations, monitors the quality of performance and provides reinforcement or suggestions for improvement. The 2010 American Heart Association Guidelines for CPR and ECC and the 2013 CPR Quality Consensus Statement state that high-quality CPR should be recognized as the foundation for all other resuscitative efforts because it increases patient survival. The AHA RQI program helps provide better CPR. Learn more about the problem of rapid skills decay and the solution that RQI offers at www. heart.org/RQI.

American Hospital Dubai labs receives CAP accreditation for 9th consecutive time

he laboratory of the American Hospital Dubai (AHD) was accredited for the ninth consecutive time by the College of American Pathologists (CAP) after passing the latter’s rigorous onsite inspections and evaluation procedures. This accomplishment is the latest in a string of recognitions bestowed on the Laboratory Department and the hospital as a whole for their efforts to provide excellent and high-quality patient care and healthcare services.

HOSPITAL PASSES CAP’S RIGOROUS ONSITE INSPECTIONS AND EVALUATION PROCEDURES During the CAP accreditation process designed to ensure the highest standard of care for all laboratory patients, the CAP inspectors examined the Laboratory Department’s records and quality control procedures for the past two years. They also studied the qualifications of the laboratory staff, equipment, facilities, safety program and record, and overall management. The American federal government recognizes the CAP Laboratory Accreditation Program launched in the early 1960s as being equal-to or morestringent-than the government’s own inspection program. The American Hospital Dubai’s laboratory was the first private lab in the Middle East to earn accreditation by the CAP 2001. Following this year’s successful accreditation, Dr. Aaron Han, Chief of the Pathology Department, was commended for his effective leadership, unwavering commitment to delivering top-notch healthcare solutions, and intensive efforts to continuously

improve the laboratory’s services, processes, and systems. “Dr. Han will be the first to tell you that this would not have been possible without a remarkable group of people who comprise the AHD Laboratory team. As we all know, every team needs an effective leader and Dr. Han is such a leader. I would also like to commend the entire Laboratory Department for this outstanding recognition. Congratulations to the AHD Laboratory team for their outstanding service and their CAP accreditation. This is a well-deserved honor!” said Peter Makowski, CEO, American Hospital Dubai. Makowski added: “At AHD, we always strive to offer the most outstanding and cost-effective medical services to all our patients according to the highest American healthcare standards. This latest CAP accreditation is a testament that we are making major progress in our quest to be the best private healthcare institution

in the Gulf region and our newest achievement will only further inspire us to look for better ways to efficiently address the health needs of the UAE and its neighboring Gulf states.” The AHD is a 254-bed, acute care, general medical/surgical private hospital with a multi-specialty physician group practice. It is also the first hospital in the Middle East to be awarded JCI accreditation in May 2000 and has successfully maintained its accreditation. The AHD has continued to expand to meet the demand for more personalized services, comfort and convenience, while broadening the services and deepening the level of expertise and care offered. In June 2016, the hospital became the inaugural Middle East member of the prestigious Mayo Clinic Care Network. Its physicians and team are able to collaborate and leverage the expertise of Mayo Clinic for the betterment of patients in the UAE and surrounding region.

ARTICLE FEATURES . Parkinson’s Disease

PARKINSON’S

disease

Tremor, slowed movement and rigid muscles are the main symptoms

bout 10 million people around the world are estimated to be living with Parkinson’s disease. A person with Parkinson’s has abnormally low dopamine levels. Dopamine-generating cells, known as dopaminergic neurons in the substantia nigra part of the brain have died. Experts do not know why these cells die. When dopamine levels are too low, people find it harder to get things done, to control their movements. Dopamine levels progressively drop in patients with the disease, so their symptoms gradually become more

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ARTICLE FEATURES . Parkinson’s Disease

severe. Dopamine is involved in the sending of messages to the part of the brain that controls coordination and movement. Although Parkinson’s disease is not a direct cause of death, it is a progressive chronic disease, and symptoms get worse over time. Parkinson’s disease symptoms and signs may vary from person to person. Early signs may be mild and may go unnoticed. Symptoms often begin on one side of your body and usually remain worse on that side, even after symptoms begin to affect both sides. Parkinson’s signs and symptoms may include tremor, slowed movement, rigid muscles, impaired posture and balance, loss of automatic movements, speech and writing changes. Parkinson’s disease can’t be cured, but medications can help control your symptoms, often dramatically. In some later cases, surgery may be advised. Many doctors who diagnose this brain disorder rely on the Hoehn and Yahr rating scale to classify the severity of symptoms. The scale is broken into five stages based on disease progression. The five stages help doctors evaluate how far the disease has advanced. Stage one: During this initial phase of the disease that lasts around 3 years, a patient usually experiences mild symptoms. Stage two: In the second stage of Parkinson’s disease that lasts around 6 years, the patients’ symptoms are bilateral, affecting both limbs and both sides of the body. Stage three: Stage three symptoms of Parkinson’s disease last around 7 years and can be rather severe and include the inability to walk straight or to stand. There is a noticeable slowing of physical movements in stage three. Stage four: This stage of the

disease is accompanied by severe symptoms of Parkinson’s. Walking may still occur, but it is often limited and rigidity and bradykinesia are often visible. During this stage that lasts around 9 years, most patients are unable to complete daily tasks, and usually cannot live on their own. Stage five: The final stage of Parkinson’s disease lasts around 14 years and it usually takes over the patients physical movements. The patient is usually unable to take care of himself and may not be able to stand or walk during this stage. A patient at stage five usually requires constant one-onone nursing care.

Symptoms Parkinson’s disease symptoms and signs may vary from person to person. Early signs may be mild and may go unnoticed. Symptoms often begin on one side of your body and usually remain worse on that side, even after symptoms begin to affect both sides.

Parkinson’s signs and symptoms may include:

Tremor: A tremor, or shaking, usually begins in a limb, often your hand or fingers. Slowed movement (bradykinesia): Over time, Parkinson’s disease may reduce your ability to move and slow your movement, making simple tasks difficult and time-consuming. Your steps may become shorter when you walk, or you may find it difficult to get out of a chair. Also, you may drag your feet as you try to walk, making it difficult to move. Rigid muscles: Muscle stiffness may occur in any part of your body. The stiff muscles can limit your range of motion and cause you pain. Impaired posture and balance: Your posture may become stooped, or you may have balance problems as a result of Parkinson’s disease. Loss of automatic movements: In Parkinson’s disease, you may have a decreased ability to perform unconscious movements, including blinking, smiling or swinging your arms when you walk. Speech changes: You may have speech problems as a result of Parkinson’s disease. You may speak

ARTICLE FEATURES . Parkinson’s Disease

softly, quickly, slur or hesitate before talking. Your speech may be more of a monotone rather than with the usual inflections. Writing changes: It may become hard to write, and your writing may appear small.

Therapies in development Parkinson’s disease can’t be cured, but medications can help control your symptoms, often dramatically. In some later cases, surgery may be advised. Your doctor may also recommend lifestyle changes, especially ongoing aerobic exercise. In some cases, physical therapy that focuses on balance and stretching also is important. A speech-language pathologist may help improve your speech problems. Medications may help you manage problems with walking, movement and trem-

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or. These medications increase or substitute for dopamine, a specific signaling chemical (neurotransmitter) in your brain. You may have significant improvement of your symptoms after beginning Parkinson’s disease treatment. Over time, however, the benefits of drugs frequently diminish or become less consistent, although symptoms usually can continue to be fairly well-controlled. Scientists at the University of Dundee have identified the structure of a key enzyme that protects the brain against Parkinson’s disease. The result of a decade of work, the research team said that solving the 3D structure and inner workings of the PINK1 enzyme represented a major breakthrough. The PINK1 gene was identified as a key player by Parkinson’s UK-funded researchers back in 2004.

Drugs that can switch the PINK1/ parkin pathway back on may be able to slow, stop or even reverse nerve cell death, not only in people who have these rare inherited forms of the condition, but also those with non-inherited Parkinson’s. Previous work had indicated that the main role of the PINK1 enzyme is to sense damage to the energy centres of cells known as mitochondria and then switch on a protective pathway involving the targeting of two key proteins, ubiquitin and Parkin, to reduce the damage. But how this occurred was unknown. In the new research, the team of Dundee scientists reveal that PINK1 has unique control elements not found in other enzymes of this class that explain how it targets ubiquitin and Parkin to exert its protective role in Parkinson’s.

ARTICLE FEATURES . Parkinsonâ€™s Disease

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Heart Healthy Eating Farah Kalakesh Dietician - Al-Ahli Hospital

eart disease is significantly affected by a cluster of comorbid diet-related conditions, including abdominal obesity, high blood pressure, elevated blood glucose concentration, high triglyceride level, and low HDL; called metabolic syndrome. A heart-healthy diet and lifestyle are the best weapons to protect you from cardiovascular diseases through the regulation of blood lipids and underlying inflammation. Make the simple steps below as part of your life for long-term benefits to your heart.

What are the good and bad aliments for cardiac patients?? Soluble fiber, found in oats,

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barley, beans and pectin found mainly in vegetables and fruits like apples, are known to reduce LDL and atherosclerotic progression. Get more fiber by eating whole vegetables and fruits instead of drinking juice! Whole grains and nuts, in addition to their dietary fiber benefits, provide magnesium, vitamin E and phytosterols, which are inversely related to coronary heart disease occurrence or mortality. Be cautious that nuts may influence weight gain if consumed freely. Moderate your intake of avocados, tuna, salmon and peanuts which are good sources of niacin that seemed to raise HDL and reduce LDL. The American Heart Association emphasizes on eating more than 2 times per week seafood and vege-

tarian sources of protein rather than red meat. Clinical studies have shown that â€œcomplete soy proteinâ€? in the form soymilk or meat substitutes may reduce coronary heart disease risk by lowering oxidized LDL, raising HDL thus lowering blood pressure due to its high content of phytoestrogen (isoflavones), fiber, magnesium, calcium, zinc. Magnesium, potassium, calcium, as stressed by DASH diet(Dietary Approach to Stop Hypertension), are very abundant in low fat/ skimmed dairy products, cocoa, and fresh fruits and vegetables like spinach. In addition, fruits and vegetables like berries, oranges, capsicum, tomatoes, and broccoli, among their cardioactive components, are rich also in different

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antioxidants like vitamin c, flavonoids, carotenoids that may reduce the burden of oxidized LDL and improve endothelial function. Garlic is one of the best antihypertensive- antioxidative agents. Furthermore, shifting the balance of dietary fat away from saturated fats toward omega-3 fatty acids from fish oil and plant sources like walnuts, flaxseed, flaxseed oil, canola oil, appears to reduce atherosclerosis and may help lower coronary risk, presumably by reducing triglycerides and inflammatory processes and by raising HDL. Olive oil showed to have a beneficial effect on cardiovascular disease as a powerful antioxidant but be aware that sources of omega-3 and olive oil will also increase total fat and caloric intake, and may contribute to weight gain. Saturated fats are a major factor for increased LDL cholesterol, leading to atherosclerosis, heart attacks, and stroke while soluble fiber tends to reduce them. Avoid lamb, duck, organ meats such as kidneys and liver, and processed meats such as sausage, bacon, hot dogs, butter rolls, and croissants. The public had been warned against frequent egg consumption due to their high cholesterol content, however, we cannot eliminate it from the diet because eggs are also a source of high biological value protein, as well as vitamins and minerals such as folic acid, vitamin b12, choline, zinc, etc. Cardiac patients should be more diligent when checking nutrition labels, and eventually choose food low

in saturated fats, without trans fats since Trans fats raise LDL and lower your HDL. Even if you are not diabetic, cut on foods and beverages high in calories and sugars, like soft drinks and candies. Keep an eye on your portion sizes and type of carbs knowing that excessive intake of refined carbs raises your blood sugar as well as your triglyceride levels. Follow a low-sodium diet by avoiding salty salad dressing, pretzels, pickles, gravies. Always choose foods with less sodium content and prepare meals with little or no salt. Beneficial effects of tea (black and green) as a favorable antioxidant are still under further investigation for cardiac patients, current recommen-

dations suggest 2-3 cups green tea per day. Due to little evidence for a coffee effect, the general advice is no more than 2 cups of coffee per day.

Changing your lifestyle? Reducing body weight and controlling blood pressure are useful, respectively, for improving HDL level and preventing atherosclerosis. To reverse your metabolic syndrome, a modified diet, particularly combined with 45 minutes exercise 3-4 times a week (Walking, jogging, swimming, rowing..), in addition to stress reduction, smoking cessation can prevent, delay, or reverse the progression of atherosclerosis and other cardiovascular events. This Diet tailored by us conforms to your health condition, calorie requirements, preferences along with learning new cooking techniques and acquiring new tastes. Itâ€™s not as hard as you may think! Remember, itâ€™s the overall pattern of your choices that counts!!

INTERVIEW

Medical Director, Gilead Sciences Eastern Europe and Middle East

Dr. Samer El-Ali “GILEAD HAS CONTRIBUTED TO REVOLUTIONIZING THE TREATMENT OF CHRONIC HEPATITIS C” On the occasion of the 2nd International Hepatology Summit in Dubai held on 6-7 October 2017, the “HOSPITALS” magazine met with Dr. Samer ElAli, Medical Director, Gilead Sciences Eastern Europe and the Middle East and Dr. Fuad Hasan, a professor in the Department of Medicine, Faculty of Medicine, Kuwait University. During the interview, the meeting focused on the importance of the Summit and its desired objectives; it also featured international and regional experts and a platform to hold an interactive educational meeting with a series of integrated sessions, discussions, and workshops. The role of Gilead Sciences Eastern Europe and the Middle East has been discussed as well as its role in facilitating care and treatment for millions of people suffering from life-threatening diseases worldwide.

What is the importance of conducting IHS in Dubai? What is the volume of participation? Dubai has been established as a regional healthcare hub and a platform for the dissemination of medical information and sharing of know-how within the region and has also been recognized by international experts. At the same time, liver diseases and especially viral hepatitis are not only global problems but increasingly significant problems in the Middle East and North Africa (MENA) region. Namely, an estimated 170 million people are infected with hepatitis C virus (HCV) worldwide. MENA region has the highest prevalence of HCV infection in the world, affecting more than 20 million people in Arab countries. For this reason, we have organized International Hepatology Summit in Dubai for the second consecutive year. We were privileged to host 17 international and regional faculty as well as over 170 delegates from 17 countries across the Middle East, Europe and US, a 30% increase compared to the previous year. This

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year, the Summit entitled ‘Focused on Liver Disease’, discussed recent updates and developments in the fields of hepatitis C virus (HCV), hepatitis B virus (HBV), and non-alcoholic steatohepatitis (NASH). Our ambition is to establish a strong consensus to drive progress and better support people affected by HCV, HBV or NASH across the region, as well as support the healthcare community in the Middle East effectively treating and managing liver disease.

What are the most important topics to be addressed by the Summit? As last year, key topics of the Summit were Hepatitis C (HCV) and Hepatitis B (HBV) and within each topic, we have dived into various aspects of the disease management, with the majority of sessions focused on improving patients’ lives through screening, linkage to care and treatment. In relation to HCV, the Summit has provided insight into the challenges associated with therapy beyond

virological cure, and the long-term health concerns in patients treated for HCV. Furthermore, the benefits of curing HCV and optimizing therapy to suit individual patient needs have been explored in light of real-world data with new direct-acting antiviral (DAA) agents and newly developed pan-genotypic therapy. The Summit also focused on developing the treatment landscape for HBV and clinical outcomes beyond virological suppression that were achieved over the past two years. In addition, the faculty explored the management strategies for difficult-to-treat patients with advanced liver disease and developed resistance, highlighting the challenges encountered in managing special patient populations. As the life expectancy in the Middle East is increasing and the population is changing, so too is the burden of chronic HBV. As people get older and increasing number of comorbidities (co-existing medical conditions) is recorded, healthcare professionals are faced with new disease management challenges. In addition, this year we

INTERVIEW

also introduced a new topic – non-alcoholic steatohepatitis (NASH) – which has been identified as the number-one emerging liver disease in the Middle East and the world. Leading experts reviewed the epidemiology, pathophysiology, and diagnosis of the disease, as well as the economic burden and current treatment strategies.

How about the vision and goals? The International Hepatology Summit provides international and regional experts a platform for a very interactive educational meeting with a series of plenary sessions, debates and clinical workshops based on the specific set of educational objectives. Namely, our goal, which we successfully achieved, was to discuss the evolution of screening and linkageto-care policies in the era of DAAs and the benefits of pan-genotypic approaches for HCV treatment. In addition, we have reviewed the best practices towards HCV elimination and discussed the benefits of HCV cure from the patients’ perspective. We also wanted to understand the added value of future therapies in the treatment of HBV and review the management of nucleus(t)ide analog-experienced or resistant patients as well as to discuss the updates of HBV therapy in patients with advanced liver disease and management of patients at risk of HBV reactivation. And our final goal was to review the pathophysiology and diagnosis, as well as current best practices, in the management of NASH.

Are any new medicines and treatments for hepatitis diseases to be revealed during the Summit? Can you tell us about them? No, we have not revealed any new drugs as this was not the purpose of the Summit. As I mentioned, this Summit has an educational role in which

experts discuss their insights, clinical cases, real-life data and best practices with the goal to exchange ideas and know-how with their counterparts across the region and the world. Gilead’s role in the Summit is one of the connectors, providing a platform for such an exchange. Nevertheless, we are always working to expand access to treatment wherever possible by helping patients overcome barriers to get the medicines they need. In addition, we believe that routine screening and expanding access to treatment can play a critical role in eradicating viral hepatitis.

To what extent will these treatments improve the patient’s life? Over its short history, Gilead has helped transform and simplify care for millions of people with life-threatening illnesses around the world. Gilead is motivated by the urgent need to develop and deliver medicines that help save and improve lives. With 24 marketed products and hundreds of ongoing and planned clinical studies, we are focused on solving some of the biggest health challenges today. Gilead has helped revolutionize the treatment of chronic hepatitis C infection by providing medicines that offer cure rates as high as 95-99 percent for all genotypes (1-6) of HCV infection in less time and with fewer side effects than prior treatments. At the same time, with our HBV therapies, patients can effectively manage chronic hepatitis B infection. However, we continue to seek ways to provide a finite duration of treatment such that patients can control or eliminate the virus without having to endure a lifetime of treatment. We are also exploring investigational compounds that target different disease pathways that contribute to or cause NASH, a serious liver disease which is

affecting increasing number of people across the Middle East and the world. One way we develop new therapies is through collaboration, partnership and acquisition — combining the expertise of others with our own, and this Summit is one of the examples of our continuing efforts of including medical community in this learning process.

WHO has developed a strategy to reduce hepatitis deaths by 2030. Could you brief us on the most important points in this strategy? Is it conceivable about the mechanism to be applied? According to the Global Burden of Disease study, deaths caused by viral hepatitis have surpassed all chronic infectious diseases including HIV/AIDS, malaria and tuberculosis. Globally, only 5% of people living with viral hepatitis are aware of their condition, greatly increasing the chance of infecting others and missing the opportunity to access life-saving treatment. Because viral hepatitis has few noticeable symptoms, many people are either misdiagnosed or do not come forward for testing. Reducing hepatitis related deaths by 65% by 2030 is a key component of the World Health Organization’s (WHO) Global Hepatitis Strategy. The Strategy, which was adopted by 194 governments, sets out a list of key targets, which, if achieved will eliminate viral hepatitis by 2030. For HCV in particular, WHO has set a 90-80-90 goal, meaning that by 2030 healthcare stakeholders should strive to achieve that 90% of people living with HCV are diagnosed, out of which 80% are treated, and out of which 90% are cured. In theory, this should be possible as HCV is curable if people are screened, diagnosed and treated. However, this will only be achievable if all governments put together national eradication plans.

INTERVIEW

Professor at the Department of Medicine, Kuwait University

Dr. Fuad Hasan “THE EXISTING MEDICATIONS ARE NOT ONLY FOR SAVING THE LIVER FROM DAMAGE AND PREVENTING CANCER, BUT ALSO IMPROVING THE PATIENT’S QUALITY OF LIFE” As part of the 2nd International Hepatology Summit held in Dubai last month, “HOSPITALS” magazine met with Dr. Fuad Hasan, Professor at the Department of Medicine, Kuwait University. The meeting tackled the importance of the Summit and its objectives in addition to Gilead Sciences’ role in facilitating care and treatment for millions of people suffering from life-threatening diseases worldwide. Dr. Fuad Hasan stressed that the Summit serves as a forum for physicians in various specialties as well as healthcare providers such as pharmacists and public health workers, to share knowledge and experience. He pointed out that the existing liver medications are not only for saving the liver from damage and preventing cancer, but also improving the patient’s quality of life.

Hepatitis is a global burden for governments and stakeholders. How would you assess the situation today? What are the ways to limit the spread of the disease and raise the awareness of the risk of infection? The Middle East is endemic for viral hepatitis B and C. The incidence of hepatitis B dropped drastically especially among young people due to the introduction of the vaccination program in the early 90’s. Namely, in GCC countries all newborns are vaccinated against hepatitis B. This policy complies with the WHO recommendations. Therefore, most hepatitis B infections are now observed in patients born before 1992. These patients can be treated with oral medications that are very effective in controlling the disease and preventing its complications. They are quite safe and effective. Unfortunately, they rarely result in complete cure and patients need

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to stay on treatment indefinitely. In contrast, hepatitis C has no vaccine, but it can now be cured in over 90% of cases using safe and well-tolerated tablets for 8 to 12 weeks. Treating people infected with hepatitis C will definitely limit the spread of the virus to healthy individuals. Certain populations need special attention because they are a reservoir for infection. For example, persons who inject drugs and prisoners should be treated to prevent the spread of the disease. Moreover, even apparently healthy individuals should be screened for hepatitis because many are not aware that they carry the virus. It is important to emphasize that anyone who received blood products before 1992 should be tested. Also, those who used intravenous drugs or undergo dialysis, as well as spouses and children of infected patients should be screened. Finally, patients and healthcare providers

should be educated about the disease, its prevention, and treatment since even physicians who are not specialized in liver disease may not be fully aware of the recent developments in this field.

In your opinion, what is the importance of this Summit in the dissemination of awareness and exchange of experiences in order to reach a mechanism to reduce the spread of hepatitis disease? This Summit serves as a forum for physicians in different specialties as well as other healthcare providers, such as pharmacists and public health workers, to exchange knowledge and expertise and come up with a comprehensive 360-degree plan to educate, screen and treat infected patients. The news that comes out such meeting will help educate the public and governmental agencies in order to direct resources to the effort of eradication.

INTERVIEW

Tell us about the seriousness of this disease? How does it start and what are the most prominent symptoms? Hepatitis B and C can cause liver cirrhosis, liver failure, and liver cancer. They can also cause diseases in other organs such as the kidneys, skin, diabetes, etc. Both viruses may be completely silent in the early stages, hence the importance of being tested. Many patients experience fatigue and depression. In advanced cases, patients

may develop jaundice, fluid retention, bleeding, confusion or coma.

Is there a new treatment for hepatitis B and C? Yes. Hepatitis B can be treated with pills and injections. These medications prevent the virus from damaging the liver. In case of hepatitis C treatment can cure the virus easily and without side effects. This is considered to be a revolution in medicine because no other chronic viral

infection is curable at this time.

What are the new methods to improve the lives of patients? This is a very important question. Current medications not only save the liver from damage and prevent cancer but also improve the quality of life. Both viruses can cause fatigue, depression, loss of appetite and absenteeism from work. When treated, patients feel much better and they become more energetic and productive.

NEWS

‘A new hope for MS patients’ Eminent Lebanese Neurologists mark the latest advancements in Europe for Multiple Sclerosis treatments by Merck

arking the latest advancements in Multiple Sclerosis treatment, Merck, the leading Science, and Technology Company and a Specialty Innovator in Biopharma, in collaboration with the Lebanese Neurological Society and MS medical society held a media briefing session titled ‘A new hope for MS patients’at Phoenicia Hotel in Beirut. The panel hosted five MS Specialists from the Lebanese Neurological Society and MS Medical Society: Professor Adnan Awada, President of the Lebanese Society of Neurology, Head of Neurology Department at Hotel Dieu de France and Professor of Neurology at USJ; Professor Souheil Gebeily, Head of Neurology at the Faculty of Medical Sciences at the Lebanese University; Professor Salam Koussa, Professor of Clinical Neurology and Director of L’Observatoire Libanaise de la Scléroseen Plaques (OLSEP); Professor Naji Riachi, Associate Professor at the Lebanese American University and Head of Neurology LAUMCRH; and Professor Bassem Yamout, Professor of Clinical Neurology and Director of the Multiple

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Sclerosis Center for Clinical Research at AUBMC. The session discussedMS disease and its impact on patient daily life’s, unmet needs with current therapy platform in MS and the recent marketing authorization granted for (Cladribine Tablets) for the treatment of highly active relapsing multiple sclerosis* (RMS) in the European Union (EU). Developed by Merck, Cladribine Tablets is the first short course oral treatment for highly active relapsing multiple sclerosis (RMS) to provide efficacy on disease activity including disability progression, annualized relapse rate, and magnetic resonance imaging (MRI) activity. Highlighting on MS disease and its symptoms, Professor Naji Riachi, Associate Professor at the Lebanese American University and Head of Neurology LAUMCRH said ” Multiple sclerosis (MS) is an autoimmune, chronic and inflammatory condition that affects the central nervous system (CNS) and is the most common, non-traumatic, disabling neurological

disease in young adults. Relapsing-remitting MS (RRMS) is the most common form of MS, and around 85% of people with MS are diagnosed with this type. Symptoms of Multiple Sclerosis are variable and not all patients experience the same symptoms. Initial symptoms may be mild enough that patients do not always seek medical care. MS symptoms include fatigue, difficulty in walking, visual problems, tingling and numbness sensations, muscle weakness and spasms, problems with balance, coordination, thinking, learning and planning. Although there is currently no cure for MS, treatments are available to help alter and slow the course of the disease.” concluded Professor Riachi. Talking about the importance of early and accurate diagnosis and the prevalence of MS, Professor Salam Koussa, Professor of Clinical Neurology and Director of L’ObservatoireLibanaise de la Scléroseen Plaques (OLSEP) said: “The diagnosis of MS is a complicated process as it doesn’t rely on a single test, and other possible causes may need to be ruled out first. Once MS has been diagnosed, the type of MS can often be identified based on the pattern of symptoms. MS is associated with a substantial clinical and economic burden on patients, caregivers, and the healthcare system, and is more pronounced in patients with high disease activity, where the burden of severe MS – such as disability and unemployment – is very high. Unfortunately, MS patients have to bear the high costs associated with medication, relapses and disability progression”.

NEWS

Highlighting the needs of MS patients, Professor Souheil Gebeily, Head of Neurology at the Faculty of Medical Sciences at the Lebanese University said: “Multiple sclerosis characteristics have changed over the past decades. Today, a breakthrough in the disease course has been achieved through the new disease-modifying therapies, which must be made available to reach and every MS patient. Initiating the treatment at the earliest stage of the disease is a determinant factor in optimizing the beneficial effect on the disease outcome. Each disease-modifying therapy has a distinct risk-benefit profile and each patient is a distinct individual patient. Hence, the relationship between the MS patient and his neurologist is a key element for a successful full management which should be tailored to each patient’s specific needs. In this regard, social, familial and specific medical support should target for each MS patient good quality of life and wellbeing. As part of his contribution to the session, Professor Awada said: “Multiple MS patient’s association are available in Lebanon which provide support for patients suffering from MS. Mostly,these MS patient’s association relies voluntarily to do their own activities. These activities mainly focus on raising awareness on MS, providing physiotherapy, and continuous education about MS. Our volunteers are very specialized through continuous training and exploration of MS disease. As well as partnership with different stakeholders is a key for MS patient’s association success to develop MS organization’s capacity and strengthen their skills to help and respond better to the needs of people with MS. Finally, the main objective of all MS patient’s association in Lebanon is that people living with

multiple sclerosis can play a major role in conquering this disease and continue to be an effective member in the society” added Prof. Awada. Shedding light on the latest advancements in MS treatment, Professor Bassem Yamout, Professor of Clinical Neurology and Director of clinical research at the Multiple Sclerosis Center at AUBMC said: “Several therapies have been launched for MS including treatments for acute relapses with steroids and plasma exchange (plasmapheresis), Disease-modifying drugs (DMDs) treat the underlying immune disorder and result in reduction of relapse frequency and severity. Over the last few years, many new DMDs were added to our armamentarium of MS therapies with high level of efficacy, changing significantly the prognosis of the disease. Some of those new treatments can involve a substantial treatment administration through the intravenous route or a monitoring burden including frequent medical tests. The European Commission (EC) has recently granted marketing authorization for a new oral treatment of highly active relapsing multiple sclerosis (RMS).The new medicine is a selective immune reconstitution induction therapy which simplifies treatment administration by giving just two short annual courses of tablets in four years. Patients can benefit from this treatment over a longer period of time extending up to

four years without having to continually take medication and without the need for frequent monitoring, and as healthcare system, we are looking forward to getting this new treatment available for our patients in Lebanon soon,” added Prof. Yamout. “At Merck, we are committed to finding solutions for patient’s significant unmet medical needs. Cladribine Tablets has shown sustained clinical efficacy for up to 4 years with a maximum of 20 days of oral treatment over 2 years. It is a new approach in the management of active RMS. New treatment options will significantly help improve the quality of life of people living with active relapsing MS“said Dr. Hala Sleiman, General Manager of Merck for the Near East Region. The European Commission (EC) has granted Merck the marketing authorization the 28 countries of the European Union in addition to Norway, Liechtenstein and Iceland. The marketing authorization is based on more than 10,000 patient years of data with over 2,700 patients included in the clinical trial program, and up to 10 years of observation in some patients. The clinical development program included data from three Phase III trials. The efficacy and safety results of these studies has shown sustained clinical efficacy for up to 4 years with a maximum of 20 days of oral treatment over 2 years.

MEDICAL FAIR

BRING YOURSELF UP-TO-DATE

in infection prevention - the first MEDICA ACADEMY offers the latest expertise and practical tips on implementation for hospital and practice scenarios

maging, hygiene, surgical procedures, preventing overcharging for care, insufficient or unnecessary care or procedures in GP practices and medical innovations - these are just a few of the topics that MEDICA ACADEMY will focus on. This interdisciplinary further education event will premier as part of the MEDICA program this year. It will offer doctors from all specialties the opportunity to undertake further training throughout its four-day run, from 13 to 16 November 2017, at the Congress Center Düsseldorf (CCD Süd). MEDICA is the world’s leading medical trade fair, held in Düsseldorf. The global spread of infection and increase in resistances, particularly multiple resistances, requires that the cooperation between outpatient and inpatient sectors must be improved, along with cooperation between carers and doctors from all specialisms, to give an example. The aim is to translate current knowledge from prevention strategies into adequate hygiene measures and guideline-compliant therapies and put them into practice. “Update your infection prevention measures” is a whole day event

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which is simultaneously interpreted into English. The MEDICA ACADEMY is hosting this event so that it can focus on four central topics in infectiology and hygiene, with each topic being presented by two expert speakers in a concise, practice-oriented manner. On Thursday 16 November 2017, from 9 am to 4:40 pm, the program centers around the main focus topics of practical hygiene, frequent outpatient and nosocomial infections, infection prevention and antibiotic stewardship in practices and clinics as well as the use of psychological communication strategies to implement infection prevention. An application for CME certification from the North Rhine Medical Association has been submitted. The seminar, which was developed in cooperation with LADR, the Laboratory Group of Dr. Kramer & co. GbR, is led by Dr. Wolfgang Hell MD, from Geesthacht, Prof. Dr. Mariam Klouche MD, from Bremen and PD Dr Roland Schulze-Röbbecke MD, from Aachen. These three leaders’ main priority is to promote targeted discussion within and across specialties with expert speakers and the audience so that experiences and practical questions

from the participants are actively included in this event. “We intend to use practical, real-life examples, presented by experienced Infectiologists, doctors who specialize in hospital hygiene and hygiene experts and integrate modern communication psychology techniques to share current knowledge and show the tools that allow us to implement this in practice”, said Prof. Dr. Mariam Klouche MD. “The aim is to improve infection prevention and the prevention of infectious disease in outpatient and inpatient care,” explained the Consultant for Clinical Pathology, Microbiology, Infectious Disease Epidemiology and Transfusion Medicine.

Basic Hygiene - hugely important for all care actors Heike Briesch, Chairwoman of the VHD (German Association for Hygiene Specialists) and member of KRINKO (the German Commission for Hospital Hygiene and Infection Prevention) will introduce the first module by giving an update on basic hygiene that prevents transmissible diseases from spreading and serves to protect patients and residents of care facilities as well as their workers and visitors. Briesch

MEDICAL FAIR

points out that hygiene and infection prevention are essential in ensuring patient safety. “Nosocomial infections don’t just affect patients that come to stay in the hospital for treatment. They also affect people that receive inpatient and outpatient care. This means that implementing hygiene measures is of the utmost importance for each patient or resident, regardless of whether we know their infection status or not, and basic hygiene plays an essential role here.”

Hand disinfection - a must for every situation Hand disinfection is one of the most effective methods for preventing nosocomial infections and the transmission of multiple resistant pathogens, and we have known this for a long time. On the basis of the Clean Care is Safer Care campaign from the WHO, significant measures to improve hand disinfection have been implemented in inpatient and outpatient medical facilities within the scope of the Clean Hands Campaign. “We still need to improve compliance with hand disinfection standards” stated Dr. Tobias Kramer MD, MSc (Infectious Diseases) and Antibiotic Stewardship Expert (for the German Association for Infectiology, the DGI). As a science expert working on the Clean Hands Campaign at the Charité University Hospital in Berlin, Kramer knows that these measures need to be supported by stakeholders at all levels if the successful long-term implementation is to be ensured.

“The influence and role-model potential that management-level employees can have, in particular, should not be underestimated. This potential should be used to its fullest extent”, stated Kramer. Which measures should implement to boost compliance further? Kramer thinks that we should generally be looking at tried and tested measures, such as those recommended in the Clean Hands Campaign. These include sharing knowledge, reports on observations on compliance and use of hand disinfection agents at all stations, memory aids, and optimized dispenser location and fitting. Furthermore, there is growing evidence that having the station’s employees make their own commitment and having them establish targets to be attained can lead to a sustained improvement in behavior in terms of compliance with hand disinfection standards. Kramer also believes that patients and their relatives and friends could also help to improve medical professionals’ compliance in hand disinfection by informing them when and where hand disinfection is required in advance and then telling them to request this from staff. “Many patients already check the medication that they are given by hospital staff, and we want to encourage this same activity for hand disinfection. Both patients and staff are unsure of procedures in this respect”, said Kramer.

Urinary Tract Infections - prevent them with new approaches

In addition to traditional sets of hospital hygiene measures, such as hygienic hand disinfection that complies with indications and aseptic techniques, other aspects also play a role in preventing infectious disease. These aspects are not necessarily new, but they are fundamentally different from those named above. This is true of diagnosing a urinary tract infection, for example. The UTI shows up because it matches a certain clinical picture, or in many cases as a result of a microbiological diagnosis. “Both of these involve disturbance variables that can lead to a false diagnosis being given which in turn leads to non-indicated antibiotic exposure”, warned Dr. Thomas Schwanz MD, Head of Department for the Institute for Medical Microbiology and Hygiene of the University of Mainz. Schwanz has thus decided to point out these various limitations and the possibility that diagnoses, that have also been described in the latest literature, may be erroneously interpreted in his speech. He hopes that discussing these will lead to the development of optimized strategies for preventing UTIs in the future.

Clostridium difficile – a global challenge Prof. Dr. Mariam Klouche MD reports on the latest on Clostridium difficile infections and their huge relevance to medical practice. Screening for Clostridium difficile is no longer only being carried out for patients that have been treated in the hospital mul-

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tiple times. It is increasingly also being screened for in outpatient care. “Clostridium difficile is a global challenge. The pathogen can appear as a colonization of the colon and can lead to serious, or potentially fatal infections as a result of antibiotic therapy or other predisposing factors” explained the Medical Director of LADR GmbH MVZ [Medical Care Centre] Bremen. Recently, we were able to show that the incidence of C. difficile infections could be drastically reduced by infection stewardship programs and, more specifically, through restricting certain antibiotics. In her presentation, she describes the special features of C. difficile, the new risk groups that have cropped up, most recently in outpatient units and the current therapy options. Potential prevention measures will be presented and discussed with the participants.

Post-Operative Wound Infections - you can’t prevent 100% of them After the closing round of questions that concludes each module, presented by the leaders to each speaker and the public, the third section will focus on the management of antibiotics. PD Dr. Roland SchulzeRöbbecke, Consultant for Hygiene and Medical Microbiology, addresses the issue of Post-Operative Wound Infection (POWI). The approach of reducing POWI by reducing the bacteria that can enter the operating wound from the environment has mostly been exhausted in the industrialized countries. “The general belief that POWI occurs because of dirty surgical instruments, air conditioners that don’t work or theatres not being cleaned properly is actually false. In rich industrialized countries, at least, this doesn’t play any role at all in practice. Most incidences of POWI are rather caused by bacteria that the pa-

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tient brings into theatre themselves, and these can only be partly eliminated”, explained Schulze-Röbbecke. Current evidence-based recommendations on how to reduce POWI rates focus on the bacteria on the patient’s own body which inevitably enter the operating wound in each operation. The risk of POWI caused by this type of bacteria, endogenous bacteria, can be reduced by sufficient perioperative antimicrobial prophylaxis for many operations, to give one example. Further evidence-based preventive measures focus on maintaining normal levels of body temperature and blood sugars, as well as on achieving optimal blood flow ratios and oxygen supply to the operated tissue so that the patient’s physiological defense mechanisms are impaired as little as possible. Pre-operative antiseptic skin preparation (washing) with products which contain alcohol, an agent which works quickly, and Chlorhexidine, as a residual active agent, is also relevant. The recording and evaluation (monitoring) of POWI incidence is very important in reducing POWI rates is impossible without this data being present. “Complete elimination of POWI is impossible, at our current level of knowledge”, said Schulze- Röbbecke, giving his opinion on the situation, “this is because many of the significant risk factors cannot be influenced, for example severe primary disease, old age, obesity and nicotine abuse”.

Antibiotic Stewardship - decreases the rate of pathogens’ resistance to antibiotics in clinics Anne Eva Lauprecht, a hospital doctor specializing in hygiene at the Essen-Mitte clinic group, shows that the “Clean and Isolate” strategy alone is not enough to bring about a reduction in hospital infections.

On the contrary, this costs hospitals a lot of money although there isn’t any scientific evidence in favor of many of these measures. In addition, the individual outcomes for isolated patients are poorer than those for patients treated without these hygiene measures. This is because isolated patients have less contact with care staff and doctors. The national German Prevalence Survey for 2016 showed that the prevalence of nosocomial infections in hospitals was 4.6%, just slightly lower than it was five years ago when it was 5.1%. The primary objective must be to improve infection prevention significantly and to implement strategies for a reasonable level of antibiotic therapy in line with Antibiotic Stewardship (ABS) in hospitals as well as in the outpatient sector. “Using ABS, we can do more than simply significantly reduce the local rate of pathogens’ resistance to antibiotics in local hospitals within a short time” summed up Lauprecht, “Moreover, studies overwhelmingly show that Clostridium difficile infections can be drastically reduced by ABS and by restricting the prescription of certain groups of antibiotics”. The ABS expert also remarked that a consistently high rate of resistance to many antibiotics and the constant rise in 3MRGN E-coli in hospitals are generally problems that are caused in-house. This is crucial, particularly for calculated antibiotic therapy. A low rate of pathogen resistance to antibiotics results in safer medical treatment and thus ensures a better quality of care, continued Lauprecht. In terms of concrete implementation, she said that this meant that, “ABS measures need to be set up in clinics so that they are used in all aspects of the daily antibiotic prescribing process. To do this, knowledge on

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antibiotics and antimicrobial therapies must be improved for service providers. In-house guidelines on antibiotics and information on local resistance development are just first steps in this measure. Individual ABS measures need to be designed so that they are completely understandable and reproducible for the service providers, and above all so that they can be implemented easily. Data on the amounts of antibiotic used and how frequently they are used enable service providers to evaluate and adjust their own prescribing patterns”, said Lauprecht.

We’ve found the problem we just need to remedy it “We know that we’ve got a way

to go in hospital hygiene. The issue is implementing measures”, says Dr. Wolfgang Hell MD, Head of the Specialist Hygiene Service at LADR Geesthacht, in the final module. The organization is a problem in infection prevention - who does what? Hell attempts to answer this question in his speech. For him, it’s also important to scrutinize the difference between the actual conditions and the objectives with hygiene specialists and to look at this within the various contexts that different facilities provide, from hospitals to rehabilitation clinics, from outpatient clinics to doctors’ practices.

Implementing hygiene measures without coming

up against communicative resistance The day will come to a close with an awareness session on the communication situations with a view to providing a strategic and sustainable implementation of important infection prevention measures. Birgit Jacobowsky, Social Psychologist, and Coach, will play out different scenarios that we see in hospitals and practices every day and will demonstrate different types of communication and the effect and significance that these have. Communicating on implementing hygiene measures without meeting with resistance is the goal that all participants in this workshop will be driving it!

NEWS

Losing 5-10% of Body Weight Greatly reduces risk of Comorbidities Linked to the Disease of Obesity

disease linked to a range of other comorbidities, obesity’s harmful impact on health can be significantly reduced with sustained loss of 5–10% of body weight, with benefits including improvements in blood glucose levels, blood pressure, and lipid profile, as well as decreased risk of type 2 diabetes and obstructive sleep apnea, and enhanced health-related quality of life. “Obesity is on the rise in Lebanon, where local estimates show it affecting nearly 30% of the population, while most people are not aware that it’s a disease that subjects them to higher risks for numerous comorbidities,” said Stathis Psimmenos, Lebanon General Manager at leading global pharmaceutical company Novo Nordisk which is teaming up with the Lebanese Society of Endocrinology, Diabetes & Lipids (LSEDL) to raise awareness about Obesity-related health issues, and call on people with the disease to take serious measures to lower their body weight. “Sustainable weight loss must become a priority for anyone serious about their health,” said Dr. Emile Andari, LSEDL President. “It’s really quite alarming that the general public is not aware that obesity is a harmful disease, nor is it being managed adequately neither by individuals, physicians, nor governments.” “While lifestyle interventions such as diet and exercise are the first-line treatments for people with Obesity, most tend to engage in those sporadically and fail at sustaining any weight

loss they achieve in the process,” according to Andari. Compounding the problem is that people who lose weight generally experience an increase in hunger and a decrease in fullness leading to an increased desire to eat, with changes persisting for at least one year as the body alters a number of hormones to prevent further weight loss. “This is generally why second-line treatment options including pharmacotherapy are becoming more and more necessary,” added Andari. “Medical advice for those who seek it is dependent on assessments of the severity of obesity-related comorbidities in each individual, and their impact on their health.”

Rising Epidemic The global prevalence of obesity was estimated in 2014 to be 11% for men and 15% for women, translating into over 600 million adults living with obesity worldwide.

More on Obesity Overweight and Obesity are defined as abnormal or excessive fat accumulation that presents a risk to health.Body mass index (BMI) is a simple index of weight-for-height that is commonly used to classify overweight and obesity in adults, with a BMI of 30 kg/m2 or greater being classified as obese. Obesity is a complex and multi-factorial disease influenced by physiological, psychological, environmental, socio-economic, and genetic factors.

References: 1. Knowler WC, Barrett-Connor E, Fowler SE, et al; for the Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393-403. 2. Wing RR, Lang W, Wadden TA, et al. Benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes. Diabetes Care. 2011;34(7):1481-1486. 3. Riddle DL, Stratford PW. Body weight changes and corresponding changes in pain and function in persons with symptomatic knee osteoarthritis: a cohort study. Arthritis Care Res (Hoboken). 2013;65(1): 15-22. 4. Tuomilehto H, Seppa J, Uusitupa M, et al. The impact of weight reduction in the prevention of the progression of obstructive sleep apnea: an explanatory analysis of a 5-year observational follow-up trial. Sleep Med.2014;15(3):329335. 5. Foster GD, Borradaile KE, Sanders MH, et al; for the Sleep AHEAD Research Group of the Look AHEAD Research Group. A randomized study on the effect of weight loss on obstructive sleep apnea among obese patients with type 2 diabetes: the Sleep AHEAD study. Arch Intern Med. 2009;169(17):16191626. 6. Warkentin LM, Das D, Majumdar SR, Johnson JA, Padwal RS. The effect of weight loss on health-related quality of life: systematic review and meta-analysis of randomized trials. Obes Rev. 2014;15(3):169-182. 7. World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. 2000;894:1-253. 8. AMA adopts new policieson second day of voting at annual meeting [news release]. Chicago, IL: American Medical Association; June 18, 2013. http:// finance.yahoo.com/news/ama-adoptspolicies-second-day-200737194.html. Accessed February 15, 2017. 9. Mechanick JI, Garber AJ, Handelsman Y, Garvey WT. American Association of Clinical Endocrinologists’ position statement on obesity and obesity medicine. Endocr Pract. 2012;18(5):642-648. 10. Allison DB, Downey M, Atkinson RL, et al. Obesity as a disease: a white paper on evidence and arguments commissioned by the Council of the Obesity Society. Obesity (Silver Spring).

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