HOSPITALS Magazine issue 41 by The Arab Hospital Magazine

Issue 41 / 141 JULY - AUGUST 2018

THE ARAB HOSPITAL APPLICATION IS AVAILABLE

PREVENTIVE MEDICINE Strengthens the health services MALARIA Transmitted by mosquito bites

SHIPPING SERVICES In the Healthcare Sector Smart Beds in Hospitals A revolution in patient safety

PET-CT SCAN

helps detect very early changes in the cells

NEWS

Changing Perspectives: XN-L Series

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

Around 1,000 AC, the Arab medical scientist Qasim Al-Zahrawi published his renowned 1,500-page illustrated encyclopedia about the basics and methods of surgery and its tools. It was used as a reference for Arabs and Europeans for eras. Al-Zahrawi was the first to perform a caesarian operation, which successfully contributed to millions of births around the world. He was also the first to use an aneurysm needle and a thread made of silk to ligate the artery and control blood flow, in addition to his further achievements. For the first time in the history of mankind, Ibn al-Haytham was the first to explain that the eye is a tool that receives the reflected light from objects and is not a source of light as the Greeks thought. He was also the first to say that the convex lens helps see things larger than they are, and the first to explain the composition of the eye. This is a sample of history and, of course, there are many other achievements which, although dating back to many eras, remain fundamental for subsequent accomplishments. This is true, as we are witnessing today numerous achievements in the Arab medical sector across this region from the ocean to the Gulf. Whether at the individual level where many Arab medical innovators are excelling in medicine worldwide or at the level of Arab hospitals whose specifications match the best hospitals in the world with their state-of-the-art facilities, expert management and leading medical staff; and of course, this will lead to further successes that will regain the former glory that faded but is always there. The Publisher

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

JULY . AUGUST 2018

40 52

44 36

74 46

NEWS

1 6 American Hospital Dubai to begin fit-out of its new clinic in Galleria Mall Al Barsha 8 Baylor St. Luke’s Medical Center offers a new breath of life for transplant patient 10 Emirates Rare Diseases Association Holds its First Awareness Event 12 Dr. Zulekha Daud honored by H.H. Sheikh Abdullah bin Zayed Al Nahyan 14 UK-Based Medical Tourism Marketing Agency Expands to Dubai in Response to Rapid Growth of Global Medical Tourism Industry 18 The new Leonardo DR mini II Now even lighter and more comfortable 24 RAK Insurance wins ‘2018 UAE Medical Insurance Company of the Year Award’ 26 Weill Cornell Medicine-Qatar

Grand Rounds discusses healthcare improvement teams 32 Dr. Azad Moopen receives Lifetime Achievement Award at the Gulf Indian Leadership Summit 2018 34 Mubadala Healthcare’s Healthpoint Launches Integrated Information System and Achieves Top Industry Recognition 36 Bellevue Medical Center (BMC) Becomes First Hospital in Lebanon Awarded Gold Certification for Excellence in Person-Centered Care by Planetree International 56 Boehringer Ingelheim’s 4th Regional Thoracic Medicine Forum 60 Experts highlight the need for comprehensive stroke care

FEATURES

1 40 PET-CT Scan

82 46 64 Global accreditations in Medical Laboratory 74 Malaria 78 Preventive Medicine 82 Medical Shipping 92 Multiple Sclerosis

SMART BEDS

44 Smart Beds 50 MEATI Smart Bed Content - HILL ROM 52 Building strategy for Smart Hospitals by Dr. Anees Fareed 54 All about safety - LINET

ARTICLES

68 Deep infiltrating endometriosis, should all surgery be centralized? 70 Coronary artery disease in patients with chronic kidney disease 86 Gallstones 94 Facts about Obesity 96 The impact of sleep on childhood obesity

INTERVIEWS

62 Dr. Christian Haddad Laboratory Director at the University Hospital Center of Notre Dame des Secours (CHUNDS), Jbeil and Head of the Lebanese Syndicate of Biologists (SDBL) JULY.AUGUST 2018

‫ديسمبر ‪December 2018‬‬

‫‪ORTHOPEDIC MECHANICS‬‬

‫مـيكانيـكـيا تـقـويم العظام‬

‫‪ORTHOPEDICS‬‬

‫جراحة العـظـام‬

‫‪RHEUMATOLOGICAL DISORDERS‬‬

‫أمـــــــــــــــــــراض المفـــــــــــــــــــــــاصل‬

‫‪MUSCULOSKELETAL DISORDERS‬‬

‫اضطرابات الجهاز العضلي الهيكلي‬

‫‪NEWS‬‬

NEWS

American Hospital Dubai to begin fit-out of its new clinic in Galleria Mall Al Barsha quality of care closer to our patients in Al Barsha and surrounding neighborhoods to meet their evolving needs.”

Mr. Miltos Bossinis

Dr. Robert Courteney

merican Hospital Dubai – one of the leading pioneers of private healthcare in the Middle East – is set to start the fit-out of its second community clinic off-campus serving the growing population in Dubai’s residential community of Al Barsha. The new clinic will be strategically located in the newly constructed Galleria Mall Al Barsha, near Al Barsha Pond Park, and will offer the same quality of care for all members of the family through a dedicated team from American Hospital Dubai, which has served local and regional patients from its main campus since opening in 1996. The hospital’s new Al Barsha Clinic is expected to open in the last quarter of 2018. American Hospital Dubai’s Al Barsha Clinic will offer a range of services for all members of the family, starting with primary care, endocrinology, dermatology, and physiotherapy. The 11,500-square-foot clinic will have a dedicated physician team supported by an on-site nursing team and support staff. Once open, the Al Barsha Clinic will offer close and convenient

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access to high-quality primary care for patients in the nearby residential areas, as well as access to the American Hospital Dubai’s full range of specialty services and diagnostics at the main hospital campus. Commenting on the new clinic, American Hospital Dubai’s Chief Medical Officer and Acting CEO, Dr. Robert Courteney-Harris, said: “We are excited to start the fit-out of the American Hospital Dubai’s Al Barsha Clinic. We have always been one of the leaders in private healthcare and the latest addition to our clinics continues this tradition. This major development reflects our commitment to continuing to serve the community of Dubai. Our plan is to take our established

Mr. Miltos Bossinis, the CEO of H&H Investment and Development, stated: “We are delighted that American Hospital has become a partner in the Galleria Mall Al Barsha. American Hospital is renowned as a standard bearer throughout Dubai for quality private healthcare which is in line with our vision of delivering bespoke quality developments that enhance communities and redefine the urban fabric of the UAE”. He continued, “H&H is delighted to develop and manage Galleria Mall Al Barsha, another great retail development which we strongly believe will follow the steps of the already successful Galleria Mall located in Jumeirah”. Al Barsha clinic will complement AHD’s existing clinic in Dubai Media City (DMC) which is located in the Business Central Towers on Sheikh Zayed Road and will bring high-quality care closer to an even wider part of the Dubai community. In the DMC clinic, that first opened its doors in 2015, patients can get a feel of what they can expect from the new Al Barsha clinic once it opens.

NEWS

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NEWS

Baylor St. Luke’s Medical Center Offers a New Breath of Life for Transplant Patient

Dr. Gabriel Loor

ilviano Trino is breathing a sigh of relief after undergoing a groundbreaking, long-awaited double-lung transplant. Baylor St. Luke’s Medical Center (Baylor St. Luke’s) is the first hospital in Texas and third in the United States to perform a breathing lung transplant using the Ex Vivo Lung Perfusion (EVLP) procedure with Organ Care System Lung (OCS Lung) technology. This technology is designed to keep donor lungs functioning and “breathing” in human-like conditions from the time of the donor procedure all the way to the transplant surgery. After being turned away from four medical centers in other parts of the country due to his health, Trino

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met with Dr. Gabriel Loor, surgical director of the lung transplant program at Baylor St. Luke’s and director of lung transplantation in the Michael E. DeBakey Department of Surgery at Baylor College of Medicine, and his transplant team where it was determined he would be a candidate for the EVLP transplant. Shortly after, Trino and his family made the move from Miami to Houston where they would wait for the call for a viable pair of lungs. The surgery was performed as part of the EXPAND II OCS trial, for which Baylor St. Luke’s is a study site, testing the outcomes of transplanted donor lungs that are transported, preserved, optimized, and monitored on a portable OCS device. Led by Dr. Gabriel Loor, the trans-

plant was performed at Baylor St. Luke’s using the newest generation of EVLP platforms, Transmedics Organ Care System (OCS), a portable device that maintains the organ in its own physiologic state with warm blood perfusion, ventilation, and a sophisticated monitoring system to continually assess the organ in flight. In Trino’s case, the donated lungs were flown in to Houston from the Midwest and were kept “breathing” on the OCS Lung machine for a total of 11 hours. The device is the only portable EVLP system in the world and the only one that has undergone a positive U.S. Food and Drug Administration (FDA) panel review in the U.S. as well as two rigorous international clinical trials. The OCS Lung System was officially approved by the FDA

NEWS

on March 23. The technology has the ability to keep the lung active, healthy, and breathing, which had the same affect the patient. A short thirty-six hours following the surgery, Trino was in his room recovering; 10 days later, he was out of the hospital. Trino is even enjoying being able to sing again – something he hasn’t done in years. With nearly 100,000 people on the waiting list for life-saving organ donations in the United States, the

new technology paves the way for future groundbreaking transplants across the country. Thanks to this revolutionary OCS technology, donor organs are more protected and transplants are no longer restricted by time or distance. This improves the standard method of organ transplantation and provides the opportunity to widen the potential organ donor pool and help save more lives. Trino and his family are thankful for the life-saving procedure per-

formed by Dr. Loor and his dedicated team at Baylor St. Luke’s. He can now breathe, and sing, easier knowing he has a second chance at life. The lung transplant program at Baylor St. Luke’s in Houston’s renowned Texas Medical Center continually strives to meet the needs of patients through innovative breakthrough research and leading-edge technology, and is committed to compassionate quality healthcare that improves and saves lives.

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

NEWS

Emirates Rare Diseases Association Holds its First Awareness Event

n collaboration with Sheikh Hamdan Bin Rashid Al Maktoum Award for Medical Sciences, The Emirates Association of Rare Diseases will organize an awareness and entertainment forum, in conjunction with the International Phenylketonuria Day. The event is geared towards patients, their families and nutritionists, and will be held on the 28th of June, 2018 at the Lapita Hotel, Dubai Parks & Resorts. Mr. Meshaal Hamady, President of the Society said, “The association organizing this event aims to introduce the Society and its activities The objectives of this Society include supporting patients and their families, and organizing a program of education and awareness for the community, clinicians, specialist nutritionists, nurses and specialized students. The Society also plans to focus on the development of research into rare diseases, and to highlight the role of the United Arab Emirates in preventing and detection of rare disease through early screening of newborns.” Dr. Fatma Al Bastaki, Consultant Pediatrician in Clinical Genetics and Metabolism, and member of the Board of Directors of the Society, said

Dr. Fatma Al Bastaki

“Phenylketonuria is a rare genetic disorder resulting in the accumulation of an amino acid called phenylalanine in the body. The affected gene (genetic mutation) causes a deficiency of the enzyme needed to process the amino acid, phenylalanine. The serious accumulation of phenylalanine occurs when a person with phenyl ketone is eating protein-rich foods such as milk, cheese, nuts, meat, and also cereals, such as bread, pasta, or aspartame-an artificial sweetener. This accumulation of phenylalanine causes damage to nerve cells in the brain. People affected with the severe form of the disorder, whether they are infants, children or adults, need a diet for the rest of their lives that limits phenylalanine, which is found in foods containing protein”.

HE Abdullah Bin Souqat

On his part HE Abdullah Bin Souqat, Executive Director of the Award, said” The Award is always keen to participate in such important events, which aim to spread awareness on public health. The Award has especially given rare diseases top priority over the last eight years through its many awareness campaigns, and school competitions. This in in addition to the contributions of the Awards’ Centre for Arab Genomic Studies (CAGS) in issuing reports and scientific research articles on rare diseases. Our objective is to raise public awareness about the concept of genetic diseases in the Arab world, and to help identify pathogenic gene defects among Arabs with the help of our in-house database on genetic diseases in the region. “

74 Female Students Participate in the 26th Cultural Pluralism Program of Al Maktoum College in Scotland

nder the patronage of H.H. Sheikh Hamdan bin Rashid Al Maktoum, Deputy Ruler of Dubai and UAE Minister of Finance, 74 female students participated in the 26th "Cultural Pluralism and Leadership Skills Program - Summer Academic Training Program (ATP)," which was organized by the Al Maktoum College of Higher Education. The students represented 13 universities and colleges from the UAE and the Police Academy in Abu Dhabi, Malay University in Malaysia, the Economics and Political Science

JULY.AUGUST 2018

College at Cairo University, Fujairah University and the Hamdan bin Mohammed Smart University, as well as the Emirates National Oil Company, ENOC, for the first time. Mirza Al Sayegh, Chairman of the Board of Trustees of the College, said that the program will include many academic and summer activities, which aim to achieve its desired objectives and reinforce inter-cultural communication. The students will visit historic areas of Scotland and will attend various workshops on the history and culture of Scotland, cultural pluralism, Islam from a political perspective, Islam and women, and the relations between communities, he further added.

NEWS

Dr. Zulekha Daud honored by H.H. Sheikh Abdullah bin Zayed Al Nahyan care sector in the UAE and her tireless efforts to boost welfare levels for UAE citizens and residents.

.H. Sheikh Abdullah bin Zayed Al Nahyan, Minister of Foreign Affairs and International Cooperation recognized and honored Dr. Zulekha Daud, Founder and Chairperson of Zulekha Healthcare Group and presented her with a letter of thanks and appreciation of her five decades of valuable contributions to the health-

The recognition coincides with the “Year of Zayed” Initiative during which the country is commemorating the indelible legacy of the Founding Father. It also comes to reaffirm the deeply-rooted relations between the two countries across different domains. The ceremony highlighted the long-standing relationship between the UAE and India. Overwhelmed with the recognition Dr. Daud said, “The award is an absolute honour for me and I extend my heartfelt gratitude to Sheikh Abdullah. The UAE Government has always appreciated my work and this inspires me to do more for the nation. The people and its Rulers have been very welcoming, generous and motivated my endeavours, which gives me strength.” The recognition and private meeting took place at The Leela in New Delhi, in the presence of her family including Mr. Taher Shams, Mrs. Zanubia Shams, Aamir Shams, and Dr. Ahmed Abdulrahman Al Banna, the UAE Ambassador to India.

Leading International Trade Fair

WORLD FORUM FOR MEDICINE

DÜSSELDORF, GERMANY 12–15 NOVEMBER 2018 www.medica-tradefair.com

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The world of medicine at a glance: • Electromedical equipment/Medical technology • Laboratory technology/Diagnostics • Physiotherapy/orthopaedic technology • Commodities and consumer goods • Information and communications technology If you want to see it all, understand it all and experience it all, then come to Düsseldorf for the world’s largest forum for medicine!

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NEWS

UK-Based Medical Tourism Marketing Agency Expands to Dubai in Response to Rapid Growth of Global Medical Tourism Industry

combined with the continued growth of Dubai’s medical tourism industry, make this the ideal timing to cement our position in Asia and the Gulf Cooperation Council. We’re excited to further support this geographic market and healthcare providers globally as Dubai quickly gains momentum as the world’s foremost healthcare destination.”

igital Hermes, the world’s exclusive medical tourism marketing agency, is expanding beyond its United Kingdom headquarters with a new office in Dubai. The expansion strategically supports Dubai’s strong emergence as the future medical tourism capital of the world – one of the fastest growing global markets with a compound annual growth rate (CAGR) of 18.8 percent1. Dubai has experienced spectacular growth over the past decade as one of the Middle East’s most-visited tourist destinations, due in part to its impressive commitment to improving its medical infrastructure. Medical tourism in Dubai has gained traction due to its high-quality facilities, English-speaking medical staff and no waiting lists for treatments. Dubai offers a myriad of first-class medical treatments, including cochlear implants, diabetes treatments, orthopedics, cardiology, obesity surgery, oncology, neurology, plastic and cosmetic surgery, physical therapy, dermatology, rheumatology, ophthalmology, lung treatments and urology. “We’re thrilled to announce the expansion of Digital Hermes with this new office,” said Digital Hermes CEO Anna Kaczmarska. “Our continued mission of assisting healthcare providers with local and international marketing strategies,

JULY.AUGUST 2018

The medical tourism industry’s rapid growth is due to expensive or insufficient healthcare services in certain countries, resulting in individuals seeking medical attention outside their country of residence. The industry is currently valued at more than $68 billion and projected to exceed $125 billion by 2021. Currently, 63 percent of patients think they deserve more attention from their healthcare provider. Approximately 34 percent of patients are more careful in selecting a healthcare provider than they were just one year ago, resulting in 11 million medical tourists annually. Digital Hermes’ medical tourism marketing and business development solutions help reach these target patients to offer world-class treatments combined with holidays, therefore creating optimum patient experiences. The company strives to provide improved healthcare worldwide, positioning clients as leading international brands in their respective specialties and generating demand for their specific treatments. To date, they have helped clients in 14 countries expand internationally and attract more patients. Last year alone, they helped clients reduce patient acquisition costs by 60 percent. Supporting its expansion into Dubai, Digital Hermes has also welcomed Dr. Abdullah Alabdulkarim as an investor and managing partner from Saudi Arabia. Additional information about Digital Hermes can be found online, at www.digitalhermes.com.

Digital Hermes Digital Hermes is a global medical tourism marketing agency specializing in healthcare and medical tourism communications solutions. The company offers integrated solutions for healthcare practices worldwide, with vast experience in European, Middle East, Asian, African and Latin American markets. Digital Hermes bridges every discipline and every communication channel to help medical practices create value, gain speed and grow patient satisfaction. Its clients include doctors, clinics, patient support groups and other healthcare and well-being centers and institutions. 1. Orbis Research 2016-2021 Market Data Forecast

NEWS

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

Under the patronage of

10 - 12 SEPTEMBER 2018, Riyadh International Convention and Exhibition Center, Riyadh, KSA

Be part of the Saudi’s premier healthcare business platform

>> Meet decision-makers, government authorities, high net worth investors from the KSA >> Promote your products and services to more than 10,000 industry professionals across the Kingdom >> Align your brand with the only show under the patronage of the KSA Ministry of Health

10,000

250+

attendees

international & local exhibitors

conferences

Market overview 52.3%

Market Share KSA is the largest healthcare market in the GCC as it accounts for more than half (52.3%) of the region’s market share. Source: GCC Healthcare Construction Market Outlook September 2015

$4.3bn

$40bn

Healthcare Projects

Healthcare Spend

Saudi Healthcare sector to grow at a rate of 12.3% through to 2020 well above the MENA average of 5.3%

Saudi Arabia is planning to build several ‘medical cities’ in the Kingdom at a total cost of $4.3bn

Source: Big changes Ahead Saudi Arabia, Oxford Business Group 2017

$11bn

$42bn

The cumulative expenditure in this sector is set to reach $11bn by 2021 of which 98% is imported

Saudi Arabia imports 70% of its pharmaceutical needs and is set to reach $42bn by 2021

Source: Healthcare & Life Sciences, Invest Saudi

Medical Devices

Pharmaceuticals

Official Country Pavilions:

Supported by:

Canada

China

Pakistan

Media Partners:

Organised by:

Germany

Turkey

Italy

Netherlands

In collaboration with:

life sciences exhibitions

GET INVOLVED EXHIBIT & VISIT sales@globalhealthsaudi.com

www.globalhealthsaudi.com

@globalhealthsaudi

@healthsaudiexpo

Global Health Exhibition

NEWS

The new Leonardo DR mini II Now even lighter and more comfortable

n May 2018, OR Technology presents the second generation of the portable X-ray case Leonardo DR mini. The Leonardo DR mini II surpasses its predecessor in its equipment at lower weight. At only 8.9 kg, the Leonardo DR mini II is one of the world’s lightest portable X-ray case systems. The case does not only convince by its attractive design. The high-quality plastic processing and the well-planned space concept form the basis for a practical case for any outdoor use. If necessary, the case shell can be easily cleaned with water. The mobile compact package fits behind every car seat. The practical suitcase solution is quickly ready to go and easy to use. All components are integrated in the X-ray case. The 17” laptop can easily

JULY.AUGUST 2018

be removed from its holder in the case and used as a tablet for presentation purposes. The notebook is equipped with the dicomPACS®DX-R acquisition and diagnostic software. The wireless CsI X-ray detector is transported space-saving in the case inside and guarantees best image quality even at low X-ray doses. Everything is stored perfectly. The Leonardo DR mini II supports its users in outpatient digital radiology in the areas of human medicine such as home care, disaster control, emergency medicine on ships, yachts and oil platforms as well as in medical services. In veterinary medicine, the suitcase solution can be used in a veterinary practice, equine clinic or university facilities. On our website, you will find all important information about the equipment, dimensions and advantages of the Leonardo DR mini II.

The highly functional X-ray suitcase Leonardo DR mini II lets you provide both passengers and crew members with the best possible medical X-ray care in an emergency. The X-ray suitcase - the latest development of the Leonardo series - combines X-ray detector technology with the powerful acquisition and diagnosis software. Weighing only approx. 8.9 kg, the compact suitcase with its shock-absorbing, dirt-repellent plastic coating is one of the lightest X-ray systems in the world. At sea, situations can arise that require rapid radiological clarification. The integrated reporting software offers a worldwide, fast and cost-effective exchange of information (via ORCA cloud or email) while complying with and taking into account security regulations for telemedical solutions. In an emergency, X-ray images can be transferred to a specialist for an exact diagnosis. The straightforward operation of the system and the integrated acquisition and diagnostic software by OR Technology make it easy even for less radiologically trained personnel to take optimal X-ray images. In addition, the integrated X-ray assistant provides videos to support the correct positioning of the patients during the X-ray process. The Leonardo DR mini II is quickly ready for use and easy to operate. A built-in 17" premium notebook with touchscreen and high screen resolution as well as the integrated acquisition and diagnosis software guarantee an excellent image display. The notebook can be very easily removed from the suitcase, moved into an ergonomic working position and used as a tablet for presentation purposes

NEWS

Moorfields Dubai highlights concerns about cataracts The leading cause of blindness - as ageing population & diabetes threaten ‘perfect storm’

Dr. Ammar Safar

his Cataract Awareness Month (June 2018), consultants at Moorfields Eye Hospital Dubai are sharing their concerns about the increasing incidence of cataract - the leading cause of blindness in the world - in the region. The GCC has a growing population over the age of 40 and also faces the challenge of diabetes – the two major risk factors for cataract. The good news is that cataracts can be treated very effectively (95% success), quickly (20 minute procedure), simply (in an outpatient setting) and safely, with intraocular lens implants; even better, the condition does not reoccur after treatment. Moreover, cataract treatment has now become one of the most common procedures performed worldwide. ‘Cataract’ (meaning a large waterfall) describes the gradual clouding of the natural lens of the eye – which is like looking through a waterfall. They

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can be caused by a wide variety of factors including age, trauma, illness or use of medications. Over time, the lens protein undergoes structural transformation, leading to the clouding effect and to loss of vision. According to the World Health Organisation (WHO), cataracts are the leading cause of blindness and visual impairment in the world (47.9%) and their prevalence increases each year as the world’s population ages. In the USA alone, there are 24 million people over the age of 40 who are affected by cataracts. In the Gulf region, an ageing population combined with the high incidence of diabetes is raising concerns. The over-65 group is forecast to rise from 1.2% of the population in 2015 to 14.2% by 2050. The risk of cataracts is much higher amongst the large community of people with diabetes in the GCC - those with type 2 diabetes statistically face a 60% greater risk of developing cataracts. Research has also shown that people with type 2 diabetes who lower their HbA1c level by just 1% can reduce their risk of cataracts by 19%.

Cataracts can affect people of any age including children and young adults although, in adults, symptoms may not appear until the age of 40. The causes are not clear but could include hereditary factors, illness, eye trauma and smoking. There is no way to prevent age-related cataracts but a healthy lifestyle – including healthy eating and not smoking - can slow their progression. Dr. Ammar Safar, Consultant Vitreoretinal Surgeon and Medical Director of Moorfields Eye Hospitals in the UAE, said: “Of course, the region’s naturally ageing population will lead to more age-related health issues, including cataracts, but the high incidence of diabetes will amplify this ageing effect significantly. Cataracts generally develop and progress slowly and will lead to significant vision problems and ultimately blindness, if left untreated. The good news is that cataracts can be treated very effectively with modern surgery to remove the cloudy lens and insert a high-quality lens implant. Once treated, cataracts do not return.”

NEWS

Trend Micro Expertise

Results in Conviction from Scan4You Trial

back in 2012 and collaborated closely with the FBI. The service went offline following the arrest of two suspected administrators in May 2017.

Ruslans Bondars was found guilty as a result of the trial, while Jurijs Martisevs pled guilty in March 2018. The arrest and trial were the result of an exclusive investigative cooperation between Trend Micro researchers and the FBI. Scan4You allowed cybercriminals to check the detection of their latest malware against more than 30 modern antivirus engines, enabling them to make attacks more successful. Trend Micro began its research

“As a leading voice and global citizen in the fight against cybercrime, we are always proud to support law enforcement globally,” says Ed Cabrera, chief cybersecurity officer for Trend Micro. “In this case, our global threat intelligence network and team of researchers proved an invaluable resource for the FBI as it honed in on this notorious CAV service. This is a big blow to cybercrime, helping to disrupt countless threat actors and prove there are consequences to their actions. We stand shoulder to shoulder with law enforcement in our efforts to secure the connected world.”

rend Micro Incorporated (TYO: 4704; TSE: 4704), a global leader in cybersecurity solutions, announced details of its close cooperation with the FBI to identify, arrest and bring to trial the individuals linked to the infamous Counter Antivirus (CAV) service Scan4You.

JULY.AUGUST 2018

Trend Micro has a long and successful history of cooperation with global law enforcement. To date, our investigative efforts have supported approximately 20 law enforcement cases around the world, including work with Interpol, Europol and the UK’s National Crime Agency (NCA). Most recently, a multi-year collaboration with the NCA led to the successful conviction of the operator of notorious CAV service reFUD.me. To find out more on Scan4You and how Trend Micro’s research-fueled solutions and collaboration with law enforcement help to proactively block threats from impacting customer organizations, read our new white paper: The Rise and Fall of Scan4You.

NEWS

RAK Insurance

wins ‘2018 UAE Medical Insurance Company of the Year Award’ at the 2018 Frost & Sullivan Middle East Best Practices Awards Banquet

AK Insurance was named the ‘2018 UAE Medical Insurance Company of the Year Award’ at the 2018 Frost & Sullivan Middle East Best Practices Awards Banquet held on 14th May, 2018 at Atlantis, The Palm in Dubai. Ras Al Khaimah National Insurance Company (RAK Insurance) has more than four decades of experience in medical insurance with numerous offerings catering to both individuals and corporates. RAK Insurance offers the largest medical insurance offering to group clients with more than 250 products. It has a diverse portfolio for individual clients with the option to choose from 14 medical insurance packages. The company’s innovative medical insurance provision services that include online and mobile applications, together with its strong technology partnerships have ensured its growth even in a slow market. The company also invests heavily in educating end consumers on the benefits and ease of subscribing to medical insurance. RAK Insurance’s expertise in risk assessment and insurance consulting has further strengthened its position in the UAE market as the leader in Medical Insurance.

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Mr. Andrew Smith, CEO of RAK Insurance commented “We would like to thank Frost & Sullivan for honouring RAK Insurance with this award. 2017 was a challenging year for the medical insurance sector in the UAE with increasing competition, a changing regulatory landscape and pressure on pricing. I am delighted with our achievements to date andI would also like to congratulate my team for their continuing contribution to the success of RAK Insurance. Our focus for 2018 will continue to keep our clients at the centre of our business. We shall further develop our digital capability to enhance our client proposition and broaden our medical offering to the UAE Insurance Market.” Extending congratulations to RAK Insurance on winning the award, Mr. Sandeep Sinha, Vice President, Transformational Health Practice, Frost & Sullivan said “2017 has been a successful year for RAK Insurance during which its year-on-year revenue growth rate has been over 13% in the UAE medical insurance market while enhancing its member services. The company has a deep and diversified experience in the insurance industry, which it has inculcated to widely develop the medical insurance sector in the UAE. RAK Insurance offers the largest number of medical insurance products in the UAE, which together with its well-trained, digital application solutions and strategic partnerships are the key factors contributing to its leadership position in the region. RAK Insurance’s integrity, information technology knowledge and process transparency has set the standard for medical insurance providers in the Emirates.”

Frost & Sullivan Awards recognise companies across regional and global markets for outstanding achievement and performance, superior leadership, technological innovation, customer service, strategic product development, etc. The methodology for short-listing Award winners is by an eminent Jury that deliberates on structured data and research backed presentation / recommendation by our Senior Industry Experts. Frost & Sullivan Industry Experts track markets and companies by holding detailed interactions with industry experts, market participants, end users, other stakeholders / value chain players and extensive research of proprietary data, to compile the Jury Evaluation Matrix. Evaluation by the Jury ultimately results in the final Awardee, from amongst the nominees.

Frost & Sullivan Frost & Sullivan, the Growth Partnership Company, works in collaboration with clients to leverage visionary innovation that addresses the global challenges and related growth opportunities that will make or break today’s market participants. For more than 50 years, we have been developing growth strategies for the global 1000, emerging businesses, the public sector and the investment community.

RAK Insurance Ras Al Khaimah National Insurance Company (P.S.C.) trading as RAK Insurance is a Public Shareholding Company established in 1974. The Company is listed in the Abu Dhabi Securities Exchange (ADX) and the authorised and paid up capital is AED110 million.

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Weill Cornell Medicine-Qatar Grand Rounds discusses healthcare improvement teams Dr. Deborah White, full professor, Dean and CEO of the University of Calgary in Qatar, gave a presentation explaining the capacity of high-performing teams for initiating positive change in healthcare, as well as the challenges facing them.

Dr. Deborah White

trategies for facilitating the transformation of local healthcare through improvement teams and networks were discussed at the latest Weill Cornell Medicine-Qatar (WCM-Q) Grand Rounds.

Speaking at WCM-Q to an audience of physicians, pharmacists, nurses and allied health professionals, Dr. White identified various facilitators and barriers to the creation of quality and safety improvement teams, which are often termed ‘quality circles’. She also explained the key skills required of clinicians and leaders as members of high-performing improvement teams, and the impact of shared culture, attitudes and beliefs on teams and im-

provement initiatives. In particular, Dr. White said that a shared commitment to quality must pervade not just entire teams but entire organizations, and that this is facilitated by opportunities for multi-level engagement. Dr. White said: “Culture is really important and quality is everyone’s business, all the way from the people who do the cleaning in the hospital right through to the senior leadership. In some of my experiences going across Canada, that was demonstrated in the hospitals in quality circles where nurses, physicians and support workers all talked together about what they were doing. That sort of engagement at all levels is necessary as a platform for innovation and success.”

... Research probes links between gut health, autism and bowel disorders

Dr. Ghizlane Bendriss

esearchers at Weill Cornell Medicine-Qatar (WCM-Q) are investigating the role of bacteria in the human gut in the development of autism spectrum disorder and inflammatory bowel disease.

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In the first study of its type to be conducted in Qatar, WCM-Q researchers are collaborating with the Child Development Center to attempt to establish whether microorganisms living in the gut – collectively known as ‘gut microbiota’ – could be linked to autism spectrum disorder (ASD) and inflammatory bowel diseases such as Crohn’s disease, ulcerative colitis, celiac disease and irritable bowel syndrome.The study has been prompted by a growing body of international research, which suggests the link between the gut and the brain is far more important to human health than previously thought. WCM-Q’s Dr. Ghizlane Bendriss, visiting lecturer in biology, is leading the study. Dr. Noha Yousri, adjunct assistant professor of genetic medi-

cine, and Dr. Dalia Zakaria, biological sciences teaching specialist, are responsible for the bio-statistical and microbiological analyses of the project, respectively. Dr. Bendriss said: “We have ten times more bacteria cells than human eukaryotic cells in our body and these bacteria play important roles in the secretion of metabolites, neurotransmitters, and other modulators. These microorganisms need to be in a state of balance between the beneficial and harmful bacteria; disruption of this balance is called dysbiosis and appears to impact the function of various organs. The first organ to be altered is the gut itself, which will become leaky, thereby allowing allergens, metabolites and other molecules to enter the blood and later on cross the bloodbrain barrier to reach the brain.”

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LINET Group provides a complete patient care solution. The innovative beds, mattresses and other equipment are designed to support the treatment and convalescence of the patient as well as safe, ergonomic and less physically demanding nursing.

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Zulekha Hospital introduces ‘Lose More Win More’ campaign in support of UAE’s quest to fight obesity I was able do it. I was motivated to continue my healthy diet and other healthy practices that led to the loss of 16 kilos eventually. I realized I was more energetic and that in itself is a wonderful feeling. Many of my colleagues were motivated to adapt some of my new healthy practices after seeing my results, and it made a positive difference to the team as a whole.”

ulekha Hospital has announced the results of its ‘Lose More Win More’ campaign which is an employee drive designed to raise awareness on the importance of combatting obesity in UAE. The campaign involved an employee challenge to lose weight with monetary prizes as an incentive. The programme is aimed at fighting obesity in line with the UAE’s national agenda which includes 10 specific health goals to be achieved by 2021, five of which are related to Non Communicable Diseases (NCDs): tackling CVD (Cardiovascular Diseases), diabetes, cancer, obesity and smoking. According to WHO (World Health Organization), obesity is a major cause of NCDs which account for 76% of all deaths in the UAE equating to 11,600 every year. Staggeringly, there is almost a one in five chance of dying prematurely – between the age of 30 and 70 – from one of these largely avoidable conditions.*

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“Tackling obesity as a major cause for common diseases was the main purpose of the campaign which caters not only to spread a healthy lifestyle across Zulekha Hospital employees, but also to the wider UAE community. We’ve witnessed an exciting journey by those who challenged themselves to lose weight and gain self-confidence in the process, achieve better health, as well as receiving motivational prizes,” said Taher Shams, Managing Director of Zulekha Healthcare Group. The Lose More Win More campaign comprised of four rounds, periodic monitoring for participants and nutritionist advisory visits. Pratheesh Raj, P - OT - Staff Nurse at Zulekha Hospital Sharjah and the winner of the 1st prize, added: “When I took up the challenge, it seemed impossible and difficult to stick to the action plan to achieve my weight loss goal. After I lost two to three kilos, I was more confident that

Jane Frances Chidamba, the winner of the 2nd prize from the Nursing Team in Zulekha Hospital Sharjah, commented after achieving a remarkable weight loss: “Such positive initiatives are welcomed by all employees. I am very happy I was able to lose over 15.5 kilos during a sixmonth period with the support of the programme and my colleagues – I am now much more confident. The prize money itself was motivating for sure, but being able to give back to oneself and take care of my body became more important as we went through this experience.” Commending the willpower of all participants Mrs. Nafeesa Ahmed, Director of Nutrition and Lifestyle Management in Zulekha Hospital says, “Most participants lost over 10 kilos in the campaign period and it is heartening to see their enthusiasm during their weight loss journey. We are keen to launch this campaign year-on-year and encourage a culture of health consciousness within the organisation. Diet plays a very significant role in shaping one’s identity. We must all be extra cautious of what foods we intake.” *Source: WHO

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Clinical Therapeutics, Dietary Supplements and Aesthetic Solutions Propel the Anti-aging Market to Hit $85.6 Billion by 2022

rug-as-a-service model leveraging big data analytics, multi-ingredient products, and nanotechnology applications will create growth opportunities, finds Frost & Sullivan. The anti-aging industry is experiencing a paradigm shift toward embracing an age prevention-management-treatment continuum that is focused on health span rather

than lifespan-driven metrics. This transformation will drive new growth opportunities for providers offering integrative solutions combining the three market segments—conventional therapies, dietary supplements, and aesthetic procedures, devices and products—delivered using digital enablers. Frost & Sullivan, in partnership with A4M.com, has recently released its analysis, Anti-aging Therapies &

Services Market—Trends & Growth Opportunities, which provides an assessment of trends, challenges, and growth opportunities tied to emerging anti-aging therapies and services. Business models, market dynamics, technology applications, and investment opportunities are also discussed. This market is forecast to reach $85.6 billion, growing at a compound annual growth rate (CAGR) of 6.5 percent from 2017 to 2022.

Technologies that will be key enablers in the anti-aging market include: •

• • •

Artificial Intelligence: AI-powered virtual assistant can help improve drug adherence as well as prevent adverse events. Additionally, AI-powered digital therapeutics will be crucial for driving digitally-enabled customer engagement. Big Data & Analytics: Drug-as-a-service models will require seamless access to and analysis of patient healthcare data and will drive pharmaceutical and technology company collaborations. IoT & Cloud: Real-time telehealth/telemedicine applications, such as on-body trackers and diagnostic devices, will drive the need for IoT-enabled, cloud-based solutions. Mobile Devices: The widespread prevalence of mobile devices will boost the growth of applications based on solutions for drug adherence, activity monitoring, as well as virtual assistance.

“The industry’s movement toward a ‘prevent-manage-repair’ approach to aging is creating opportunities for integrative methodologies for age management,” said Neelotpal Goswami, Global Transformational Health Senior Industry Analyst at Frost & Sullivan. “Key technology trends such as the use of digital enablers and drug-as-a-service will drive pharmaceutical and technology company collaborations.”

To benefit from these growth opportunities, savvy companies should: • • • • •

Adopt novel pharmacological approaches that target specific drivers of aging, such as telomeres, rapalogs, senescent cells, and mitochondria-based therapies. Develop regenerative medicine focused on cell and gene therapy. Enhance dietary supplements, personalized genome-based diets and fasting-mimetic diets that offer clinically validated results. Leverage digital therapeutics and digital pills powered by big data and analytics, artificial intelligence, cloud computing, and mobile technologies. Foster aesthetic solutions that offer long-term results with minimum discomfort.

“Aging is the result of multiple physical pathways and processes, making it complicated to manage. Additionally, regulations are a key challenge for the industry, with aging still not being recognized as a disease by regulatory bodies, making it difficult for companies to position their products and solutions,” observed Goswami. “However, these multiple pathways offer opportunities for multi-pronged pharmacological approaches focused on areas such as telomeres and senescent cells, as well as the use of regenerative medicine.” Anti-aging Therapies & Services Market—Trends & Growth Opportunitiesis part of Frost & Sullivan’s Transformation Health – Life Sciences Growth Partnership Service program. JULY.AUGUST 2018

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Dr. Azad Moopen receives Lifetime Achievement Award at the Gulf Indian Leadership Summit 2018

r. Azad Moopen, Founder Chairman & Managing Director of Aster DM Healthcare, received the Lifetime Achievement Award at Gulf Indian Leadership Summit and Awards 2018, organized by Republic TV.

The award recognises Dr. Moopen’s outstanding contribution in shaping the healthcare industry in UAE and the Gulf. Starting from a single clinic in Dubai in 1987 to global healthcare conglomerate of more than 323 facilities spread across nine countries, Aster DM Healthcare established by Dr. Moopen, has been driven by his mission of providing quality healthcare that is affordable and accessible to everyone. The award was presented by Shri Rajyavardhan Singh Rathore, Minister of State- Ministry of Youth Affairs and Sports; and Union Minister of State- Ministry of Information and Broadcasting in India; accompanied by Mr. Arnab Goswami, Managing Director of Republic TV during the prestigious felicitation ceremony held at Grand Hyatt Hotel, Dubai.

Aster Pharmacy

Launches its First Eco-Friendly Pharmacy in UAE

ster Pharmacy, the largest healthcare retail chain in UAE has launched a one-of-its-kind green pharmacy which is built with sustainable, recyclable visual merchandise and branding material to minimize impact on environment.

Delivering upon its philosophy of ‘Delivering Good Health and Happiness’ this concept was introduced by Aster pharmacy to safeguard the health of its customers and also the surrounding environment.

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Mubadala Healthcare’s Healthpoint Launches Integrated Information System and Achieves Top Industry Recognition

•

ubadala Healthcare and Cerner, a global leader in healthcare technology, have collaborated to implement Cerner’s integrated electronic health record (EHR) at Mubadala Healthcare’s Healthpoint facility. “We are pleased to be one of the first hospitals in the Middle East to upgrade our health information system with the latest Cerner software,” said Dr. Jose Lopez, CEO, Healthpoint Abu Dhabi. “Our patients will benefit from a seamless experience that starts with their arrival at the check-in desk. The new software will help us access the right information at the right time and supports our physicians in making the appropriate decisions for our patients. Cerner will empower us to provide our community with the healthcare services they deserve.” “Sehati,” Arabic for myHealth, is the name given to the integrated clinical information system operating

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on Cerner Millennium® for use within Mubadala Healthcare’s facilities, which are Healthpoint, National Reference Laboratory, Wooridul Spine Center, Cleveland Clinic Abu Dhabi’s Anatomic Pathology Lab and other remote sites. Cerner’s EHR is designed to support an individual’s healthcare journey across the continuum – from the doctor’s office to the hospital and outpatient clinics – with consistent patient engagement. Implementing Cerner solutions will benefit Healthpoint’s clinicians and patients in several ways, including: • Documenting care, placing medication and other orders easily. • Supporting high-quality care with the use of standardized treatment guidelines. • Reducing the potential for transcription errors by having all care documented electronically, eliminating the possi-

bility of errors due to illegible handwriting. Improving access to information with clinicians having near real-time access to patient details when needed with no time wasted searching or waiting.

“Cerner is honored to collaborate with Healthpoint to mark a new transformation in the delivery of advanced healthcare services in Abu Dhabi. This collaboration is a strategic fit to Cerner’s long-term presence in the Middle East region and United Arab Emirates,” said Michael Schelper, General Manager – UAE & Kuwait, Cerner Middle East and Africa. “We look forward to continuing working together and planning with the Healthpoint team to achieve their vision.” In addition, Healthpoint achieved Stage 6 of the Electronic Medical Record Adoption ModelSM (EMRAM) from Healthcare Information and Management Systems Society (HIMSS) Analytics. The HIMSS Analytics EMRAM Stage 6 award was presented to the hospital during the EMRAM Awards Ceremony that was held at the 2017 annual HIMSS UAE eHealth Week in Dubai. “Healthpoint is also a HIMSS EMRAM Stage 6 certified hospital and with these new enhancements, the hospital looks forward to achieving HIMSS Stage 7 soon,” said Dr. Jose Lopez. “By collaborating with Cerner, Healthpoint aims to achieve the UAE Vision 2021 of providing patients with a world-class healthcare system and stimulate the overall development of the sector in the UAE.”

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Bellevue Medical Center (BMC) Becomes First Hospital in Lebanon Awarded Gold Certification for Excellence in Person-Centered Care by Planetree International

ellevue Medical Center (BMC) has received the Gold Certification for Excellence in Person-Centered Care by Planetree International, a not-for-profit organization that has been at the forefront of the movement to transform healthcare from the perspective of patients for 40 years. The ceremony was attended by Mr. Elie Zeitouni, representing Lebanese Minister of Public Health, Ghassan Hasbani, and a large crowd of prominent political, religious and social figures, in addition to the hospital’s specialists, administrative staff and media representatives.

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BMC is one of only 85 healthcare organizations worldwide to receive the Person-Centered Care Gold Certification since the program’s launch in 2007, the second in the MENA region and the first in Lebanon. This Person-Centered Care Certification recognizes BMC’s achievement and innovation in the delivery of person-centered care, including the quality of patient-provider interactions, access to information, family involvement and the physical environment of care. Importantly, the criteria that BMC satisfied to achieve

the certification also focus on how it supports staff and grants the opportunity for staff, patients, and families to have a voice in the way care is delivered. It is also about the ways BMC is reaching beyond its walls to care for its community. Mr. Elie Zeitouni, the representative of the Minister of Public Health, expressed his appreciation to Bellevue Medical Center, saying: “The most remarkable thing for me today at this event is the approach to the care of the individual which provides joy and accelerates the healing process for

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the patient at this hospital. I hope that the Ministry will be supporting the hospitals further, to continue the journey that has made Lebanon the number one in healthcare in the Middle East and the 32nd worldwide. This achievement is a result of the work of the hospitals, doctors, nurses and administrative staff in our healthcare system. I hope that the standards we are working on with the Syndicate of Hospitals and Order of Physicians will always match the global standards to portray better understanding of healthcare and quality of work.” “At Bellevue Medical Center, we want to make healthcare a better place. The management of the patient’s care is very special; it is innovative, as it looks at the patient as a whole person.

This achievement is a one step further to reach our vision of being a leading hospital in Lebanon and the MENA region in the provision of compassionate and person-centered care delivered in a safe, healing and state-of-the-art facility,” said Mrs. Remie Maalouf, Executive Manager and Planetree and Person Centered care coordinator. The President of Planetree International, Susan B. Frampton addressed BMC saying: “It is indeed an important milestone to celebrate the very first gold-certified organization in Lebanon, and I thank you for your dedication and hard work. Your leadership will no doubt inspire others to follow in your footsteps, and help to continue to advance excellence in patient-centered care globally.”

As part of the certification process - which included a site visit by representatives from Planetree - discussion with recent BMC patients, families and current staff validated that specific person-centered policies are in place, including non-restrictive visiting hours and a shared medical record policy; that staff members at all levels are involved in the implementation of person-centered care; and that the hospital’s physical environment supports patient and family engagement in their care. The process also included a review of the BMC’s performance on patient experience and quality of care measures, and how the measurement of these indicators improves the hospital’s outcomes.

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Transasia brings forth the latest trends in Biochemistry and Hematology

ransasia Bio-Medicals Ltd., India’s leading In-vitro Diagnostic Company recently organized a scientific seminar in East Delhi on the latest advancements in biochemistry and hematology for laboratories. Titled Transasia Scientific Seminar (TSS) Ace, this pioneering academic initiative aims at encouraging the exchange of technical know-how among doctors. The seminar focused on biochemistry and hematology - two of the most critical areas for in-vitro diagnostics. The session on ‘Effective Use of Database Systems by doctors’ by Dr. (Col.) Arun Harith (Sr. Consultant & Head of Department-Biochemistry, Medanta Medicity, New Delhi) highlighted the growing need of database for improving test outcomes. On the other hand, Dr. (Col.) Jyoti Kotwal (Chairperson & Prof.- Dept. of Hematology, Sir Gangaram Hospital, New Delhi) spoke on ‘Clinical Utility of Advanced Hematology Parameters.’ She emphasized on how the latest automation in hematology helps in enumeration of the different parameters such

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as IPF, Ret He, Immature Granulocytes, NRBC, etc. and how these parameters help in early diagnosis of diseases. The sessions were chaired by Dr. Meera Sikka (Head of Dept.- Pathology University College of Medical Sciences.) Transasia offers the entire range of semi and fully automated analyzers and reagents in Biochemistry and Hematology. The latest in clinical chemistry is a fully automated, random access clinical chemistry analyzer, XL 1000 with a throughput of 1040 tests/ hr. It offers a host of key features such as sample clot detection, permanent hard glass cuvettes and four channel direct ISE measurement, among others, making it an ideal choice for high volume labs. The seminar received an overwhelming response with full-house participation. The over 70 attendees comprised pathologists, physicians and clinicians from reputed Government institutions such as Delhi Cancer institute, IHBAS, Swami Dayanand Hospital, Rajiv Gandhi Super Specialty Hospital, Hegdewar Hospital, LBS Hospital and private institutes such as MAX Healthcare, Kailash Healthcare Ltd., Yashoda Super

Specialty Hospital, Dr. Lal PathLabs, Metropolis, SRL Diagnostics, etc. Speaking on the occasion a spokesperson for Transasia Bio-Medicals Ltd. said, “There is an alarming burden on the society from both communicable and non-communicable diseases in India. 70% of the treatment decisions are based on lab results. Yet, less than 30% of the Indian population has ever got their blood test done. The major chunk of the 70% population is in the smaller towns. At Transasia, we are committed to reaching out to the pathologists and clinicians in every nook and corner of the country, so that they are well equipped to cater to this population. TSS Ace is a unique platform that empowers the pathologists with the technological advances and encourages exchange of scientific updates, backed by expertise and experience. ” Over the years, TSS Ace has grown in popularity and has become Transasia’s identity. It has been well accepted as a successful forum and benefits more than 800 pathologists and clinicians annually.

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ARTICLE FEATURES . PET-CT Scan

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ARTICLE FEATURES . PET-CT Scan

ET-CT scans are a very advanced technique in the field of nuclear medicine especially in the diagnosis of cancer tumors, heart disease, epilepsy and others; This effective and very accurate imaging test helps reveal how the tissues and organs are functioning. Imaging can provide early and more accurate diagnoses. In some cases, it might even lead to better and more successful treatment. PET/CT scans give a doctor a broader view of a personâ€™s condition. PET is able to pick up the metabolic changes associated with cancer much earlier than you could see tumors or other physical changes in the organs. A PET scan is an effective way to examine the chemical activity in parts of your body. It may help identify a variety of conditions, including many cancers, heart disease and brain disorders. The pictures from a PET scan provide information different from that uncovered by other types of scans, such as computerized tomography (CT) or magnetic resonance imaging (MRI). A PET scan or a combined CT-PET scan enables your doctor to better diagnose illness and assess your condition. An integrated PET-CT scan combines images from a positron emission tomography (PET) scan and a computed tomography (CT) scan that have been performed at the same time using the same machine. Because a CT scan provides detailed pictures of tissues and organs inside the body, while a PET scan reveals any abnormal activity that might be going on there, combining these scans creates a more complete image than either test can offer alone.

ARTICLE FEATURES . PET-CT Scan

An integrated PET-CT scan is a diagnostic tool used to detect cancer and find out the cancer’s stage, a way of describing where it is located and spread and whether it is affecting the functions of other organs in the body. Knowing the cancer’s stage helps the doctor decide what kind of treatment is best and helps predict prognosis. The scan can also be used to locate

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an area for a biopsy or to evaluate the effectiveness of cancer treatments. Combining positron tomography (PET) and computer tomography (CT) in one device (PET-CT) offers the following advantages: • Accurate diagnosis of the smallest cancer sites • Effective monitoring of disease development

ARTICLE FEATURES . PET-CT Scan

•

Optimal treatment plan: After just two weeks, the efficacy of chemotherapy can be determined, which will help reduce costs and improve patient lifestyle. A PET scan measures important body functions to help doctors evaluate how well organs and tissues are functioning.

Preparation Preparing the patient to undergo this technique is very important because any mistake in the preparation process may affect the accuracy of the results. The results of positron emission tomography may be false if the patient does not refrain from eating for a specific time before the examination or if his blood sugar level is not within the normal range. An integrated PET-CT scan is a diagnostic tool used to detect cancer and find out the cancer’s stage, a way of describing where it is located and spread and whether it is affecting the

functions of other organs in the body. Knowing the cancer’s stage helps the doctor decide what kind of treatment is best and helps predict prognosis. The scan can also be used to locate an area for a biopsy or to evaluate the effectiveness of cancer treatments. A PET scan creates pictures of organs and tissues inside the body. A small amount of a radioactive substance is injected into a vein and is absorbed mainly by organs and tissues that use the most energy. Because cancer cells tend to use more energy than healthy cells, they absorb more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body. Meanwhile, a CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a contrast medium (a special dye) is injected into a patient’s vein to provide better detail in the images.

The entire PET/CT Scan lasts around 3 hours then the images are sent to cancer specialists and after 48 hours, they are sent to the physician on a CD or over the internet in order to save time and do the necessary in case the analysis revealed that the patient needed treatment or surgery. This machine is not only limited to detecting the tumor and its type but also observing the biological changes occurring inside the body including the detection of tumor in its early stages before it spreads. This technique is used to detect cancerous cells and determine how much they are spread in the human body; this helps the physician set an effective plan for the treatment of cancer. It also detects if cancer recurs after treatment in addition to determining the blood flow in the heart muscle and the cause of heart attack. It contributes as well to detecting the abnormal function of the brain such as detecting tumors or problems in memory or problems related to the nervous system in addition to examining the function of the heart.

ARTICLE FEATURES . Smart Beds

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ARTICLE FEATURES . Smart Beds

he concept of smart hospitals is expanding given their benefits to the patient, hospital management and manufacturers. The adoption of smart hospital beds is becoming more common as they have changed the medical concept in the world. The specifications of smart beds make them more than just a place to embrace the patient, but also a contribution to his comfort and recovery, and the doctor’s assistant for the patient’s monitoring, in addition to meeting many of the patient’s medical and non-medical needs, during the recovery period. The benefits of these beds are no longer limited to hospitals only, but have become an important resource for manufacturing companies after the significant increase of sales figures and the destination to sophisticated and smart hospitals adopting state-of-theart technologies. How can we describe this development today, what are its numerous advantages, and how will it be viewed in the future?

DESIGNED TO FACILITATE THE PATIENT’S MOVEMENT WHILE HELPING HIM REGAIN HIS NATURAL MOVEMENT FASTER

The use of smart technologies and advanced medical equipment in hospitals has been increasing significantly. The health sector has become one of the sectors that have benefited from successive developments, either at the level of technology or at the level of medical and surgical achievements. The development in this field is not confined to the operating rooms or the methods of diagnosis and treatment, but also includes the administrative work within the hospitals and health centers, including the patient’s bed and medical data, which changed from manual to electronic. Smart beds have become part of the technological development which is spreading within the hospitals due to their role in improving cooperation between the

medical care team, raising the level of patient safety and following up on their medical condition, in addition to improving operational efficiency. Today, the smart bed is able to monitor the patient’s condition through sensor chips that monitor the patient’s breathing, pulse, temperature etc. Smart beds can also show clear data without confounding the patient’s general health condition and his sudden deterioration, such as suffering from sudden stroke or heart attack, which allows fast and immediate intervention from the doctor. Physicians can know the smallest details about the patient’s condition through a computer. For some time, new smart and electronic buildings and hospitals that use several innovative technologies and applications for more accurate patient care have been invading the US. Many smart electronic hospitals, which are now being opened around the world, are designed in a way that helps accelerate the recovery and prevent the occurrence of medical errors through the hospital’s automation and networking and making them electronic and smart, in addition to using accurate techniques for the convenience of patients while increasing efficiency and meeting the growing needs of the elderly. Also, smart beds are designed to facilitate the patient’s movement while helping him regain his natural movement faster given their effective role in the patient’s speedy recovery. Studies confirm that the patient’s movement during his ICU stay contributes to a speedier recovery and faster hospital discharge. In addition, smart beds allow patients with limited mobility to change their position without needing assistance from medical staff, making work easier for caregivers.

ARTICLE FEATURES . Smart Beds

Features of Smart Beds Smart beds feature many characteristics that make them a real revolution in the world of medicine. They are no longer just a space for the patient to lie down, but an integrated care room to benefit the patient and the hospital together, and provide the best performance for all. Tablets provided for each hospital bed allow the patient access to the medical file, check the treatment plan and the results of medical examinations and learn about the medical team, medicines and physical therapy appointments as well as medical appointments and other information about the patient. The patient can communicate with doctors in their rooms through text messages or video calls when needed at any time to seek medical help or meet their own needs. They can also control the lighting and room temperature through the smart

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tablet in addition to various entertainment options. The smart services allow all patients to communicate with the outside world through various social media platforms as well as the possibility of ordering and buying meals from restaurants in the hospital campus and paying with a credit card through the tablet on the patientâ€™s bed. At present, the solutions to prevent bedsore include using various techniques for movement and displacement of patients, which is not possible for some patients or dangerous for some of them while it also poses problems for healthcare providers. On the other hand, development of information technology in the healthcare system including application of wireless sensor networks (WSNs) has led to easy and quick service-providing. It can provide a solution to prevent bedsore in motionless and disabled

patients. Hence, the aim was first to introduce WSNs in hospital beds and second, to identify the benefits and challenges in implementing this technology. Therefore, identification and implementation of this technology will be a step toward mechanization of traditional procedures in providing care for hospitalized patients and disabled people. The smart bed and mattress, either alone or in combination with the other technologies, should be capable of providing all of the novel features while still providing the comfort and safety features usually associated with traditional and hospital mattresses.

From a health standpoint Decubitus ulcer is a common and serious problem for inpatients in the hospital. When someone is in the sleep mode, pressure of his body

ARTICLE FEATURES . Smart Beds

weight enters into certain points and in the long term, this results in bruises and ultimately incurable wounds; therefore, the hospital staff has to rotate these patients on their beds regularly to prevent it from happening. Prevention is more cost-effective than treatment and the cooperation of healthcare staff can help in the prevention of decubitus ulcer; decubitus ulcer is still as a significant problem for certain patients in the hospital and society. Using wireless sensor network (WSN) in smart beds is an appropriate solution to prevent decubitus ulcer and a way to forger the pressures of decubitus ulcer in patients hospitalized for a long time. Bedsore is the third costly disorder after cancer and cardiovascular diseases. In various studies, treatment costs have been estimated to be about $125-451 for grades 1 and 2 of bedsore. In Spain 5.20%, in the UK about 3.2%, and in the Netherlands

more than 1% of the total healthcare costs are spent on the treatment of bedsore. In developed countries, the prevalence of bedsore varies 3-30% and its incidence varies 1-50%. Annually, these wounds affect more than 1.3 million adults in the world. Bedsores can cause pain, depression, reduction of performance and independence, higher risk of infection and sepsis, all of which potentially lead to an increase in the duration of hospitalization. Moreover, the mortality rate caused by this disease has been high and can be effective at any age. According to a study entitled “Prevention and Management of Pressure Ulcers in Primary and Secondary Care”, even with hospital development and considerable healthcare resources, the prevalence of patients with bedsore shows a growth of 32% in hospitals and 22% in nursing homes.

From a medical standpoint The operation of the monitoring system is kept simple and consists of only three simple steps. Firstly, it uses 12 FBG sensors with different Bragg wavelengths, cascaded along a single ﬁber. The 12 FBG sensors are mounted on the surface of the bed to form a 3*4 matrix array, and the bed is then covered by the usual mattress. Each FBG sensor is specially packaged into an arc-shaped elastic bending beam using some carbon ﬁber reinforced plastic (CFRP) material, which ensures excellent sensitivity and good linear translation from a lateral force exerted to the apex of the sensor into axial strain of FBG when a subject is on the bed. Secondly, the optical interrogator is turned on, and the software application is run to acquire all wavelength data of the sensors.

Protecting Patients by Anticipating Care SM

Hill-Rom and Welch Allyn collect the information that matters, identify opportunities to improve care and deliver actionable insight to caregivers and patients-all supported by clinicians, every step of the way.

www.hill-rom.com

ARTICLE FEATURES . Smart Beds

Lastly, the body movement and respiration pattern will be captured and displayed once a patient lies on the bed. Smart hospital beds are well equipped with the latest technology for patient’s care. They feature LCD monitors to check the patient’s condition such as blood pressure, blood flow pattern, spinal movement during the period of treatment or sleep etc. and transfer them directly to the physician. Smart hospital beds can be connected to the internet and can be remotely monitored by the doctor, nurses or healthcare professionals. Smart hospital beds have wheels that help the healthcare professional move the patients during various medical check-ups and scanning process. The bed also offers “continuous lateral rotation therapy,” automatically turning patients from side to side at appointed times to decrease pulmonary complications often related to lying in bed for extended lengths of time. An alarm sounds if patients are not resting at a 30-degree angle, a position recommended to reduce fluid buildup in the lungs. The bed is equipped with a comfortable air mattress that continuously redistributes a patient’s weight, and microclimate technology that controls temperature and keeps patients cool and dry, thereby preventing bed sores and improving a patient’s quality of life. The smart bed provides “progressive mobility therapy” by folding itself into a chair position and tilting forward, helping patients to stand.

Other features include: •

•

Motors that make it easier to move beds from one area to another. Computers that allow information, such as a patient’s weight and movements, to

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•

be transmitted to electronic patient records. An ability to lengthen and shorten according to a patient’s height. There is also a special model for overweight patients.

From an economic standpoint Smart hospital beds are a growing market during the forecast period, with healthcare spending increasing, technology advancing and the number of patients with heart disease needing close monitoring is also increasing the demand for smart beds. Smart hospital beds provide ideal conditions for pressure and cooling system according to patients’ condition. Smart hospital beds are based on product type such as semi-automatic and fully-automatic. Based on use, there are acute care environments and post-acute environments. Based on geography, smart hospital beds are widespread in North America, Europe, Latin America, Asia-Pacific and Middle East and Africa. Also, rising consumer preference towards highly facilitated and efficiently equipped hospitals is another crucial factor accelerating the growth of the market. Moreover, customized hospital beds manufactured according to the specific needs of patients is also a major aspect fueling the overall hospital beds market across the globe. However, high initial costs of hospital beds is a key factor hampering the growth of the hospital beds market since such high cost restricts its affordability in the developing and low income geographies. As the practice of medicine and technology has evolved, hospital beds turned into more sophisticated medical devices especially from comfort and safety standpoints. More advanced positions like lateral

tilt effectively assists in early recovery and mobility and thus help in reduced average length of stay. Therefore, innovation is giving the industry a boost. Thanks to rising demand for smart beds, the industry is expected to grow by 4.2 percent over the next few years. The industry’s financial volume reached $ 2.5 billion in 2012, according to research firm IBISWorld. It grew significantly from 2012 to early 2018 given the high demand due to its several advantages and benefits. Manufacturers have recently reduced manufacturing costs to become more accessible to suppliers and accessible to as many hospitals as possible. Between 2018 and 2028, actual and potential real output alike are projected to expand at an average annual rate of 1.9 percent. The global hospital beds market is poised to grow at a CAGR of around 5.5 percent from 2017-2025 to reach approximately USD 2.91 billion by 2025. Increasing aging population, rising prevalence of chronic diseases, technological advancements in healthcare and medical industry, and increasing number of hospitalization cases are some of the factors driving the market growth. In addition, enhanced and improved infrastructure of healthcare coupled with growing middle class population as well as increasing investments for advancement of healthcare sector are some key elements propelling the growth of the global hospital beds market.

The Gulf States are taking the lead This rapidly expanding technology worldwide has invaded the Arab region, where hospitals and health centers are undergoing major development. Smart beds have become one of the most advanced smart technologies

ARTICLE FEATURES . Smart Beds

deployed in hospitals and medical centers across the Gulf, especially in the Middle East region in general. It has played an important role in raising its efficiency and improving the level of services in it, as well as helping medical staff and healthcare providers to fully perform the tasks entrusted to them, thus reducing the rate of medical errors in hospitals. Since 2014, the Dubai Health Authority has revealed the use of smart beds equipped with tablet devices that allow pediatric patients requiring longterm hospital stay to communicate with their schools, follow up on their classes, interact with their teachers and take their exams. Engineer Essa Al Maidoor, Director-General of the DHA, explained that smart beds are

available at Al Jalila Childrenâ€™s Specialty Hospital and ensure that children are kept abreast of the educational process through their communication with their school. Al Maidoor added that screens will be implemented for all 200 beds of Al Jalila Childrenâ€™s Specialty Hospital that provide the patient with numerous options that meet all his needs. He added that the Authority will develop smart service applications for the public that can be used on smartphones or tablets, including the hospital road map, in order to provide easy access to the service location and hospital departments with the help of the smartphone. In addition, a service will also be developed that introduces the doctor, his medical training and experience. The service will also include

the request for medical reports and knowing the dates of receipt, with the possibility of managing outpatient clinic appointments, booking or postponing them. The implementation of telemedicine programs will be provided so that parents and children can communicate with hospital service providers through video communication as well as interactive medical applications targeted at patients or the community. It is true that smart devices are invading all sectors and occupying all fields, but their use by the medical sector and its pioneering interaction with them, achieved a qualitative leap in the field of hospitalization, establishing a real revolution at the level of providing treatment and achieving the desired health results.

Smart Beds

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Smart Beds

Hill-Rom’s Smart Beds and Commitment to Connectivity In today’s clinical care environment, hospitals need solutions that enhance outcomes for patients and their caregivers. Hill-Rom Smart Beds – designed for the medical/ surgical ward as well as the ICU, relay up to 35 points of data, varying by bed type and application. Hill-Rom Smart Beds are designed to get patients better and out of bed faster; clinical protocols around early mobility take advantage of Hill-Rom’s innovative bed technology. Hill-Rom smart bed-generated data, such as headof-bed angle, bed height, side-rails and exit alarm status, patient weight and more, is made actionable, visible and useful through seamless connectivity to: • Hill-Rom® Nurse Call and other Nurse Call systems. • Status Boards. • Wireless Phones and Pendants. • Electronic Medical Records. • Other Clinical Applications.

Hill-Rom Smart Beds - Preventing and Alleviating Pressure Injuries One in 10 patients in acute care have pressure injuries, and one in 20 patients experience a facility-acquired pressure injury (Source: VanGilder C, et al. WOCN Conference. 2012.) Hill-Rom’s Smart Bed frames pair with the company’s

wide range of therapeutic surface technologies. Hill-Rom’s more advanced surfaces address shear, friction and pressure, and keep the patient cool and dry. Hill-Rom’s patented Advanced Microclimate® technology wicks away heat and moisture, making the skin less susceptible to damage and helping to prevent and alleviate pressure injuries.

Patient Safety The capabilities of Hill-Rom Smart Beds and Surfaces are augmented by Hill-Rom’s NaviCare® Patient Safety Solution, which helps reduce patient falls by ensuring patients are in a safe state at all times. NaviCare automatically: • Activates safety settings on the bed based on patient presence (i.e. bed exit alarm) • Alerts caregivers when bed enters and unsafe state (bed height not low, rails out of position) • Cancels and suppresses alerts based on caregiver presence in the room. • Resets alarms when the caregiver leaves the patient room. •

Hill-Rom Smart Beds and NaviCare patient Safety Solution

Together, the Hill-Rom family of Smart Beds and the NaviCare Patient Safety Solution: • Reduce interruptions: Bed data, such as patient weight, is sent directly to the patient’s record in the EMR to reduced documentation requirements for staff. • Impact Patient Safety: Unit-level visibility of bed state and patient risks to address falls and pulmonary risks. • Patient-Focused: Continuous monitoring of bed state and automated arming of bed exit alarms maintains the caregiver to focus on the patient. • Optimize Care: Reports help identify trends and inform caregiver practice to improve care and reduce risk.

Smart Beds

Building strategy for Smart Hospitals by Dr. Anees Fareed Chief Medical Information Officer, Al Jalila Children’s Specialty Hospital, Dubai | Transformation Strategist, Cerner Middle East Well, as of today, that world is indeed just a tick away. In the era where adoption of smart technologies such as mobile applications, tablet PCs and wearables in healthcare seem to be the new norm and investments in digital infrastructure and connecting devices are on the surge this dream of a ‘smart hospital’ is no longer distant. However, every hospital aspiring to become smart needs to know how to plan well ahead and build strategy, carefully select and implement available smart technologies and transform healthcare delivery processes to meet key objectives of a smart hospital which are: ensuring seamless patient flow; improved clinical processes and ability; offering remote patient care; access to the right information to the right people at the right time from anywhere; and enhanced patient safety.

Improving Patient Experience

While I was lost in the thoughts on complexities of hospital workflow scenarios and was struggling to visualize how her ‘one click away’ fantasy comes true, she elaborated, “Once I check in to a hospital, the whole journey should be seamless be it the long queues at multiple counters for various administrative purposes or clinical tests, all these should be just that click away. I would never ever be burdened with that hefty folder of tests and results, all information required for my treatment should be readily available to all care providers, and finally when I return back home I should have access to relevant information to continue my treatment and stay healthy, such a hospital “she exclaimed “would indeed be smart”. And then it all started to make sense to me. What she meant was better patient experience, improved efficiency of patient services and care processes that ensure seamless patient flow and access to relevant information to both healthcare providers and patients.

Usage of smart technologies for a better patient journey experience begins well before the patient arrives to the hospital by using smart mobile applications and patient portals allowing patients to provide and update required personal information, insurance details and relevant clinical history including lab reports and allergies. Patient will also be able to search for apt physicians, view their credentials, make bookings, receive reminders, cancel or reschedule appointments. Smart parking apps will enable them to locate vacant parking space, the facility to book and pay would help patients escape the tedious task of finding vacant parking lots. Patient kiosks integrated with queue management system will enable patients to not just self-check-in with a smartcard and get token numbers but also receive location directions to departments or procedure rooms where they have appointments. Registration desk equipped with eSignature pads and payment machines would help them read and sign on required consent forms and would make advance payments for services indeed just a ‘click away’. At the time of admission, the patients would be tagged with an electronic wristband that allows doctors and nurses to track their vital signs, medication times and sleep patterns remotely and receive alerts if anything goes abnormal to take necessary actions.

hat’s a smart hospital? I asked my wife, who is apparently oblivious to everything happening around healthcare industry. She did not know much about innovative and interactive smart technologies available for patient care, or the unlimited possibilities of big data in population health or the role of AI in future of healthcare, how does she decipher the word ‘smart hospital’, the answer was short and abrupt. “A smart hospital” she said, “in which, anything and everything is just a click away”

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Smart Beds

Patient rooms can be equipped with a large, flat screen monitor that will not only offer entertainment such as TV, video games, or internet, but also patient education content and instructions about their health condition or a pending procedure. They will also be able to access dietary services and order their meal and receive reminders about upcoming appointments. A smart digital screen in front of the room could display vital information about the patient including care provider name and allergies if any.

Improving Care Processes and Support Services A well-integrated Electronic Medical Record (EMR) connected to medical devices, point of care devices and investigation equipment could automate documenting every clinical data including physiological parameters, investigation reports, images and videos and make it accessible through a single source. This will allow the care providers to access information relevant to patient care at the right time from anywhere in the hospital network. Usage of RFID and Barcode-assisted assisted blood transfusion and drug administration, smart infusion pumps which can document infusion details and robotic drug dispensing machines and lab instruments are few other examples of smart technology applications that can not only improve patient safety but also enhance clinical processes efficiency.

Building a Smart Strategy A well-thought smart hospital strategy should be directed towards building or transforming the hospital to a facility that will provide excellence in clinical outcome, efficiency in operations and enhancement of patient experience. Building a smart hospital strategy is more than just bringing together smart devices and applications connected to high-speed infrastructure. The strategy should also aim to redefine the care processes, operational procedures and redesigning physical infrastructure to drive a new way of delivering care. Smart hospitals require a complete revisit of how different patient services are offered within the hospital. For example, building patient rooms equipped with patient infotainment systems redefines how information

related to patients’ condition, procedure, medication and treatment are disseminated to them in addition to providing entertainment. Investing on Kiosks and patient portals redefines how patients are being registered, checked in and make payments which enhance operational efficiency and enhance patient experience Patient care delivery processes are another area which needs to be re-designed to meet smart hospital requirements. Healthcare mobile applications, sensors and wearable monitoring and communication devices are transforming the way patients interact with providers. These smart applications and devices can shift some of the care processes beyond hospital settings either at satellite health centers or even at patient’s home. While surgical robots improve the accuracy and efficiency of procedures, certain new treatment methods such as micro – surgeries are available now which cannot be done by clinicians. Multispecialty team-based care model across hospitals are now easier with the ability to share and monitor patient information and stream images and videos. A shift in logistics and support services workflow designed to be considered with the availability of smart technologies such as RFID and secured wireless network which can be used to identify, track and report on locations and utilization of hospital resources. Robotics in pharmacies and laboratories which automates majority of the workflow processes requires redesigning of the processes as well as physical infrastructure. These technologies transform the way how logistics and support services are managed more efficiently while minimizing waste and reducing cost. Smart hospitals should give adequate focus on people management, training and adoption to take full leverage of digital capabilities and smart technologies. Leadership must think through how the smart hospital transformation will affect management systems, governance and technical competencies among its people. A solid governance model which facilitates collaboration between technical and clinical staff is required for successful implementation of smart technologies and achieving smart hospital vision.

It’s not just the technology that builds a smart hospital, it just demands us to get a bit smarter and do it right!

Smart Beds

All about safety

e at LINET devote maximum attention to TOP products for ICU and to models for a broad spectrum of hospital care. Price is not the issue as all our products come with above-standard safety parameters. An example is the unique so-called overload protection. All 4 motors (7 motors in the case of ICU beds with lateral tilt) which ensure positioning, have separate control. In addition, they have overload protection not just for each motor, but the current setting is defined individually for all stages of the bed’s movement. For example, stronger current is set for start-up which requires higher current whereas a downward movement requires a lower current. All bed positions are equipped this way, including the more complicated preset positions which combine several movements of various construction segments. Overload protection is set up to the last detail in the control unit while it is tested and validated with any change in the bed’s construction, as for example with a change in material or production technology. Thanks to this we continuously provide maximum protection for staff and patients, but we also protect your investment – prevention against damage and minimisation of repair and maintenance costs. Another example, how to keep the safety and full functionality of the bed for patients is the Safe Working Load (SWL) dimension. For LINET beds the maximum is 250 kg, so that the weight of a patient of 185 kg, the mattress and other accessories, such as a bar, an infusion holder or traction frames, are included in the total weight in accordance with standard regulations. Altogether, the reserve is 65 kg. Internationally recognized and strict safety standards such as EN 60601-2-52 for bed manufacturers prescribe a minimum SWL value of more than 200 kg, and it is very common for companies to set the SWL just above this legal limit. LINET, on the other hand, has set an SWL of 250 kg across its entire portfolio of electrically adjustable beds, ranging from the TOP models, Multicare and Eleganza 5, to the economic Eleganza 1 beds. Jiří PLECITY, Managing Director – LINET Middle East and Africa

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Smart Beds

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Medical experts discuss regional insights at

Boehringer Ingelheim’s 4th Regional Thoracic Medicine Forum

t its 4th Regional Thoracic Medicine Forum, which was held recently in the United Arab Emirates (UAE), Boehringer Ingelheim, one of the world’s leading pharmaceutical companies, brought together over 150 of the region’s top pulmonologists to shed light on continued innovation in respiratory care. At the event, experts have mentioned that the region as a whole has witnessed an increase in pulmonary diseases due to risk factors which include smoking, extreme weather variations, as well as genetic conditions. The prevalence of smoking and obesity has also reached alarming heights and the associated lung diseases present a major health burden to medical systems. The forum served as a platform to highlight the diagnosis and misdiagnosis as well as challenges towards controlling the prevalence of pulmonary diseases across the region

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that include asthma, chronic obstructive pulmonary disease (COPD) as well as Idiopathic pulmonary fibrosis (IPF). In addition, healthcare professionals from the region also stressed the importance of early detection of the symptoms and proper adherence to treatment protocols. Dr. Wajdi Abi Saleh – Associate Professor – Head of Division at Lebanese University and Clemenceau Medical Center said, “COPD is a chronic disease that causes limitations in lung airflow and the fourth leading cause of death worldwide, and is expected to become the third leading cause by 2030. The current rate of COPD prevalence in Lebanon is high, with 80% of the cases are misdiagnosed. The most common symptoms are breathlessness and a chronic cough. Although COPD is not curable, it is preventable; where treatment can help slow down the progression of the disease. Data from

the landmark 52-week DYNAGITO® trial, involving more than 7,800 people with COPD, showed a lowered rate of moderate-to-severe exacerbations know as flare-ups after the trial. This important trial sheds light on the central role in managing COPD which can help reduce symptoms and minimizing the future risk of exacerbations.’’ People who have a family history of COPD are also more likely to develop the disease if they smoke. In addition, long-term exposure to other lung irritants also is a risk factor for COPD such as air pollution, chemical fumes and dusts from the environment or workplace. Dr. Abi Saleh also noted that, “With more and more exposure to environmental and occupational factors, the risk of contracting pulmonary diseases such as COPD among the general population is high. Smokers, usually visit the doctor complaining

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from heart problems and are unaware of what COPD is. It is important to take into account that not only is early detection important, but also the form of treatment, as well as the training required for doctors and hospitals to deliver the best care possible for those who are affected by COPD.” In addition, experts at the forum shed light on the impact of asthma in the region. They said that the disease is not properly controlled and requires immediate action especially to increase awareness and overall understanding of chronic pulmonary diseases amongst patients, healthcare providers and governments. The number of people suffering from asthma across the world estimated to be as high as 334 million. Asthma is not just a public health problem for high income countries: it occurs in all countries regardless of level of development. Over 80% of asthma deaths occurs in low and lower-middle income countries. “The burden of asthma in Lebanon and the extent to which guidelines are being followed for optimum asthma control are largely unknown. There are no reliable data on the prevalence of asthma in Lebanon to date, but according to studies, the prevalence of asthma among school children in the country have shown that the prevalence of the disease is 14%. Asthma diagnosis requires the presence of more than one of the respiratory symptoms, worsening of the symptoms at night and exacerbation of the symptoms by viral infection, exercise, allergens, changing weather or smoke, Abi Saleh said. “The disease can cause a consid-

erable burden on the physical, social, and professional lives of affected individuals and family. According to the International Study of Asthma and Allergies in Childhood (ISAAC) and the European Community Respiratory Health Survey (ECRHS), there has been an increase in the general prevalence of asthma. Although the prevalence of the disease is more in developed countries, evidence in recent years has shown a sharp increase in developing countries due to the impact of urbanization’’ added Dr. Abi Saleh. Doctors also highlighted the region’s increased prevalence of Idiopathic pulmonary fibrosis (IPF), a chronic and rare disease which is characterized by a progressive decline in lung function. Moreover, Dr. George Dabar, Pulmonologist and Critical Care Physician at the Hotel Dieu de France Hospital in Beirut said, “The lungs of a patient with IPF, over time builds up with scar tissue which is called fibrosis. This causes the lungs to become stiffer and lose their elasticity and so the lungs become heavy and incapable to of driving air in. On the other hand, the scarring prevents oxygen from going through the lung and diffuse into the blood. Most patients diagnosed with this disease are likely to die as a result of complications such as infections, respiratory or heart failure. The prognosis of IPF is worse than many forms of cancer- the 5-year survival rate with IPF is 20–40%. Symptoms of IPF are similar to other pulmonary diseases such as COPD and asthma which includes shortness of breath and chronic cough and so most patients are often misdiagnosed. Proper diagnosis requires a set of diagnostic tests and it can take

between one and two years from initial to diagnosis. In Lebanon, the prevalence of IPF stands at 0.002% of the total populations. Early diagnosis and treatment of IPF remains a critical unmet need that needs an action, because acting quickly can make a difference. Currently there are available medications that can prevent the IPF disease from progressing.” Dr. Dalia Mahmoud Amr, Medical Lead, Middle East, Turkey and Africa (META) at Boehringer Ingelheim, said, “This year saw another successful edition of the Boehringer Ingelheim Regional Thoracic Medicine Forum, which aims to address ongoing issues pertaining to pulmonary conditions and provides a platform for experts from around the region to exchange knowledge and explore a holistic approach to the treatment of COPD, asthma and IPF. Research and development has been the cornerstone of Boehringer Ingelheim’s success and continues to be the major driver of innovative new approaches that help improve patient’s lives and address unmet therapeutic needs; in line with both national healthcare initiatives and systems.’’ The two-day event comprised of interactive sessions with the overall goal for experts coming together to discuss the latest medical and scientific insights on treatment and management of pulmonary diseases across the META region. Doctors agreed that there is still an urgent need to raise awareness among patients and inform doctors about respiratory illnesses, ensuring optimal diagnosis and recommendations around the right method of managing the burden of such diseases.

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Boehringer Ingelheim

has a very successful 2017 financial year

he research-driven pharmaceutical company Boehringer Ingelheim can look back on a very successful 2017 financial year. All businesses contributed to net sales growth. R&D expenditure exceeded three billion euros, around 2.7 billion euros of which was in the human pharmaceuticals area alone. “There are still more questions than answers in medicine. We want to continue putting all our efforts into tackling the challenges in research. A high level of investment in R&D therefore reflects our corporate identity,” explained Hubertus von Baumbach, Chairman of the Board of Managing Directors. Last year, Boehringer Ingelheim generated net sales of nearly 18.1 billion euros, representing an increase of 15.7 per cent in currency-adjusted terms (+13.9 per cent in euro terms). Adjusted for all the one-off effects that have resulted from the business swap with Sanofi, the company

Enrique Manzoni

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recorded currency-adjusted net sales growth of 6.1 per cent (+4.4 per cent in euro terms). With operating income of around 3.5 billion euros, the return on net sales came to 19.3 per cent. The company employed an average of approximately 50,000 people worldwide in 2017. Enrique Manzoni, Regional Managing Director – Middle East, Turkey, Africa (META) at Boehringer Ingelheim said, “Boehringer Ingelheim’s consistent strong performance across the META region is backed by a strong and excellent execution of the company’s business strategy and a solid business model that reflects its position as the fastest growing pharmaceutical company in the region in our Human Pharma business. Our financial and operational performance mirrors the company’s consistent commitment towards meeting the region’s unmet medical needs by delivering innovative initiatives across a number of key ther-

apeutic areas such as type 2 diabetes and stroke.” “The region is well poised to be the next growth engine of global pharmaceutical sales. To that extent, we continue to work with our partners to further support and enhance the healthcare infrastructure that ultimately aims at providing integrated healthcare services and solutions. In 2017, we have been able to launch 10 products in addition to registering 38 products across the region,” added Manzoni. In addition, Christoph Raab, Head of Finance and Administration at Boehringer Ingelheim META said, “In the META, we have achieved a 10% sales growth during 2017 compared to the same period last year. Moreover, the company’s Human Pharma portfolio recorded a 13.1% growth, while the Animal Health business achieved a 3.6% growth. Our top performing markets included the United Arab Emirates, Saudi Arabia and Turkey“.

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Worldwide Net sales growth in all businesses Boehringer Ingelheim experienced organic growth across all business areas last year. “Our human pharmaceuticals business in particular exceeded our expectations,” emphasised Michael Schmelmer, Member of the Board of Managing Directors responsible for Finance. “The main growth drivers here were our business in the US market and emerging markets.”

Major success with human pharmaceuticals globally In the human pharmaceuticals business, Boehringer Ingelheim last year succeeded in generating net sales of more than one billion US dollars each with six medicines that focused on respiratory illnesses such as chronic obstructive pulmonary disease (COPD) and Idiopathic pulmonary fibrosis (IPF), the anticoagulant reversal agent, type 2 diabetes, as well as the treatment of hypertension. Overall, net sales from human pharmaceuticals grew by 6.9 per cent in currency-adjusted terms to more than 12.6 billion euros (+5.0 per cent in euro terms). This growth outpaced the market. The human pharmaceuticals business therefore contributed around 70 per cent of total net Christoph Raab

sales. 2017 was also a very successful year for Boehringer Ingelheim in R&D. The company accomplished the transfer of 13 new active ingredients to clinical studies as first-in-man applications. The company is thus focusing on the areas of cardiometabolic diseases, oncology, respiratory diseases, diseases of the central nervous system and immunology. “We have an extremely competitive pipeline with 80 development projects,” said von Baumbach. “This provides us with strong future prospects for sustainable business development and particularly for innovation that benefits patients.” As a result of the additional net sales brought about by the transaction, net sales in animal health have more than doubled to 3.9 billion euros. The two parasiticides generated the largest share of net sales: the beef flavoured chews for dogs is the best-selling product at 546 million euros, followed by flea and tick treatment at 381 million euros. Overall, Boehringer Ingelheim generated around 22 per cent of its total net sales in the animal health business. “We have made good progress with a challenging and complex integration process,” explained von Baumbach. “Our employees deserve our unreserved recognition

and our gratitude for this – due in no small part to their commitment, we are now a competitive player for the future in the animal health business. We are outstandingly positioned for medical breakthroughs that will make animal diseases controllable through prevention.” The biopharmaceutical contract manufacturing business grew by 10.7 per cent in currency-adjusted terms last year to 678 million euros and contributed four per cent to total net sales.

Holistic approaches for humans and animals A key strategic objective of Boehringer Ingelheim globally is to develop holistic approaches that benefit patients, both human and animal. Digital projects that focus on patients are an example of this. Boehringer Ingelheim recently established the BI X digital laboratory and increased the Boehringer Ingelheim Venture Fund from 100 to 250 million euros, 50 million of which is intended for digital innovation alone. “At the same time, we always ask ourselves how we can further improve the lives of patients and relatives as well as the treatment options for doctors,” explained Schmelmer.

Outlook for 2018 For the current financial year, Boehringer Ingelheim globally is expecting slight growth in net sales on a comparable basis. “In the META region, we are well on our way to continue achieving growth levels in 2018, in line with our overall business strategy and leveraging synergies across the region. In 2018, the company is expecting 33 market authorizations throughout the wider META region. In addition, we are also expanding our footprint in the Sub Saharan Africa with key investments in driving access to healthcare programs to develop innovative solutions,” concluded Manzoni.

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Experts highlight the need for comprehensive stroke care Boehringer Ingelheim inaugurates its 4th Middle East, Turkey and Africa (META) stroke academy with leading cardiologists and neurologists highlighting the latest protocols in managing stroke incidences in the region from prevention to treatment urgent need to develop more efficient and accurate methods to measure stroke. There is also a significant call to increase public awareness and implement interventions on stroke, its risk factors and symptoms to help people understand the negative impact on the quality of life.

oehringer Ingelheim, one of the world’s leading pharmaceutical companies recently inaugurated its 4th META Stroke Academy in the United Arab Emirates. The two-day event included over 150 leading neurologists and cardiologists from across the region who shed light on the importance of implementing immediate stroke prevention and treatment processes so that lives of stroke patients can be saved and permanent disabilities reduced. The META Stroke Academy is accredited by three reputable bodies including the Dubai Health Authority (DHA), European Board for Accreditation in Cardiology (EBAC) as well as the European Stroke Organization (ESO) to drive the program’s overall scientific value. During the working sessions as part of the event, medical experts highlighted the epidemiological change of stroke and the disease’s continued increase worldwide and in the region. They said that there is an

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The META Stroke Academy focuses on prevention of stroke and immediate treatment on occurrence to save lives. Prevention of stroke measures involves identification of risk factors, which may include the increased prevalence of hypertension, diabetes and a high BMI. The increased incidences of these diseases lead to a number of complications that include atrial fibrillation, irregular blood circulation, and tendency for blood clotting, which requires effective available treatment to minimize the chances of stroke occurrence. Over the past four years, collaborative efforts between hospitals, regulators and Boehringer Ingelheim have resulted in the development of a comprehensive stroke centers across the META region. In 2015, in both the UAE and Saudi Arabia, there were three certified centres. Six centers are expected to be in place by the end of this year and 10 by 2019. A stroke occurs when the blood supply to part of your brain is interrupted or reduced, depriving brain tissue of oxygen and nutrients. Within minutes, brain cells begin to die. Atrial fibrillation (AF) is the commonest persistent cardiac arrhythmia (irregular heartbeat) and is an important cause of stroke. In atrial fibrillation, blood can pool

in the heart’s upper chambers (atria) and form blood clots. If a blood clot forms, it can travel from the heart to the brain, obstructing the flow of blood to the brain and causing a stroke.To address this, experts also discussed the importance of doctors making the right choice for their patients when it comes to stroke prevention through the use of oral anti-coagulants which are used to treat atrial fibrillation. Studies have shown that anticoagulation can result in a 64% reduction in strokes. Dr. Nooshin Bazargani, Board Member, World Heart Federation, and Chair – Prevention Working Group of Emirates Cardiac Society said, “Stroke and cardiovascular diseases (CVDs) are the most common causes of death worldwide. ’Stroke is a feared and common complication of atrial fibrillation and is associated with significant mortality and morbidity. Patients with atrial fibrillation are five times more likely to have a stroke, which has become a major issue for global healthcare systems.” “According to studies, heart diseases is the number one killer in the UAE. The prevalence of Atrial Fibrillation in the Middle East stands at 15%. However, Africa is lower than other regions in the developing world with only 1.6% to 6.9% in stroke patients, 4.6% to 5.5% in cardiology patients. In addition, ischaemic strokes are the most common type of atrial fibrillation related stroke and can cause considerable disability and possibly death. This is a strong indication of the need for community members to recognise

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heart disease symptoms and know the optimal action to take in response to heart disease,” added Dr. Bazargani. Dr. Suhail Abdulla Al-Rukn, Neurology Consultant and Stroke Specialist, Neurology Department at Rashid Hospital also noted, “The impact of suffering stroke incidences leave a devastating mark on patients and their families. We need to continue to intensify our efforts to developing dedicated stroke care centers, which will directly lead to faster and better patient outcomes and aim to provide superior technology with multidisciplinary teams that exclusively manage stroke patients in a ward. Having such centers will decrease the mortality rates, the complications and outcomes of stroke. This because patients lose about 120 million brain cells within 1 hour of suffering from a stroke incident. The underlying aim here is to deliver the right patient to the right medical facility in the right time frame. In the UAE, there are more than 10,000 stroke cases per year. We believe that over 80% of all stokes are preventable by lifestyle adjustments.” “Rapid diagnosis in a dedicated stroke centre can quickly determine the stroke and immediate medical treatment, in less than 60 minutes, known as the Golden Hour reduces the chances of further complications.

Our aim is to improve thrombolysis rates to reach an average of 18-20% (a worldwide best practice), establish tele stroke units in urban areas, as well as increase patient awareness to recognize symptoms leading to stroke. It is worth mentioning that within two years, Rashid Hospital has succeeded to reduce the door-to-needle time frame from 95 minutes to 45 minutes,” added Dr. Al Rukn. The META Stroke Academy has emphasized on accelerating the decreasing door-to-needle, which is the interval between patient’s arrival to the hospital and starting the treatment; support in establishing a dedicated stroke unit in hospitals which will directly lead to faster and better patient outcomes and; the most important objective is raising and increasing the awareness of a robust stroke management among community and healthcare professionals. Experts have also underscored the important use of groundbreaking technology to managing stroke. A live digital simulation took place during the event, where a room was fully equipped with smart screens that showcased different stroke cases. Doctors present at the event examined each case with an accurate diagnosis leading to the decision to administer

the right medication within the onehour time frame. The activity provided an opportunity for patients to respond and engage with medical experts, who examined patients’ body parts, while also performing a CT scan. Enrique Manzoni, Country Managing Director for Middle East, Turkey and Africa Region (META) added “We are proud to host the 4th META Stroke Academy in the United Arab Emirates, which continues to provide a platform for leading neurologists and cardiologists to come together under one umbrella and put a holistic approach from effective prevention to the treatment of stroke. As a company, we remain committed to our patients in the region and support healthcare professionals by driving the implementation of dedicated stroke care centers across the region.’’ Symptoms of stroke can include sudden numbness or weakness of the face, arms or legs on one side of the body, as well as speech impairment, trouble with eye sight, loss of balance as well as severe headache. Experts stressed that F.A.S.T is an easy way to remember the sudden signs of stroke, which reflects Face Dropping, Arm Weakness, Speech Difficulty and Time to call for support.

INTERVIEWS

Laboratory Director at the University Hospital Center of Notre Dame des Secours (CHU-NDS), Jbeil and Head of the Lebanese Syndicate of Biologists (SDBL)

Dr. Christian Haddad “UN-Series is the number 1 among the fully automated urine analyzers”

ysmex Middle East, one of the Middle East region’s leading diagnostic suppliers with a reputation for high-quality products, service and reliability, did an interview with Dr. Christian Haddad, Laboratory Director at the University Hospital Center of Notre Dame de Secours (CHU-NDS), Jbeil and Head of the Lebanese Syndicate of Biologists (SDBL) to receive his feedback on the Sysmex Fully Automated Urine Analyzer UN-Series after one week of evaluation and training in his facility. Below is his feedback and the full interview:

Dr. Christian’s feedback: As a feedback about the results, we did a comparison study between the manual microscopy and the instrument; the results are approximately the same, in plus that the instrument is more precise because it is aspirating more urine volume in comparison with the manual fields. Crystal’s image is very nice and net same as if you see them in Atlas which is facilitating the recognition of crystals by the technicians, but when crystals are rarely present sometimes the technician might miss it because he is not looking at all the fields under the slide/microscope and here the added value of the machine that is counting a huge number of cells. The screen showing the images (U-WAM) is very nice, easy, flexible and modern because you can zoom in and zoom out the images or even the particles. Regarding the casts, all casts subtypes shown and counted by the

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INTERVIEWS

machine are better than the manual work of the technician because sometimes technician might miss them under the microscope, while we saw that the machine detects them in some cases. Regarding Yeast, the instrument had an advantage over the manual work of the technician even the technicians here (at NDS) are having high experience in this field. Regarding the biochemistry, the instrument is able to give the microalbumin, creatinine in urine and the A/C P/C Ratio’s, a clinical value that is really new and relevant. One the best advantages of UN-Series that is analyzing and giving accurate results for Body Fluids, it gave us in one Cerebrospinal Fluid CSF the presence of Bacteria while there were no bacteria but maybe there is a cutoff limit and the result didn’t exceed this limit in ul. We wished to have during this week a bacterial meningitis sample to confirm the real count and identification of Bacterial presence; that will be really a great advantage that can facilitate the work of pediatrics and clinicians during the results interpretation. In general, what I can say is that the fast analysis of Body Fluids is a great added clinical value for UN-Series. The problem now in Lebanon is the cost. The prices are still the same

since 15 years, for example, the urine sample is costing or reimbursed by 5$ only, this obstacle is the one that might let the laboratories and hospitals in Lebanon think twice when they want such a machine even with such great quality and added values. We previously did several comparisons with several urine automation systems that came to our facility as a Demo, of course, I will not mention their names but what I can see and judge is that Sysmex UN-Series has many and great advantages over the others, till now UN-Series is the best instrument that I have ever seen.

Doctor, do you see that the differentiation between Gram + and Gram – that is suspected by the machine might have an advantage for the clinicians? Yes for sure, this point needs to be verified and validated in the lab. We couldn’t do the verification because we couldn’t do a high number of samples for one week. We have to validate it in the microbiology with a high number of samples. And when it is valid, it will facilitate and accelerate the accuracy of Antibiotic’s prescription.

If a doctor from Lebanon calls you and asks you for your feedback on UN-Series, will you recommend it to him? My feedback is highly positive re-

garding this instrument, and for sure I will recommend any doctor to get it. There are a lot of doctors here in Lebanon who are calling to ask about my feedback concerning some Demo machines. Well, we have a big and high-quality qualified hospital, and we try a lot of instruments throughout the year, so yes usually doctors call me because they trust my opinion based on my experience. Up to me and briefly, UN-Series is the number 1 among the fully automated urine analyzers.

It is really a pleasure to hear that from you Doctor and we are thankful for the opportunity that you gave us to perform the first installation and demonstration in your facility NDS-Lebanon. We are happy to hear your positive feedback and thanks for the technicians who were very supportive and they were helping us. Actually, all the technicians were happy to use this instrument. Sometimes in labs, you can find some kind of disappointment about some new instruments in some points, but here they were all happy; even the laboratory clinicians were happy as well from the reliable reports and the new added clinical values of UN-Series. We did a comparative study of around 50 to 60 positive urine samples and the results were perfectly correlating.

ARTICLE FEATURES . Medical Laboratory

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ARTICLE FEATURES . Medical Laboratory

ccurate diagnosis of the medical condition is key to patients receiving appropriate treatment, thus having a speedy recovery. Hence, the importance of laboratories and medical examinations, which are the first steps taken by the patient towards his recovery. Doctors require a series of medical tests in order for them to know what is happening inside the patientâ€™s body; and based on the test results, they choose the appropriate treatment. Based on the importance of lab work and its vital role in accurate diagnosis, specialized accreditations for medical labs have been established. Today, advanced laboratories are subject to a series of procedures that allow them to obtain international accreditations. According to WHO, laboratory quality can be defined as accuracy, reliability, and timeliness of the reported test results. The laboratory results must be as accurate as possible, all aspects of the laboratory operations must be reliable, and reporting must be timely in order to be useful in a clinical or public health setting. When all of the laboratory procedures and processes are organized into an understandable and workable structure, the opportunity to ensure that all are appropriately managed is increased. Medical laboratories in the world always strive to provide correct and accurate analytical results in order to prove the level of accuracy and validity that characterize their results. This is achieved through the application of quality assurance systems and the introduction of quality control mechanisms into daily analytical operations in a systematic and organized manner. Quality control programs are

therefore a tool for evaluating the validity and comparability of analytical results. Hence, the application of quality control systems is one of the most important ways to obtain reliable and credible results.

ing system must be provided, as well as a fire alarm system, a fire extinguishing system, which must operate in accordance with the general characteristics of the laboratory, its programs and the level of risk.

Quality in laboratories

Laboratory safety precautions and guidelines should also be put in place by suspending signs or plates inside and outside the laboratory in order to minimize accidents that may be experienced by individuals by increasing their awareness of the various hazards. First-aid materials and facilities must be readily available to deal with different accidents that may occur due to exposure to chemicals, electric shocks, or mechanical, physical or biological hazards. On installation (commissioning), the laboratory staff must check that the equipment achieves the agreed and specified performance (validation). A record of the commissioning process as well as validation must be kept and subsequent performance must be continuously monitored by the laboratory staff. Validation should be conducted regularly and at least on an annual basis, and as and when maintenance or repairs have been done. Transport must be safe for the carrier, the general public and the receiving laboratory, and adhere to national or accepted regulatory requirements. Liquid specimens, including blood specimen bottles and tubes, should be transported upright and secured in a screw-cap container or in a rack in a transport box. Containers with liquid specimens should be wrapped in absorbent paper to soak up the liquid in case of spillage. Appropriate protective clothing must be worn at all times in the laboratory, and gloves should be worn when required.

Obtaining accurate results that enable the doctor to build a suitable method to treat the medical condition requires the use of top quality methods in measuring the performance of medical laboratories, through the collection of data to assist in the statistical control of the processes that can be monitored in the medical analyses provided. These tools are not only used to solve problems but also create an incentive for quality in every business. Thus, the use of these tools should be an integral part of a future plan aimed at implementing Top Quality Management (TQM) in all medical laboratories to provide a high-quality model of health services to contribute to reaching the level of progress in patient service. Quality in laboratory work is not an end in itself, but is mainly a means to improve the level of performance of the services provided as well as the level of professional performance of employees, in addition to the optimal use of material and human resources while maintaining the safety of lab workers and patient safety in addition to achieving absolute and continuous satisfaction. In order to obtain international accreditation, the high-quality medical lab should be designed appropriately to perform the required tasks, in addition to providing the necessary means of protection for lab technicians during their work as well as training them on how to use them. An in-house ventilation and light-

ARTICLE FEATURES . Medical Laboratory

ISO Certification The patient is reassured once he knows that he underwent his blood tests in a world-class lab, which also received accreditation. To be accredited, quality control and quality assurance programs must be in place for all aspects of the laboratory operations. All facilities and equipment are tightly scrutinized to assure adequacy for intended applications. An accredited laboratory has demonstrated that it can produce accurate, high-quality results on a consistent basis. The ISO accreditation is a global initiative that aims at creating standard measure of quality in medical laboratories. The standard has developed initiatives to promote competence and responsibility in medical laboratory processes, equipment and outcomes. ISO 15189 was developed by the International Standards Organizations Technical Committee and has been implemented in over 200 countries. The process involves testing of the effectiveness of laboratory equipment and the impact those particular equipment have on the processes in the labs and their outcomes. ISO certification has a unique set of advantages and its main objective is quality assurance. This also clarifies the requirements of the quality system (based on ISO 9001) and

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standards of technical competence (based on ISO / IEC 17025) of medical laboratories. It is an initiative that presents a global concerted approach in creating a standardized measure for management practices in medical laboratories. An ISO 15189 certification has been seen as a critical initiative towards harmonizing global practices in medical laboratories towards a common measure of quality assurance and safety. The approach takes into account a lot of perspectives, including the interpretation of test results, the method patient samples are actually collected as well as the time required for the tests to be carried out. An ISO 15189 certification promotes development of an international reputable image for your organization through Quality Assurance and Management Systems. It promotes a strong degree of consistency in compliance to medical laboratory laws and legislation both from an international and national perspective, fundamentally critical in promoting laboratory efficiency and responsibility for better results and service delivery. The certification program also has been very critical in promoting modern laboratory practices that include professionalism and expertise in conduction of medical activities in the labs. It ultimately promotes the growth of customer satisfaction in organizations involved in medical laboratory testing.

CAP Certification The College of American Pathologists (CAPâ€™s) Laboratory Accreditation is as important as the ISO Certification. The specifications, standards

and requirements of the CAP system are also as important as ISO in terms of applying the highest international standards of quality and accuracy in all stages of laboratory work. The CAP is widely considered the leader in laboratory quality assurance; it is an advocate for high-quality and cost-effective medical care. It also offers an accreditation service to help laboratories earn accreditation under ISO 15189 Medical Laboratories. The College of American Pathologists (CAPâ€™s) Laboratory Accreditation Program accredits the entire spectrum of laboratory test disciplines with the most scientifically rigorous customized checklist requirements. The Laboratory Accreditation Program inspects a variety of laboratory settings from complex university medical centers to physician office laboratories, and covers a complete array of disciplines and testing procedures. CAP Laboratory Accreditation helps laboratories ensure compliance through the guidance of the most comprehensive scientifically endorsed laboratory standards, maintain accuracy of test results and ensure accurate patient diagnosis and increase the value they bring to organizations, customers and patients. To be eligible for CAP Laboratory Accreditation, the laboratory must have a qualified laboratory director, participate in proficiency testing/external quality assurance, and perform patient testing.

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DEEP INFILTRATING ENDOMETRIOSIS, should all surgery be centralized? By Dr. Marlin Mubarak, Consultant Gynecologist and Head of British Society Gynecology Endoscopy Endometriosis Centre, Canadian Specialist Hospital

revalence of endometriosis is around 10%, however, the prevalence of Deep Infiltrating Endometriosis (DIE) is estimated to be 1% – 2%. Endometriosis is a chronic recurrent disease that has significant impact on a woman’s life and chances of pregnancy. There is huge diagnostic challenge and delay of diagnosis is up to 20 years in some of the research.

In the UK, NHS England estimated 5000 new cases of DIE diagnosed per year and the numbers are increasing due to increased awareness among doctors. The surgery requires special expertise and surgical skills and is ideally performed laparoscopically. Work published by Oxford University highlighted the challenges of developing the specialist expertise in performing complex laparoscopic surgery for DIE and maintaining the skills in view of the small number of cases. The complexity and risk associated with this surgery is related to the presence of DIE involving the bowels and/or associated with bowel adhesion. The British Society of Gynecology Endoscopy (BSGE) set up and accredited specialized endometriosis centres to provide the best results, particularly for those women that require a multidisciplinary approach. Also the European Society of Human Reproduction and Embryology published in 2014 had recommended that these patients should be managed as part of multidisciplinary team in a specialized centre (Dunselman et al., 2014). Part of the workup in endometriosis centres is to establish accurate diagnosis about the presence, location

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and extent of DIE and bowel endometriosis preoperatively, which will allow optimal management. Wolthhuis et al highlighted that a multidisciplinary centre optimizes coordination of interdisciplinary radical treatment and standardize therapy for DIE (Wolthuis et al., 2014). This can only be achieved by a well-trained interdisciplinary team that can perform treatment with low incidence of major complications (Bachmann et al., 2014). Centralizing surgery will support research; especially that endometriosis research suffers from lack of standardization and well-designed randomized control trials to establish management of this complex disease. We are proud to announce that

Dr. Marlin Mubarak who was a Lead for Endometriosis Centre in the UK had been awarded BSGE accreditation for establishing an endometriosis Centre at the Canadian Specialist Hospital. Our experienced team in addition to Dr. Marlin as a Laparoscopic Gynae surgeon include radiology, urology and Laparoscopic bowel surgeon who have expertise in such complex surgery. This provides best outcome for patients, improving their pain, quality of life and chances of pregnancy if they wish. Patient is assessed according to the BSGE recommendations, also will have an MRI that is protocoled to assess for DIE. She will have expert counseling regarding treatment with multidisciplinary approach.

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By Dr Yasir Parviz, Consultant Interventional Cardiologist, Canadian Specialist Hospital

he incidence and prevalence of end-stage renal disease (ESRD) are rising in the United Arab Emirates (UAE). The UAE population is living longer, with increasing aging population and surge in the incidence of chronic diseases such as diabetes mellitus (DM) and hypertension (HTN) the trend of Chronic Kidney Disease (CKD) is increasing in UAE. The prevalence of ESRD in a recent study from Dubai has shown 152 patients per million populations per year. Approximately over 2,000 CKD patients are undergoing dialysis in the country and this number increases by 10 to 15 percent every year. Cardiovascular diseases are the leading causes of death in patients with CKD.Patients with CKD have

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chronic progressive disease process and many of these patients need renal replacement therapy (RRT)or renal transplantation. Despite the fact that they have numerous comorbidities the main concern and cause of morbidity and mortality are cardiovascular disorders. Hence it is the need of the hour that cardiovascular disorders are diagnosed, timely and appropriately to help guide the right decisions in the management of these complex group of patients.

Coronary Artery Disease is more Prevalent in CKD patients: Patients with CKD have high likelihood of CAD. These patients are complex and have multiple other comorbidities, like hypertension, diabetes mellitus, dyslipidemia, obesity,

and tobacco use, all independently associated with increasing risk of CAD. There is very high incidence of CAD in patients going for dialysis, even ranging up to 38%, with a relative risk of 5- to 20-fold that of the general population.

The disease process is different in CKD patients: The cardiovascular disease process is different in CKD patients in comparison to general population. They have more aggressive and severe pattern of disease. It is important to understand that dialysis does not prevent the disease process or progression of CKD but transplantation has been shown to prevent the damages caused by the chemicals associated with chronic kidney dis-

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ease. Hence there is an incentive that these complex patients should have an early assessment so that we can diagnose these cases early and refer for the transplantation to minimize the long-term consequences of the disease process.

Management of CAD in CKD patients is challenging: There are a number of challenges in the management of these patients. It is well observed that many of the treatment strategies are less effective in these patients. Commonly used tablets to lower cholesterol, like statins and medications like angiotensin-converting enzyme (ACE) inhibitors and aspirin may have diminished clinical benefit in ESRD. The atherosclerotic disease process in these patients is complex and coronary plaque morphology shows extensive calcification. Even in when

young patients with CKD are screened for the atherosclerotic coronary artery disease, a disproportionate incidence of high calcium scores is detected with the probability of coronary artery calcification increasing with longer duration of dialysis. The clinical presentation of these patients is different, and more patients are presenting with acute coronary syndrome in comparison to angina in patients without the renal disease.

When to Assess the CAD in CKD? Many sets of guidelines aim to guide cardiovascular evaluation in renal transplantation candidates, but there is no universal consensus on an optimal approach. The 2014 American College of Cardiology (ACC) and American Heart Association (AHA) guidelines have given some sug-

gestions in this regard. The difficult decision in the management of these patients when and how to evaluate these patients. One of the important aspects that can help direct the decision-making process is the effort capacity or simply how much exercise patient can perform. Patients who can do moderate exercise with the functional capacity of moderate exercise (defined as â‰Ľ4 metabolic equivalents(METS), and who are asymptomatic and undergoing noncardiac surgery do not need a routine testing. We should investigate and evaluate patients who have poor functional capacity (<4(METS) or unknown functional status. These decisions are not simple and need expert evaluation.

What is a high-risk patient group: The common risks to look for these patients are diabetes mellitus,

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prior cardiovascular disease, >1 year on dialysis, left ventricular hypertrophy (LVH), age >60 years, smoking, hypertension, and dyslipidemia. Any patients with CKD and these risk factors should be evaluated for CAD.

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How Often Should Patients be evaluated?

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1. Annual evaluation for CAD is recommended for patients who are diabetic and awaiting renal transplantation. 2. In high-risk patients without diabetes mellitus on the transplantation waitlist (≥2traditional risk factors, known the history of CAD, peripheral vascular disease, and LV ejection fraction [LVEF] ≤40%), evaluation for CAD every 24 months is recommended. 3. Patients on hemodialysis with an LVEF ≤40% or those with new symptoms of concern regarding ischemic heart disease are recommended to be evaluated continuously for CAD. 4. Repeated evaluation is recommended on an annual basis in patients at high risk, with re-evaluation every 3 years for low-risk patients

Our strategy for evaluation of CAD in patients with ESRD: Patients with CKD who attend to our clinic are assessed for cardiovascular disease according to a set protocol. • Clinic consultation with a detailed careful clinical history and baseline ECG in all patients. • Echocardiography to assess ventricular dimensions and function. This allows us to look for the pumping action and assessment of valves. We can detect any possible regional wall motion abnormalities by this simple test.

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Dobutamine Stress Echocardiogram. Patients with risk factors and multiple comorbidities are assessed with dobutamine stress echocardiogram for possible ischemic heart disease. A negative dobutamine stress test has high negative predictive value. It is important to note that patients with multiple risk factors for CAD (≥3 risk factors: diabetes mellitus, prior cardiovascular disease, >1 year on dialysis, LVH, peripheral arterial disease, age >60 years, smoking, hypertension, dyslipidemia) should be considered for further imaging or cardiac catheterization despite a negative stress test in some instances.

When to consider Coronary Angiography and Revascularization: Coronary angiography is usually reserved for patients with evidence of ischemia on non-invasive imaging to determine their need for preoperative revascularization. It is to be emphasized that coronary angiography in renal transplantation candidates at high risk of CAD despite normal stress tests, should be considered. This is based on the limitations of non-invasive tests. It is important to identify prognostic ally important CAD that may require revascularization prior to transplantation. In patients with ESRD, other clues for the atherosclerotic disease should be considered particularly peripheral arterial disease, that may help identify patients with advanced coronary atherosclerosis. The peripheral vascular disease

is highly associated with CAD and it is a reasonable approach to have an evaluation of coronary artery disease in patients with peripheral arterial disease despite negative stress tests. Another group of patients where we should evaluate for coronary artery disease are patients who have cardiac autonomic dysfunction, autonomic neuropathy, and retinopathy. One of the important considerations to be aware of in patients with diabetes mellitus. In these patients when they have normal stress tests may represent a particularly high-risk group that should be considered for coronary angiography, given their high pre-test probability for CAD, as myocardial perfusion imaging has a high false-negative rate in this population. One of the unfortunate aspects is that despite the fact that these patients are high risk for coronary artery disease these patients are less likely to get treatment strategies offered in comparison to other patients with normal renal function, as there are concerns of contrast-induced nephropathy and requirement of dialysis. Another unfortunate aspect is that even when these patients are presenting as an acute heart attack and there is a need for immediate revascularisation, these patients are less likely to get revascularized in comparison to other patients with normal kidney function. These patients can be better managed by a collaborative work between various healthcare professionals. The decision to pursue revascularization (CABG or PCI) or to treat medically should be made after a multidisciplinary discussion among interventional cardiologists, nephrologists, and cardiothoracic surgeons and should be individualized to each patient, given the current lack of evidence to guide the treatment strategies.

ARTICLE FEATURES . Malaria

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ARTICLE FEATURES . Malaria

alaria is a common and contagious disease mostly occurring in sub-Saharan Africa. It is caused by a one-celled parasite called a Plasmodium. The World Health Organization pays great attention to the development of modern treatments to eradicate the disease or at least control its spread and reduce its development. Malaria can be cured with early diagnosis and treatment given the risk of complications that can lead to death without immediate medical intervention.

But how does the disease invade red blood cells? After a person gets malaria from the bite of an infected mosquito, the mosquito injects immature form of Plasmodium parasites into the host’s body; travel through the person’s bloodstream to the liver and grow into mature form; the mature form of parasites then enter the bloodstream again and attack the red blood cells, where they multiply quickly. The number of parasites increases until the red blood cells burst, releasing thousands of parasites into the person’s bloodstream. Then the parasites continue to attack other red blood cells, and symptoms start to develop as the cycle of infection continues. The disease can spread when a mosquito bite an infected person and carry the parasites and re-infect other people via biting. Malaria can also be transmitted through blood transfusions from infected people or needle sharing for intravenous drug. Malaria infection either causes the patient to die or the parasite is defeated by

the immune system or medications. However, in most cases, the body’s immune system can control malaria. In the early stages, the symptoms of malaria are similar to those of the common flu and it becomes harder to diagnose it. A malaria infection is generally characterized by recurrent attacks with the following signs and symptoms: • • • • • • • • • • •

High fever. Muscle pain. Profuse sweating. Headache. Nausea and vomiting. Dry cough. Abdominal pain. Diarrhea. Fatigue. Loss of consciousness. Blood in stool.

Acute symptoms include severe anemia due to the destruction of a large number of red blood cells, kidney failure, loss of consciousness, delirium, mental confusion and pulmonary edema.

The malaria paroxysm comprises three successive stages: 1. The first stage is a 15-to-60 minute cold stage characterized by shivering and a feeling of cold. 2. The second stage is the 2-to6 hour hot stage, in which there is fever and often headache, nausea, and vomiting. 3. The final stage is the 2-to-4 hour sweating stage during which the fever drops rapidly and the patient sweats.

4. As the disease gets established, the patient starts getting relapse of symptoms at regular intervals of 48-72 hours. The primary attack may spontaneously abort in some patients and the patient may suffer from relapses of the clinical illness periodically after 8-10 days owing to the persisting blood forms of the parasite.

Plasmodium falciparum is the most prevalent malaria parasite There are four parasite species that cause malaria in humans: 1. Plasmodium malariae. 2. Plasmodium ovale. 3. Plasmodium vivax. 4. Plasmodium falciparum. P. falciparum is the most prevalent malaria parasite on the African continent. It is responsible for most malaria-related deaths globally. Plasmodium falciparum is a unicellular protozoan parasite of humans, and the deadliest species of Plasmodium that cause malaria in humans. It is transmitted through the bite of a female Anopheles mosquito. It causes the disease’s most dangerous form called falciparum malaria. The disease depends on several factors, including the type of parasite, the severity of the disease and the person’s immunity. The intensity of transmission depends on human-related factors and mosquitoes carrying the infection as well as the human immune system and parasites responsible for the spread of the disease as well as the surrounding environment.

ARTICLE FEATURES . Malaria

Mosquito bites occur in the evening and mosquitoes multiply in water such as ponds.

Treatments Malaria treatment aims at treating acute attacks and stopping transmission. The type of medication is determined by the area visited by the patient, and most of the drugs given today contribute significantly to controlling the symptoms of malaria. The types of drugs and the length of treatment will vary, depending on which type of malaria parasite you have, the severity of your symptoms, your age and whether you’re pregnant. There are some common treatments for malaria symptoms including paracetamol for high fever, blood transfusion in case of severe anemia, regularly monitoring the patient’s blood pressure, fever, urine quantity and blood sugar level in addition to checking the number of parasites as

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well as kidney and liver functions. Prevention is paramount. People who intend to travel to areas where the disease is spread should follow some guidelines to avoid mosquito bites. Prevention guidelines include: • Stay inside when it is dark outside, preferably in a screened or air-conditioned room. • Wear protective clothing (long pants and long-sleeved shirts). • Use insect repellent with DEET. You can buy repellents in different strengths. • Use bed nets (mosquito netting) sprayed with or soaked in an insecticide. But make sure that these insecticides still work against the mosquitoes where you are. • Use flying-insect spray indoors around sleeping areas. • Avoid areas where malaria

and mosquitoes are present if you are at higher risk (if you are pregnant, very young, or very old). If you are going to a location where malaria is present, it is very important to take preventive medicines and to follow the correct schedule for taking them. You should take the first dose of chloroquine a week before entering an area where malaria occurs. This is to ensure there is sufficient medicine in your bloodstream to give you the required protection. You should continue to take chloroquine throughout your stay and for a further four weeks after you have left the area. Early diagnosis and treatment are crucial as they will reduce the severity of the disease and prevent the death of the patient while contributing to the reduction of transmission. WHO began to recommend confirmation of all suspected malaria cases by microscopy or rapid diagnostic test before treatment.

ARTICLE FEATURES . Preventive Medicine

Preventive Medicine Modern medicine is aimed at protecting communities from disease and epidemics

overnments and medical institutions throughout the world are putting preventive medicine as their top priority for its important role in providing means that protect the community in general from the risk of diseases, or at least limit their spread by putting preventive means that limit the spread of diseases and epidemics. Paying attention to personal hygiene, adopting a healthy lifestyle, doing regular exercise and other daily practices are all among the steps that should be followed for the prevention of diseases, which is the focus of awareness campaigns that urge the community to adopt these patterns as well as undergoing regular check-ups that contribute to the early detection of any health problem so that it can be immediately treated. Preventive medicine aims to protect society from the spread of epidemics by taking rapid measures in order to prevent their occurrence or spread, raise the level of public health and preserve the lives of the healthy and sick. Primary healthcare is one of the top priorities of preventive medicine as measures that greatly contribute to the prevention of diseases are being taken through the adoption of an immunization schedule approved by the government as recommended by the World Health Organization. In addition to educating the community about the importance of handwashing as it is one of the best ways to protect yourself and your family from getting sick and it’s one of the most effective ways to prevent the spread of germs. Clean hands can stop germs from

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spreading from one person to another and throughout an entire community. Secondary care also falls within the framework of preventive medicine, and should undertake the mission of detecting diseases and looking for early treatments to prevent complications. This is done by making the patient undergo treatment with anti-inflammatory drugs and having regular tests and check-ups for the early detection of any disease, especially cancer, as annual mammograms should be routine for women over 40. In the context of preventive medicine, we find the so-called advanced prevention by reducing the risk of the disease in order to avoid complications that can have serious consequences, such as prevention of chronic diseases complications such as diabetes, hypertension and cholesterol. Some believe that preventive medicine is not beneficial and it cannot be applied for several reasons. First, people do not complain about any pain or symptom, so there is no need to visit the doctor to look for the health problem. Second, they believe that it will be costly. However, many experiences in developed countries and some Gulf countries that have adopted the policy of primary healthcare have reached many benefits in terms of protecting society from many diseases by raising the level of health awareness. More importantly, for governments, the cost of disease prevention is much less than the cost of treatment and its complications.

Primary Healthcare According to the World Health Organization (WHO), primary health-

care is the essential healthcare that is made available to individuals and families in the local community, with their full participation and at costs that local community members and the country’s population can afford. Such care is an integral part of the country’s health system, as it is the core of that system and of the overall social and economic development of local community. One of the strategic objectives of primary healthcare is to reduce the burden of diseases on society and improve the quality of life of individuals by providing preventive health services in the first place, and then therapy and rehabilitation for all age groups. This is accomplished through several steps, beginning with preventing communicable and non-communicable diseases, and activating healthcare in mothers, children and the elderly, in addition to activating healthcare for people with special needs, promoting health and urging teenagers to follow disease prevention steps by leading a healthy lifestyle.

This can be achieved by providing the following services: • •

• • •

Spreading health awareness and prevention. Developing appropriate solutions to control and eliminate health problems. Ensuring good nutrition. Providing maternal and child healthcare services. Immunization against infectious diseases, especially childhood diseases.

ARTICLE FEATURES . Preventive Medicine

•

• • •

Controlling communicable diseases as well as their spread. Treating common diseases in society. Performing basic surgical operations. Providing essential medicines.

Primary healthcare aims to strengthen the health services provided to all segments of the society by developing productive and continuous partnerships with the concerned parties and achieving better health outcomes through closer cooperation and coordination between the public and private sectors and supporting their participation, coordination and cooperation with non-governmental organizations and civil society institutions in addition to everyone concerned about primary care. Primary healthcare framework also includes the improvement of decision-making and planning by providing health information to all health workers in a clear, accurate, correct and timely manner, developing a supportive regulatory structure by strengthening the primary healthcare status in the MOH’s organizational structure and allocating an independent budget for healthcare services and programs, as well as developing an integrated electronic information system for primary healthcare activities and services. The efficiency of workers in this field is key for the success of primary healthcare strategy. An appropriate work environment should be provided and the level of performance should be maintained in line with the best international standards through the preparation of an approved and certified system of programs for training employees and expanding the various family and community medicine programs.

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Vaccines Vaccines are part of the fundamentals of preventive medicine for their role in preventing disease. Today, there are many diseases that we no longer hear about, but were once epidemics that killed many people, including poliomyelitis. Vaccines protect children from certain infectious diseases and their serious complications, thus leading to a healthy community free from these infectious diseases and the epidemics they cause. Vaccines are like a training course for the immune system. They prepare the body to fight disease without exposing it to disease symptoms. When foreign invaders such as bacteria or viruses enter the body, immune cells called lymphocytes respond by producing antibodies, which are protein molecules. These antibodies fight the invader known as an antigen and protect against further infection. According to the Centers for Disease Control and Prevention (CDC), a healthy individual can produce millions of antibodies a day, fighting infection so efficiently that people never even know they were exposed to an antigen. Vaccines available to protect again diseases include BCG vaccine that gives protection against tuberculosis (TB) infection; it is given at birth or in the first two months. DTP vaccine, which refers to a class of combination vaccines against three infectious diseases in humans: diphtheria, pertussis (whooping cough), and tetanus. Vaccines also include Polio vaccine and MMR vaccine to protect against measles, mumps, and rubella as well as Hepatitis A and B vaccines. It is critical for children to receive the necessary vaccines for their role in the prevention of infectious diseases, especially as they protect children from deadly complications and disabilities that may result from the disease itself. It is true that some vaccinated children may get the disease, but symptoms are mild and without serious consequences such as disabilities that may occur in non-vaccinated children, especially in the case of polio.

ARTICLE FEATURES . Preventive Medicine

Vaccines for Adults Vaccines are not just for children; today we hear about the need to follow up on the immunization schedule to prevent many diseases. It is worth mentioning the HPV vaccine that protects against the two high-risk HPV types (types 16 and 18) which cause 70% of cervical cancers in women and 90% of all HPV-related cancers in men. It also protects against two low-risk HPV types (types 6 and 11), which cause 90% of genital warts. The United States Food and Drug Administration (FDA) has approved the use of two vaccines in the United States, Gardasil and Cervarix, which contribute to preventing most cases of cervical cancer if injected into a woman or a girl before being exposed to the virus. HPV vaccination is recommended for 11 and 12 year-old girls. It is also recommended for girls and women age 13 through 26 years of age who have not yet been vaccinated or completed the vaccine series; HPV vaccine can also be given to girls beginning at age 9 years. CDC recommends 11 to 12 year olds get two doses of HPV vaccine to protect against cancers

caused by HPV. Each vaccine is administered in three doses over six months. The second dose is given one or two months after the first dose and the third dose is administered six months after the first dose. On the other hand, shingles is the most common among the elderly and can be prevented with vaccine as scientists have been able to develop a vaccine for the virus that causes the disease. The best way to prevent this disease is to give the vaccine for people over the age of 50; it does not prevent shingles but significantly reduces the risk. Chickenpox vaccine should also be administered in childhood as it contributes to the delay of infection. Shingles is caused by varicella zoster virus, the same virus that causes chickenpox.

diagnosis, and developing a treatment plan based on the rest of the family and involve them in the plan.

Family Doctor

Family medicine is part of comprehensive and continuous primary healthcare through focusing on the individual as a social unit; it is a specialty based on health, psychological, behavioral and social sciences. The family doctor has the following tasks: • Addressing the health problems of the individual within the family. • Ability to communicate with the patient in the family from the physical, social and psychological aspects. • Having knowledge about health problems in the society and the ability to set priorities • Raising the health level of the individual, family and society.

The family doctor is the first step towards the success of primary healthcare systems. The doctor is responsible for all family members as he is trained to deal with the health condition in terms of causes, the ability to diagnose and inform the family of the

One of the most important factors of a family doctor’s success is his ability to communicate, raise awareness and deal with health problems, in addition to mastering the basics of clinical medicine in many specialties.

ARTICLE FEATURES . Medical Shipping

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ARTICLE FEATURES . Medical Shipping

he world has entered the revolution of openness, rapid communication and bridging the distance; the medical sector is at the heart of this revolution given the patients’ urgent and critical needs that require speedy delivery and implementation on the one hand and the privacy in the packaging and shipping of medicines, treatments and medical materials on the second hand.

In addition, the openness to the world has increased the shipping traffic in the healthcare sector, which has necessitated the development and expansion of the shipping traffic technologies, as we have been witnessing the opening of new centers and routes in order to meet the increasing medical needs and requirements, and improve safety and security as part of the quality of the medical service, which has become an ongoing target for all workers in the sector. The medical equipment shipping has expanded to form a new business field between medicine and trade. With time and the necessities of medical privacy, it has become more widespread and sophisticated, and more in line with the medical requirements in hospitals. On the other hand, it is now a worldwide financial movement of billions of dollars.

Multi-level development Shipping operations in the healthcare sector have quickly invaded the world and are expanding technically and spatially. After adopting specific cases, especially in Europe and America, its use has begun to spread in the West and East, where a number of Arab countries started not only to adopt these services but also expand their use and develop its technologies. In this context and in order to provide the best medical equipment

shipping, logistics company “Matternet” has announced a permanent autonomous drone network in Switzerland that will now see lab samples like blood tests and other diagnostics flown between hospital facilities, clinics, and labs. According to the published information, users operate the system via an app to create shipment details. Items are placed into a compartment box in the station before being loaded into a drone for delivery. Packages are then flown to another Matternet station, where receivers can obtain their package by scanning a QR code. The Matternet drones have a maximum range of 20 kilometers or about 12 miles, and can carry a 2 kilogram payload. They fly at an average speed of 36 kilometers or 22 miles per hour. The drones are quadcopters with duplicate sensors and autopilot systems on board. The option to fly samples between hospitals, without having to commission piloted helicopters or planes, could alleviate delays in testing and therefore patient care. Such transport planes have been used by the Tanzanian government in a move that is the first of its kind to transport medicines to all parts of the country, particularly East Africa. The Tanzanian government is working with US logistics company “Zipline” to launch “the world’s largest national drone delivery network” to provide access to essential medical supplies and life-saving care. In the first quarter of 2018, Tanzania’s government began using drones to make up to 2,000 deliveries per day to more than 1,000 health facilities, Zipline said in a statement. The service will be crucial in times of unexpected demand or bad weather and for small but critical orders, said Laurean Bwanakunu, director-general of Tanzania’s national medical stores.

ARTICLE FEATURES . Medical Shipping

Since October 2016, Zipline has been operating a similar drone delivery service in Rwanda for emergency blood deliveries to transfusion clinics. The logistics of distribution of medical services, drugs, equipment and blood units, are based on temperature-controlled transportation to maintain the required temperature. The medical transportation companies in Germany, Europe, America and Asia are implementing this by adopting the main logistics of the supply network for the transportation of medicines based on good distribution practices, providing an ideal way of shipping. Regarding the packaging, Pharmaserv Logistics has a license to package medication (secondary packaging) as per §13 of the German Medicines Act. A packaging unit comprising modern equipment has been set up for this business area. Its modular structure allows for maximum packaging flexibility: all vial sizes can be packed, for example, or country-specific data printed in line. Pharmaserv Logistics is the logistic partner for the expert storage of pharma products and smooth handling of the cargo. The partners chosen by Pharmaserv keep a close eye

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on your sensitive products along the supply chain, as continuous monitoring is essential for temperature-sensitive goods. F.lli Sebeto Trasporti, one of the carriers, has the same reliability in shipping to all European destinations, especially to Germany, France, Switzerland, Austria and the Netherlands. It collects goods locally and globally, and transfers liquid foods in temperature-controlled tanks.

The first and largest facility in the world In the Arab world, more than one country has opened air routes for such medical devices and supplies. Emirates SkyPharma, Emirates SkyCargo’s new purpose-built facility dedicated exclusively to the timely and secure transport of temperature sensitive pharmaceutical shipments at Dubai International Airport (DXB) was officially inaugurated in September 2016 by His Highness Sheikh Ahmed bin Saeed Al Maktoum, Chairman and Chief Executive of Emirates Airline and Group. “Pharmaceuticals are one of the most important products we transport because of the impact on people’s lives and communities across the world,” said Nabil Sultan, Emir-

ates Divisional Senior Vice President, Cargo. “As a leader in the global air cargo industry we decided that it was not only important for us to build stateof- the-art cool chain facilities for the transport of pharma products but to also go the extra mile and ensure the compliance of our operations against the highest international standards. Our customers can continue to rest easy knowing that shipping their high-value and temperature-sensitive goods with Emirates SkyCargo is a safe and efficient choice for their business and end customers.” First and largest GDP Certified multi-airport hub in the world, the new purpose-built Emirates SkyPharma facility, part of the new 11,000 square metre extension of Emirates SkyCentral terminal at Dubai International Airport, offers 4,000 square metres of space dedicated to pharmaceutical cargo. It also features temperature controlled zones (2-8 degree Celsius and 15-25 degree Celsius), 88 temperature controlled individual positions in the automated ULD (aircraft pallet) handling system and 5 temperature controlled acceptance and delivery truck docks.

ARTICLE FEATURES . Medical Shipping

The new Emirates SkyPharma facility at Dubai International airport works in conjunction with Emirates SkyCentral DWC, the carrier’s freighter hub in Dubai World Central which offers 4,600 square metres of dedicated area for pharmaceutical cargo. Both facilities complement the range of innovative cool chain products and solutions offered by Emirates SkyCargo including the Cool Dolly, the White Container and White Cover Advanced, all of which are designed to prevent temperature fluctuations or spikes from occurring during any part of the transportation process. Emirates SkyCargo has also been awarded the certification of compliance under the EU Good Distribution Practice guidelines (GDP) for medicinal products for human use by Bureau Veritas following an audit conducted by the certification agency’s team from Germany. The certification validates the carrier’s adherence to the strict guidelines on the transport and handling of pharmaceutical products and covers all Emirates SkyCargo handling activities for pharmaceutical products at its hub in Dubai. Emirates SkyCargo is the first cargo airline in the world that has obtained GDP certification for its hub operations covering two airports and the 24/7 bonded trucking service that connects cargo between them. The carrier also operates the largest GDP certified area in the world offering a total area of 8,600 square metres of combined handling space dedicated for pharmaceutical products at Dubai International Airport and Dubai World Central. The Good Distribution Practice guidelines outlined by the European Commission have been designed to ensure that the quality and integrity of pharmaceutical products are maintained during transportation.

As part of its audit process, Bureau Veritas, well known around the world for their high standards, subject knowledge and experience, scrutinised all aspects of the handling and storage of pharmaceutical shipments through Emirates SkyCargo’s dual hubs in Dubai to ensure compliance with GDP guidelines on a number of subjects including quality management, product integrity, security and training of staff handling pharmaceutical products. In 2015, Emirates SkyCargo shipped close to 11,000 tonnes of pharmaceutical products across its global network through its hub in Dubai. The top pharmaceutical products shipped include critical medication for diabetes and cancer, active pharmaceutical ingredients (APIs), blood derivatives and vaccines.

Specialized shipping service Saudia Cargo announced that it has introduced its new Pharma.2.World Active product. Using the latest design in sophisticated active heating and cooling cargo containers, the Active solution is able to maintain the correct internal temperatures required for the transport of essential pharmaceutical and life science products, whatever the external temperature may be. Pharma.2.World Active shipments can be booked via local Saudia Cargo sales offices and will initially be available to/from Riyadh, KSA. Subsequent phases will see the rollout of the product to additional stations within the Saudia Cargo network. “The company was keen to provide high quality shipping services related to the pharmaceutical and medical industries and complying with international standards and requirements. This step is part of the company’s strong aspirations to diver-

sify its products and services all year round and meet the demands of its customers everywhere,” commented Nabil Khojah, CEO at Saudia Cargo. Saudia Cargo customers will have access to the latest air cargo containers specifically designed for pharmaceutical and life science products thanks to an agreement with Envirotainer and CSafe, under which they can lease a choice of active containers from selected origin points on the Saudia Cargo network. Additional benefits of Pharma.2.World Active include: ready-to-lease containers offering temperature control ranging from -20˚C to +25˚C; a dedicated product manager with specially trained staff and specific handling procedures; temperature, battery and re-icing checks as necessary during acceptance, transit and delivery; and priority access to capacity on selected flights and pre-alerts to facilitate customs clearance and delivery. Saudi Airlines Cargo operates a fleet of 15 freighters and sells the belly-capacity on 145 passenger aircraft for Saudi Arabia’s flag carrier Saudia, spanning a rapidly expanding global network of 225 destinations. In addition to its scheduled freighter services, the cargo airline also provides cost-effective and practical worldwide charter flight solutions from a growing fleet of dedicated charter aircraft. All these developments indicate that the world attaches great importance to the medical sector at all levels, in addition to this sector’s expansion, which is no longer limited to hospitals, pharmaceutical companies and pharmacies, but has exceeded the traditional concepts of medical practices to include many sectors including health insurance, medical tourism, and medical equipment shipping among others.

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allstones are stones that formed in the gallbladder. The gallbladder is an organ in the body attached to the liver that stores the bile, secreted by the liver. Gallstones can vary in size from less than a millimeter to several centimeters. Bile is a liquid that is made by the liver and is important for digestion of food particularly fats and eliminating toxic substances from the body. Bile formed in the liver is stored in the gallbladder. In the gallbladder, bile is concentrated by absorption of water. During a meal, gallbladder contracts and squeezes the concentrated bile into the intestine through the common bile duct. Gallstones usually form in the gallbladder; however, they may also form anywhere in the biliary ducts.

Types of gallstones: There are several types of gallstones & each type has a different cause.

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Cholesterol gallstones Cholesterol gallstones are the most common gallstones. Cholesterol gallstones are mainly made up of cholesterol. Cholesterol is one of the substances secreted by the liver into the bile. Secretion of cholesterol in bile is an important mechanism by which the liver eliminates excess cholesterol from the body. Cholesterol is a fat and it will not dissolve in water, so to keep it in dissolved form, the liver also produces detergents like bile acids and lecithin. If the balance between these two is disturbed. For example, more cholesterol in bile or fewer detergents, then it promotes cholesterol particle and then stones.

Pigment gallstones Pigment gallstones are the second most common type of gallstones. The main component of the pigment gallstones is bilirubin which is normally produced in the body by the

Dr. Munir Saeed Associate Consultant Surgeon breakdown of old red blood cells. There are two types of pigment gallstones. 1. Black Pigment Gallstones: If there is too much bilirubin in bile, the bilirubin combines with calcium to form stones that are black in color, so, therefore, called black pig-

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ment gallstones. 2. Brown Pigment Gallstones: The stones are formed if bile is stored in the gallbladder for a long time like if there is a reduced contraction of the gallbladder. In this condition, bacteria can ascend from the duodenum into the bile ducts and then gallbladder and these bacteria alter the bilirubin and then altered bilirubin combined with calcium to form brown pigment stones.

Other gallstones One of the rare causes of gallstones is secondary to the intake of medications like ceftriaxone. Ceftriaxone is mainly excreted from the body by the liver into the bile and it combines with calcium to form crystals and stones, but these stones often disappear once the antibiotic treatment stopped.

Risk Factors for Gallstones Cholesterol Gallstones There is no direct relationship between the cholesterol level in the blood and formation of cholesterol gallstones. The following are the risk factors for cholesterol gallstones: 1. Gender: More common in women than in men. 2. Age: Gallstone prevalence increases with age. 3. Obesity: More common in obese. 4. Pregnancy: Due to hormonal changes in pregnancy, bile contains more cholesterol and also gallbladder does not contract normally, so chances for cholesterol stones increase. 5. Birth control pills also increase the risk for cholesterol

gallstones. 6. Rapid weight loss by whatever means whether by diet or obesity surgery causes cholesterol gallstones in up to 50% of individuals. Some of them might disappear after the weight is lost but many do not. 7. Crohn’s disease. In Crohn’s disease of the ileum, the bile acids are not reabsorbed. As a result, there are not enough detergent bile acids to keep cholesterol dissolved in bile, resulting in gallstones formation. 8. Increased blood triglycerides.

Pigment Gallstones Increased destruction of red blood cells produces more pigment that is bilirubin and increased the risk of formation of pigment gallstones, for example in diseases like a sickle-cell disease, thalassemia, etc. Also, pigment stones are common in liver cirrhosis and stasis of bile like stricture of the bile duct, etc.

Symptoms of Gallstones Majority of people with gallstones have no symptoms and detected incidentally on ultrasound of the abdomen done for other reasons. These are called silent or asymptomatic gallstones. Over the period of five years, about 10% of people with silent gallstones develop symptoms. Once symptoms appear, the symptoms are likely to continue and often get worse. The most common symptom is biliary colic or pain. Biliary colic comes on suddenly or just rapidly in few minutes. It is a constant pain although it may vary in intensity. It lasts usually from 15 minutes to four or five hours.

If the pain is for more than four to five hours, it means that a complication, usually cholecystitis, has developed. It often accompanied by nausea, usually felt in the middle of the upper abdomen. The second most common location is the right upper abdomen just below the ribs. Occasionally, pain can be felt at the back, at the low tip of the scapula. Usually, it can be mistaken as heart attack or angina. Biliary colic is a recurring symptom. After the first episode, it is likely to have more episodes. It varies from individual to individual. Symptoms not caused by gallstones but usually blamed and related to gallstones are dyspepsia, intolerance to fatty food, belching and flatulence.

Complications of Gallstones Common complications related to gallstones are: • Cholecystitis. • Cholangitis. • Gangrene of the gallbladder. • Obstructive jaundice. • Pancreatitis. • Sepsis. • Fistula between gallbladder and intestine. • Gallstone ileus. • Cancer of the gallbladder: Cancer of the gallbladder is almost all the time is associated with gallstones.

Treatment of Gallstones Silent gallstones: Silent gallstones do not need treatment in certain individuals. For example, in an individual, if gallstones are discovered at the age of 65 years, the chance of developing symptoms is 20% or less. It is advisable not to treat that individual. Another example is if silent gallstones diagnosed in

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an individual at a young age who has some serious life-threatening disease like heart disease and is not fit for surgery. On the other hand in healthy young individuals, treatment should be considered even for silent gallstones because of chances of developing symptoms from gallstones over a lifetime is higher.

Symptomatic gallstones: Cholecystectomy Cholecystectomy is the standard treatment for gallstones. Cholecystectomy is the removal of the gallbladder with surgery. Nowadays, this is done laparoscopically with small punctures in the skin. Before it was done through a large abdominal incision. Cholecystectomy has a low rate of complications but serious complications such as damage to the bile duct and leakage of bile can occur occasionally. Problems following removal of the gallbladder are very few. Digestion of food is not affected and no change in diet is necessary. Sphincterotomy and extraction of gallstones Sometimes, gallstones may be stuck in the hepatic or common bile duct. There are usually gallstones in the gallbladder also and cholecystectomy is necessary. It is possible to remove stuck gallstones in the duct at the time of surgery but this may not always be possible. So, the gallstones in the duct can be removed by sphincterotomy and extraction of gallstone by an endoscope before or after the cholecystectomy. Oral dissolution therapy It is possible to dissolve some cholesterol gallstones with medication taken orally, medications called

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ursodeoxycholic acid or Ursodiol. Ursodiol reduces the amount of cholesterol secreted in bile. The bile then has less cholesterol and becomes capable of dissolving the cholesterol in the gallstones. Limitations are: 1. It is only effective for cholesterol gallstones and not pigment gallstones. 2. It only works for small gallstones that are less than 1 to 1.5 cm in size. 3. It takes one to two years for the gallstones to dissolve and many gallstones reform following cessation of treatment. Due to these limitations, Ursodiol is used only in individuals with smaller gallstones that are likely to have very high cholesterol content and who are at high risk of surgery because of ill health. Ursodiol is most useful in individuals who develop gallstones due to the transient effect like rapid weight loss since the gallstones would not be expected to recur following successful dissolution.

Prevention Prevention of gallstones is possible since Ursodiol is available. The difficulty is to identify individuals who are at high risk of developing cholesterol gallstones over a short period of time so that the duration of preventive treatment can be limited. One such group is obese individuals losing weight rapidly with very low calorie or surgery. The risk of gallstones in such individuals is as high as 40% to 60%. Ursodiol has been shown in several studies to be very effective at preventing gallstones in these individuals. It is important to stress that no dietary changes have been shown to treat or prevent gallstones.

Can symptoms continue after treatment of gallstones? Removal of the gallbladder (cholecystectomy) should eliminate all gallstone-related symptoms except in following situations: â€˘ Gallstones were left in the bile duct. â€˘ There are problems with the bile duct in addition to gallstones like stricture or narrowing. â€˘ Gallstones were not the cause of the symptom.

Latest Update About Gallstones It is clear that genetic factors are important in determining who develops gallstones. To date, 8 to 10 genes have been identified as being associated with cholesterol gallstones at least in animals that develop gallstones. The long-term goal is to identify the individuals who are genetically at very high risk for gallstone formation. Also, an understanding of the exact mechanism of gallstones formation may also result in new therapies for treatment and prevention. Surgery for gallstones has undergone a major transition from requiring large abdominal incisions to requiring an only tiny incision for laparoscopic cholecystectomy. It is possible for another transition. Surgeons are experimenting with the technique called Natural Orifice Transluminal Endoscopic Surgery (NOTES). NOTES is a new technique for accomplishing standard intraabdominal surgery but access to the abdomen is through a natural orifice, the mouth, anus or vagina. There are potential advantages to this type of surgery but it is in the early stages of development and it is unclear what the future of NOTES will be in the world of surgery.

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ARTICLE FEATURES . Multiple Sclerosis

Multiple Sclerosis

Many advanced treatments altered the disease course

ultiple sclerosis is an unpredictable, often disabling disease of the central nervous system that disrupts the flow of information within the brain, and between the brain and body. The diagnosis of multiple sclerosis needs to be very accurate and the patient must undergo several diagnostic tests in order to rule out other diseases. Although there is no cure for multiple sclerosis, the new and sophisticated treatments that are currently available, in addition to the tests that are being worked on, will relieve symptoms in a better way or even eliminate the disease in the future. Multiple sclerosis is a chronic

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inflammatory disease that affects the central nervous system. Damage to myelin causes interference in the communication between your brain, spinal cord and other areas of the body. This condition may result in deterioration of the nerves themselves, a process that’s not reversible. Doctors have always sought to start treatment in order to control symptoms and improve the patient’s life given the absence of a cure for MS. A number of drugs have shown to slow the progression of the disease and reduce the frequency and severity of relapses. In the same context, doctors advise patients with multiple sclerosis to avoid anything that would trigger the disease and lead to a

relapse such as extreme fatigue and stress, smoking, fever, hot baths and exposure to sunlight. The cause of multiple sclerosis is unknown. It is considered an autoimmune disease in which the body’s immune system attacks its own tissues. In the case of MS, this immune system malfunction destroys myelin, the fatty substance that coats and protects nerve fibers in the brain and spinal cord. Myelin can be compared to the insulation coating on electrical wires. When the protective myelin is damaged and nerve fiber is exposed, the messages that travel along that nerve may be slowed or blocked. The nerve may also become damaged itself. It isn’t clear why MS develops in

ARTICLE FEATURES . Multiple Sclerosis

some people and not others. A combination of genetics and environmental factors appears to be responsible. Women are about twice as likely as men are to develop MS. It can occur at any age, but most commonly affects people between the ages of 15 and 60. Symptoms of multiple sclerosis vary, depending on the location of affected nerve fibers. Multiple sclerosis symptoms may include numbness or weakness in one or more limbs, partial or complete loss of central vision, usually in one eye, often with pain during eye movement (optic neuritis), double vision or blurring of vision, tingling or pain in parts of your body, electric-shock sensations that occur with certain head movements, tremor, lack of coordination or unsteady gait, slurred speech, fatigue and dizziness. There are no specific tests for MS. Instead, a diagnosis of multiple sclerosis often relies on ruling out other conditions that might produce similar signs and symptoms, known as a differential diagnosis. Your doctor is likely to start with a thorough medical history and examination. Your doctor may then recommend blood tests, to help rule out other diseases with symptoms similar to MS. Tests to check for specific biomarkers associated with MS are currently under development and may also aid in diagnosing the disease. Lumbar puncture (spinal tap), in which a small sample of fluid is removed from your spinal canal for laboratory analysis. This sample can show abnormalities in antibodies that are associated with MS. Spinal tap can also help rule out infections and other conditions with symptoms similar to MS. MRI, which can reveal areas of MS (lesions) on your brain and spinal cord. You may receive an intravenous injection of a contrast material to highlight lesions that indicate your disease is in an active phase. Evoked

potential tests, which record the electrical signals produced by your nervous system in response to stimuli. An evoked potential test may use visual stimuli or electrical stimuli, in which you watch a moving visual pattern, or short electrical impulses are applied to nerves in your legs or arms. Electrodes measure how quickly the information travels down your nerve pathways.

The latest treatments Although there is no cure for MS, there are many important steps to be taken in order to help the patient continue his life actively and independently. Treatment typically focuses on speeding recovery from attacks, slowing the progression of the disease and managing MS symptoms. Some people have such mild symptoms that no treatment is necessary.

Treatment is divided into three types: 1. Treatment of the attack: Treatment of MS relapses focuses on shortening the length of a relapse and speeding up relapse recovery. If the attack is mild and the symptoms are bearable, you may respond to rest for a day or two, drink enough cold fluids and cool down the room. Corticosteroids are prescribed to reduce nerve inflammation. 2. Treatment of the disease: Beta interferons are among the most commonly prescribed medications to treat MS. They are injected under the skin or into muscle and can reduce the frequency and severity of relapses. Side effects of beta interferons may include flu-like symptoms and injection-site reactions. Youâ€™ll need blood tests to monitor

your liver enzymes because liver damage is a possible side effect of interferon use. People taking interferons may develop neutralizing antibodies that can reduce drug effectiveness. 3. Treatment of complications: In MS patients, multiple complications may occur including muscle spasm which may cause a major problem due to stiffness and pain, which are usually treated with muscle relaxants; while tremor is treated with Inderal and others. Some patients may experience trigeminal neuralgia, a type of nerve (neuropathic) pain in the side of the face which can be a symptom of multiple sclerosis. Trigeminal neuralgia is treated with carbamazepine initially. The treatment is usually taken several times a day and the dose is increased slowly over a few days or weeks until an effective dose is reached. If you need to stop carbamazepine for any reason, the dose will usually be reduced gradually. Medical professionals have developed many advanced treatments that have contributed to modifying the course of the disease and treating relapses, enabling the patient to perform his daily activities. Treatment may vary from one person to another. Today, a major breakthrough has been achieved in terms of therapies, which is a combination of drugs that are adapted to the disease and must be available to all patients with multiple sclerosis. Receiving treatment from the earliest stages of the disease is a key factor in enhancing the positive impact of the disease.

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Facts about Obesity A chronic condition defined by an excess amount of body fat What are the health risks associated with obesity? Obesity is not just a cosmetic consideration; it is harmful to one’s health as it increases the risk of developing a number of chronic diseases, including the following: • Insulin resistance and Type 2 diabetes. • Hypertension • Hypercholesterolemia. • Stroke (cerebrovascular accidents). • Heart attack. • Congestive heart failure • Gallstones. • Gout and gouty arthritis. • Osteoarthritis (degenerative arthritis) of the knees, hips, and the lower back. • Sleep apnea. • Cancer: Obesity is a risk factor for cancer of the colon in men and women, cancer of the rectum and prostate in men, and cancer of the gallbladder and uterus in women. Obesity may also be associated with breast cancer, particularly in postmenopausal women.

What causes obesity? The balance between calorie intake and energy expenditure determines a person’s weight. If a person eats more calories than he or she burns (metabolizes), the person gains weight (the body will store the excess energy as fat). Ultimately, body weight

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is the result of genetics, metabolism, environment, behavior, and culture. • Genetics. A person is more likely to develop obesity if one or both parents are obese. • Overeating, especially if the diet is high in fat or sugar. • A diet high in simple carbohydrates. • The frequency of eating. • Physical inactivity. Sedentary people burn fewer calories than people who are active. • Medications. Medications associated with weight gain include certain antidepressants, anticonvulsants, some diabetes medications, certain hormones, and most corticosteroids. Some high blood pressure medications and antihistamines cause weight gain. • Psychological factors. • Diseases such as hypothyroidism, insulin resistance, polycystic ovary syndrome, and Cushing’s syndrome are also contributors to obesity. • Social issues. The body mass index (BMI) is a now the measurement of choice for physicians and researchers studying obesity. The body mass index (BMI) equals a person’s weight in kilograms (kg) divided by their height in meters (m) squared. The World Health Organization uses a classification system

Dr. Bakhos Alhaddad Specialist General Surgeon using the BMI to define overweight and obesity. • A BMI of 25 to 29.9 is defined as a “pre-obese.” • A BMI of 30 to 34.99 is defined as “obese class I.” • A BMI of 35 to 39.99 is defined as “obese class II.” • A BMI of or greater than 40.00 is defined as “obese class III.”

What is the role of physical activity and exercise in obesity? Physical activity and exercise help burn calories. The amount of calories burned depends on the type, duration, and intensity of the activity. It also depends on the weight of the person. But exercise as a treatment for obesity is most effective when combined with a diet and weight-loss program. Other benefits of exercise include: • Improved blood sugar control and increased insulin sensitivity (decreased insulin resistance). • Reduced triglyceride levels and increased “good” HDL cholesterol levels. • Lowered blood pressure. • A reduction in abdominal fat.

ARTICLE

MAINTAINING YOUR IDEAL BODY WEIGHT IS A BALANCING ACT BETWEEN FOOD CONSUMPTION AND CALORIES NEEDED BY THE BODY FOR ENERGY. YOU ARE WHAT YOU EAT. THE KINDS AND AMOUNTS OF FOOD YOU EAT AFFECT YOUR ABILITY TO MAINTAIN YOUR IDEAL WEIGHT AND TO LOSE WEIGHT.

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Reduced risk of heart disease. The release of endorphins that make people feel good.

What is the role of diet in the treatment of obesity? The first goal of dieting is to stop further weight gain. The next goal is to establish realistic weight-loss goals. General diet guidelines for achieving and maintaining a healthy weight: • A safe and effective long-term weight reduction and maintenance diet have to contain balanced, nutritious foods to avoid vitamin deficiencies and other diseases of malnutrition. • Eat more nutritious foods that have “low energy density.” Low energy dense foods contain relatively few calories per unit weight (fewer calories in a large amount of food). Examples include vegetables, fruits, lean meat, fish, grains, and beans. • Eat less “energy dense foods.” Energy-dense foods are high in fats and simple sugars. They generally have a high-calorie value in a small amount of food. Examples include red meat, egg yolks, fried foods, high fat/sugar fast foods, sweets, pastries, butter, and high-fat salad dressings.

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About 55% of calories in the diet should be from complex carbohydrates. Eat more complex carbohydrates such as brown rice, wholegrain bread, fruits, and vegetables. Avoid simple carbohydrates such as table sugars, sweets, doughnuts, cakes, and muffins.

What is the role of medication in the treatment of obesity? Medication treatment of obesity should be used only in patients who have health risks related to obesity. Medications should be used in patients with a BMI greater than 30 or in those with a BMI of greater than 27 who have other medical conditions (such as high blood pressure, diabetes, high blood cholesterol) that put them at risk for developing heart disease. Medications should not be used for cosmetic reasons. Medications should only be used as an adjunct to diet modifications and an exercise program.

What is the role of weight loss surgery in the treatment of obesity? The National Institute of Health consensus has suggested the following guidelines for weight loss surgery in obese patients:

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Patients with a BMI of greater than 40 (morbid obesity). Patients with a BMI of greater than 35 who have serious medical problems such as sleep apnea that would improve with weight loss.

Currently, there are basically two types of bariatric surgery: • Restrictive surgeries: These surgeries restrict the size of the stomach and slow down digestion. • Malabsorptive/restrictive surgeries: These surgeries restrict the size of the stomach but also bypass or remove part of your digestive system to decrease absorption of food/ calories. • The Common Surgical Bariatric Procedures: Laparoscopic Adjustable Gastric Banding, Laparoscopic Sleeve Gastrectomy, Laparoscopic Gastric Bypass, and Laparoscopic Gastric Mini Bypass. • The Common Endoscopic Bariatric Procedures: Intra-Gastric Balloons, Intra-Gastric Botox Injection, and POSE Procedure.

The impact of sleep on childhood obesity Researchers at Weill Cornell Medicine – Qatar (WCM-Q) have shown that lack of sleep is likely to be a contributing factor in childhood obesity in Qatar

Dr. Shahrad Taheri

he relationship between obesity and insufficient sleep has been demonstrated before, but the majority of studies have relied on subjective estimates of sleep, and only one indicator of obesity.

By contrast, the team from WCM-Q used five indicators of obesity to ensure the condition was accurately defined. They also issued each subject with a wrist actigraphy device which records movement and allows researchers to accurately and objectively estimate sleep parameters. The study was conducted on 335 elementary schoolchildren in Qatar who were aged between seven and 12. Each child was asked to wear

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the actigraph for seven consecutive days and nights. The children had their neck and waist circumferences measured, their height and weight are taken (allowing their body mass index [BMI]) to be calculated, and their percentage of body fat and fat mass measured. The research found that the average time at which the children went to sleep during the week was 9.22pm, and the average time at which they woke was 6.26am. Of the sample, 42.1 percent were classified as either overweight or obese according to the definitions from the World Health Organization. Of those children, weekday sleep duration was significantly shorter at 7 hours 36 minutes, as opposed to 7 hours 54 minutes for those who were a healthy weight. Although sleep is certainly not the only factor involved in obesity, the researchers state that it appears to be a contributory factor. Sleep duration may influence food intake, food selection, and energy

expenditure with downstream effects on body fat. Dr. Shahrad Taheri, director of the clinical research core and assistant dean for clinical investigations said that the body of evidence pointed to a lack of sleep has an effect on a person’s weight, and there is increasing evidence to support this from studies of both children and adults. Dr. Taheri added: “Here, we observe the relationship between sleep and obesity in the first study of sleep in schoolchildren in Qatar. The study demonstrates that conditions like obesity are far more complex than we first thought, and should be treated holistically. Qatar has a high prevalence of obesity and there is a need to look at improving sleep to prevent and tackle obesity. We plan to undertake further research to see if it is possible to reduce obesity through a lifestyle change that includes diet, physical activity, and sleep.”

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

The Leader in Medical Training in the Kingdom Project: 2 Small TV Screens in the General Hospital

Project type: Non-Medical Location : Lecture Rooms – General Hospital Floor : G.F.

“Empowering teams and developing talent”

International Local

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2018