HOSPITALS Magazine issue 40 by The Arab Hospital Magazine

Issue 40 / 140 MAY - JUNE 2018

THE ARAB HOSPITAL APPLICATION IS AVAILABLE

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

Funds and hope... The medical sector has expanded significantly in the world as a whole and in the Arab region, which has led to a renaissance on many levels. Since all this requires increased investment in this sector, large sums have been channeled into the medical sector for years, in addition to conferences and seminars that shed light on how to direct these investments and make the most out of them. In this context, it is worth mentioning that a report issued by the Organization for Economic Co-operation and Development (OECD) predicted that the healthcare market is expected to double by 2035 and quadruple by 2060. According to the report, the share of health spending will rise by 10 percent until 2030 of GDP. As a result of this shift in healthcare, the medical sector has become one of the most important pillars of the world economy, as companies operating in this sector are competing not only with other productive sectors but are also introducing shares on the international stock market. It set a record in 2016 when the MSCI world index for industrial countries rose by about 8 percent, while the value of healthcare shares has increased by 17 percent. Hence the importance of the Arab partnership in the health field as it is an important pillar of economic relations. Arab medical conferences have always recommended that the Arab private sector should be encouraged to invest in the healthcare sector and increase its contribution as a provider of health services at the national level as well as participate in the management and operation of health services in order to ensure their equitable distribution and safety. There are high hopes regarding the continuation of these investments, and even increase them for the benefit of the medical sector and the safety of society. The Publisher

Photographer Hanna Nehme 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 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

China China International Health & Medical Tourism Association (CIHMTA) 中华医疗健康旅游协会 Dr. JIA XIAO FANG T: +86-010-82825920 Whats app +86-18675588998 M: +86-18675588998 E: CIHMTA@hotmail.com Printing Arab Printing Press S.A.L. Distribution KSA - UAE - OMAN LEBANON - JORDAN - SYRIA - KUWAIT BAHRAIN - QATAR - EGYPT

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COVER STORY

6 Novo Nordisk 9 Interview with Frederik Kier 10 Interview with Mads Bo Larsen 11 Interview with Ayman Hassan 12 Friends for diabetes and Novo Nordisk sign partnership for diabetes treatment

NEWS

14 Latifa Women & Children Hospital - Dubai Health Authority to cohost 4th Latifa Hospital International Pediatric & Neonatal Conference in Dubai 16 The University of Manchester highlights the industry leadership challenges in the Middle East healthcare sector at an executive forum in Dubai 22 Boehringer Ingelheim releases breakthrough findings on COPD 24 Capital Health opens new Health Shield Medical Center 26 Children’s Cancer Hospital Egypt

achieves High Level of Health Care IT Adoption and reaches HIMSS 6 32 The Gilbert & Rose-Marie Chagoury School of Medicine and LAU Medical Center–Rizk Hospital Establish the First Comprehensive Stroke Center in the Country 38 Baylor St. Luke’s Medical Center First in Texas to Offer PulseRider Technology for Minimally Invasive Treatment of Complex Brain Aneurysms 55 Al-Ahli Hospital in partnership with the International Council of Ophthalmology 92 BMC hosts a regional conference to reduce bone fractures in the Middle East and inaugurates the multidisciplinary spine center 93 Hamdan Medical Award trains over 100 radiology specialists on improving the safety of imaging techniques 94 Serco Middle East expands its growth & development team

80 46 FEATURES

42 Complete Blood Count 70 Diabetes and eye problems 76 Adrenaline 90 Peripheral Artery Disease 96 Safe Fasting with Diabetes

ARTICLES

50 Blood and Blood Donation 60 Reliable & fashionable hearing glasses made in Austria by BHM

62 Machine washable beds from Stiegelmeyer 64 Immunotherapy treatments 80 Medical Informatics 86 Telemedicine

MEDICAL FAIRS

18 Global Health Exhibition to launch in Saudi Arabia

INTERVIEWS

46 Sa’ad Kayali, The Managing Director of Sysmex Middle East FZ-LLC

52 Jamal Saleh, Hammad Deputy Chief Cxecutive officer of Al-Ahli Hospital Doha-Qatar 56 Dr. Alexander Varghese, Hospital Director at New Mowasat Hospital, Kuwait

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COVER STORY

Modern and advanced treatments that changed the concept of diabetes around the world

ovo Nordisk is one of the world’s leading companies in introducing innovative diabetes treatments. Over the past few years, it has achieved several accomplishments that had a significant impact on regulating the rate of diabetes in many patients who have always suffered from high or low blood sugar levels. Novo Nordisk’s modern treatments, whether through insulin injections, tablets or others, have changed the management concepts of diabetes and the company came a long way in this field.

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Novo Nordisk’s leading position today was not out of thin air; it is the result of hard work that began in 1922 since its inception and still hasn’t stopped. It is the inexhaustible effort of the giant company’s leaders to provide all the new treatments in the field of diabetes. Despite the importance of the achievements made by the company in the framework of introducing drugs and insulin injections, which contributed to changing the face of medicine and its vision to diabetes through the possibility of controlling the disease, however, the ultimate goal is to reach a completely curable treatment. Today, Novo Nordisk is one of the oldest healthcare companies and is the world leader in the treatment of diabetes with insulin by injection or tablets.

Developments and innovations Novo Nordisk invested the experience of more than 5,900 employees in research and

development, in addition to investing more than $ 2 billion a year for the purpose of producing new medicines that help diabetes patients enjoy a normal life and improve the quality of their lives, while keeping their blood sugar levels stable as long as possible in addition to leading a healthy lifestyle. Developments and innovations never stopped in the company, which ranked number two in “Science Careers Top Employers” survey and the “Most Innovative Pharmaceutical Company” in Europe by the survey participants. Novo Nordisk is headquartered in Denmark but has a strong presence across the globe. The company has products marketed in more than 165 countries with affiliates and offices in 77 countries and more than 42,000 employees. The company has strategic production facilities in Brazil, China, Denmark, France and USA, in addition to production facilities in Algeria, Russia and Japan.

COVER STORY

Initiatives Community initiatives are at the core of Novo Nordisk’s work, believing in the importance of educating diabetics and spreading the culture of dealing with the disease to safely cope with it. “Cities Changing Diabetes” is one of the company’s initiatives that put managing diabetes on the main agenda of participating cities. “Team Novo Nordisk” is a professional cycling team all of which are Type 1 diabetics proving that you can lead a normal life and exercise normally if you manage your diabetes properly.

COVER STORY

ovo Nordisk A/S Denmark, a focused healthcare company and a world leader in diabetes and obesity care, has expanded its presence in the UAE and opened a new regional office that covers a vast area that includes more than half of the world’s population. Locally Novo Nordisk UAE is the ninth largest pharmaceutical company in the UAE. Novo Nordisk UAE has recently announced several unique initiatives in collaboration with health authorities and organizations focusing on private public partnerships. “Hospitals” magazine managed to get exclusive access and interviews with the region, business area and affiliate leaders of Novo Nordisk operating out of Dubai. The interviews also addressed the focus areas of Novo Nordisk and the importance of managing diabetes and obesity in the Gulf.

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COVER STORY

Senior Vice President for region AAMEO

Frederik Kier Mr. Frederik Kier you are the Senior Vice President for region AAMEO, can you shed some light on what this region is? Region AAMEO is an Acronym for Asia, Africa, Middle East and Oceania. It is a big region with diverse cultures and a population of 4.5 billion people that we serve. In order to be closer to our stakeholders, we established presence in Dubai being a suitable, business encouraging and close hub.

So what is Novo Nordisk all about Mr. Frederik? In Novo Nordisk, we are driving change to defeat diabetes and other serious chronic conditions. Diabetes poses one of today’s biggest global health challenges. We work for a future where fewer people get diabetes, everyone with diabetes is diagnosed, and everyone who is diagnosed receives adequate treatment and can live a life with as few limitations as possible. Since the company was founded in Denmark more than 90 years ago, we have been changing diabetes. This heritage has given us experience and capabilities that also enable us to help people defeat other serious chronic conditions: haemophilia, growth disorders and obesity.

You have recently entered into the field of obesity care, what are your main aims? Even though obesity has been classified as a disease by the WHO, it is still not widely regarded as such. Novo Nordisk aims to ensure obesity is widely recognised as a chronic disease and that a clinically meaningful weight loss of 5–10% is acknowledged as a key contributor towards improving weight-related comorbidities (accompanying disease), such as type 2 diabetes and cardiovascular disease.

We heard a lot about recent initiatives carried out by Novo Nordisk, what is it all about? Yes there are many worldwide but

I would like to highlight two activities related to the UAE market. The UAE affiliate signed a memorandum of understanding with friends for diabetes society in collaboration with the Emirati Red Crescent where Novo Nordisk pledged to provide insulin treatment for 50 type 1 patients. Also, we had a very special visit by Novo Nordisk’s CEO Lars Fruergaard Jørgensen where we engaged with several UAE key opinion leaders and stakeholders to strengthen and expand obesity care in the UAE. These projects are part of our patient-centric focus where we can touch many lives and one of the many reasons that make us proud to work for Novo Nordisk.

COVER STORY

Corporate Vice President at Novo Nordisk

Mads Bo Larsen

oving to business area Africa and Gulf, “Hospitals” magazine was privileged to get a special interview with Mr. Mads Bo Larsen, the Corporate Vice President.

Can we have a resume profile about yourself? When and why did you join Novo Nordisk? I joined Novo Nordisk in 1995 as a pharmaco-economist and over the past 23 years I managed several functions including strategic operations, sales & marketing effectiveness, finance and IT in different roles across countries. Regarding this region, I have worked here for more than 15 years where I led business areas covering the Middle East, India, Africa and the Gulf. I am currently heading the Africa and Gulf Business area with 700 employees, 58 countries and 1.4 Billion inhabitants as Corporate Vice President.

Can you share some of the main challenges that you face in developing markets especially in the GCC? We cater to a large number of countries with different needs and we strive to make the best medicines available for patients living in these countries. Challenges in Africa are

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very different from the Gulf as you could imagine but we make sure that we have the right people that drive the right actions to best support the community. We also run several access initiatives in Africa to ensure that proper education and treatment are in place. For example the Changing Diabetes® in Children (CDiC) is a programme for children with Type1 diabetes which aims to bring all elements of necessary diabetes care closer to children who need it and at the same time, build capacity for the diagnosis and treatment for these

children living in resource-poor settings.

What are Novo Nordisk’s plans for the vast area you are responsible for? Novo Nordisk will continue to work with different stakeholders in the region to increase awareness towards diabetes, obesity, haemophilia & growth hormone deficiency to enable early diagnosis and avoid or reduce complications. We will continue to provide and develop the best products to combat our focus disease areas to help improve the quality of life of patients.

COVER STORY

Vice President and UAE General Manager at Novo Nordisk

Ayman Hassan

o shed more light on Novo Nordisk specific activities we had an interview with Dr. Ayman Hassan, Vice President and UAE General Manager at Novo Nordisk. First, I have to commend the business environment in the UAE and the authorities have put a great effort in attracting global business into UAE through supportive laws and regulations which, as evident to everyone, has paid off significantly. On the other hand, Novo Nordisk is one of the fastest growing multinational pharmaceutical companies in the UAE in 2017. This was primarily driven by the introduction of new medicines that added value to the well-being of patients and addressed their unmet needs together with the strong local focus and investments. Diabetes and obesity are big health challenges with almost one fifth of the population being affected by diabetes and one third being affected by obesity. On the obesity front, we plan to collaborate with the Health Authorities to develop stronger knowhow about managing obesity, increase awareness towards the issue and ensure that the best

management options are available. While on the diabetes front, several activities were conducted focusing on raising awareness towards diabetes through team Novo Nordisk (the worldâ€™s first all-diabetes professional cycling team, which participated in the Dubai Tour, with the mission to inspire, educate and empower

everyone affected by diabetes. We also supported many academic and educational activities in collaboration with international Universities, Dubai Health Authority, Ministry of Health and Health Authority of Abu Dhabi. Going forwards we plan to increase our private public partnerships and improve access of care to our patients.

COVER STORY

Friends for diabetes and Novo Nordisk sign partnership for diabetes treatment

anish pharmaceutical giant Novo Nordisk signed a memorandum of understanding (MoU) with a UAE volunteer support society, Friends for Diabetes (FFD), in a bid to improve access to care for people living with diabetes in the region. Under the MoU, Novo Nordisk will undertake to provide insulin treatment for 50 type 1 patients, whereas FFD will facilitate the exercise in collaboration with the Emirati Red Crescent. combined efforts will go a long way in making a positive impact for patients.” On her part, FFD founder, Dr. Elham Al Amiri welcomed the partnership terming it as timely and noble. She said that the joint initiative will greatly raise awareness levels in the region as well as serve as a motivation towards proper management of the disease.

Speaking during the MoU signing ceremony, spokespersons from Novo Nordisk, Friend for Diabetes and the Royal Danish Embassy expressed optimism that the initiative will positively impact the management of diabetes for needy patients. In the joint presser held under the patronage of the Danish Consul General and Head of Mission H.E. Morten Siem Lynge and in the presence of the Danish Ambassador to the UAE H.E. Merte Juhl, Mr. Ole Ramsby Senior Vice President and

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General Counsel for Novo Nordisk A/S also noted the partnership will create sustainable and long-term solutions that will drive change in the fight against diabetes. On his part, Dr Ayman Hassan, the General Manager for Novo Nordisk UAE mentioned that “Diabetes is a huge burden on society and no single entity can combat it alone. It is similar private public partnerships that give hope for addressing this serious issue. In joining hands with Friends for Diabetes, we are confident that our

“We welcome this noble gesture by Novo Nordisk to partner with FFD in the provision of care and better treatment of diabetes in the region. This partnership will go a long way in complementing our ongoing programs, which are aimed at increasing awareness about diabetes, training and education, arranging activities around the World Diabetes Day, and sourcing and securing funds to support patients in need of treatment.” said Dr. Al Amiri. The MoU will also seek to address the numerous hurdles being faced by a huge number of expats’ children whereby the cost of medication and insurance coverage has continued to be a stumbling block.

COVER STORY

Novo Nordisk in brief

NEWS

Latifa Women & Children Hospital - Dubai Health Authority to cohost 4th Latifa Hospital International Pediatric & Neonatal Conference in Dubai We’re proud to provide a platform and an excellent opportunity for exchanging ideas on technological trends and best practices.”

Dr. Mahmoud El-Halik

Abdulla Bin Souqat

developments and findings in pediatrics, pediatric surgery and neonatology, of which 400 are participating.

His Excellency Abdulla Bin Souqat, Executive Manager of the Sheikh Hamdan Bin Rashid Al Maktoum Award for Medical Sciences, remarked: “Our children’s happiness and wellbeing is our top priority, of which the provision of the best possible medical care contributes to. This can only be achieved through continued research and translating its results into reality within our medical community. Furthermore, these medical congresses provide opportunities for the exchange of experience and updated clinical information between experts within the region.”

Dr. Mahmoud Saleh El-Halik, Conference President and Head of Pediatrics and Neonatology at Latifa Women and Children Hospital, stated: “Latifa Women and Children Hospital has been a pioneer for almost 30 years for its outstanding medical services, teaching excellence, serving the community and developing academically.

The conference is CME-accredited by the Dubai Health Authority and spanned over three days, covering 15 sessions and 6 specialized workshops in pediatrics and neonatology. Additionally, an exhibit displaying cutting-edge medical technologies, resources and treatment options was opened to those participating.

ith the support of the Sheikh Hamdan Bin Rashid Al Maktoum Award for Medical Sciences, the 4th Latifa Hospital International Pediatric and Neonatal Conference took place from the 22nd to the 24th of March at the Mohammed Bin Rashid Medical Academy in Dubai Healthcare City. The conference comprised of a wide population of locally-based healthcare professionals offering the latest

Arab International Men’s Health Congress provided its attendees up to 20 CME Credit Hours

he Arab International Men’s Health Congress will be attended by Urologists, Endourologists, Endocrinologists, Pharmacists, Uro-oncologists, Uro-radiologists, Phycologists, General Practitioners and Other Allied Health Professionals. The attendees will join mostly from the UAE, KSA, neighboring GCC countries, Middle East & Africa, Europe and the Asia Pacific.

The Congress took place on the 12th -14th of April at Conrad Hotel in Dubai, UAE. The programme is designed to cover the latest contemporary approaches in Men’s Health industry and current updates on management and treatment in different areas. The programme covered topics such as urology, andrology, neuro-oncology, endourology, endocrinology, sexual medicine and infertility, recent techniques in laparoscopic surgeries, psychology and mental health.

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NEWS

The University of Manchester highlights the industry leadership challenges in the Middle East healthcare sector at an executive forum in Dubai continues to outstrip the supply of services and talent and is leading to escalating costs. Public-Private Partnerships (PPP) are a route to access new sources of finance and expertise to build capacity and deliver much-needed services. According to Dr. Brookes, a shared vision and clear focus on the public interest are essential for successful leadership in these increasingly complex organizations and collaborations, to balance the demands of shareholders and stakeholders – a style he refers to as ‘selfless leadership’.

senior member of the faculty at The University of Manchester - Alliance Manchester Business School has highlighted the challenges facing leaders in the regional healthcare sector, at a major industry executive forum held in Dubai – Forbes Middle East healthcare event.

“Leading through networks requires a much more collective approach rather than taking the traditional single-minded focus of the individual leader leading through a hierarchy,“ he says. “Aligning both public and private provision of healthcare with an even stronger need to balance profit and the public interest is a challenge. Most importantly, it’s about putting the patient at the heart of what healthcare leaders do.”

Keynote speaker Dr. Stephen Brookes, senior fellow in public leadership at The University of Manchester, which was the Knowledge Partner to the event, focused on the need for collective and selfless leadership to successfully meet the public’s healthcare needs. With the region’s high population growth and the rise of noncommunicable diseases, greater focus on wellness and prevention, and digital transformation of the industry, demand for healthcare services

Dr. Brookes, who also leads the new part-time MSc International Healthcare Leadership – the first of a series of new industry-led Masters programmes introduced into the region by the university, highlighted the university’s own research that shows that there are four principal challenges in healthcare leadership. Ensuring equal access to healthcare in a timely, cost-effective and seamless manner; Giving prevention as much priority as treatment; Delivering healthcare across a range of public and private,

Dr. Stephen Brookes

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and hybrid systems; and Integrating care across primary secondary and tertiary providers. “A selfless leader is someone who leads in the public interest to create public value. This requires a break from the traditional notions of leader and followers, and a shift to ‘us’ as leaders working collectively towards collective aims in the public interest, and overcoming the challenges facing the industry. Given the structure of communications and social media today, there are now many more opportunities to be far more inclusive in the leadership of healthcare.” To illustrate the idea of selfless leadership, Dr. Brookes used a quotation from His Royal Highness Sheikh Mohammed bin Rashid Al Maktoum, in his book “My Vision: the challenges in the race for excellence”. “The real crisis is rather one of leadership management and perennial egotism. This is the kind of crisis that is bound to happen when lust for power prevails over granting people the love and care that they deserve and when the interests and destiny of one individual become more important than those of the whole nation”. The inaugural Forbes Middle East healthcare event – ‘Healthcare Innovation and Investment: the Right Medicine’ (Dubai, 31 March 2018) brought together healthcare regulators, senior leaders, experts and investors to discuss the challenges facing the sector, during a period of rapid transformation, and to share best practices from across the world.

Are you ready to take on the next challenge in your career? Join MSc in International Healthcare Leadership in Dubai Accepting applications for September 2018 Intake

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Dr. Karan Thakur, Class of 2009

Apollo Hospital, New Delhi

All healthy systems are unique with fast-changing demographics and most are witnessing changes in the way they provide healthcare. this course helped us understand how those changes are occuring

The University of Manchester Middle East Centre Office F16- , Block 2B, Dubai Knowledge Park Email: ihl@manchester.ac.ae | Tel.: +971(0) 4 446 8664 | www.manchester.ac.ae Permitted by the Knowledge and Human Development Authority. The academic qualifications granted by this institution and certified by the KHDA shall be recognised in the Emirate of Dubai by all public and private entities for all purposes.

MEDICAL FAIRS

Global Health Exhibition to launch in Saudi Arabia In line with “Saudi Arabia’s Vision 2030”, Global Health Exhibition will provide a business platform for 10,000 attendees to make inroads into the Kingdom’s healthcare market

n line with “Saudi Arabia’s Vision 2030” to transform the Kingdom healthcare sector and develop strategic partnership programmes with local and multinationals institutions, firms and experts. Under the patronage of the Ministry of Health, Informa Life Sciences Exhibitions, the organizers of Arab Health, in collaboration with XS Conferences and Exhibitions, has announced the launch of Global Health Exhibition - Saudi Arabia’s premier healthcare platform for the global market to meet and network with the Saudi healthcare sector pioneers and officials. Taking place from 10-12 September 2018 at the Riyadh International Convention and Exhibition Center in Riyadh, Saudi Arabia, more than 10,000 industry professionals from across the globe are expected to explore +500 Saudi-based and international exhibiting companies showcasing the latest advances in health services, pharmaceuticals, training and education, and medical device technologies. According to Peter Hall, President, Informa Middle East: “Diminishing market access barriers for foreign investment, coupled with a huge investment in healthcare infrastructure, has positioned Saudi Arabia as a top-tier market for medical

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MEDICAL FAIRS

device manufacturers, services providers, and dealers and distributors from across the globe. Through the launch of Global Health Exhibition, companies now have an opportunity to promote their products and services to a whole new audience of buyers and make significant inroads into the Saudi market.” As the largest and fastest growing healthcare market in the region, healthcare spending in the Kingdom is estimated to reach $40 by 2020. Currently, 87 of the 150 major healthcare infrastructure projects in the Gulf Cooperation Council (GCC) due for completion in 2021 are in Saudi Arabia. Commenting on the launch of Global Health Exhibition, Meshal Al Rubiaan Ministry of Health spokesman said: “The objectives set out by the “National Transformation Program 2020”, part of the Kingdom’s Vision 2030, has enabled the Ministry to cultivate a favorable atmosphere to attract private healthcare providers and investors from abroad. We will continue to work closely with our strategic partners to support important economic trade platforms such as Global Health Exhibition that promote and facilitate the achievement of that vision.” The exhibition will also attract world-class leaders and experts in the healthcare industry to support our objective to share knowledge and experience. Over the three-day event, the exhibition will also offer multi-disciplinary congress that aims to build world-class healthcare practices and standards for the Kingdom. The conference programme will have specific focuses on Healthcare Transformation, Healthcare Investment & Finance, Technology & Innovation, Public Health and eHealth.

Photo: Shutterstock

“The Global Health Exhibition Congress is a key component of the event as it aims to delve deeper into worldwide advancements and best practices in the healthcare industry with an emphasis on the Vision 2030 to identify the immense opportunities represented for healthcare advancements in Saudi Arabia. From emerging health disruptive and innovative trend to the impactful change at the public health and policy level, the Congress will explore ways to transform and adapt current healthcare landscape to better utilise existing system’s capacity and capabilities in the hospitals and healthcare centres, and enhance the quality of preventive and therapeutic healthcare services,” commented Adel Abdel Shakor, CEO of XS Conferences and Exhibitions.

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NEWS

Canadian Specialist Hospital wins ‘Best Hospital for Medical Tourism’ at DHA Health Awards 2018 certification body exclusive for departments of international patient services which evaluates the facility’s services to international patients against set requirements. Recently, the hospital received its 3rd JCI accreditation.

anadian Specialist Hospital won the title of ‘Best Hospital for Medical Tourism’ at the recently held Annual Health Awards. The annual event, organized by Dubai Health Authority and the HEALTH magazine, aims to acknowledge and appreciate exceptional accomplishments in the field of healthcare. Apart from the ‘Best Hospital for Medical Tourism’ category, Canadian Specialist Hospital was also nominated for ‘Best Hospital in UAE’ and ‘Best Organization for Informative Technology in the UAE’. “We are proud to announce that Canadian Specialist Hospital has been awarded ‘Best Hospital for Medical Tourism’ during the prestigious Annual Health Awards 2018 and has gained recognition for its efforts and dedication towards the progress of medical tourism in the UAE. We have been promoting medical tourism since the very beginning and have focused on providing the best services and facilities to our international patients. Our team has worked extremely hard to identify and fulfill the requirements

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of our international patients and create the best packages for them. We would like to thank the entire team of Canadian Specialist Hospital for their hard work and determination that has led us to position ourselves as one of the finest hospitals in the UAE”, said Dr. Yashar Ali, CEO, Canadian Specialist Hospital. The hospital has been promoting Health Tourism since 2006 and has a fully functional department dedicated exclusively to international patients. It is recognized as one of the leading health tourism centers in Dubai and offers a variety of packages for people with different needs and resources including orthopedics, ophthalmology, dental, dermatology, wellness and preventive health check-up. Over the years, Canadian Specialist Hospital has established itself as one the leading hospitals for medical tourism and received prestigious accreditations for its efforts to enhance the department. The hospital has been certified by Temos for ‘Quality in International Patient Care’ and ‘Excellence in Medical Tourism’. Temos is a

“The hospital has a full-fledged team that manages the necessary arrangements for international patients, starting from visa and accommodation till consultation and transportation, based on the requirements of the individual. We have a prompt response system to address global inquiries without any delay, offering high priority to our international patients and ensuring convenience to our customers”, said Mr. Ahmed Shams, Admission & International Patient Relation Manager at Canadian Specialist Hospital. Moreover, Canadian Specialist Hospital has a dedicated internal team of translators for over 22 languages to ensure the accuracy of information conveyed and enhance communication between the patients and the doctors. Canadian Specialist Hospital is a multi-specialty hospital with qualified doctors trained from prestigious institutes around the world and a state-of-the-art laboratory and imaging department. The hospital currently offers 35+ specialties including cardiology, dermatology, gastroenterology, pulmonology, nephrology, dialysis and a rehabilitation department. The rehabilitation department provides services for orthopedic, neurological, cardiac, oncological and metabolic treatment. The hospital will soon be adding new departments for oncology, pediatric surgery, pediatric neurology and family medicine.

NEWS

Preventing flare-up incidence in people with COPD Boehringer Ingelheim releases breakthrough findings on COPD in a new study published in the Lancet Respiratory Medicine

Dr. Salah Zein El-Din

oehringer Ingelheim, one of the world’s leading pharmaceutical companies, has released data from its landmark 52-week DYNAGITO® trial, involving more than 7,800 people with the chronic obstructive pulmonary disease (COPD). Among people with COPD, a lowered rate of moderate-to-severe exacerbations or flare-ups was discovered after the trial. The findings support international Global Initiative for Chronic Obstructive Lung Disease’s (GOLD) 2018 strategy recommendations, that shed light on the central role treatments play in the management of COPD and help achieve key treatment goals that include reduced symptoms and minimizing the future risk of exacerbations. This study has also been published in the Lancet Respiratory Medicine. In Lebanon, COPD is largely underdiagnosed and hence undertreated until it is moderately advanced due to the lack of standardized methods

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to diagnose COPD, and general lack of information. The prevalence of COPD, adjusted by age and by gender in Lebanon is 5.3%, with an underdiagnosis rate of 28.8%. COPD is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. Symptoms include breathing difficulty, cough, mucus production and wheezing. It’s caused by long-term exposure to irritating gases or particulate matter, most often from smoking cigarettes. People with COPD are at an increased risk of developing heart disease, lung cancer and a variety of other conditions. Symptoms of COPD often don’t appear until significant lung damage has occurred, and they usually worsen over time, particularly if smoking exposure continues. These may include shortness of breath, chest tightness, excess mucus in the lungs, frequent respiratory infections, as well as lack of energy. In the Middle East and North Africa (MENA), the prevalence of COPD has been estimated at around 4 percent of adults aged over 40 years in the general population. Dr. Salah Zein El-Din, President of Lebanese Pulmonary society said, “According to several studies, a high prevalence of COPD in Lebanon was determined, 80% of which was undiagnosed by a physician. Older individuals have an increased risk of COPD, in addition to smokers. Awareness must be raised about COPD in Lebanon, and diagnosis must be improved. Early diagnosis is critical to managing the progression of COPD and improving chances of survival. Reduced flare-ups can positively impact disease progression. A flare-up can lead to a 25 percent loss in lung function often causing

COPD to progress even faster.” Dr. Zein El-Din also added, “Flare-ups are usually caused by an infection in the lungs or airways and inhaling heavy air pollution. Such exacerbations in COPD can be prevented, by smoking cessation, timely vaccination against flu and pneumonia, increased physical activity, adherence to prescribed medications for COPD, regular contact with doctors, adequate sleep, and staying hydrated.” Dr. Mohamed Meshref, Boehringer Ingelheim’s Medical Director, META said, “At Boehringer Ingelheim, we are actively working to study and develop a close understanding of chronic respiratory diseases that are increasing in frequency, morbidity, and mortality. With their economic and social impact increasing rapidly, early intervention could result in significant reductions in cost and mortality. Largely preventable – it is important to work closely with the primary care service and government bodies to ensure better health outcomes for the population in the region that continues to have a high profile of cardiovascular and respiratory risk factors.” One in three people hospitalized may have to be readmitted after a flareup within eight weeks. According to the World Health Organization (WHO), risk factors that contribute to developing COPD, which include tobacco smoking, indoor and outdoor air pollution as well as being exposed to occupational dust and chemicals. The disease represents a major health concern for developing countries and is ranked as the fourth leading cause of death worldwide, and is expected to become the third leading cause by the year 2030.

NEWS

SMILE WITH TOM THE BEAR We deliver bedding to hospitals that is completely adapted to the needs of small patients. We know that spending time in a hospital can be very stressful for them. This is why Tom the bear was created, he does his best to make children happy and conjure up smiles on their faces by distributing colouring books, crayons and balloons.

TomÂ´s coulouring book

Crayons

Plush bear

JOIN OUR PROGRAMME Register your hospital or department and receive TomÂ´s cheer up package and gift for you.

www.tom2.com Visit us at Arab Health 2018 Stand #S1.G30

www.linet.ae

NEWS

Capital Health opens new Health Shield Medical Center The multi-specialty healthcare facility opens in the nation’s capital

Dr. Mishal Al Kasimi

Capital Health Doctors

apital Health, a newly formed private integrated healthcare group, opened its first multi-specialty healthcare facility, Health Shield Medical Center, in Abu Dhabi. Located in the Ministries Complex area of the capital, the medical center will provide local residents and medical tourists access to world-class technologies, treatments and expertise from leading medical professionals. The two-floor facility, boasting 125 staff and 18 internationally-certified doctors, offers healthcare services for the whole family, across 12 specialties including dentistry, cardiology, rheumatology, pulmonology, pediatrics, dermatology, ENT and physical and rehabilitation medicine, amongst others. Delivering the finest levels of specialist consultations, diagnostic tests, treatment, one-day surgery and recovery support, Health Shield Medical Center, at full capacity, will provide up to 350 people per day with healthcare services including one-day

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surgeries in its two ultra-modern operating theaters. With more US-board certified doctors than any other facility in Abu Dhabi, distinguished clinical talent joining the facility include the double American board certified and Harvard honors graduate, Dr. Michael Kelley, Internal Medicine Consultant and Pediatrics Consultant, and Dr. Irena Khostanteen, who is one of only two specialized Rheumatology Consultants in Abu Dhabi. Dr. Mishal Al Kasimi, CEO of Capital Health and Health Shield, commented, “At Health Shield, we are committed to providing each of our patients with the highest quality of medical care through state-of-theart technologies and we are proud to bring in world-class specialist consultants who are renowned in their respective fields.” Centrally located in the Ministries Complex area, Health Shield is set to serve both the local Emirati community as well as employees in the neigh-

boring businesses, such as TwoFour54 and many more. Dr. Al Kasimi, concluded, “Presently, there is a large gap in the Abu Dhabi healthcare market as many medical centers are either not offering the same specialties or are simply not qualified to do so. This new facility will provide a full range of adult and pediatric outpatient therapies to the emirate’s population and with that we are strategically filling this need in the market to better provide excellence in healthcare as mandated by the UAE and Abu Dhabi’s visions.” Health Shield Medical Center is just one of the facilities that Capital Health has developed in line with UAE Vision 2021and Plan Abu Dhabi 2030. With a strategy to pioneer new healthcare models, patients will be provided with the best quality care possible from Capital Health. Health Shield is a part of Abu Dhabi Capital Group and accepts all major insurers including AXA, Alico, Daman, Daman-Thiqa, NextCare, NAS and many more.

NEWS

Children’s Cancer Hospital Egypt Achieves High Level of Healthcare IT Adoption and reaches HIMSS 6 Ayman Ibrahim, Vice President of technology of Hospital 57357.

hildren’s Cancer Hospital Egypt (Hospital 57357) is the first and only integrated digital hospital in all of Africa to achieve Stage 6 on the Electronic Medical Record Adoption ModelSM (EMRAM) by the Healthcare Information and Management Systems Society (HIMSS) Analytics. The accomplishment is an international benchmark for the use of advanced IT to improve patient care. “Hospital 57357 shares Cerner’s belief that a solid health IT infrastructure is the foundation for improving the health and care of patients through standardization and automation of processes, and interactive clinical decision support for care providers. Being the first Healthcare facility in Africa to achieve Stage 6 is not only an honor but also a reflection of the hard work and dedication of our staff,” said Dr. Sherif Abouelnaga, CEO of Hospital 57357. Nine years ago, Hospital 57357 launched the Cerner Millennium® integrated clinical information system, which enabled authorized users to capture, retrieve and share patient data seamlessly.

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“Cerner Millennium supported our goal of providing integrated, high-quality Healthcare services to our patients. The rich data we are collecting at every step in the care journey is the foundation for our research activities to improve cure rates,” said Dr. Mohamed Aggag, Chief Medical Officer of Hospital 57357. The hospital’s healthcare information system enables the use of barcoded medication administration, which helps verify that the right dose of the right medication is given to the right patient at the right time. This is critical for patient safety and an essential requirement for HIMSS Stage 6 accreditation. Another prerequisite for the HIMSS recognition is the Computerized Physician Order Entry, which improves the accuracy and timeliness of tests, procedures and medication orders. “When we implemented Cerner Millennium back in 2008, we called it MISK®, which stands for Medical Informatics Saving Kids. This reflects our belief in the importance of the healthcare information technology throughout the patient’s care journey,” said

HIMSS is a global, not-for-profit organization that recognizes hospitals who have improved their delivery of healthcare through the use of information technology and electronic management systems. HIMSS Analytics developed EMRAM as a methodology for evaluating the progress and impact of electronic medical record systems for hospitals in the HIMSS Analytics Database. There are eight stages (0-7) that measure a hospital’s implementation and utilization of information technology applications. Hospitals can track and review their progress in completing each stage as they proceed toward Stage 7, which represents an advanced electronic patient record environment that delivers safety and efficiency improvements. “Cerner is celebrating 10 years of a successful and fruitful relationship with Hospital 57357. This award comes at the perfect time to highlight the success of Hospital 57357 in using their information system to provide a high quality of care to its patients. HIMSS Stage 6 is not just a technology award but also reflects a commitment to harnessing the EHR to provide safer, proactive and more efficient patient care,” said Alaa Adel, Director and General Manager, Cerner Middle East and Africa. “We are delighted that Cerner Millennium is supporting Hospital 57357 in its noble mission. We believe that this accomplishment will highlight Hospital 57357 as a role model for improving healthcare in Egypt and Africa.”

NEWS

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NEWS

Ministry of Health & Prevention launches Harvard Diabetes Management Program

he Ministry of Health and Prevention has launched the ‘Harvard Diabetes Management Program’, in collaboration with AstraZeneca as part of the Circle of Care initiative and the Hope Project launched earlier in 2016, in cooperation with the Emirates Diabetes Society.

The program was introduced in the presence of Dr. Buthaina Abdullah bin Balila, President of the Non-Communicable Diseases Division Department, the directors and heads of departments in the sector, and members

of the Diabetes Committee with Dr. Enrique Capellero. The program looks to train family doctors and general practitioners of primary healthcare, where the first batch, consisting of 20 family doctors from the Ministry were enrolled in the six-month educational program, including several distance learning programs. The Care Circle program offers a primary approach to diabetes treatment using fully-customized educational tools and training targeting all the society including citizens and residents, taking into consideration the diversity among cultures, beliefs and backgrounds that affect the lifestyle of diabetes type 2. H.E. Dr. Hussein Abdel Rahman Rand, Assistant Undersecretary for Health Clinics and Centers, underscored the commitment of the Ministry to reducing the prevalence of diabetes in the country from 19.3 percent in 2015 to 16.28 percent by 2021 as it is one of the health goals of the National Agenda 2021 and comes in line with the Minis-

try’s strategy to provide comprehensive and integrated healthcare in innovative and sustainable ways to ensure community protection against disease. He added that the Ministry has developed plans, programs and strategic partnerships to protect the community and achieve the country’s targets, including the promotion of continuing medical education for physicians through the launch of the ‘Harvard Diabetes Management Program’. Dr. Buthaina Abdullah bin Balila, has explained that this program comes as part of the Continuing Medical Education component of the Circle of Care Program. The ministry has launched in collaboration with AstraZeneca, the Harvard Diabetes Management Program, which aims to improve and update the knowledge, competencies and skills of general practitioners and primary care physicians to design suitable treatment plans for patients with diabetes of type 2 and meeting the needs of diabetic patients.

Genetic Compatibility among recently married couples reduces the risk of transmitting gene disorders through DNA

genomix, a company that provides advanced services in the field of reproductive genetics, has stressed on the importance of Carrier Genetic Testing (CGT) in the Middle East region.

Dr. Rupali Chopra, Laboratory Director of Igenomix, said, “The emergence of modern medical breakthroughs has now allowed the medical community to detect and prevent genetic disorders--which has been passed on from generation to generation. The lack of awareness of parents, especially in the Middle East, has caused many children to be born with genetic disorders--you may be a carrier of a serious genetic disorder like Thalassemia without even knowing. Through a CGT screening, doctors can now find out if patients are a carrier of a genetic disorder and still lead a healthy life.”

Dr. Rupali Chopra PhD

MAY.JUNE 2018

NEWS

The Gilbert & Rose-Marie Chagoury School of Medicine and LAU Medical Center–Rizk Hospital Establish the First Comprehensive Stroke Center in the Country

a multidisciplinary team to offer comprehensive and up-to-date treatment solutions to complicated medical conditions such as stroke”

nder the patronage of his excellency, the Minister of Public Health Ghassan Hasbani, LAU Medical Center – Rizk Hospital inaugurates the first comprehensive stroke center in the country, during a press conference organized at the medical center. Present at the conference was Mr. Elie Zeytouni representing Minister Hasbani, General Joseph Aoun Lebanese Armed Forces Commander, Dr. Antoine Zoghbi President of the Lebanese Red Cross, Dr. Joseph Jabbra President of LAU and Dr. Michel Mawad Dean of the Gilbert and Rose-Marie Chagoury School of Medicine at LAU, Mr. Sami Rizk CEO of LAU Medical Center-Rizk Hospital, media members and social influencers.

The conference started with a live transmission of a drill conducted by a Lebanese army helicopter, transporting a patient with a stroke to the LAU Medical Center-Rizk Hospital, to emphasize the importance of a quick treatment in securing the best results for patients suffering from a stroke.

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Following the drill, Dr. Joseph Jabbra, President of LAU gave a speech, and explained the idea behind founding another specialized treatment center: “We at LAU aim to provide integrated medical solutions within our medical center facilities, by establishing this facility that combines cutting-edge equipment and high-level expertise from different departments working together to save patients’ lives.” In his turn, Mr. Sami Rizk, CEO of LAU Medical Center-Rizk Hospital stated: “This hospital has been a pioneer in offering the Lebanese many first medical achievements over almost 100 years of existence. Among these firsts was the first Kidney Transplant from a living donor in Lebanon, the opening of the first non-profit blood bank, and later became the first national blood transfusion center, one of the first heart transplants in the country. And today, we are proud to open the first Comprehensive Stroke Center in Lebanon. As a leading Academic Medical Center in the region, it is very important that we work together as

“Stroke is one of the most serious and widespread medical emergencies in the world. In Lebanon, Stroke is thought to be the second leading cause of death and one of the leading causes of disabilities. We are opening today a Comprehensive stroke Center for the diagnosis and treatment of cerebrovascular disease and stroke. With the cutting-edge technology it offers and its multidisciplinary stroke team, LAU Medical Center-Rizk Hospital has become the point of reference for stroke-related diseases in Lebanon.” Commented Dr. Michel Mawad, Dean of the Gilbert and Rose-Marie Chagoury School of Medicine at the LAU. In the end, Mr. Dan Raffi, the Senior Director Neurovascular EMEA of Medtronic, said: “We are proud of the collaboration between Medtronic and the Gilbert & Rose-Marie Chagoury School of Medicine aiming to provide the best care through our medical technologies, services, and solutions.” Following the conference, General Aoun and LAU Medical Center – Rizk Hospital representatives cut the ribbon of the new facility and announced the official opening of the Comprehensive Stroke Center. This center prides itself on fast response time in treating stroke, a multidisciplinary team of specialists, cutting-edge technology and latest international treatment guidelines to secure the best outcome for stroke victims.

NEWS

Aetna International Signs strategic partnership deal with Humanis sion into the French market, guided by Humanis’ local expertise and understanding of the French government. Together, Aetna International and Humanis will offer affordable healthcare to their joint global members, building a healthier world that focuses on prevention first.

RIchard di Benedetto

eading global health insurance provider Aetna International has signed a strategic partnership deal with Humanis, a French insurance group currently insuring 10 million people with 700,000 corporate clients. The partnership will increase access to global healthcare solutions for large corporations and French expats around the world, while also expanding Aetna International’s already-growing global reach. The partnership will offer Humanis’ existing members Aetna International’s broad medical network and a wide range of solutions. This includes better control of healthcare costs in the US for Humanis’ members, as well as a healthcare solution that meets regulatory requirements in the UAE. The partnership will enable an easier customer journey through a single sign-up process, a single point of contact, and overall consistency in the services offered. Likewise, the partnership will increase Aetna International’s footprint in continental Europe with an expan-

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“This strategic partnership agreement with Humanis comes at the right time. Aetna’s expertise and global presence, combined with the exceptional quality and local service that Humanis provides to its customers, will allow us to expand and improve the services we offer to our members. This partnership is part of our strategy to provide local services to our members worldwide while adapting to national and regional disparities. We look forward to working together with Humanis on improving quality and access to healthcare for our members around the world”, says Richard di Benedetto, CEO of Aetna International. Aetna International is committed to tackling wastage and inefficiency across all parts of the healthcare economy. In the US alone, it is estimated that $800 billion per year is wasted on un-integrated healthcare systems. Moreover, healthcare is often focused on treatment, not prevention which means that the system is constantly under strain and firefighting. Combined with the world’s growing aging population with the growth in the prevalence of chronic disease, there is a need for urgent industry-wide solutions. Aligning with government payers and collaboration with providers such as Humanis can ensure that healthcare is based on overall health and outcomes, not just volume of treatment.

“The agreement with Aetna International is part of Humanis’ open-architecture approach to partnerships and reinforces our ambitions in the development of our international mobility business. Our goal is to capitalize on the synergies between our two groups to optimize our global healthcare service while retaining our USP as a one-stop-shop for health and protection insurance in France”, says Sylvaine Emery, Director of International Activities, Humanis Group.

Aetna International Aetna International is committed to helping create a stronger, healthier global community by delivering comprehensive healthcare benefits and population health solutions worldwide. One of the largest providers of international health benefits and services, Aetna International serves more than 900,000 members worldwide, including expatriates, local nationals, and business travellers. Its global benefits include medical, dental, vision and emergency assistance and, in some regions, life and disability.

Humanis group As a leading player in health and protection insurance both in France and abroad, Humanis helps companies insure their employees, and offers lifelong protection to people around the world. With expertise in health and protection insurance for French citizens settling abroad or in Overseas France, Humanis offers global solutions in Retirement, Health and Social Welfare for all types of international mobility, in perfect harmony with French social security systems.

NEWS

Early Detection & Diagnosis of necrotizing enterocolitis & Role of Feeding…! (A Clinical Case Presentation)

Dr. Amr Ismael M. Hawal Specialist Pediatrics & Neonatology

K, a male preterm baby (30+ Weeks) who was born to a 29-year-old first-time mom, was one of the recent Preterm infant newborn babies that complicated with necrotizing enterocolitis (NEC) cases. NEC is a serious medical condition that mostly affects very low birth weight (VLBW) infants. Affecting six to eight percent of VLBW babies, this disease is one of the leading causes of mortality and the most common reason for gastrointestinal medical & surgical emergencies in newborns. NEC remains a major unsolved medical challenge for which no specific therapy exists. Additionally, despite progress in technologies, there has been no method to identify infants who will progress to severe stages, hence, the need for more new and innovative therapeutic approaches to the disease.

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Abdominal Near Infra-Red Spectroscopy (A-NIRS) now plays an excellent important role in early detection & diagnosis of NEC cases through estimation of localized (regional) Spo2 over babies’ intestines through a non-invasive procedure by a skin prop. Symptoms may vary and be confused with neonatal sepsis when the warning signs manifest themselves at the onset. Symptoms include apnea or pause in breathing; slowing of heart rate; lethargy; temperature instability; bloody stool, vomiting; diarrhea; and feeding intolerance. Abdominal tenderness, abdominal wall erythema, peritonitis, palpable mass, and bleeding disorders, among others, are signs warning of progression of the illness. In RK’s case, the baby cried soon after birth, but owing to poor respiratory efforts he needed intubation and ventilation. He was admitted to the neonatal intensive care unit (NICU) for management of prematurity and respiratory support. He was started on IV ampicillin and gentamicin owing to high risk of infection but these were later discontinued after 48 hours as he remained well. His sepsis screen and sterile blood culture were eventually found to be normal, while his initial chest x-ray was unremarkable. The baby was later extubated to a noninvasive ventilator and commenced feeds on day five. On day seven, however, he was noted to have abdominal distension that was rapidly progressing to a shiny red abdomen with increased gastric aspirates. To make the diagnosis, doctors normally conduct a series of physical examinations, laboratory tests, and

abdominal x-rays. RK’s doctors initially ordered withholding of food and fluids and the baby was given antibiotics but there was still rapid deterioration in his clinical condition over a period of a couple of hours. In the subsequent 72 hours, due to features of disseminated intravascular coagulation (DIC), he underwent blood, fresh frozen plasma, and platelet concentrates infusion. Supportive treatments with immunoglobulin were given. Within 24 hours, his abdominal distension was noted to have gradually resolved and once he was noted to be hemodynamically stable along with improving platelet counts, normalized coagulation profile with declining CRP levels and sterile blood culture. RK then underwent laparotomy with resection and anastomosis of his intestine and formation of ileostomy. One perforation was noted at the duodenojejunal junction and multiple perforations were noted proximal to the ileocecal valve. Approximately 15 centimeters of bowel resection was performed followed by end-to-end anastomosis. The histopathology of the bowel specimen sent revealed NEC. What could be learned from RK’s case is that prematurity is the single greatest risk factor for NEC and avoidance of premature birth is the best way to prevent NEC. The role of feeding in the pathogenesis of NEC is uncertain, but it is prudent to use breast milk, when available, and advance feedings slowly and cautiously.

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Unlock your true potential Hybrid ORs with more patient safety and highly efficient workflow: TruHybrid™ Solutions Modern Hybrid ORs state the scene for safe and efficient procedures – especially, when they combine cutting-edge technology with intelligent concepts. Such as TruHybrid™ Solutions by Trumpf Medical, where our leading products and services perfectly interlock with the medical imaging solutions of our partners. Discover the true potential of Hybrid-OR technology on:

www.trumpfmedical.com/truhybrid

NEWS

Baylor St. Luke’s Medical Center First in Texas To Offer PulseRider Technology for Minimally Invasive Treatment of Complex Brain Aneurysms

Peter Kan

aylor St. Luke’s Medical Center (Baylor St. Luke’s) is the first hospital in Texas to treat patients using PulseRider, a revolutionary neurovascular device that enables minimally invasive endovascular treatment of patients diagnosed with wide-necked bifurcation aneurysms, which are complex brain aneurysms originating on or near a vessel bifurcation at the base of the skull. The PulseRider technology acts as a neck bridge for wide-neck aneurysms arising at or near a vessel bifurcation or branch point and is used in conjunction with coil embolization. During coil embolization, platinum coils are placed into an aneurysm to

seal it off to avoid rupture or hemorrhage. The PulseRider allows the physician to easily reposition the device during the procedure, leaves 90 percent less metal inside the patient than traditional stenting and conforms to the variable anatomy of each patient’s aneurysm. The recovery period for patients who undergo treatment utilizing the PulseRider is generally shorter than that of traditional open aneurysm procedures. The first patient to undergo this treatment at Baylor St. Luke’s was observed ambulating shortly the following surgery and then discharged from the hospital the following day. “Baylor St. Luke’s is committed to

delivering the most effective treatment options to meet the needs of all neurological patients,” said Peter Kan, M.D., neurosurgeon, Baylor St. Luke’s. “The PulseRider offers a potentially curative treatment option for patients suffering from wide-necked bifurcation aneurysms. We are proud to treat the first patient in Texas using this leading-edge technology.” The neuroscience services department at Baylor St. Luke’s in Houston’s renowned Texas Medical Center welcomes the PulseRider as a new era in the treatment of complex brain aneurysms and is dedicated to the highest levels of neurological and neurosurgical care.

FOR MORE INFORMATION CONTACT INTERNATIONAL SERVICES AT BAYLOR ST LUKE’S MEDICAL CENTER Via email at international@stlukeshealth.org or call +1 832 355 3350 or visit StLukesInternational.org Texas Medical Center, Houston, Texas - USA

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NEWS

A Free 5-Minute Questionnaire from the US’ Cleveland Clinic Analyzes Lifestyle and Family History to Check Whether Risk is Low, Medium or High, and Recommends Next Steps for Prevention to screening. After completing the survey, participants get a score of average, or above average at low, medium or high risk of colorectal cancer based on reported personal and family history of colorectal cancer, polyps or both. They also receive a family tree showing the relatives reported to be affected with colorectal cancer or polyps and a call to action outlining what age to start screening and how frequently it should be done.

Carol A. Burke

free online ‘risk assessment’ from a leading U.S.-based hospital is helping people around the world take positive steps to reduce their risk of developing colorectal cancer, and giving doctors more data on the risk factors associated with the disease.

Colorectal cancer is the third most common cancer worldwide, according to World Health Organization figures, responsible for the deaths of an estimated 774,000 in 2015, the most recent year for which data has been published. Yet, according to physicians at Cleveland Clinic, it is also one of the most easily treated if detected early enough. A five-minute web-based questionnaire, which can be found at clevelandclinic.org/preventcoloncancer, aims to help people get that early diagnosis. The free assessment asks respondents about age, gender, ethnicity, height, weight, dietary factors, smoking history, physical activity, personal and family history of colorectal cancer or polyps, and adherence

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“Our hope by providing this online assessment is that individuals could take it, print out the results with the call to action and take it to their physicians to start the colorectal cancer screening conversation,” says Carol A. Burke, MD, a Cleveland Clinic gastroenterologist, and past president of the American College of Gastroenterology. “In turn, physicians can start the discussion with the patient about the importance of colorectal cancer screening,” adds Dr. Burke. Dr. Burke and colleagues developed the online survey to provide patients with information about their colorectal cancer risk based upon self-reported personal and family history of colorectal cancer and polyps. The survey generates suggestions for each participant to modify risk factors through screening as well as lifestyle and dietary changes. In 2017, analysis of more than 27,000 responses from around the world found that individuals who exercised more followed a healthy diet and did not smoke were less likely to have a personal history of colorectal cancer or colon polyps. The analysis also highlights the modifiable risk factors,

such as diet and lifestyle behaviors, reported by patients without a personal history of colorectal cancer and polyps. The research was presented at Digestive Disease Week 2017. The investigators, Drs. Burke and Dornblaser, also found that less than 10 percent of all respondents stated they ate five or more servings of fruit, vegetables and grains per day, and only about 25 percent undertook at least 30 minutes of exercise four times per week. They additionally found that only 36 percent of respondents were up to date with current colorectal screening, according to the U.S. Preventive Services Task Force guidelines. “Colon cancer is a preventable disease. These results emphasize the known modifiable factors that can alter the risk,” says Dr. Burke. “Colon cancer has had a significant decline in the U.S. since 1980 when colorectal cancer screening was 1st introduced, but these results show screening for the disease – and adherence to a healthy lifestyle – appear woefully underutilized.”

ARTICLE FEATURES . Medical Laboratory

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ARTICLE FEATURES . Medical Laboratory

he complete blood count (CBC) is one of the most commonly ordered blood tests. It is the calculation of the cellular (formed elements) of blood. These calculations are generally determined by special machines that analyze the different components of blood in less than a minute. A major portion of the complete blood count is the measure of the concentration of white blood cells, red blood cells, and platelets in the blood.

in case he suffers from a chronic disease, microbes or viruses that negatively affect his physical health. This test helps the physician gain a better idea of what’s going on inside your body, because blood is the most important window through which we can peer into a person’s health or illness. This test also helps detect many deficiencies that must be quickly treated in order to regain wellness and safety of the body.

The complete blood count test is performed by obtaining a few milliliters of blood sample directly from the patient. The skin is wiped clean with an alcohol pad, and a needle is inserted through the area of cleansed skin into to patient’s vein. This sample is taken to the laboratory for analysis. Doctors often use this blood test to monitor the patient’s health condition and detect diseases early so they can be treated promptly, or if the patient is suffering from specific symptoms so the physician can determine the causes and the type of disease. Although most people do not undergo blood tests until symptoms appear, doctors recommend that healthy people get a blood test done regularly every six months in order to make sure they have no disease and to detect any medical condition before it gets worse. Complete blood counts can be used to help detect a variety of disorders including infections, anemia, diseases of the immune system, and blood cancers. A complete blood count (CBC) gives important information about the kinds and numbers of cells in the blood, especially red blood cells, white blood cells, and platelets. A CBC helps your doctor check any symptoms, such as weakness, fatigue, or bruising, you may have. CBC test reveals a lot about the person’s overall health

Components of Complete Blood Count Complete Blood Count test measures several components and features of your blood, including:

White Blood Cells (WBC): It is the number of white blood cells in a volume of blood. Normal range varies slightly between laboratories but is generally between 4,300 and 10,800 cells per cubic millimeter (cmm). This can also be referred to as the leukocyte count and can be expressed in international units as 4.3 to 10.8 x 109 cells per liter. White blood cell differential count: White blood count is comprised of several different types that are differentiated, or distinguished, based on their size and shape. The cells in a differential count are granulocytes, lymphocytes, monocytes, eosinophils, and basophils. Each type of cell plays a different role in protecting the body. The numbers of each one of these types of white blood cells give important information about the immune system. Too many or too few of the different types of white blood cells can help find an infection, an allergic or toxic reaction to medicines or chemicals, and many conditions, such as leukemia.

Red Blood Cells (RBC): It signifies the number of red blood cells in a volume of blood. Normal range varies slightly between laboratories but is generally from 4.2 to 5.9 million cells/ cmm. This can also be referred to as the erythrocyte count and can be expressed in international units as 4.2 to 5.9 x 1012 cells per liter. Red blood cells carry oxygen from your lungs to the rest of your body. Hemoglobin: Hemoglobin is a protein in the red blood cells that carries oxygen and gives blood its red color. The normal range for hemoglobin may differ between the sexes and is approximately 13 to 18 grams per deciliter for men and 12 to 16 grams per deciliter for women. Hematocrit: This is the ratio of the volume of red cells to the volume of whole blood. Normal range for hematocrit is different between the sexes and is approximately 45% to 52% for men and 37% to 48% for women. A low hemoglobin level is referred to as anemia or low red blood count. A lower than normal number of red blood cells is referred to as anemia and hemoglobin levels reflect this number. There are many causes for anemia including heart or liver disease in addition to smoking.

Mean corpuscular volume (MCV): It is the average volume of red cells. The reference range for MCV is 80100 fL/red cell in adult.

Mean Corpuscular Hemoglobin (MCH): It is the average amount of hemoglobin in the average red cell. This is a calculated value derived from the measurement of hemoglobin and the red cell count. Normal range is 27 to 32 picograms.

ARTICLE FEATURES . Medical Laboratory

Mean Corpuscular Hemoglobin Concentration (MCHC): It is the average concentration of hemoglobin in a given volume of red cells. This is a calculated volume derived from the hemoglobin measurement and the hematocrit. Normal range is 32% to 36%.

Red Cell Distribution Width (RDW): It is a measurement of the variability of red cell size and shape. Higher numbers indicate greater variation in size. Normal range is 11 to 15. If you score outside this range, you could have a nutrient deficiency, infection, or other disorder. However, even at normal RDW levels, you may still have a medical condition. To receive a proper diagnosis, your doctor must look at other blood tests — such as the mean corpuscular volume (MCV) test, which is also part of a CBC — to combine results and provide an accurate treatment recommendation.

MOST PEOPLE DO NOT UNDERGO BLOOD TESTS UNTIL SYMPTOMS APPEAR, DOCTORS RECOMMEND THAT HEALTHY PEOPLE GET A BLOOD TEST DONE REGULARLY EVERY SIX MONTHS IN ORDER TO MAKE SURE THEY HAVE NO DISEASE Platelet Count: The number of platelets in a specified volume of blood. Since platelets are so small, they make up just a tiny fraction of the blood volume. The main function of platelets is to prevent bleeding; they play a vital role in blood clotting. Normal range varies slightly between laboratories but is in the range of 150,000 to 400,000/ cmm (150 to 400 x 109/liter). If there are too few platelets, uncontrolled bleeding may be a problem. If there are too many platelets, there is a chance of a blood clot forming in a blood vessel.

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Preparation for CBC In order to have accurate CBC test results and help the doctor know your overall health, you should follow these steps: • Fasting for at least 8-12 hours before the test • If the patient is taking some medication in the morning, it should be postponed until the blood sample is taken • If the woman is menstruating, she should inform the lab specialist. • Refrain from taking vitamins and supplements 48 hours before the CBC appointment, unless your doctor advises otherwise. • Factors affecting results • Taking some drugs that cause low platelet counts such as cortisone, antibiotics, diuretics and chemotherapy. • High triglycerides level or a significant increase in white blood cells may cause a false increase of hemoglobin. • An enlarged spleen can cause a decrease in platelet counts or white blood cells. • Pregnancy naturally leads to a decrease in the number of red blood cells and an increase in the number of white blood cells. These factors may interfere with the accuracy of the CBC test result; therefore, the patient must inform his doctor or the lab specialist if he had taken any medication before the blood test or in case he suffered from any chronic disease or allergies and others.

INTERVIEWS

MAY.JUNE 2018

INTERVIEWS

AT THE FOREFRONT OF MEDICAL DIAGNOSIS

ysmex stands by innovation and technological edge life science solutions and In vitro diagnostics. Sa’ad Kayali is an enterprising person. Talking to him is not only a pleasant experience but also informative to the core. The Managing Director of Sysmex Middle East FZ-LLC is articulate enough to win the argument, but the surprising point is that he doesn’t believe in a diatribe nor does he enter a tête-à-tête. He is convincing and his fineness is in his approach to the issues at hand. He is the best when it comes to human resource management and an icon when it is technical-cum-professional.

— being one of the world’s leading healthcare providers and a global leader in in-vitro diagnostics with a niche core in haematology, urinalysis and hemostasis — but also in its devotion and determination to help shaping the healthcare industry in its fight against cancer.

“Lighting the way with diagnostics” is his motto, and Mr Kayali visualizes new heights in it.

“This is not the whole story”, Mr Kayali added: “You will be amazed If you see what Sysmex has achieved in the recent years at a regional level, just to mention a few:

While Sysmex is a brand name for designing and producing diagnostic solutions for medical laboratories, including automation, Mr Kayali foresees exceptional growth potential in the years to come, especially in the 17 countries that he deals with directly in the region and beyond. Sysmex Middle East FZ LLC is a subsidiary of Sysmex Europe GmbH, and was established in April 2008, as a regional hub for Sysmex activities throughout the Middle East with a head office in Dubai. Mr Kayali not only echoes pride in every word he spoke about Sysmex

regional high-end hospitals with solution that are modular in design to accommodate the various need and clinical workflow demands of our market! •

With its recently acquired technologies like Companion Diagnostics of “Inostics”, Advanced flow cytometry of “Partec” and the ongoing R&D investments, Sysmex is gradually stepping into a complete wholestic approach for all cancer diseases pathways: screening, treatment and management.

•

Since the nineties, Sysmex was known globally for its pioneering solutions in Hematology automation, what has been unique for us in the Middle East region, is that, we have proudly managed to translate this global presence into a real tangible benefits for our patients, our doctors and the whole healthcare industry and stakeholders alike, via the overwhelming success in automation setups that are populating most of the

•

By introducing the “Power of Blue” technologies recently, Sysmex has stepped up “urinalysis”, as we know it, into a completely new quality era, a real paradigm shift in detection, identification and diagnostics of urinalysis testing with the launch of UN-Series. A true and complete modular, scalable solution based on latest innovations in laser technologies, image processing and chemistry analysis Sysmex various contributions to the region were not less than the previous milestones. On the scientific side, we have managed to conduct regional scientific seminars to disseminate and share latest scientific studies and clinical applications to our valued clients. Let alone the enormous number of localised seminars and workshops to facilitate knowledge and know-how transfer to the region We believe this is the least we could do towards our region, healthcare society,

INTERVIEWS

AT THE FOREFRONT OF MEDICAL DIAGNOSIS driven by our lovely “Sysmex Way” in doing things. With a twinkle in his eye, the Managing Director says, “We want to take diagnostic solutions to the next level and are pro-active to the needs of the market.” The Sysmex chief says that diagnostics and supplies for the treatment of cancer, and the like, will become easier and more affordable as competition in the industry and development in technology grows. Mr Kayali further adds that like Dubai, and the UAE, Sysmex’s future is bright. “All we need to do is to keep the focus on innovation and keep a tab on creativity and customer satisfaction. It is the people who matter at the end of the day, and Sysmex believes in creating a better tomorrow for them.”

Excerpts from an interview with Saad Kayali: Sysmex is recognised as a “region’s leading diagnostic supplier”. Please elaborate. Customer satisfaction is our goal. We endeavour to reach out to our valued clients by keeping ourselves abreast of the latest developments, and converting them into appropriate applications. Technical training and harnessing relevant skills remain our prime concern and area of attention. We invest a lot in terms of time, money and energy in beefing up the enterprising and professional skills of

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our employees. We work in tandem with our distributors, to ensure that Sysmex comes with the best solution to the necessities of the industry and our end-users.

What are your core areas of expertise and main offerings? We are growing and looking at diversification in our products to fit the needs of the market. As of now, we are trendsetters in the realms of haematology, urinalysis, hemostasis, total laboratory solutions, cytometry, and oncology. I believe in living by example, and empowering people in the choices they make.

What gives Sysmex a competitive edge in this region? This can be simplified by saying that quality and superiority of our products is what makes us unique. Our networks and our people are our strengths. We do not provide only analysers, but also complete solutions to our customers we work with closely on clinical values, productivity and professional services offered to them. With a smile, Mr Kayali says, “Innovation is our daily cup of coffee, which I cannot drink without seeing that sparkle in the eyes of each and every Sysmex employee each day in the morning.”

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Blood and Blood Donation What is a blood donation? A blood donation is the transfer of blood or blood products from one person (donor) into another person (recipient). This is usually done as a lifesaving maneuver to replace blood cells or blood products lost through severe bleeding (e.g. trauma), during surgery when blood loss occurs or to increase the blood count in an anemic patient.

What are the different blood groups? Blood is made up of red blood cells, white blood cells and platelets in a liquid called plasma. Our blood group is identified by antibodies and antigens in the blood. Antibodies are proteins found in plasma, they are part of our body’s natural defenses, and antigens are protein molecules found on the surface of red blood cells. Accordingly, there are four main blood groups (types of blood) A, B, AB and O.

Blood group is determined by the genes inherited from parents. Blood group A: has A antigens on the red blood cells with anti-B antibodies in the plasma Blood group B: has B antigens with anti-A antibodies in the plasma Blood group O: has no antigens, but both anti-A and anti-B antibodies in the plasma Blood group AB: has both A and B antigens, but no antibodies.

Red blood cells have another antigen, a protein known as the RhD antigen. • •

If it is present, blood group is RhD positive If it is absent, blood group is

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RhD negative. This means that population can be one of eight blood groups: A RhD positive (A+), A RhD negative (A-), B RhD positive (B+), B RhD negative (B-), O RhD positive (O+), O RhD negative (O-), AB RhD positive (AB+), AB RhD negative (AB-).

Who is the universal donors? Type O negative blood is safe for everyone. People with type O negative blood are referred to as universal donors; and type O negative blood is used for emergencies in which there is no time to test a person’s blood type.

Who is universal recipients? Individuals who have type AB positive blood are referred to as universal recipients. This means that they can receive any type of blood. What is the role of Rh-positive and Rh-negative in blood donation? People who have Rh-positive blood can receive Rh-positive or Rh-negative blood. If a person has Rh-negative blood, they should only receive Rh-negative blood.

What are the types of blood donation? Blood is transfused either as

whole blood (with all its parts) or, more often, as individual parts (e.g. Red blood cell transfusion, Platelets transfusion, Clotting factors transfusion, Fresh Frozen Plasma). The type of blood transfusion you need depends on your situation. Also there is a type of donation known as autologous blood donation, this is the collection of the blood from the patient himself to be ready to retransfer it again to him during elective operation.

Who needs the blood? Blood transfusions are very common. This procedure is used for people of all ages. Many people who have surgery need blood transfusions because they lose blood during their operations. For example, about one-third of all heart surgery patients have a transfusion. Some people who have serious injuries - such as from car crashes, war, or natural disasters - need blood transfusions to replace blood lost during the injury. Some people need blood or parts of blood because of illnesses. You may need a blood transfusion if you have: A severe infection or liver disease that stops the body from properly making blood or some parts of blood, an illness that causes anemia, such as kidney disease or cancer, medicines

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or radiation used to treat a medical condition also can cause anemia, many types of anemia, including aplastic, Fanconi, hemolytic, iron-deficiency, pernicious, sickle cell anemias and thalassemia, or in bleeding disorders, such as hemophilia or thrombocytopenia.

Who can give blood? Most people can give blood. You can give blood if you: are fit and healthy, weigh between 50kg and 160kg, and aged between 17 and 66.

How often can I give blood? Men can give blood every 12 weeks and women can give blood every 16 weeks.

Who is not eligible to give blood? Individuals with acute disease (e.g. acute infection) or chronic illness (e.g. diabetic, hypertensive, hyperlipidemia) or receiving medication, females during pregnancy or lactation, in malignancy, and after receiving blood, blood products or organs.

How can you prepare before blood donation? Maintain a healthy iron level in your diet by eating iron rich foods, such as red meat, fish, poultry, beans, spinach, iron-fortified cereals and raisins, get a good nightâ€™s sleep, drink extra water, and if you are a platelet donor, remember that your system must be free of aspirin for two days prior to donation.

What is pre-donation screening? Questions about any history of chronic disease, recent fever, recent traveling, and smoking. Measuring the

Dr. Mohammad El Ahmadi

Dr. Reham Afifi

Director of Pathology &Laboratory Medicine Department

Consultant Haematopathologist

weight and the height, taking pulse, temperature and blood pressure. Blood testing for anemia.

pack periodically to the bruised area during the first 24 hours, then warm, moist heat intermittently.

What will happen during donation?

What will the donor gain from blood donations?

Once the pre-donation screening is finished, donor will proceed to a donor bed where the arm will be cleaned with an antiseptic, and blood donation kit will used to draw blood from the vein. During the donation process, individual donate one unit of blood and this takes about fifteen minutes.

1. Preserves cardiovascular health, as you can reduce your blood viscosity by donating blood on a regular basis. 2. Reduces the risks of cancer as the reduction of iron stores and iron in the body while giving blood can reduce the risk of cancer. 3. Burns calories as people burn approximately 650 calories per donation of one unit of blood. A donor who regularly donates blood can lose a significant amount of weight, but it should not be thought of as a weight loss plan by any means. 4. Provides a free blood analysis, as upon donation, donors are tested for syphilis, HIV, hepatitis, and other diseases. Testing indicates whether or not donors are eligible to donate based on what is found in their blood. 5. Treatment of some hematological diseases as erythrocytosis (i.e. increase Hb, Hct and RBCs), Hemochromatosis (iron overload).

What are the repercussions after the donation? After donating, increasing fluid intake for the next 24 to 48 hours; avoiding strenuous physical exertion, heavy lifting or pulling with the donation arm for about five hours; and eating well balanced meals for the next 24 hours are recommended. Donors seldomly experience discomfort after donating, if this happened, lie down until the feeling passes. If some bleeding occurs after removal of the bandage, applying pressure to the site and raising the arm for three to five minutes are recommended. If bruising or bleeding appear under the skin, apply a cold

INTERVIEWS

Deputy Chief Executive officer (CEO) of Al-Ahli Hospital Doha-Qatar

Jamal Saleh Hammad “AL AHLI HOSPITAL PROVED ITS DEVELOPMENTAL CAPABILITIES BY OBTAINING AN ACCREDITATION CERTIFICATE AS A PROVIDER OF MEDICAL EDUCATION AND CONTINUOUS OCCUPATIONAL DEVELOPMENT ACTIVITIES”

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INTERVIEWS

OSPITALS Magazine met with Mr. Jamal Saleh Hamad, Deputy CEO of Al-Ahli Hospital to talk about the hospital’s strategic goals and accreditation, in addition to its commitment to providing the highest levels of quality. Below is the full interview:

Al-Ahli Hospital obtained an accreditation certificate from the Qatari Council for Healthcare Practitioners as a provider of medical education and continuous occupational development activities for different healthcare practitioners... what are the efforts made to achieve that? Al-Ahli Hospital proved that it has developmental capabilities by obtaining an accreditation certificate from the Ministry of Health after fulfilling the related requirements in order to start the occupational development of its employees by developing the required knowledge and skills to enable them to successfully hold their occupational and administrative responsibilities in their professional lives. The development program includes delivering developmental lectures and holding educational workshops for the medical and nursing staff. “We have worked to establish the continuous occupational development section in Al-Ahli Hospital, which is accredited by the Qatari Council for Healthcare Practitioners, for three years, since June 9, 2016. The management of Al-Ahli Hospital exerts every effort to renew and maintain this accreditation to be able to achieve its developmental and educational goals as well as to improve the occupational performance”, he added.

What is your goal behind establishing the occupational development section? The continuous occupational development program has various benefits for the employees. This will be reflected on the hospital. These benefits include saving money, time and efforts of the healthcare practitioners who always aspire to maintain high level of efficiency and professional performance in their work. This program helps them to complete the required points to renew their medical license.

Does the occupational development section include administrative employees training? All the employees are evaluated by the sections’ heads. Based on this evaluation, the courses and workshops needed to help them improve their occupational performance are determined and scheduled in the year schedule of educational and training lectures and workshops. The dates and times of these lectures and workshops are set.

“THE MEMORANDUM OF UNDERSTANDING SIGNED BETWEEN QATAR UNIVERSITY AND AL-AHLI HOSPITAL REFLECTS THE ROLE OF PARTNERSHIP IN REALIZING THE HEALTH-RELATED NATIONAL STRATEGIC GOALS” Your accreditation certificate coincided with signing a memorandum of understanding between Al-Ahli Hospital and University of Qatar. What is the role that will be played by the two institutions through this MOU?

The articles of the Memorandum of Understanding include cooperation between the two institutions to have mutual contributions in the field of continuous medical education and continuous occupational development activities as well as to make joint research projects in the fields of common interest in order to provide new scientific and practical results that can be applied in the State of Qatar.

What is the nature of cooperation between Al-Ahli Hospital and Qatar University? The Memorandum of Understanding reflects the role of this partnership in achieving health-related national strategic goals. The two institutions will cooperate to provide clinical training for students through the range of services provided by Al-Ahli Hospital and its branches, to exchange information on activities of all healthcare specialties in Qatar University and Al-Ahli Hospital and on the common fields of education and research, and to exchange publications, reports, academic materials and any information, in addition to providing mutual opportunities of employment for Qatar University’s teaching staff in different medical fields, including provision of healthcare. “Diversification of education and training methods plays a great role in occupational development by virtue of delivering lectures, presenting educational photos and videos about the latest medical updates and exchanging experiences among doctors by presenting videos of surgeries made by them in Al-Ahli Hospital, whether these surgeries are distinct and successful ones, rare ones or surgeries having complications in order to avoid

INTERVIEWS

these complications in the future”, he added.

“THE GUEST IS OUR MAIN CONCERN AND OUR BASIC COMMITMENT IS TO PROVIDE THE HIGHEST LEVELS OF QUALITY” What are the hospital’s strategies to achieve the highest standards of health and safety? Safety of guests and quality of the healthcare are among the priorities of Al-Ahli Hospital. The guest is our main concern in everything we made and our basic commitment is to provide the highest levels of quality. So, we encouraged all our guests, their families and our healthcare providers to be a part of the healthcare that we provide. We applied the best practices to ensure the highest level

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of clinical care and treatment quality. In addition, we reduced risks of the guests of Al-Ahli Hospital to ensure safe visits for all guests. We set a mechanism to control infection transmission. This mechanism is led by specialists experienced in infection control. We have dedicated a section for infection control. This section comprises doctors, nurses and all the healthcare staff. To ensure safety of surgeries in Al-Ahli Hospital, a number of strategies were set, including initiatives supported by the World Health Organization to ensure safety of all surgical procedures.

Regarding the agreement signed with the Turkish Nightingale Hospitals, what are the most important articles of the agreement? Why did you choose Turkish hospitals?

The articles of this agreement aim at enhancing cooperation between the two parties to be able to cope with the current and future requirements in the field of medical education, benefitting from professional and experienced doctors working in the Turkish Nightingale Hospitals, employing qualified doctors and nurses (from both genders), benefitting from laboratory tests by sending some samples for laboratory tests in the Turkish Nightingale Hospitals and benefitting from the advanced technological techniques. For the reason behind choosing hospitals in Turkey, we are following in the Emir’s footsteps, enhancing the relations with Turkey. The Turkish Nightingale Hospitals is distinguished from other hospitals because Nightingale Hospitals complement other specialties of Al-Ahli Hospital and is equipped with world-class medical equipment.

Al-Ahli Hospital in partnership with the International Council of Ophthalmology

he International Council of Ophthalmologyâ€™s (ICO) mission is to have a major impact on education and access to eye care worldwide by collaborating with other ophthalmology societies, eye care organizations and teaching programs. Over the past six years, the Department of Ophthalmology at Al-Ahli Hospital has joined with the ICO to conduct basic and advanced assessment of ICO postgraduates, ophthalmologists in training, ophthalmologists and those undergoing subspecialty training by hosting ICO examinations. These examinations are prepared by an international panel of examiners and are set at the same standard as the highest board and qualifying examinations anywhere in the world. ICO examinations are the only worldwide medical specialty tests featuring assessments, which are centralized, independent, and free of outside influence. Physical attendance is required. To date, 31 candidates from Qatar, Saudi Arabia, Bahrain,

Kuwait, United Arab Emirates, Jordan, Yemen, Iran and Egypt have taken the examinations here in Qatar with a pass rate of 66%. Since 1995, over 23,000 candidates have taken the ICO Examinations. In 2016 alone, over 5,000 ICO examinations were taken in 130 test centers in 80 countries. Internationally accepted and standardized examinations are offered twice per year at the Al-Ahli Hospitalâ€™s ICO examination center and the level of knowledge is benchmarked by ICO on a global scale. Al-Ahli Hospital conducted the first theoretical optics and refraction basic sciences and clinical sciences examinations in April 2013, followed by the advanced examination in October 2013, and has repeated these assessments every year since then thus contributing to the knowledge and scientific competence of candidates. Ophthalmologists passing ICO examinations have a proven and documented level of knowledge required

for state-of-the-art clinical practice and to enhance outcomes for those receiving eye care. Many countries are using successful ICO examination outcomes as a requirement for licensing and entry into sub-specialization curricula and others have added successful examinations outcomes as a requirement for their recruitment interviews. Benefits for the community may include improvements in patient safety and quality of care and outcomes on the grounds of knowledge-based education and reliability of services and clinical outcomes, key elements of the Qatar National Health Strategy 2018-2022. The ophthalmology team at Al-Ahli Hospital will continue their collaboration with the ICO in line with the key principles set out in this important framework including implementing and sustaining worldclass healthcare for the benefit of the entire Qatar community.

INTERVIEWS

Hospital Director - New Mowasat Hospital, Kuwait

Dr. Alexander Varghese BDS, MHSM, FACHE

“Fostering the country’s medical tourism potential will positively impact the private healthcare sector”

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ew Mowasat Hospital (NMH), Kuwait, a luxurious healthcare facility with both the American (JCI) and Canadian (ACI Diamond) accreditations & standards, good clinical outcomes, worldclass professional doctors, nurses & administrators, top-of-the-range equipment, has grown to become a leading provider of premium healthcare in Kuwait. Committing itself to providing high-quality care, the highest possible level of comfort for patients, and maintaining the incredibly high standards is what the hospital stands for. “Hospitals” Magazine met with Dr. Alexander Varghese, Hospital Director of New Mowasat Hospital in Kuwait to talk about the hospital’s expansion and accreditation, in addition to the challenges they are facing on a daily basis and the hospital’s ultimate goal. Below is the full interview:

What are the latest updates in terms of expansion, manpower, new technologies, accreditation, exposure, etc.? New Mowasat Hospital has been offering premium medical services to the people of Kuwait for over half a century. We were the first private hospital to achieve both the American & Canadian accreditations in Kuwait. We have many Centers of Excellence, wherein the clinical results can be compared with global standards in Orthopedics & Spine surgery, Obstetrics & Gynecology, Pediatrics & Neonatology, Diabetes & Endocrinology, Physical Medicine & Rehabilitation, In Vitro Fertilization (IVF), General & Laparoscopic Surgery, Ophthalmology and many others. We are able to treat all complexities and cases related to these specialties and provide worldclass outcomes. We stand as a high-

end secondary & tertiary care hospital. We plan to strengthen our critical care services and ICU services and have started Nephrology & Dialysis Services recently. Our plan this year is to get into more complex specialties including Neurology, Interventional Neurology, Interventional Radiology, Pediatric Cardiology, Interventional Cardiology among others. One of the Centres of Excellence at New Mowasat Hospital is IVF and Reproductive Medicine for which it hires some of the best professionals in the world. We are considered to be the best hospital for IVF treatment in the region and we have very high success rates. We always publish results in this field on our website, so for all those needing information regarding that, they can visit our website. We have implemented many new medical technologies throughout the past years. We are renowned in Kuwait and a good number of the Kuwaiti citizens were born here as we have always had a very strong Obstetrics & Gynecology Department.

Can we conclude that your hospital is ranked number 1 in Kuwait? Ranking is based on criteria and if the criteria include patient safety, outcomes, clinical excellence etc, then we are definitely among the top. However, it will be good to know that there are many good hospitals and healthcare professionals of worldclass repute living and working in Kuwait, who may not be working with New Mowasat Hospital.

As a Hospital Director, what are the main challenges that you are facing on a daily basis? Finding good quality, profession-

INTERVIEWS

meet the patients’ needs?

ally qualified and competent manpower is our biggest challenge, as is the case for all hospitals in the region. We have many doctors and nurses coming from different backgrounds, cultures and ethnicities and it’s always a challenge to get the best. The other challenge that we are facing is that Kuwait does not promote medical tourism as much as possible in order to become a global destination for medical tourism. Therefore, the private hospitals work hard on promoting the high-quality medical services that we are providing to our patients. We strongly believe that we are doing very well in this regard and our outcomes in Kuwait can be compared with other organizations globally.

efforts in this regard. Thus, we are reaping constant growth and development in the healthcare sector which enables the community and patients at large to trust us for good quality, safe and equitable healthcare.

What are the adjustments needed in order to help improve the sector’s performance? We need to promote tourism in Kuwait in order to help all business sectors including the healthcare sector. Fostering the country’s medical tourism will positively impact the private healthcare sector here as it has been successfully done in other parts of the world.

Have you always been able to

We always aim to meet our patients’ needs and move beyond that to delight them, which is one of our main objectives. We have succeeded in doing so most of the time as it is highly important for us and has helped us maintain a good position & positive community feeling for a very long time. Like other institutions, we have resources to implement cutting-edge technologies and to bring in worldclass treatments and professionals, but everything needs time. Sometimes adding state-of-the-art technologies will in return lead to increased medical costs. Nevertheless, we are always trying to adopt the latest innovations in the medical field in order to provide our patients with the best medical services especially that patients now have an advanced level of medical knowledge.

What is your ultimate goal? Our ultimate goal is not a destination, but is a journey and that is “CARING FOR GENERATIONS” as envisioned by the founders of the organization.

Do you think that the Kuwait healthcare sector drives in trust for patients and the community? I have been here for only two years and I have noticed that the healthcare sector is on the right track and is heading in the right direction. Undoubtedly, the sector’s performance is continuously improving due to the government’s strenuous

NEWS

A breakthrough in infant formula

2’-FL HMO will narrow the gap between Breastfed babies and Formula-fed babies

he Arab Hospital and Hospitals magazine had the opportunity of attending the HMO Talk that was held in Paris on March 2, 2018 “Why HMOs Matter to Infant Nutrition”. Abbott gathered doctors, scientists and media from around the world, to learn about its newest scientific innovation in baby formula. A breakthrough product, that can mimic the benefits of mother’s milk

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and strengthen the immune system in formula-fed babies. For many years, people have been interested in Human Microbiome, probiotics and gut health, without really knowing it plays an important role in strengthening the immune system, particularly in infants. Newborn babies leave their mothers’ womb without any microbes, then they develop on their way out more than 100 times bacterial genes than human genes.

Mothers are the primary source of a child’s gut microbiome from the moment of birth through early childhood. An infant body begins to develop trillions of microbes through mother’s birth canal, to skin touching and breastfeeding. That’s why doctors advise pregnant women to take care of themselves and follow a healthy diet throughout the pregnancy, and later breastfeed and have skin-to-skin contact with their babies.

NEWS

Dr. Ardythe Morrow

Rachael Buck

Dr. Hakim Bouzamondo

“My team and I imagine a better and healthier future for all people, and good nutrition has a crucial role in building and maintaining good health”, comments Dr. Hakim Bouzamondo, MD, Divisional Vice President of Global Research and Development at Abbott. “The first thing we do when we’re born is eat, and we know that nothing can replace a mother’s milk. But for moms who cannot breastfeed, we are providing them with the most scientificallyadvanced formula containing 2’-FL HMO. After more than 15 years of clinical and preclinical research, we are proud to say that Human Milk Oligosaccharides (HMO) will now support the immune system of formula-fed babies and improve the bacteria balance of the baby’s gut. We were able to narrow this gap in immunity between breastfed and formula-fed babies. “

“There are more than 150 different HMOs, but the most abundant one in most mother’s milk is 2’-Fucosyllactose,” said Rachael Buck, PhD – an expert in immune health and lead scientist on this research at Abbott. “HMOs feed the beneficial bacteria in the gut, the essential place for a healthy immune system. We compared the immune system of exclusively breastfed babies to exclusively formula-fed babies with 2’-FL HMO. We found that the immune system in both groups was approximately identical.” Dr. Buck emphasized on the importance of breastfeeding, and that the aim of this finding is to help mothers around the world offer their children the best alternative for breast milk in case they couldn’t breastfeed for any circumstance. Human Milk Oligosaccharides are a major solid component of human milk

after lactose and lipid, and have similar concentration as protein. We know that it cannot be digested by babies own enzymes So it is not absorbed as other nutrients, but once it reaches the colon it has the same beneficial effects as prebiotics that help colonize the infant gut with beneficial bacteria. Dr. Ardythe Morrow, Professor of Pediatrics at Cincinnati Children’s Hospital Medical Center added that “human milk can protect babies against infectious diseases, that is why educating mothers on how to provide their babies with the most effective nutrition is very important.” Mothers who have difficulty breastfeeding or don’t have enough milk abundance sufficient for their babies growth should accept supplementing their babies diet, with formula to ensure a proper growth.

goodluz/shutterstock.com

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he ideal solution for people who need a little extra support in their hearing and vision. Hearing glasses by Austrian hearing device manufacturer BHM stand out for their reliability, practicality and individual design.

See better, understand better Hearing is so much more than simply the perception of sounds, tones or words; hearing holds 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 precisely why it is so important to provide reliable hearing systems for those with a hearing impairment. Hearing glasses are a great solution for those who need a little help not only with their hearing but also with their vision. Such solutions include, for example, the innovative

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models by BHM, Austriaâ€™s only manufacturer of hearing devices.

Hearing glasses based on bone conduction systems BHM specialises in hearing systems based on what is known as bone conduction technology. These are hearing aids that generate vibrations instead of sound, rendering it unnecessary to put an additional object in the ear canal. Hearing glasses are a hearing aid and a visual aid in one, with the frame temples transferring the vibrations to the inner ear. BHM bone conduction glasses stand out not only for their high degree of comfort, but also for their reliability and precision. They ensure that each wearer is given the finest hearing experience, tailored exactly to their individual requirements. Bone conduction glasses are also an excellent alternative to costly middle ear implants

involving risky surgical intervention. In addition to the two bone conduction models AN-Evo1 and contact star evo1, BHM also offers a wide range of fashionable frame fronts. Bespoke manufacture is available on request. BHM offers an outstanding hearing solution in combination with a pair of individually selected glasses. The contact star evo1 displays a special level of sophistication when it comes to individuality. Indeed, this particular model can be individually fitted to each respective wearer by means of in-situ audiometry. The new automatic recognition of different sound environments, moreover, offers optimum listening comprehension even in challenging situations.

Optimum hearing experience due to individual fitting Making full use of in-situ audiometry, BHM is a pioneer in the custom-

ised fitting of bone conduction hearing systems. So what exactly is this method and what advantages does it offer in the contact star evo1 model? In-situ audiometry (“in situ” means “at the place”, in this case “at the ear”) does not make adjustments to a hearing aid based on statistical averages, as was the case with the customary audiograms. Instead, the actual requirements of each individual wearer are taken into account and measured. This means you get a hearing aid that is perfectly tailored to you, giving you precisely the right hearing sensation. One particular problem often cited by hearing aid wearers is comprehension difficulty when in various sound situations. For example, the ambient noise in a lively restaurant is different to the rushing of the wind outside or loud background noise in a workshop. Consequently, it is often a challenge to follow a conversation in different situations. But BHM has found a solution for this too, used for the first time on the contact star evo1 model. And it’s called Sound Dynamix (BHM Automatic ).

Automatic recognition of sound environments BHM is the first provider of bone conduction hearing systems to offer an automatic recognition of different sound environments (BHM Automatic ). By selecting the “Automatic” mode on the contact star evo1, the signal received via the microphone is analysed and categorised as belonging to one of several sound environments. These are: • Quiet surroundings. • Conversation in a quiet environment. • Conversation with background noise. • Music + film.

• Background noise. • Wind noise. Depending on this classification, the parameters of the hearing system are always configured in such a way as to achieve optimum hearing comfort and language intelligibility, fully equipping the wearer of the contact star evo1 for the challenges of everyday life. BHM develops and produces hearing glasses systems based not only on bone conduction technology, but also based on air conduction technology. In short, technology that is compatible with virtually any pair of glasses.

Sophisticated & appealing hearing glasses based on air conduction The new comfort package for excellent hearing and vision goes by the name of pan. With pan, BHM combines all the advantages of a modern air conduction hearing system with the individual possibilities offered by a comfortable pair of specs. Not only is pan a technically sophisticated hearing system, it is also a highly presentable one that can be attached to any ordinary pair of glasses regardless of fashion trend or material. And it is precisely for this reason that BHM is able to offer a unique and innovative pair of glasses that provides clear and interference-free hearing thanks to its directional sensitivity, thus setting new standards in relaxed and comprehensible hearing.

racorn/shutterstock.com

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freedom to suit any requirement. The advanced device with improved technology, wireless connection function, the ability to connect to an implant, and many new features will be presented later that year. Stay tuned! 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.

Quality made in Austria Of course, BHM also takes into account people who don’t need glasses but don’t want to wear a conventional hearing aid either. Whether sports enthusiasts or children, BHM bone conduction technology can also be integrated into headbands, ski helmets and caps, thus offering plenty of

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Stiegelmeyer offers machine washable hospital beds such as Evario and Puro.

Successful fight against hospital-acquired infections

Machine washable beds from Stiegelmeyer

ospitals worldwide are fighting against drug-resistant pathogens. In many industrial countries, the probability for contracting a hospital-acquired infection during treatment is almost 10% or higher. The bedsâ€™ role in this is not unimportant as due to decreasing lengths of stay more patients are coming in contact with them in a shorter amount of time. Luckily there is a way to improve the hygiene of beds and at the same time have them operational again more quickly: automated reprocessing.

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The construction of machine washable beds is a challenge for every manufacturer. Stiegelmeyer from Germany is a pioneer in this field. For more than 40 years, the company has been providing beds suited for automated reprocessing and has continuously improved its technical advance. Stiegelmeyerâ€™s experience can also be seen in the new Evario. It is the first hospital bed that is available in a machine washable model variant with plastic safety sides and head/footboards. The split Protega safety side can be easily operated and

impresses with a modern international design. On request, a control panel can be integrated on both sides with individual functions for patients, care staff and technicians. Such a bed that is also suited for automated reprocessing has been a longstanding dream for many hospitals that has now come true. All machine washable beds from Stiegelmeyer are characterized by special cavity sealing of the frame structure as well as exclusive body impermeability of the drive

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The Evario by Stiegelmeyer is the first hospital bed that is available in a machine washable model variant with plastic safety sides and head/footboards.

consumption. “Customers using products from both companies can rely on high, validatable and reliable hygiene quality”, says Mario Ohl from Stiegelmeyer’s technical service department. Workflows within the hospital can be organized more efficiently. Staff is being relieved thanks to the elimination of physically strenuous manual cleaning. Automated reprocessing increases the safety and life quality on wards, saves time and improves the image of the hospital.

components. The robust quality also allows the surfaces to remain in top condition during the cleaning and disinfection process. Bed models such as Evario and Puro are designed with as many large surfaces and as little gaps as possible to prevent most dust and dirt from accumulating. In order to use automated bed reprocessing many hospitals first have to purchase a washing system. Stiegelmeyer focuses on ideally harmonized solutions and cooperates with Belimed, a worldwide leading manufacturer of cart washers. Belimed’s products meet all relevant standards, need little space and convince with their efficient drying process and low environmentally friendly water

Stiegelmeyer GmbH & Co. KG

Stiegelmeyer focuses on ideally harmonised solutions and cooperates with Belimed, a worldwide leading manufacturer of cart washers.

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By Dr. A. Eli Gabayan Chief of Medical Oncology at the Beverly Hills Cancer Center

mmunotherapy, the process of stimulating or tweaking the body immunity to fight cancer is changing the clinical practices in treating a variety of cancers. The concept of harnessing one’s immune system has brought about a paradigm shift in the approach of cancer treatment. Its potential in revolutionizing oncology is enormous and limitless.

change in the cancer treatments is being observed. This clearly speaks how fast immunotherapy has been generating impact based on the positive responses from various cancer treatments. Immunotherapy treatments can also be applied in combination with chemotherapy or radiation.

Currently, immunotherapy is being increasingly applied in treating many acute and advanced stages of cancer. With FDA approvals in immunotherapy treatments and drugs for specific cancers lining up, a radical

Certain parts of the person’s immune system are used to fight cancer. Some types of immunotherapy are also known as biologic therapy or biotherapy. It can be either done by stimulating the person’s own body im-

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What is cancer immunotherapy and how it is done?

munity system to make the cells work harder or by introducing man-made immune system proteins in the body.

Why Immunotherapy? Immunotherapy gives a targeted answer to cancer by virtue of its several important features. • It enables the immune system of the body to recognize and target the specific cancer cells. • Patients with specific types of cancer resistant to chemotherapy and radiation respond better with immunotherapy. • Immunotherapy in a way trains the immune system of the body to

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identify and memorize the traits of cancer cells. In this way, it offers a great possibility of long-term cancer remission. • Clinical studies on the overall cancer survival rate reveal that responses to immunotherapy are long lasting and continue even after the treatment is stopped. • Immunotherapy does not cause common side effects often seen from chemotherapy or radiation therapy. Side effects related to stimulation of body immunity system cause mild inflammation, fever, headache and nausea. Some treatments may trigger autoimmune diseases which if uncontrolled can cause severe symptoms and even death.

Primary immunotherapy treatments currently being used: • Monoclonal antibodies These are specifically designed antibodies in the lab that can attack a specific antigen found in cancer cells. The US FDA has approved more than a dozen Monoclonal Antibodies to treat specific cancers. They work by either boosting the person’s immune response to cancer cells or may block the antigens in cancer cells and prevent its proliferation. • Checkpoint Inhibitors A person’s immune system fights the foreign cells, which are different from the normal cells through specific

“checkpoints”. Checkpoints are nothing but molecules on specific immune cells that are required to be activated or deactivated to start an immune response. Checkpoint inhibitors are drugs that target these checkpoints and are showing promising results in treating melanoma, non-small cell lung cancer, Hodgkin Lymphoma and cancer of bladder, kidney, head and neck. Notable checkpoint inhibitor drugs are Pembrolizumab (Keytruda), Nivolumab (Opdivo), Atezolizumab (Tecentriq), Avelumab (Bavencio), Durvalumab (Imfinzi), Ipilimumab (Yervoy) etc. • Cancer vaccines Cancer vaccines are meant both

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for prevention and treatment. The vaccines for treatment are different from those used for prevention. Vaccines to prevent HPV (Human Papilloma Virus) and HBV infections are well known. Cancer treatment vaccines facilitate the immune system to attack the already existing cancer cells.

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These vaccines are generally made from cancer cells, parts of cells or pure antigens. The patient’s immune cells may also be used at times to create the vaccine. Sipuleucel- T (Provenge) is the only cancer treatment vaccine approved in the US for treating advanced prostate cancer.

• CAR (Chimeric Antigen Receptor) T- Cell Therapy The T-Cells, a type of white blood cells are removed from the patient’s body and tweaked in a lab to fight the cancer cells. These specially engineered cells are then infused back into the patient’s body. Currently, two

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CAR-T cell Therapies are approved by FDA – one for lymphoblastic leukemia and the other for specific types of large B-Cell Lymphoma (also one of the types of non-Hodgkin’s Lymphoma). • Non-specific cancer immunotherapies and adjuvants The adjuvants do not directly attack the cancer cells but stimulate the body immunity system to generate better immune response against the cancer cells. This is done by injecting cytokines (chemicals produced by some immune cells essential to maintain vitality of other immune cells) into the patient’s body. Sometimes these are combined with specific chemotherapy drugs but the side effects are more pronounced in combination therapy. These can be applied in treating certain types of Lymphoma, Leukemia, Melanoma and cancer of kidney. Although cancer immunotherapy is still at the nascent stage, the success achieved so far assure an enhanced standard of care for patients with advanced stage of cancer extending their longevity. Apart from all the promising features, immunotherapy cannot be applied to all cancer patients. The targeted nature of immunotherapy can also be an obstacle because all cancers may appear similar but in reality they are not. Moreover, the antigen expression in response to a specific monoclonal antibody may not be the same for all cancer patients and therefore the effectiveness may vary a lot. Another challenge can be the high cost of these treatments. Amidst the challenges, optimism rules which is reflected from the immense research support by leading authoritative bodies in cancer treatment.

Dr. A. Eli Gabayan As the Chief of Medical Oncology at the Beverly Hills Cancer Center, Dr. A. Eli Gabayan has made it a personal goal to deliver compassionate, yet state-of-the-art care in a healing environment. Dr. Gabayan is also an Assistant Clinical Professor at the UCLA David Geffen School of Medicine, and has been recognized with the Superdoctors award. The Beverly Hills Cancer Center has become renowned as among the best cancer centers in the world. http://www.bhcancercenter.com/about-us/our-team/oncologists-hematologists/

NEWS FEATURES . Diabetes and eye problems ARTICLE

MAY.JUNE 2018

ARTICLE FEATURES . Diabetes and eye problems

iabetes is a disease that affects the body’s ability to produce or use insulin effectively to control blood sugar levels. But too much glucose in the blood for a long time can cause damage in many parts of the body, including the heart, kidneys, blood vessels and the small blood vessels in the eyes. When the blood vessels in the eye’s retina, which is the light sensitive tissue lining the back of the eye, swell, leak or close off completely — or if abnormal new blood vessels grow on the surface of the retina — it is called diabetic retinopathy. Diabetic retinopathy is the most common diabetic eye disease and a leading cause of blindness. According to the Centers for Disease Control and Prevention (CDC), about 90 percent of diabetes-related vision loss can be prevented, but early detection is key. People with diabetes should get critical, annual eye exams even before they have signs of vision loss. The best ways to manage your diabetes and keep your eyes healthy are to manage your blood glucose, blood pressure and cholesterol, quit smoking and have a dilated eye exam once a year.

Diabetic Retinopathy Diabetic retinopathy is a diabetes complication that affects eyes. It is caused by damage to the blood vessels of the light-sensitive tissue at the back of the eye (retina). At first, diabetic retinopathy may cause no symptoms or only mild vision problems. Eventually, it can cause blindness. The condition can develop in anyone who has type 1 or type 2 diabetes. The longer you have diabetes and the less controlled your blood sugar is, the more likely you are to develop this eye complication.

You might not have symptoms in the early stages of diabetic retinopathy. As the condition progresses, diabetic retinopathy symptoms may include spots or dark strings floating in your vision (floaters), blurred vision, fluctuating vision, impaired color vision, dark or empty areas in your vision and vision loss. Diabetic retinopathy involves the abnormal growth of blood vessels in the retina. Complications can lead to serious vision problems including vitreous hemorrhage - the new blood vessels may bleed into the clear, jelly-like substance that fills the center of your eye. If the amount of bleeding is small, you might see only a few dark spots (floaters). In more-severe cases, blood can fill the vitreous cavity and completely block your vision. Retinal detachment - the abnormal blood vessels associated with diabetic retinopathy stimulate the growth of scar tissue, which can pull the retina away from the back of the eye. This may cause spots floating in your vision, flashes of light or severe vision loss. New blood vessels may grow in the front part of your eye and interfere with the normal flow of fluid out of the eye, causing pressure in the eye to build up (glaucoma). This pressure can damage the nerve that carries images from your eye to your brain (optic nerve). Eventually, diabetic retinopathy, glaucoma or both can lead to complete vision loss. Diabetic retinopathy is best diagnosed with a dilated eye exam. For this exam, drops placed in your eyes widen (dilate) your pupils to allow your doctor to better view inside your eyes. The drops may cause your close vision to blur until they wear off, several hours later. With your eyes dilated, your doctor takes pictures of the inside of your eyes. Then your doctor will inject

a special dye into your arm and take more pictures as the dye circulates through your eyes. Your doctor can use the images to pinpoint blood vessels that are closed, broken down or leaking fluid. Your eye doctor may request an optical coherence tomography (OCT) exam. This imaging test provides cross-sectional images of the retina that show the thickness of the retina, which will help determine whether fluid has leaked into retinal tissue. Later, OCT exams can be used to monitor how treatment is working. Treatment, which depends largely on the type of diabetic retinopathy you have and how severe it is, is geared to slowing or stopping progression of the condition. If you have mild or moderate non-proliferative diabetic retinopathy, you may not need treatment right away. However, your eye doctor will closely monitor your eyes to determine when you might need treatment. Work with your endocrinologist to determine if there are ways to improve your diabetes management. When diabetic retinopathy is mild or moderate, good blood sugar control can usually slow the progression. If you have proliferative diabetic retinopathy or macular edema, you will need prompt surgical treatment. Depending on the specific problems with your retina, options may include focal laser treatment, scatter laser treatment or vitrectomy.

Cataract A cataract is a clouding of the normally clear lens of your eye. For people who have cataracts, seeing through cloudy lenses is a bit like looking through a frosty or foggedup window. Most cataracts develop slowly and don’t disturb your eyesight early on. But with time, cataracts will eventually interfere with your vision. At first, stronger lighting and eye-

ARTICLE FEATURES . Diabetes and eye problems

glasses can help you deal with cataracts. But if impaired vision interferes with your usual activities, you might need cataract surgery. Fortunately, cataract surgery is generally a safe, effective procedure. Most cataracts develop when aging or injury changes the tissue that makes up your eye’s lens. Some inherited genetic disorders that cause other health problems can increase your risk of cataracts. Cataracts can also be caused by other eye conditions, past eye surgery or medical conditions such as diabetes. Long-term use of steroid medications, too, can cause cataracts to develop. Signs and symptoms of cataracts include clouded, blurred or dim vision, increasing difficulty with vision at night, sensitivity to light and glare, need for brighter light for reading and other activities, frequent changes in eyeglass or contact lens prescription, fading or yellowing of colors and double vision in a single eye. At first, the cloudiness in your vision caused by a cataract may affect only a small part of the eye’s lens and you may be unaware of any vision loss. As the cataract grows larger, it clouds more of your lens and distorts the light passing through the lens. This may lead to more noticeable symptoms. Studies indicate that 60% of patients with diabetes suffer from cataracts due to the high or irregular blood sugar level. The eye’s lens gets its nutrients from aqueous humor, fluid filling the front portion of the eye. Aqueous humor provides oxygen and glucose, a simple sugar energy source for the body’s cells. When you don’t have good control over your glucose levels (as with unchecked diabetes), sugar levels rise in the aqueous humor and in the lens. High levels of glucose in the lens cause it to swell, affecting

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clarity of vision. The lens also has an enzyme that converts glucose to a substance called sorbitol. When sorbitol collects in the lens, it can affect cells and naturally-occurring proteins, causing the lens to become less clear and more opaque. This condition eventually leads to cataract formation, making the world around you appear blurry, yellowish or faded, and increasing glare. To determine whether you have a cataract, your doctor will review your medical history and symptoms, and perform an eye examination. Your doctor may conduct several tests, including a visual acuity test that uses an eye chart to measure how well you can read a series of letters, a slit lamp that allows your eye doctor to see the structures at the front of your eye under magnification and a retinal exam in which the doctor puts drops in your eyes to open your pupils wide (dilate). This makes it easier to examine the retina. When your prescription glasses can’t clear your vision, the only effective treatment for cataracts is surgery.

Glaucoma People with diabetes are twice as likely to be at risk of having glaucoma compared to people without diabetes. The eye produces a small amount of fluid like water in its middle chamber, which flows around the lens of the eye into the front chamber. The fluid leaves the eye using a drainage network and then enters the bloodstream. Commonly, glaucoma causes the drainage system to become blocked, and fluid becomes trapped in the eye. This causes pressure to build up in the eye and pass to the nerve at the rear of the eye. This nerve may become damaged by glaucoma. People with diabetic retinopathy have an increased risk of glaucoma. This can happen if abnormal blood

vessel growth, which can occur as a result of retinopathy, blocks the natural drainage of the eye. Glaucoma has very few symptoms in its early stage, so people may be unaware that something is wrong with them. As someone with diabetes, an optometrist or another eye specialist should test you for glaucoma at least once each year. Glaucoma may be diagnosed by an optometrist by measuring your eye pressure, checking the eye at the optic nerve, and testing the field of your vision. A common test these days is a noncontact tonometry test (NCT test) in which a brief puff of air will be directed into the front of your eye. The machine you sit in front of measures the resistance of your eye to the puff of air without needing to make contact with your eye. Glaucoma will usually be treated with eye drops to relieve pressure in the eye. Your healthcare professional will be able to advise you further on the most suitable drops for your condition. Alternative treatments include laser treatment (laser iridotomy) and trabeculectomy surgery. Glaucoma is a group of diseases that can damage the eye’s optic nerve and result in vision loss and blindness. However, with early treatment, you can often protect your eyes against serious vision loss. Therefore it is very important that it be diagnosed.

Retinal vein occlusion (RVO) Retinal vein occlusion (RVO) is a common vascular disorder of the retina and one of the most common causes of vision loss worldwide. Specifically, it is the second most common cause of blindness from retinal vascular disease after diabetic retinopathy. Retinal vein occlusion is a blockage of the small veins that carry blood away from the retina. The retina is the layer of tissue at the back

ARTICLE FEATURES . Diabetes and eye problems

of the inner eye that converts light images to nerve signals and sends them to the brain. Retinal vein occlusion is most often caused by hardening of the arteries (atherosclerosis) and the formation of a blood clot. Blockage of smaller veins in the retina often occurs in places where retinal arteries that have been thickened or hardened by atherosclerosis cross over and place pressure on a retinal vein. Risk factors for retinal vein occlusion include atherosclerosis, diabetes, hypertension, cholesterol, smoking and high eye pressure.

There are two main types of retinal vein occlusion: 1. Branch retinal vein occlusion - the blockage occurs somewhere along the course of one of the four retinal veins. (One retinal vein drains each quarter of the eye.) Branch retinal vein occlusion is about three times more common than central retinal vein occlusion. 2. Central retinal vein occlusion - the blockage occurs in the

main vein formed by the four retinal veins coming together. If you have retinal vein occlusion, you will usually notice a decrease in your vision in one eye. Some people describe having a blind spot in one eye. The condition is mostly painless unless there are complications, such as secondary raised pressure in the eye (glaucoma) caused by new blood vessels interfering with the drainage of fluid from inside the eye. Depending on the severity and also the degree of involvement of the macula, retinal vein occlusions may cause only relatively mild visual loss. Some people who only have a small blockage of a branch retinal vein may not have any symptoms. Retinal vein occlusion is usually diagnosed after an ophthalmologist examines the back of your eye, using an ophthalmoscope or a larger special light and magnifier called a slit lamp. Treatment for the complications of retinal vein occlusion may include focal laser treatment, if macular edema is present and injections of anti-vascular endothelial growth factor drugs into the eye. These drugs

may block the growth of new blood vessels that can cause glaucoma.

Visual Impairment Diabetes can lead to numerous vision problems. When diabetes is poorly controlled, there is an excess amount of sugar in the blood, causing the vessels that supply the eye with blood to thicken and harden, which prevents them from doing their job properly. In the eye, diabetes affects primarily the iris, the crystalline lens, the vitreous humour, the retina and the optic nerve. Visual impairment caused by diabetes can often be prevented with early detection, proper management of your diabetes and routine eye exams performed by the ophthalmologist. The effect of retinopathy on vision in people with diabetes varies widely, depending on the stage of the disease. Common symptoms can include blurred vision (often linked to blood glucose levels), flashes or sudden loss of vision as well as other eye symptoms. Regular visits to the ophthalmologist are a must for patients with diabetes, even if there are experiencing no symptoms, in order to prevent eye damage and loss of vision.

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Unlocking the mystery of metabolism

etabolism describes all chemical processes happening continuously inside the body to keep you alive and your organs functioning normally. This includes processes such as breathing, repairing cells and digesting food. These complex chemical processes require energy to perform, with the minimum amount required termed the Basal Metabolic Rate (BMR).

MYTH: People who are obese have the same metabolism as people who are at a normal weight FACT: There are many potential differences in the metabolic system of people with obesity and normal weight individuals. A key difference is insulin resistance when blood sugar levels in the body fail to respond normally to the production of insulin. Insulin resistance can lead to type 2 diabetes and heart disease, two common comorbidities associated with obesity.1 Other metabolic differences may include leptin resistance, muscle efficiency and the body’s response to eating a meal.

MYTH: If you exercise and eat right, metabolism doesn’t matter FACT: Whilst exercising and eating right are important to maintain a healthy lifestyle, some individuals still struggle to lose weight based on lifestyle modification alone. A growing body of research supports the concept of ‘set point’, where it is thought that regardless of what you would like your weight to be, your brain has its own sense of how much body fat you should retain and regulates energy intake and expenditure to

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maintain levels within a ‘set point’ range. Moreover, research suggests that when people with obesity go on a calorie-deficit diet, then there are significant alterations in appetite hormones leading to increased food intake, reductions in energy expenditure including changes in ‘muscle efficiency’ that together can increase body weight.

MYTH: A ‘slow’ metabolism causes obesity FACT: A number of studies involving thousands of people worldwide have failed to find evidence to support the widely held belief that overweight people must have slower metabolic rates. Metabolism is complex and there are many factors that affect the amount of energy we use – including ‘resting’ energy requirements, exercise and the body’s response to food. Some studies suggest that overweight people may actually have a higher BMR than their leaner counterparts, reflecting the resting energy requirements needed to maintain a larger body size. Another factor is the thermogenic response to food – this is the added energy we need to process and store the food we eat. Research suggests that there are subpopulations that have a thermogenic defect when they eat, which can affect metabolism. Individuals with this defect are more prone to obesity.7 However, not all people with obesity have this defect, suggesting there are different causes of obesity.7

MYTH: Prevention strategies are more effective than treatment

FACT: Researchers and doctors are increasingly aware that obesity is a disease with complex origins. It is now understood that environmental, social, and dietary factors and aspects relating to common medications, stress and sleep are thought to play a role, as such there is no one-size-fitsall approach to combatting obesity. In addition, prevention strategies are of little use to those already severely affected by obesity. For those severely affected by obesity and associated diseases, it is vital that they are treated as patients and given access to viable treatment options such as professional lifestyle intervention, pharmacotherapy and surgery. In fact, bariatric surgery has shown significant results in treating type 2 diabetes in patients with obesity for whom medical plus lifestyle therapy is insufficient.

MYTH: You can be obese and healthy FACT: Although some people living with obesity maintain a healthy metabolic profile, recent research suggests that they have a greater risk of developing heart disease than normal-weight individuals. A major study of more than half a million people across Europe found those who were overweight or obese had up to a 28% higher risk of developing coronary heart disease – where arteries in the heart become clogged leading to heart attacks or heart failure. Another study found that so-called ‘healthy obese’ people have a 7% higher risk of stroke, twice the risk of heart failure, and a greater risk of peripheral artery disease (which is the narrowing of blood vessels to the arms and legs).

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MYTH: The stigma towards people who are obese has decreased in recent years FACT: Unfortunately, despite the science, the social stigma towards obesity still exists. The belief that

obesity is a lifestyle choice remains prominent, significantly affecting the psychosocial wellbeing and behavioral patterns of people with obesity. Living with obesity has also been demonstrated to lead to significant personal and professional

disadvantages, with obese people less likely to marry or reach their educational potential and on average, earn less than normal-weight individuals. With this in mind, it’s time to redefine our attitudes towards obesity. It’s Time to Act.

REFERENCES 1. Singla P, et al. Metabolic effects of obesity: a review. World J Diabetes 2010;1:76–88. 2. Serván PR. Obesity and diabetes. Nutr Hosp 2013;28(Supl. 5):138–43 3. Chan RSM and Woo J. Prevention of overweight and obesity: how effective is the current public health approach. Int J Environ Res Public Health 2010;7:765–83. 4. Banerjee D, et al. Insulin resistance and risk of incident heart failure: Cardiovascular health study. Circ Heart fail 2013;6:364–70. 5. Martin, S.S. et al., Leptin Resistance: A Possible Interface of Inflammation and Metabolism in Obesity-Related Cardiovascular Disease. J Am Coll Cardiol. 2008 Oct 7; 52(15): 1201–1210. 6. Goldsmith R, Joanisse DR, Gallagher D, et al. Effects of experimental weight perturbation on skeletal muscle work efficiency, fuel utilization, and biochemistry in human subjects. American Journal of Physiology - Regulatory, Integrative and Comparative Physiology. 2010;298(1):R79-R88. doi:10.1152/ajpregu.00053.2009. 7. Jequier, E & Schutz, Yves. New evidence for a thermogenic defect in human obesity. International journal of obesity. 1985. 9 Suppl 2. 1-7. 8. Farias MM, et al. Set-point theory and obesity. Metab Syndr Relat Disord 2011;9:85–9. 9. Rosenbaum M, Kissileff HR, Mayer LES, Hirsch J, Leibel RL. Energy Intake in Weight-Reduced Humans. Brain research. 2010;1350:95-102. doi:10.1016/j.brainres.2010.05.062. 10. Sumithran, P et al. Long-Term Persistence of HormonalAdaptations to Weight Loss. New England Journal of Medicine 2011; 365;17 11. Anthanont P and Jensen MD. Does basal metabolic rate predict weight gain? Am J Clin Nutr 2016;104:959–63. 12. Dal U, et al. Resting energy expenditure in normal-weight and overweight/obese subjects was similar despite elevated sympathovagal balance. Obes Facts 2012;5:776–83. 13. DeLany JP, et al. High energy expenditure masks low physical activity in obesity. Int J Obes (Lond) 2013;37:1006– 14. Thielecke F, et al. Determination of total energy expenditure, resting metabolic rate and physical activity in lean and overweight people. Z Ernahrungswiss 1997;36:310–2. 15. Merghani TH, et al. Prediction of basal metabolic rate in overweight/obese and non-obese subjects and its relation to pulmonary function tests. BMC Res Notes 2015;8:1–6. 16. Hoffmans M, et al. Resting metabolic rate in obese and normal weight women. Int J Obes 1979;3:111–8. 17. Ravussin E, et al. Twenty-four-hour energy expenditure and resting metabolic rate in obese, moderately obese, and control subjects. Am J Clin Nutr 1982;35:566–73 18. Hruby A and Frank B. The epidemiology of obesity: A big picture. Pharmacoeconomics 2015;33:673–89. 19. Arterburn DE, et al. A multisite study of long-term remission and relapse of type 2 diabetes mellitus following gastric bypass. Obes Surg 2013;23:93–102. 20. Lassale. C et al. Separate and combined associations of obesity and metabolic health with coronary heart disease: a panEuropean case-cohort analysis. European Heart Journal ehx448, available online: https://doi.org/10.1093/eurheartj/ehx448 21. Study of 3.5 million people shows ‘healthy’ obese people are still at higher risk of cardiovascular disease events than the general population. EUROPEAN ASSOCIATION FOR THE STUDY OF OBESITY, https://www.eurekalert.org/pub_releases/2017-05/ eaft-so3051517.php 22. Brewis AA. Stigma and the perpetuation of obesity. Soc Sci Med 2014;118:152–8. 23. Obesity, bias and stigmatization. The Obesity Society. 24. Kark M and Karnehed N. Weight status at age 18 influences marriage prospects. A population-based study of Swedish men. BMC Public Health 2012;12:1–7.

ARTICLE FEATURES . Adrenaline

Adrenaline

Stress and Fear Hormone

drenaline is a stress hormone produced within the adrenal gland that quickens the heartbeat, strengthens the force of the heartâ€™s contraction, and opens up the bronchioles in the lungs, among other effects. The secretion of adrenaline is part of the human â€˜fight or flightâ€™ response to fear, panic, or perceived threat, also known as epinephrine. It is mainly released in response to stressful events, which lead to the activation of nerves connected to the adrenal glands, which trigger the secretion of adrenaline and thus increase the levels of adrenaline in the blood. This process happens relatively quickly, within 2 to 3 minutes of the stressful event being encountered. When the stressful situation ends, the nerve impulses to the adrenal glands are lowered, meaning that the adrenal glands stop producing adrenaline.

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ARTICLE FEATURES . Adrenaline

Stress also stimulates the release of adrenocorticotropic hormone from the pituitary gland, which promotes the production of the steroid hormone cortisol from the cortex of the adrenal glands. This steroid hormone is more important in altering the body’s metabolism (i.e. raising plasma glucose) under conditions of longer-term, chronic, rather than acute, stress. Adrenaline is associated with negative emotions that can be experienced by people such as grief, fear, anxiety, nervousness and anger. Key actions of adrenaline include increasing the heart rate, increasing blood pressure, expanding the air passages of the lungs, enlarging the pupil in the eye, redistributing blood to the muscles and altering the body’s metabolism, so as to maximize blood glucose levels (primarily for the brain). A closely related hormone, noradrenaline, is released mainly from the nerve endings of the sympathetic nervous system (as well as in relatively small amounts from the adrenal medulla). There is a continuous low level of activity of the sympathetic nervous system resulting in release of noradrenaline into the circulation, but adrenaline release is only increased at times of acute stress. Overproduction of adrenaline is rare. Too much adrenaline can be caused by a variety of things, including a rare tumor of the adrenal medulla. Symptoms may include rapid heartbeat, high blood pressure, anxiety, weight loss, excessive sweating and palpitations. When anxiety becomes very extreme, you may experience constant adrenaline rushes and high levels of stress and emotions generally pose a threat to human life due to the fluctuation of adrenaline levels.

Symptoms that indicate high levels of adrenaline: • • • • •

Feeling anxious and tense in general Chronic headaches Heart rate increase and palpitations Body aches and pains Shaking (tremors)

How to control adrenaline levels The adrenaline level in the body can be controlled by reducing stress, anxiety, and having enough sleep, as fatigue due to lack of sleep increases stress levels. We can also avoid high adrenaline levels by reducing the consumption of added sugars, saturated fats and white flour because they are unhealthy foods, and it can be make it hard to cope with life pressure. Deep breathing can help your body distribute oxygen to your body, which can reduce heart rate and normalize your pulse. It will also help relax tense muscles that may be exacerbating the adrenaline rush. Inhale and exhale completely and in a balanced manner through your nose.

Following these steps would contribute to reducing high adrenaline levels: • • •

• •

•

Slow and deep breathing when exposed to panic Exercise regularly Avoid thinking about work pressures and life requirements Try neglecting any cause of pressure and tension Have enough sleep, because sleep deprivation causes increased adrenaline levels Reduce the consumption of stimulants as they contain

• •

•

caffeine, which increases the secretion of adrenaline hormone. Eat healthy food Get a 45-minute massage using an essential oil that relaxes muscles and removes tension Drink a cup of chamomile or anise tea.

Effect of adrenaline on the heart The adrenaline hormone has a positive and negative effect on the health of the heart. It is necessary for the body to prepare for movement and face danger. For example, an athlete needs it to exercise, as the average person needs adrenaline to do the simplest things such as climbing stairs. Beta-adrenergic receptors are linked to the myocardial cells which cause increased heart rate and blood pumping to all body tissues. Adrenaline is also used to increase the heart rate when it begins to slow down. In some very dangerous cases, adrenaline-based drugs are used to control very low blood pressure. Adrenaline can negatively affect the heart if the person suffers from cardiovascular disease. In such cases, this hormone has a bad impact on the heart as it contributes to increase the heart rate, which may cause a heart attack in some patients. Effect of adrenaline on the skin The effect of epinephrine on the skin is mainly caused by it binding to alpha-adrenergic receptors, the alpha-2-adrenergic receptor in particular. Restriction of the arteries is caused by the binding of epinephrine to these alpha-adrenergic receptors. This cuts off blood supply to the skin. A signaling cascade is also stimulated.

ARTICLE FEATURES . Adrenaline

This results in the contraction of the smooth muscle cells in the skin, which cause the raising of the hairs on the surface of the skin.

Effect of adrenaline on the lungs The lungs contain smooth muscle. Epinephrine causes smooth muscles to relax. Specifically, epinephrine binds to beta-2-adrenergic receptors on bronchiole muscle cells. This allows the bronchioles to relax, which enables intensified respiration.

Effect of adrenaline on the liver One of the places where epinephrine has an effect is in the liver. Epinephrine, along with another hormone called glucagon, is responsible for the breakdown of glycogen in liver cells. Epinephrine binds to a receptor on the outside of a liver cell causing a conformational change to occur. The second messenger then causes the activation of a protein kinase which activates phosphorylaze, an enzyme

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which catalyzes the breakdown of glycogen to glucose.

Medical uses Doctors use adrenaline in medicine as a drug in some cases such as: • Stimulating and revitalizing the heart during a heart attack. • Narrowing of blood vessels • Opening the airways to reduce breathing difficulties, • Narrowing the blood vessels to combat low blood pressure and to ease the faint feelings. One of the roles of adrenaline is to promote the release of glucose from the locations in the body where it’s stored. Skeletal muscles--those that promote movement and that humans can contract at will--store glucose, as does the liver. The muscles and liver store glucose in the form of a long chain of glucose molecules, called glycogen.

Released adrenaline causes the liver and muscles to break down glycogen into glucose.

Gland that secretes adrenaline It is the adrenal glands, one of the most important and essential glands in the body, sitting on top of the kidneys. The importance of the adrenal glands and their benefits are endless, as they perform many significant functions and the body cannot function normally without them. The adrenal glands also produce a large number of hormones, including sex hormones, but adrenaline is the most important hormone produced as nerve signals stimulate the core of the adrenal glands in order to secrete adrenaline. It is excreted in the bloodstream through which the body is given the ability and strength to react in case of sudden stress and it will help the body adapt to such situations and make a quick reaction to any fear, danger or threat.

ARTICLE FEATURES . Adrenaline

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Medical Informatics A story to be told

Professor Mukhtar Al-Hashimi Ahlia University – Bahrain

oday, information and telecommunication technologies have tremendously impacted every discipline of our daily life. Reflecting on the state of healthcare over the last two decades, one can infer that the medical and healthcare sectors have been under pressure to meet their customer demand in an efficient and effective manner through adopting standards, and optimal clinical outcome with minimum cost. These challenges have facilitated the adoption of medical computing and acceptance of computer application in healthcare and medicine since 1990’s, resulting in the formulation of a new discipline known as “medical informatics.”

The literature introduces terminology such as Hospital or Health Information System, Clinical Infor-

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mation System (CIS), Patient Data Management System (PDMS), and Electronic Health Record (EHR). The Health Information Management Systems Society (HIMSS) views Electronic Health Records, EHRs as “A longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting including: patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data, and radiology reports.” Another definition for medical informatics come from Healthcare Information and Management Systems Society, “HIMSS” which define medical informatics as “the interdisciplinary study of the design, development, adoption and application of IT-based innovations in healthcare services delivery, management and planning.”

Today, medical informatics has revolutionized every aspect of healthcare process, leading to changes in the healthcare model from administrative, clinical functionalities, diagnostics, treatment, logistical and strategic planning, across the primary, secondary and tertiary healthcare bodies while extending the accessibility of patient information and resources across different innovative technologies such as clinical stations, handheld devices, and smartphones apps. Without a doubt, the advancement of medical informatics has reduced the administrative bottleneck, minimized the complexity of medical delivery, medical error and enhanced the medical decision support either through structure information, business intelligent, or automated clinical alert and protocol aimed to enhance the clinical outcome while reducing

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the cost of healthcare. Since the early 1990s, healthcare leaders in Bahrain have envisioned the value of a patient care information system. Leaders planned to introduce a comprehensive patient care information system in a leading hospital in the country, with the emphasis on the lesson learned from previous international experiences and medical informatics. The author was given the opportunity to develop a comprehensive medical information system named AL-Care System. This project can be considered a pioneering experience of medical informatics in the country and was the brainchild of the author. The AL-Care System was successfully implemented and having the system resulted in the local and regional recognition of Bahrain’s experience in medical informatics that deserves to be shared. Accordingly, a vision for the AL-Care System has outlined around three dimensions of a patient-centric system: 1. All design will center on the patient care process. 2. Efficiency in every process and human interaction. 3. Effectiveness in utilizing resources. Importantly the system should be economically feasible, integrate creative and innovative concepts, ideas, and technology that are applicable and timely for the users. Thus, the system success will inspire healthcare executive to adopt and recognize the importance of medical informatics for their healthcare setting. Today’s healthcare system should be designed and built around patient needs in terms of clinical, administrative and financial aspects. In other words, the system should cover the

activities chain involved across the healthcare’s internal and external boundaries. Once these needs have been met, it would be possible to achieve the strategic objective of MIS. Generally, the modules of MIS can be classified into clinical and non-clinical modules. The clinical modules focus on the core patient diagnostics and treatment activities designed to collect, store and manipulate data for the purpose of clinical assessment, and the director indirect decision-making process. There is a range of clinical modules, including patient clinical profile, laboratory, pharmacy, surgery, doctors’ orders, radiology, physiotherapy, clinical encounters, accident and emergency, and triage, besides the nursing and physician notes and discharge notes and follow-up. Clinical modules will facilitate efficient data entry and retrieval, eliminate error and duplication through enforcing the quality control, standardize workflow and standard clinical protocols embedded within the clinical module while generating alert or clinical decision-making based on logic, statistics, data mining, and knowledge-based representation. As for the patient, administrative and support modules are aimed at automating these activities that support the healthcare provider with logistics and inventory, and patient need of hospitality services as well as patient admission and discharge. Another major group of modules is the patient billing and cost monitoring modules, along with the quality control modules.

Patient Registration Module The main objectives of the module are to add registration details of patients, to query registration details and to see the bed census. The Patient Registration Module is based on a unique patient identification number, which is assigned to each patient. Using the Registration module, the healthcare authorities can understand the distribution of their patients, categories, last admission and discharge dates along with other essential information such as admitting doctor, last chief complaint and discharge diagnosis, based on the International classification of diseases (ICD).

Clinic Appointment Module This module comprises the appointments for the medical staff, private practice, and medical support facilities such as Laboratory, Physiotherapy and Radiology. Each appointment is linked to the actual attendance of the patient on the specific appointment date. This feature enables the decision-maker to plan manpower needs on the basis of patient load at a given time and period.

At his point, is worth to elaborate on some of the clinical and non-clinical modules developed for the AL-Care system in order to provide a comprehensive snapshot of the MIS modules.

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Clinical Profile Module This module is designed to give the healthcare provider a quick snapshot of the patient clinical status. It contains the following components for a given patient: clinical base parameters, allergy details, blood transfusions, drugs prescribed from different sources, family history details, existing disabilities, existing chronic diseases, surgery details and vaccination details. The clinical profile is the central clinical store for the healthcare provider in assessing the patient and family clinical status. The information from the clinical profile could be downloaded and stored on electronic chips, such as a Smart Card.

Doctor Station Module The Doctor Station is a specially designed module to facilitate the clinical capabilities of doctors. Through this module, a doctor can see all diagnostic documents related to one patient without logging to different modules. Doctors can press any button such as Drugs, Surgery, Radiology, Lab results, etcetera. To view the related documents for that patient. This module is highly useful in a clinical environment.

The Doctor Order module is intended to eliminate paperwork at the wards and to reduce prescription errors. It facilitates the doctors’ diagnoses and prescriptions for patients. By the implementation of this module, doctors are not required to write prescriptions on a piece of paper. They can enter the prescriptions through the computer. The doctors are provided with current pricing and stock levels of drugs, substitutes for unavailable medications, and possible interactions. The module results in quicker turnaround times for medications and better quality patient care. Voice messages can be sent to WhatsApp or SMS messages for medication reminders. Automatic refills are provided according to physician-specified refill instruction.

medical records, called SOAP. SOAP is divided into four components: 1. Subjective – the patient presents complaint and history. 2. Objective – the examination and other objective data 3. Assessment – diagnosis or differential diagnosis. 4. Plan – investigation and treatment. Physicians can enter the data either by typing the text, or using common templates designed to treat a certain disease, in addition to selecting the diagnosis code, visit outcome, and a number of leave days. The system provides an auditing and monitoring tool for quality improvements, as well as an educational and research tool, and understanding the distribution of diseases.

Physician Chart Module

Surgical Module

The main aim of this module is to create clinical workstations, where a doctor views previous patient encounters for all clinics, leading to the elimination of patient files, saving money and retrieval time. It is based on international problem-oriented

The Surgical Module is a clinical-based system where information regarding surgeries done in the hospital is easily attained. The main features of the module are surgery requests, add procedures and add disposables. Each and every surgical procedure provided to patients are entered into the system. The system enables viewers to see how many operations performed by a doctor, by procedure, by a department, and by cost.

Doctor Order Module

Laboratory Results All lab results are now available in the MIS system. Lab results are divided into Microbiology results, Hematology results, Serology results, and Biochemistry and Histopathology results. All the lab machines are interfaced to AL-Care system and they send the results directly to the system, eliminating a lot of paperwork and saving time.

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Pharmacy system The pharmacy module was developed by incorporating desirable changes in the old system. The pharmacist can enter each prescription in the system by entering the patient number. After that, he can enter the drugs as per prescription. He can also select common dosage from the list provided. After finishing the entry, a label is printed for each medicine which contains the details about the patient, drug name, and instructions for the patient in both English and Arabic. This eliminates all manual jobs in the pharmacy in issuing drugs. On a practical level, when implementing a medical information system in a healthcare organization, it is important to ensure that the system planning has to revolve around at least three strategic dimensions: cost leadership, efficient services, effective services and aligned to the strategic objectives of the organization while recognizing the potential value of each module and the organization readiness in term of resources, end-users competencies skills, implementation stage and both market competitiveness and cooperate strategy. It is important not to ignore the challenges that could arise from the implementation of a MIS, which could be lack of leadership support and end-users resistance to change. Finally, a healthcare organization should develop a strategy to plan and implement a medical information system to ensure return on investment.

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B. Braun increases sales and earnings with investments of one billion euros

. Braun Melsungen AG finished the fiscal year 2017 with total sales of € 6,789 million (previous year: € 6,471 million). Sales increased by 4.9 percent from the previous year, or 5.7 percent after currency corrections. Consolidated net income increased by 3.9 percent, to € 411.5 million (previous year: € 396 million). “Our earnings for the 2017 fiscal year were satisfactory.”

Dynamic development in the OPM and B. Braun Avitum divisions All the divisions contributed to the positive sales growth results for the Group. Business was very dynamic in the Out Patient Market and B. Braun Avitum divisions. The largest division, Hospital Care, increased sales by 4.1 percent to € 3,114 million (previous year: € 2,991 million). Growth was strong in the Compounding areas for production of custom solutions for clinical nutrition and IV sets. Sales also increased for large-volume standard solutions. Sales performance in the US was satisfactory for 2017, and the European market continued to grow. At the country level, sales growth came primarily from Germany, Russia and Spain. The Aesculap Division posted sales of € 1,786 million (previous year: € 1,725 million), up 3.6 percent from the year before. The essential drivers of growth were China, Germany and Japan. Additional growth came from Turkey, Indonesia, South Korea, Italy, Mexico, Argentina and Poland. Sales growth was mainly realized in angioplasty products, surgical instruments, shunts, access ports and knee implants. The Out Patient Market (OPM) division posted sales of € 827.5

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million (previous year: € 782 million), an increase of 5.9 percent. Strong growth was seen in the United States, with the sale of elastomeric pumps, parenteral nutrition and intravenous needles. Other growth markets were Germany, South Africa, Portugal and Brazil. Development was very solid in Basic Care, Wound Care and Disinfection product ranges. Sales in the B. Braun Avitum division increased by 9.2 percent to € 1,031 million (previous year: € 945 million). As the operator of 370 renal care centers, B. Braun Avitum supplies 30,000 dialysis patients worldwide. In the product business, sales were strong for consumer products and dialysis machines, and the water treatment systems business also expanded. The worldwide performance of B. Braun renal care centers was equally promising. This business segment continued to expand, with the acquisition and founding of new renal care centers, and they have already had a positive impact on sales.

Growth in specific regions Germany, with sales growth of 3.5 percent, showed positive results in a very competitive environment. In Europe (excluding Germany) sales growth was robust at 4.7 percent in local currencies, while growth in euros was 5.1 percent. Performance in the Asia-Pacific region was strong in local currencies, with sales in local currencies up 9.2 percent. Growth in euros was 6.3 percent, with sales increasing to € 1,236 million. China, South Korea and the Philippines achieved particularly strong sales growth. North America showed solid sales growth both in US dollars, with 5.2 percent, and in euros, with 3.1 percent. Expenses of € 65 million were incurred due to regulatory requirements and extensive modernizations in US production facilities. The Africa and Middle East region also performed very well in the B. Braun Group’s currency, with a gain of 7.5 percent. Growth in local currency was 5.1 percent. Latin America also

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showed impressive sales growth of 8.9 percent in local currencies. Growth in euros was 9.7 percent. Progress was especially strong in Brazil, Chile, Colombia and Mexico.

Over a billion more euros in investment In 2017, for a second straight year, B. Braun had over one billion euros in investment. After investing € 1.098 billion the previous year, in 2017 the Group invested € 1.285 billion for the expansion of production capacities and for research and development of new products and processes. 44.2 percent of this investment went to the company’s sites in Germany. The Hospital Care division expanded its global capacities for large-volume infusion solutions in Spain, Indonesia, Malaysia and Germany. The expansion of the enteral nutrition pumps production capacity and other equipment continued at various locations. Research and development activities were primarily focused on increasing patient and user safety and improving hospital workflows. Aesculap combines both internal and external innovations in its research and development activities. Internal research focused on the innovation fields of miniaturization and biological solutions. The emphasis of external research was on young companies and business incubators. In Spain, the division continued to upgrade a previously acquired building to allow automation of production in Closure Technologies. The renovation of the division’s headquarters in Tuttlingen also continued with additional investments. The Out Patient Market division focused on the developing the urology, stoma care, hand disinfection and wound care product ranges. Investments were made in the production

of pen needles at the Penang site, among others. In France, the first steps were taken in the site master plan, and planning continued for the Sempach site in Switzerland. The goal of research and development for the B. Braun Avitum division was to improve extracorporeal blood treatment quality and efficiency. In addition, the division increased market share by expanding existing renal care centers, building new centers, and acquiring centers in various countries. Construction on a new modern filter production facility at the Wilsdruff site in Germany also made great progress.

62,000 employees worldwide The B. Braun Group had 61,583 employees as of December 31, 2017. This is up 6.1 percent from the total of 58,037 employees the previous year. In Germany, the number of employees climbed by 3.6 percent to 15,415 (previous year: 14,876). This was due to smaller acquisitions, along with expansion of production capacity and recruitment for R&D. In light of demographic changes, making qualification possible with a wide range of vocational training programs is very important to B. Braun. 342 trainees successfully completed their training at our locations in Brazil,

Germany, Malaysia, Poland and Switzerland in 2017 (previous year: 373). Over the same period, the Group hired 261 trainees (previous year: 275) after the completion of their training. In Brazil, Germany, Malaysia, Poland and Switzerland, there are currently 1,091 young people doing their apprenticeship with us (previous year: 1,065).

Outlook “For the financial year 2018, we expect that the Group will continue to grow in sales and earnings”, Prof. Große stated at the financial press conference. Sales growth will be between five and seven percent, assuming exchange rates remain constant. The process of “digitization” is an integral component of all of the Group’s development and projects and is something B. Braun considers to be part of its continued progress and a guarantor of long-term competitiveness. The system partnership approach will also stay in focus in 2018. “In the spirit of the principle “Sharing Expertise”, we strive as a “System Partner in Healthcare” to develop effective solutions and innovative standards for Healthcare in close partnership with our customers and partners”, Große explained. The first signs of success in the market show that B. Braun is on the right path with these initiatives.

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Making Healthcare Facilities Available and Affordable Operating design of a Telehealth Service Model addressing affordability & availability issues for the underprivileged population

o be able to deliver Healthcare Services over the internet is one of the biggest technological revolutions of the current era. Telehealth Services including Telemedicine have proven to have a positive impact on the healthcare delivery around the world.

It is no longer a question of “if” Telemedicine helps to improve healthcare. Multi-center studies have confirmed its efficacy in several ways including maintaining healthcare quality, patient engagement and the system cost-effectiveness. The market for telemedicine technologies is predicted to grow at a compound annual growth rate of 18.4% through the year 2020. (Forbes)

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Telemedicine brings a set of benefits to improve healthcare delivery in the following ways: • • • •

Access to care. Care coordination. Healthcare quality. Cost-effectiveness of Healthcare expenditure.

The evolution of Telemedicine impacts three strategic focus areas: • •

Improving health outcomes. Accelerating change in medical education. • Enhancing physician satisfaction and practice sustainability. Telemedicine is defined as “A

system that engages one or several means of telecommunication to deliver a range of healthcare services connecting the healthcare provider (the doctor, therapist or nurse) and care recipient (the patient)”. At present, over 75% of Telemedicine is conducted over Online Live Video.

Telemedicine technology, at present, has evolved and shaped in following three designs: • • •

Store-and-forward. Remote monitoring. Real-time interactive services.

Advantages of deploying Telemedicine Services Improved Access Minimum Physi-

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cian Density for safe healthcare is to be 1 doctor for 1000 people. WHO

The Physician Density has wide international and national variables e.g.: • •

India – 0.59 doctor for 1000 patients. UK – 2.81 doctors for 1000 patients.

Telemedicine services being able to connect doctor and patient globally over the internet, balance out the Physician Density across various countries and within a country between various cities. Cost Efficiencies Telemedicine to benefit people who can’t otherwise access healthcare. Forbes

Cost of Healthcare Services has been shown to be reduced by deploying Telemedicine solutions: • • • •

Better management of chronic diseases. Shared health professional staffing. Reduced travel times. Fewer or shorter hospital stays.

In US, the average cost of a virtual visit is $45 while attending a clinic can cost as much as $176 per visit. Improved Quality Help patients by allowing more Telemedicine. Forbes Studies have consistently shown that quality of outpatient healthcare services delivered via telemedicine is as good as traditional in-person consultations.

Telemedicine offers medical consultation to patients with several benefits such as:

Dr Suhail Chughtai

Dr Samer Ellahham

Fellow of Royal College of Physicians & Surgeons Glasgow, UK and a Microsoft Certified Professional. Based in London UK as an Orthopaedic Surgeon, Medico-legal Examiner and Medical IT Expert with special experience in designing Telehealth Software and Service structures. An International Speaker on Medical IT and Telehealth having instructed and spoken over 100 Medical IT and Telehealth Conferences and Workshops in several countries in the last 15 years. Leads a Telemedicine Firm (Medical City Online, www.Medicalcity.Online) with a portfolio of over 20 Telemedicine and e-Training projects for Medical Professionals in several countries.

Regional Chair, Middle East, Patient Safety Movement Foundation, Cleveland Care Giver, Cardiology Consultant Cleveland Clinic Abu Dhabi, American Board Certified Internist, Cardiologist & Vascular Medicine Consultant. He led the development of a quality and safety program that has been highly successful and visible and has been recognized internationally by several awards. He is recognized as a leader in quality, safety, and the use of robust performance improvement in improving healthcare delivery. Certified Professional in Healthcare Quality (CPHQ) and in Medical Quality (CMQ) by The American Board of Medical Quality (ABMQ). Lean Six Sigma Master Black Belted.

• •

•

Healthcare advice when they need, and where they need it. Medical issues can be quickly addressed through real-time urgent consultations within minutes. A timely diagnosis initiates prompt treatment to improve clinical outcome and reduce the subsequent cost of a delayed diagnosis. Remote monitoring of patients discharged from hospital enables early intervention if needed.

Healthcare delivery issues addressed by the suggested Telehealth Service model

•

Affordability issue: Connecting Specialist and Patient for an affordable Online Medical Consultation to extend the healthcare facilities to people in the low-income band who cannot otherwise afford Specialists’ fee or at places even can’t afford family physician’s consultation. Distance and Reach issue: Connecting primary healthcare support via an Online Medical Consultation between a Patient and a Family Physician from main cities to smaller towns and villages for a nominal cost or even free wherever possible.

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•

Access to quality medical care: The filtration process while selecting healthcare professionals for both specialist and family physician consultations will enable provision of highly qualified medical assistance to patients in less advantaged areas who may otherwise fall prey to quackery.

Elements of the Service Model •

•

Peripheral Online Medical Clinic Hub: A suitably qualified nurse, trained in operating a Telemedicine Software, equipped with a webcam-laptop on the standard internet will run the Peripheral Online Medical Clinic Hub (Peripheral OMC Hub) which could be a local dispensary, primary health center, a well-established pharmacy or similar healthcare facility. Healthcare Service Provider: A Family Physician or GP (primary healthcare advice provider) would be trained on the Telemedicine Software, to be able to provide Online Teleconsultation from home or clinic using an internet connected laptop with a webcam. Appointments: To be made at the Peripheral OMC Hub through local advertisement using print, media and other suitable means of the campaign. Billing: Billing will be at the Peripheral OMC Hub for offering highly discounted fee structure. In places, it can be free depending upon the level of funding available. Prescription: The prescription will be printable at the

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•

Peripheral OMC Hub and at places will be dispensable in the same facility within a range of available medicines. Follow-up: Repeat appointment as guided by the involved doctor will be arranged by OMC Hub Incharge through the Telemedicine Software. Electronic Medical Records: Uploading of the available records (Documents, X-rays, Images) will be the responsibility of the Nurse In charge of the OMC Hub who will be trained in such process. Requesting new investigations: Local Labs and Radiology facilities will be engaged for OMC Hub with a view to cost-effective solutions for the patients, thus adding further value for service.

Structure of the Management Team for the Telehealth Project Telemedicine Software Provider Firm • Provider of Technology. • Maintenance of the Telemedicine Software system. • Software Trainer and Expertise in Clinical Adaptation. Coordinator for the Medical Professionals • Suitable personnel with a capacity to engage relevant medical professionals. • Ability to setup roster of the Online Medical Professionals. • Ability to draw a backup plan if an Online Medical Professional’s short notice absence. Coordinator for the Peripheral Online Medical Clinic Hub

•

Suitable personnel with the capacity to judge and choose a Peripheral OMC Hub depending upon the population density and need. Ability to set up the necessary services needed at the facility.

The Project Directors • Technical Services Coordination. • Performance and Output Coordination. The Account Management and Financial Audit Team • Suitably qualified and experienced accountant to monitor and audit financial transactions and business aspect of the project. • Expertise to draw a financial forecast and a Profit-Loss balance sheet. • Expertise to enlist expenses, both routine and irregular expenditure. The Project Marketing Team • Suitably qualified and experienced marketer to use print and social media for raising awareness about the service. • Expertise to set up local TV programs, organize road shows in the local areas etc. The Project Correspondence Secretary • Suitably qualified and experience Admin personnel to manage telephone calls, emails and coordinate between various teams.

Roles and Responsibilities of each Team Project Director – Technical Services

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• •

•

To choose a suitable Telemedicine Software for the service. To enable deployment of Software and Hardware between the doctor and peripheral hub. Master level Training of the Doctors involved in using the Software for an efficient service. Training the Trainers and Team-on-ground to handle routine software queries. To run regular webinars for both doctors and field workers on using the Telemedicine Software for upscaling knowledge and motivation. To evaluate and update the software with developing needs of the healthcare infrastructure.

Project Director – Technical Services • To formulate Clinical Adaptation Strategy for an efficient and safe medical practice. • Research and Development for ensuring Clinical Compliance for day to day practice • Setting up KPIs for Medical Professionals and Para-medical staff of the project. • To manage clinical governance issues and ensuring patient safety. • To ensure an appropriate selection of other support teams.

Coordinator for the Medical Professionals To manage Family Physicians and Specialists • Locating relevant medical professionals using help of other project teams and medical organizations affiliated to the program.

•

• •

•

Inviting doctors through emails and managing their queries on phone calls. Going through CVs and setting up a database (Medical City Online Platform). Ensuring validity of qualifications and medical registration. Shortlisting and inviting doctors to Online Video Interviews (Medical City Online Platform). Interviewing and finalizing the selection of the Medical Professionals. Preparing Contractual Agreements for the doctors.

To setup Online Clinics Calendar • Setting up Clinic Diary for the OMC Hubs. • Getting Doctors to cover the Clinic Days. • Ensuring a backup for each clinic. • Providing information on whom to contact for technical troubleshooting. • Strategize expansion of service to suitable locations.

Coordinator for the Peripheral Online Medical Clinic Hub •

•

To research, locate and engage a local outlet for serving as an OMC Hub to be remotely connected to the Healthcare provider. To locate, shortlist, interview and employ the OMC Hub Staff. A qualified healthcare nurse or paramedic or trained health technician. A receptionist with above average computer literacy for managing appointments/ records.

•

To train OMC Hub Staff to a master level on using Telemedicine Software on billing, printing the prescription etc To provide a basic introduction of the Telemedicine Software to the Medical Professionals leaving Master Skills Training for Medical City Online team Managing queries of the Doctors on the usage of the Software after they received Master level training from the Medical City Online team Acting as “Team on Ground” for the Telemedicine Software and Hardware related queries

Potential Project Enablers Project Enablers are the organizations which can contribute or provide logistical, financial or clinical support to the Medical City Online project through their established position in the field of their expertise or business. • Pathology Labs. • Pharmacies. • Private Hospitals. • Doctor’s organizations. • Medical Colleges in Private Sector.

The intended Outcome The population living in less privileged areas will get access to qualified healthcare service providers discouraging the use of quackery in medical practice. The standards of healthcare are likely to improve by not only improving timely access to qualified help but by minimizing the complications occurring due to unavailability of medical advice. A detailed model of the service and its cost-effectiveness is available with the authors along with case study of its deployment and performance.

ARTICLE FEATURES . Peripheral Artery Disease

Peripheral Artery

DISEASE

rteries are blood vessels that carry blood rich in oxygen throughout your body. Healthy arteries have smooth inner walls and blood flows through them easily. Some people, however, develop clogged arteries, which result from a build-up of a substance called plaque on the inner walls of the arteries. Arterial plaque can reduce blood flow or, in some instances, block it altogether.

Peripheral artery disease (PAD) is a common circulatory problem in

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which narrowed arteries reduce blood flow to your limbs. When you develop PAD, your extremities - usually your legs - donâ€™t receive enough blood flow to keep up with demand. If left untreated, PAD can lead to gangrene and amputation. However, modern methods of treatment have been accompanied by state-of-the-art equipment to treat the hardening or blockage of peripheral arteries; therefore, it is rare nowadays to find a patient who got gangrene which causes the amputation of the foot.

PAD is usually caused by a buildup of fatty deposits in the walls of the leg arteries. The fatty deposits, called atheroma, are made up of cholesterol and other waste substances. The build-up of atheroma on the walls of the arteries makes the arteries narrower and restricts blood flow to the legs. Many people with PAD have no symptoms. However, some develop a painful ache in their legs when they walk, which usually disappears after a few minutesâ€™ rest. The pain can range

ARTICLE FEATURES . Peripheral Artery Disease

from mild to severe, and usually goes away after a few minutes when you rest your legs. Both legs are often affected at the same time, although the pain may be worse in one leg.

Causes People with diabetes are at higher risk of developing atherosclerosis, the most common cause of peripheral artery disease. Factors that increase your risk of developing peripheral artery disease include smoking, diabetes, obesity, high blood pressure, high cholesterol, increasing age, a family history of peripheral artery disease and heart disease or stroke. If the blockage remains in the peripheral arteries in the legs, it can cause pain, changes in skin color, sores or ulcers and difficulty walking. Total loss of circulation to the legs and feet can cause gangrene and loss of a limb. If the blockage occurs in a carotid artery, it can cause a stroke.

Symptoms While many people with peripheral artery disease have mild or no symptoms, some people have leg pain when walking (claudication). Claudication symptoms include muscle pain or cramping in your legs or arms that’s triggered by activity, such as walking, but disappears after a few minutes of rest. The location of the pain depends on the location of the clogged or narrowed artery. Calf pain is the most common location. The severity of claudication varies widely, from mild discomfort to debilitating pain. Severe claudication can make it hard for you to walk or do other types of physical activity. Symptoms also include painful cramping in your hip, thigh or calf muscles after certain activities, such

as walking or climbing stairs, leg numbness or weakness, coldness in your lower leg or foot, sores on your toes, feet or legs that won’t heal, a change in the color of your legs, among others. If peripheral artery disease progresses, pain may even occur when you’re at rest or when you’re lying down (ischemic rest pain). It may be intense enough to disrupt sleep. Hanging your legs over the edge of your bed or walking around your room may temporarily relieve the pain.

Peripheral angioplasty A peripheral angiogram is a test carried out to identify any blood vessel narrowing or blocked areas in the arteries. By injecting a dye (contrast material) into your blood vessels, this test allows your doctor to view blood flow through your arteries as it happens. Your doctor is able to trace the flow of the contrast material using imaging techniques, such as X-ray imaging or procedures called magnetic resonance angiography (MRA) or computerized tomography angiography (CTA). Catheter angiography is a more invasive procedure that involves guiding a catheter through an artery in your groin to the affected area and injecting the dye that way. Although invasive, this type of angiography allows for simultaneous diagnosis and treatment — finding the narrowed area of a blood vessel and then widening it with a dilating procedure or administering medication to improve blood flow. Before the procedure you will be given medicine to help you relax. You will be awake, but sleepy. You may also be given blood-thinning medicine to keep a blood clot from forming and

you will lie down on your back on a padded operating table. Your surgeon will inject some numbing medicine (local anesthesia) into the area that will be treated, so that you do not feel pain. Your surgeon will then place a tiny needle into the blood vessel in your groin. A tiny flexible wire will be inserted through this needle. • Your surgeon will be able to see your artery with live x-ray pictures. Dye will be injected into your body to show blood flow through your arteries. The dye will make it easier to see the blocked area. • Your surgeon will guide a thin tube called a catheter through your artery to the blocked area. • Next, your surgeon will pass a guide wire through the catheter to the blockage. • The surgeon will push another catheter with a very small balloon on the end over the guide wire and into the blocked area. • The balloon is then filled with contrast fluid to inflate the balloon. This opens the blocked vessel and restores blood flow to your heart. A stent may also be placed in the blocked area. The stent is inserted at the same time as the balloon catheter. It expands when the balloon is blown up. The stent is left in place to help keep the artery open. The balloon and all the wires are then removed. The entire process takes between half an hour and an hour, but in some cases it may take longer if the doctor decides to treat the blockage of the artery by dilating it or injecting drugs to dissolve the blood clot if present.

NEWS

Bellevue Medical Center hosts a regional conference to reduce bone fractures in the Middle East and inaugurates the multidisciplinary spine center his pain, which is 90% of the cases might be done through non-surgical treatment options like medical treatments, stress management, physiotherapy and rehabilitation, osteopathy, psychotherapy and others.

eputy Prime Minister and Minister of Public Health Ghassan Hasbani inaugurated the regional conference to reduce bone fractures in the Middle East, hosted once again by Bellevue Medical Center, in addition to the multidisciplinary spine center which adopts a different treatment approach in this field. The opening ceremony, organized by the Fragility Fracture Network (FFN), was attended by a large number of prominent Lebanese and international physicians, specialized nurses and other health specialists as well as media professionals. The conference, which lasted for three consecutive days, discussed the latest scientific developments and treatments in the field of bone surgery. It also hosted eleven of the best international speakers in the world, including Professor Paolo Falaschi, president of Fragility Fracture Network (FFN), as well as a selection of famous Lebanese and international physicians and many specialists in several health fields, who shared the advanced methods in the field of bone surgery, including limbs surgery, spinal surgery, lower back pain, etc. The conference coincided with the inauguration of the multidisciplinary spine center at the hospital, founded by Professor Nabil Okais. It is based on a new and comprehensive approach to treat patients and give them hope of recovery without resorting to the option of surgery immediately. This unique center includes a team of physicians and healthcare professionals from different specializations who study the file of each patient and meet with him to explain his condition in order to take effective action to relieve

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Commenting on the two events, Deputy Prime Minister and Minister of Public Health Ghassan Hasbani said: “I am honored to inaugurate the BMC Spine Center with you and happy to witness medical providers teaming up to serve man and medicine. I always think of health from a patient’s point of view. But what I found today, in this excellent hospital, is exactly what patients need. Your therapeutic approach is humane, multidisciplinary, integrative, holistic, and complete. It is fit to deal with any patient with back pain - regardless of the physical or psychological stressors they face. They will heal, with you standing by them.” Dr. Ghassan Maalouf, Medical Director and Vice President for Medical Affairs at Bellevue Medical Center expressed his pride that Lebanon is hosting this international medical conference given the need for continuous education and sharing the latest international innovations. He said: “I thank His Excellency the Minister of Health for his presence and support for this conference which will emphasize Lebanon’s pioneering status in keeping abreast of the latest developments in the world of bone surgery and providing the best treatments for patients, especially that bones and spine problems are worsening, most notably back pain.” He added: “44% of Lebanese office workers suffer from low back pain, 54% of them are hospital staff, which makes it the second most important reason for seeing a doctor, the fifth reason for being hospitalized, and the third reason to undergo a surgery. Therefore, and in order to ensure the well-being of our patients, we decided to open the spine center and make true the dream of Professor Nabil Okais given the importance of multidisciplinary care and the need to include psychological and physical therapy, bone surgery and neurosurgery.” The conference and the new center will provide an excellent quality of care for orthopedic patients and improve their physical and psychological well-being. This is the approach adopted by the hospital to treat the human being as a whole, not only his illness.

NEWS

Hamdan Medical Award trains over 100 radiology specialists on improving the safety of imaging techniques gram and earned 8.5 CME hours accredited by the Dubai Health Authority. At the opening, His Excellency expressed his pleasure with the Award’s organization of this important training program under the direction of His Highness Sheikh Hamdan Bin Rashid Al Maktoum, Deputy Ruler of Dubai, Minister of Finance, President of the Dubai Health Authority, and Sponsor of the Award. He has played an instrumental role in the fulfillment of the Award’s most important goal, which is to further medical excellence on all levels.

Dr. Jamila Al-Suwaidi, Consultant in Radiation in Medicine Developments at the Dubai Health Authority’s Department of Medical Education, and Associate Director of the training program, extended her gratitude and appreciation towards His Highness Sheikh Hamdan Bin Rashid Al Maktoum for his continued support in holding these events, which serve to progress the healthcare sector in the United Arab Emirates. She added that the Award’s coordination of these programs is important, considering the ever-increasing use of radiological imaging – in particular, the use of x-rays – and has played a significant role in educating and training professionals in the field and improving the overall performance of medical centers in the country. This year’s training program discusses the importance of following safety procedures and taking measures to protect patients – especially younger patients – against the dangers of radiation, as well as the effects of radiation on the physician. Additionally, training will highlight the importance of adequate monitoring, dosing, and a comparison of practice will be made between medical centers across the UAE, Duke University Medical Center and Massachusetts General Hospital.

The program will take place over two days at the Mohammed Bin Rashid Academy of Medicine and Health Sciences at Dubai Healthcare City, with the third day of workshops dedicated to revising safety protocols for the use of x-rays. Over 100 referring physicians, radiologists, radiographers and medical physicists attended the pro-

The Hamdan Medical Award has organized numerous training programs from 2014 till date – in collaboration with the Dubai Health Authority – and strives to contribute towards the education and professional development of practitioners across the nation. One of the Award’s top priorities is to continually refine the quality of services within local medical centers and to accredit clinics across the country. These training programs offer preventive measures in radiological practice that are approved by the Federal Authority for Nuclear Regulation in the UAE.

is Excellency Abdulla Bin Souqat, Executive Manager of the Sheikh Hamdan Bin Rashid Al Maktoum Award for Medical Sciences, inaugurated a training program organized by the Award in collaboration with the Dubai Health Authority, Harvard Medical School, Massachusetts General Hospital, and Duke University Medical Center titled “Making Patients and Staff Safer in Radiological Imaging”.

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Serco Middle East expands its growth & development team by appointing Ayesha Sultan as Managing Director Growth

Aeysha Sultan

erco Middle East, a leading provider of public services has expanded its Growth team in the region by appointing Ms. Ayesha Sultan as Managing Director Growth.

Ayesha Sultan, a UAE National, is a tri-lingual strategy and investment professional with over 18 years of

experience across the UAE, UK and France, with multinational organisations including Dubai Holding, DP World, Dubai Expo 2020, PA Consulting Group, Royal Bank of Scotland, Pfizer, Glaxo Smith Kline and Government entities. Ms. Sultan will be reporting directly to David Greer the CEO of Serco Middle East. Ayesha holds an MSc. in Operational Research and BSc. in Mathematics and French from the University of Southampton, UK and she has completed a Leadership programme from the Wharton School of Business, University of Pennsylvania, USA. She is also a Fellow and Chartered Director of the UK Institute of Directors (MSc, BSc, CDir, FIoD) and she was a mentor on the pilot programme for ‘European Women on Board’ hosted out of Brussels, Belgium.

David Greer, CEO of Serco Middle East states: “Ayesha brings with her considerable Middle East expertise and experience in joint operations, growth strategies and mergers and acquisitions. Ayesha is a key addition to our team and her appointment comes at a time when we are continuing to expand across the Middle East and promote the development of national staff. She will be responsible for enhancing our customer base, identifying, shaping and helping to win new contracts and spearhead growth across our existing client base and help expand business across all current and adjacent geographies. She will also take a lead role in the further development of our Al Mosharakah Programme aimed at the career enhancement of all Emirati and GCC national staff.”

Serco and Dr. Sulaiman Al Habib Medical Group strengthening and developing their partnership to attain Saudi 2030 Vision Goals

n the spirit of strengthening ties between the United Kingdom and the Kingdom of Saudi Arabia, Serco and Dr. Sulaiman Al Habib Medical Group agreed to ‘expand and develop their partnership’ Hesham Al Habib Vice President, Dr. Sulaiman Al Habib Medical Group and David J. Greer Chief Executive Officer, Serco Middle East announced at Mansion House during the visit of His Royal Highness Mohammed Bin Salman, Crown Prince, Deputy Prime Minister and Minister of Defense of the Kingdom of Saudi Arabia to the UK.

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In 2013, Serco Middle East, a subsidiary of Serco Group PLC, entered into a joint venture with Dr. Sulaiman Al Habib Medical Group (HMG) creating the entity ‘Serco Saudi Services’ with the initial purpose of delivering Integrated Facilities Management in the Kingdom. Over the past four years, working in collaboration with HMG, Serco has achieved excellent performance levels across eight non-clinical services and has brought its international experience to; enhanced the skills and experience of the workforce, through training programmes and targeted profes-

sional development; and has innovated the delivery of the service through the implementation of technology including a Computer Aided Facilities Management (CAFM) system. Following this successful phase of Serco Saudi Services (SSS), Serco and HMG are seeking to expand and further develop their partnership to participate in attaining the Saudi 2030 Vision goals. SSS will work across government initiatives, in the Education, Transport and Healthcare sectors to provide Integrated Facilities Management to new infrastructure projects including Public Private Partnerships.

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National Committee for Organ Transplantation met to unify standards for organ donation in wake of successfully rescuing nineteen patients with Organ Donation

n cooperation with SEHA and Zayed Bin Sultan Al Nahyan Charitable and Humanitarian Foundation within the framework of” Year Of Zayed” events, the National Committee for Organ Transplantation organized a forum and workshop to discuss the compliance of all U.A.E health entities to unified organ donation standards, tasks, responsibilities and methodology to report brain death. Dr. Ali Karim Al Obaidli, Chairman of the National Committee for organ transplantation stated that the forum will be held after launching the program of organ donation after death in UAE. This follows the recent successful transplant of human organs from six donors who suffered brain death in UAE. Nineteen patients benefited from this organ donation process. Performance indicators and best practices in the field of organ donation were reviewed to provide hospitals with the required knowledge and support and to establish integration between them at a national level. The forum attracted a numerous attendees, with participation from leading experts in organ donation

His Excellency praised the scientific efforts provided by the National organ transplantation committee in keeping pace with rapid developments in UAE under the wise leadership of our esteemed leaders and the progressive government. He wished the forum continued success and to fulfill the potential of the foundation to serve all humanitarian capacity and encouraged all concerned persons in humanitarian organizations to support and provide assistance and cooperation. from Spain and Italy as well as representatives from health and charitable organizations from across all UAE emirates. They reviewed the importance of collaboration among governmental, private and charitable organizations in order to develop sustainable national human organ transplantation program to serve patients with organ failure. H.E. Hamad bin Salem Al Ameri, Director General of the Zayed Bin Sultan Al Nahyan charitable and humanitarian Foundation welcomed the attendees from National Organ Transplantation Committee; the physicians, specialists, and guests, emphasizing the Foundation’s interest in supporting health programs in the UAE and accomplishing its humanitarian and charitable mission as established by the founder of the Endowment Foundation, Sheikh Zayed Bin Sultan Al Nahyan, God rest his soul. The Foundation continue to support the humanitarian efforts by providing health programs along with educational and social projects to relieve the suffering of patients and to provide effective medical treatments for patients from income-limited sectors who cannot cover their treatment costs.

Dr. Faisal Shahin, General Manager of Organ Transplantation Saudi center, reviewed the KSA experience. He informed the forum that the program is under the direct supervision and support of the Custodian of the Two Holy Mosques, King Salman bin Abdul-Aziz Al Saud for the past 30 years. “The governmental and charitable organizations play an important role in supporting and establishing an integrated program”. He added that U.A.E has all fundamentals that enable her to assume a prominent position with respect to human organ donation at a regional level. From his side, Dr. Abdel Karim Al Obaidli has declared that the National Organ Transplantation Committee has an agreement with Marathon Zayed Charity Committee, in cooperation with key partners, to organize the Zayed Charity Marathon in Abu Dhabi before the end of year 2018 to support the initiation of the human organ and tissue donation program in UAE, to increase public awareness, to prevent organ failure, and to enhance a healthy lifestyle through patient education and support for patients with organ failure.

ARTICLE FEATURES . Safe Fasting with Diabetes

Safe Fasting with Diabetes

any patients with diabetes insist on fasting during Ramadan, despite the high temperature and long hours during the day, creating a challenge for themselves and their healthcare providers. Doctors believe that diabetic patients can fast provided that they comply with their instructions; however, there are some medical conditions that prevent a patient with diabetes from fasting. Therefore, the commitment of diabetic patients to the recommendations and guidelines of their doctor, who should be visited before the month of Ramadan, is the most important step that enables the patient to fast without causing any health problems such as sudden increase or drop of their blood sugar level. The diabetic should stick to the quantity and quality of food specified by the nutritionist in order to maintain a good health during fasting while avoiding the consumption of sugar and sweets that can be replaced with fresh fruits. The diabetic patient must also avoid

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eating fried and fatty foods. It is essential that patients monitor their blood glucose levels multiple times daily during Ramadan in order for them to determine their need of oral medications or insulin injection. Endocrinologists in the Muslim world have set some rules for the patients with type 1 diabetes who are advised not to fast during Ramadan especially those with brittle type 1 diabetes, patients who take more than 3-4 insulin injections daily or those with frequent hypo and high blood sugar, patients living alone or those with severe kidney or eye complications or who are prone to frequent diabetic ketoacidosis. Type 1 diabetics can also fast but need pre-Ramadan assessment by their doctor or

ARTICLE FEATURES . Safe Fasting with Diabetes

diabetic nurse specialist and advice on insulin regimen change or dose alteration. Any patient with type 2 diabetes suffering from one or more of these symptoms is advised not to fast. Symptoms include urinary albumin with a creatinine ratio greater than 1.5 mg, patients with diabetic retinopathy, who suffer from complications in the heart, blood vessels and brain or who have very high blood glucose level, patients who take several insulin shots daily, pregnant diabetic women and breastfeeding mothers or people suffering from acute ulcer, renal failure, mild heart attacks, severe mental illnesses or defect in liver function.

Patients with Type 1 Diabetes Type 1 diabetes is the insulin-dependent diabetes and fasting is not advised for these patients especially if they suffer from recurrent blood sugar swings or the diabetic patient is pregnant. It is essential that patients monitor closely their blood glucose levels multiple times daily during Ramadan in order to determine their need of oral medications or insulin injection. Diabetic patients should follow the health guidelines advised by their doctor while frequently monitoring their blood glucose level in order to adjust the insulin dose. Monitoring glucose level gives the diabetic patient an idea whether he is able to continue fasting during the holy month. The fast should be immediately broken if blood glucose suddenly decreases because it will drop further if treatment is delayed. Drugs used by diabetic patients differ depending on the type of treatment whether it was a drug or insulin regimen especially during the month of Ramadan. If the patient takes tablets once in the morning, he must take them with Iftar meal while

Type 1 Diabetes

Type 2 Diabetes

taking into consideration to change long-acting hypoglycemic drugs to short-acting drugs in order to prevent hypoglycemia. If the patient takes tablets twice a day, he must take one with Iftar and the other with the Suhur meal. While patients who need one dose of insulin should take the injection right before the Iftar meal and those who need two-dose insulin (day and night) are recommended to ask their doctor to avoid any risk of hypoglycemia or hyperglycemia.

their blood sugar levels to increase or drop so they donâ€™t cause any damage to their body organs, and not be forced to break their fast. If there are signs of hypoglycemia or hyperglycemia, fasting should be broken immediately and the patient should eat something in order to maintain a normal blood sugar level and prevent serious diabetes complications.

Patients with Type 2 Diabetes Patients with type 2 diabetes, noninsulin-dependent diabetes, can fast. This type of diabetes occurs when either the body makes too little insulin or the cells do not respond to insulin that is produced. Patients with type 2 diabetes may be able to control their blood sugar levels by following a diet, exercise program and losing excess weight. Studies suggest that it is useful for patients with type 2 diabetes to fast during Ramadan provided that their condition does not require them to take drugs continuously throughout the day to treat their blood sugar level. Most importantly, these patients must avoid everything that may cause

Diabetes Nutrition Patients with diabetes should follow a specific diet in order to maintain a normal blood sugar level and avoid serious complications. They should know that the healthier their diet, the more they will be able to fast without any serious health problems. Usually, breakfast should contain one date, sufficient amount of water, soup which is necessary to prepare the stomach, and then the patient should take his medicine and have a simple break that may be used to perform the prayer. After that, the patient consumes a small breakfast consisting of rice or a loaf of brown bread, a sufficient amount of vegetables, and a medium piece of meat or fish. He can also eat a fruit after an hour. The diabetic patient should consume three meals, one at Iftar and one at Suhur then a third meal; they

ARTICLE FEATURES . Safe Fasting with Diabetes

should also drink plenty of water and fluids and avoid sweetened juices due to their high sugar content. Also, fluids should be distributed throughout the night and not be drunk at once. He should also eat a small portion of Ramadan desserts and check his blood sugar level more often than on regular days. Diabetic patients are recommended to monitor their blood glucose level before and 2 hours after every meal in order to adjust the insulin dose. They should also reduce salt intake because it significantly increases the risk of kidney and heart disease in people with diabetes. Patients should not eat large food portions at Iftar as well as foods high in fat or carbohydrates, and should start eating a small amount of simple carbohydrates that can be absorbed quickly by the body such as dates. Suhur should consist of a sufficient amount of carbohydrates, a loaf of brown bread with one egg or lowfat cheese. Sweets and sugary juices

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must be avoided and the patient must drink plenty of water and avoid soft drinks. Suhur meals include a large amount of safe proteins because they are slow to be absorbed, and the blood sugar level does not increase after the meal, giving a feeling of satiety for as long as possible. It is also advised to eat complex carbohydrates in the first Suhur meal in Ramadan in preparation for fasting the first day.

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Dietary guidelines for patients with diabetes who wish to fast include: •

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Sticking to the diet, medication and guidelines regarding the food quantity allowed during Iftar and Suhur. Patients with diabetes are advised to have Iftar and Suhur and a snack in between. Drinking plenty of fluids such as soup, milk, water and unsweetened drinks. At Iftar, it is preferable to start with a simple sugar like two

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dates with yoghurt or half a glass of fresh fruit juice. Avoiding traditional Ramadan drinks such as licorice and Qamar ad-deen (or apricot juice) and replace them with yoghurt or natural fruit juice. Following healthy food instructions for patients with diabetes. Avoiding the use of meat extracts when preparing soups and replacing them with chicken broth while following the right method. The patient with diabetes can eat two pieces of Atayef two hours after Iftar. Diabetics are advised to have some sugar cubes, sweets or dates handy to reach for them directly when experiencing hypoglycemia symptoms. Using spices, onions, garlic and lemon to add flavor when preparing meals instead of butter and salt.

‫(مارس) ‪99 l 2017‬‬ ‫الثاين (يناير)‬ ‫كانون آذار‬

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