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Issue 46 / 152 MAY-JUNE 2019

THE ARAB HOSPITAL APPLICATION IS AVAILABLE

Virtues of the Holy Month Spirit Purity and Body Health The Holy Month is back, with all of its spiritual, faith, and health dimensions, many of which are considered advantageous to the body and mind. Ramadan is the ninth month of the Islamic calendar, in which Allah revealed the Quran to the Prophet Muhammad. It is a phase in which the Muslim purifies himself and his spirit of sins, and that serves as a new starting point. What makes Ramadan special is Laylat al-Qadr (The night of Destiny) which is the greatest night of the year, whereas God forgives his Muslim slaves and washes away their sins. According to hadith, fasting on this night brings abundant blessings and mercy of God. Learning patience is also one of the virtues of this month. Those who sate their hunger and thirst can be patient with other things that need time. Not fulfilling the desires of the soul is another virtue, whereas the person fasting abstains from gossiping, cursing, and bad behavior just like abstaining from food and drink. He purges himself of previous hatreds and rivalries in exchange for reward and forgiveness, forgives those who sinned against him, and apologizes to whom he has caused harm. Souls become pure then and love reigns among the society. While purging the soul, the body also gets purged and regains its energy and the cells are renewed. And thus, apart from the mental and spiritual benefits, one is rewarded on the physical level. Hence, the Holy Month contributes to the health of the body and the soul... May Allah reward our readers and partners in particular, and Muslims in general, as well as the whole world, with goodness and barakah. The Publisher

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 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 Elias Aramouni Business Dot Sulaimaniah Ofﬁces building • 2nd ﬂr M: +966 55 1595 000 T: +966 11 4568282 F: +966 11 2253666 P.O. Box: 085092 Riyadh 11691 Printing

Distribution KSA - UAE - OMAN LEBANON - JORDAN SYRIA - KUWAIT BAHRAIN - QATAR - EGYPT

MAY . JUNE 2019

Acıbadem Healthcare Group

12 Interview with Mehmet Ali Aydınlar 20 An open heart surgery at age 11 after a liver transplantation 22 One donor, one surgery, two organs 24 What are the symptoms of cerebral palsy? 26 MRIdian New Era in Cancer Treatment

NEWS

10 Grand Hamdan International Award winner donates the prize money 32 Clemenceau Medical Center affiliated with Johns Hopkins International Best Hospital in the World for Medical Travelers 46 Qatar Genome programme joins forces with Genomics England 48 Hotel-Dieu de France unveils Its Newly Renovated Emergency Department 62 Biogen Announcement Highlights Where the Industry is Going Wrong

MEDICAL INSTITUTIONS

6 Sysmex Middle East 28 Baylor St. Luke’s Medical Center 58 MedsBla

INTERVIEWS

38 Enrique Manzoni

MAY.JUNE 2019

92 56 Elie Chaillot

FEATURES

74 The Automated Lab 78 Managing Asthma 82 Asthma and allergies 84 The Fecal Immunochemical Test 86 Infertility in women 90 Weight Loss 92 Chronic Diseases during Ramadan… 100 Stroke Rehabilitation

ARTICLES

64 Al Ahli Hospital Endocrinology & Diabetes clinic 66 Glaucoma 68 Which food may be beneficial or harmful for your teeth and gums?

70 How medical tourism is developing regionally? 98 Overcome thirst during Ramadan

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MEDICAL INSTITUTIONS

Sysmex Middle East conducts its first Clinical Insight workshop in Oman

t Sysmex our mission is shaping the advancement in healthcare. For over 50 years, we have actively set new standards and driven innovation, thus becoming the global leader for haematology diagnostics. Sysmex is a very well-known brand and our products are recognised as reliable, accurate haematology analysers improving the laboratory workflow.

MAY.JUNE 2019

We now go a step further addressing clinician’s questions and highlighting the clinical insight of our advanced clinical parameters. We provide scientific knowledge going beyond the traditional cell count to gain far more clinical information from the analysed blood sample. A key feature of our XN-Series is that we are not just looking at cell morphology, we can also measure

and understand the cell functionality. Many scientific publications have increased the knowledge of the clinical insight of our advanced clinical parameters which we continually transfer to our customers. In corporation with the Ministry of Health Sultanate of Oman, Department of Laboratories – Sysmex Middle East organised an ‘Advanced Clinical Parameters in Haematology Work-

MEDICAL INSTITUTIONS

shopâ€™. Around 130 laboratory technologists and clinicians participated in the one-day workshop event from both governmental and private institutions in various governorates of Oman. Mr. Salam Al Rashdi, Head of the Diagnostic Laboratories Services at the Ministry of Health, initiated this

event to highlight the importance of the latest diagnostic developments related to haematology and quality control procedures. The workshop included a number of scientific lectures from both local and international speakers. General laboratory topics where covered on

verification/validation of medical tests and histogram and scattergram interpretation by Dr. Halima Al Balushi from Royal Hospital and Ms. Sahima Al Mamari from Sultan Qaboos University Hospital. Anaemia topics included the clinical utility of modern reticulocyte parameters and laboratory diagnostic tools presented by Dr. Benjamin Schoenbeck from Sysmex and Dr. Iman Al Noumani from Ibra Hospital. To conclude the workshop, the significance of the Immature Platelet Fraction and laboratory algorithm for clinical utility of thrombocytopenia diagnosis and management was presented by Ms. Sahar Eldewieh from Sysmex and Dr. Mohamed Al Zaabi from Khoula Hospital. Clinicians expect reliability and accuracy from the laboratory. At Sysmex we strongly feel that clinicians can confidentially use our new diagnostic parameters to know more, decide with confidence and act faster.

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NEWS

Grand Hamdan International Award winner donates the prize money Nassau Professor of Orthopedic Molecular Medicine and Chief of the Division of Molecular Orthopedic Medicine at the Perelman School of Medicine under University of Pennsylvania Health System. His investigations on the rare diseases FOP and POH have uncovered mechanisms so pathogenetically fundamental to tissue metamorphosis that they have challenged existing dogma far outside the usual realm of musculoskeletal medicine. Prof. Kaplan announced that he had donated the prize money to the International Fibrodysplasia Ossificans Progressiva Association (IFOPA), which in turn transferred the money to the Quality of L.I.F.E. Award, providing much needed funding to ensure grants for those living with FOP to improve their health, welfare and independence.

he winner of the Grand Hamdan International Award (2017-2018), Professor Frederick S Kaplan from Philadelphia, United States of America, has donated his prize money (250.000 Dirhams) to the treatment of patients with Fibrodysplasia Ossificans Progressiva (FOP), a rare and disabling disorder in which the body forms a second skeleton of heterotopic bone. Prof. Kaplan conveyed his sincere thanks and gratitude to H.H. Sheikh Hamdan bin Rashid Al Maktoum, Deputy Ruler of Dubai and UAE Minister of finance. “I am enormously honored

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and humbled to have been selected to receive the Grand Hamdan International Award for Medical Sciences in the field of Musculoskeletal Disorders”, he said. “I fervently hope that the research that my colleagues and I have done over the past 30 years will pave the way to relieve the tremendous suffering of those with the rare and catastrophic disorder, Fibrodysplasia Ossificans Progressiva, and more common and related disorders of extraskeletal bone formation”, he added. Prof. Kaplan is the Isaac and Rose

On his part, HE Mr. Abdulla bin Souqat, Executive Director of the Hamdan Medical Awards, conveyed his sincere thanks and gratitude to H.H. Sheikh Hamdan bin Rashid Al Maktoum, Patron of the Award for his continuous support to the award’s activities. He also praised Prof. Kaplan’s humanitarian initiative. Prof. Kaplan was honored at the recently concluded 10th term of the Hamdan Medical Award, where HH Sheikh Hamdan bin Rashid Al Maktoum honored the 16 winners of this term of the Award at a ceremony held at the Dubai International Convention and Exhibition Center. The event was graced by the presence of several ministers, health and medical officials, and dignitaries and official delegates representing the countries the winners represented.

An upstart on the global stage. A consistent leader in the U.S. We know children deserve the best possible care, in a safe and welcoming environment. Here in Columbus, Ohio, we have it all: world-class cultural attractions, cuisine and entertainment and — most importantly — pediatric specialty care that makes us a leading destination for patients from around the world. Our innovative research and dedicated health care team develop internationally recognized programs. From hosting a worldwide clinical trial consortium for childhood neuroblastoma to renowned gene therapy research aimed at making neuromuscular disorders a thing of the past, we aim to provide the highest level of expertise and care for our patients. Reach out to our Global Patient Services team to learn more about our unique combination of a welcoming city and remarkable care. Learn more, refer a patient or plan a trip: NationwideChildrens.org/Global-Patient-Services GlobalPatientServices@NationwideChildrens.org +1 614 362 9127 Nationwide Children’s Hospital, Columbus, Ohio - USA

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Chairman of Acıbadem Healthcare Group

Mehmet Ali Aydınlar “WE ARE OPEN TO TAKE ADVANTAGE OF OPPORTUNITIES IN GULF COUNTRIES” MAY.JUNE 2019

Mehmet Ali Aydınlar is one of the reputable businesspeople in Turkey who is renowned for creating a global healthcare brand out of a district hospital. Being Chairman of Acıbadem Healthcare Group, which is the leading healthcare organization in Turkey and Member of Board in IHH Healthcare Berhad, which is the second largest health chain of the world, Mehmet Ali Aydınlar has achieved great successes and gained numerous awards in his business life. Currently, he is getting ready to represent Turkey in “EY World Entrepreneur Of The Year” contest, after being elected as “EY Entrepreneur Of The Year in Turkey”. We interviewed him on healthcare sector and investment strategies of Acıbadem Healthcare Group.

We do know the fact that the journey of Acıbadem in healthcare sector has begun in a district hospital. Your Group has a history of 28 years. Could you please summarize your current position? We were a small district hospital in the beginning. We named our hospital after the name of district. Today, this name is a well-known global brand in the healthcare sector. Now, Acıbadem operates in 4 countries, namely Turkey, Macedonia, Bulgaria and the Netherlands with 22 hospitals and 15 outpatient clinics. In addition to hospitals and outpatient clinics, we are represented in 19 different

countries and 28 cities with 30 Health Point information offices abroad. Acıbadem has approximately 23.000 employees, including 4.000 doctors and 4.200 nurses. We provide services to 5 million people in a year.

Acıbadem Healthcare Group is a rapidly growing and globalizing company... What was your impetus to reach this point? Acıbadem Healthcare Group grows and develops rapidly both in Turkey and abroad. It has become a group that operates in 4 countries and creates an ecosystem with its business model in a very short time. The

“We dreamed to be a global player, when we established Acıbadem, and we also acted in line with this dream.” 13

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driving power of our overall growth strategies is our motivation to act in line with the desire of innovation and perfection with both our business model and our employees, who had already adopted this model, while precisely focusing on patient satisfaction and safety. Acıbadem has blazed many trails and successful works both in Turkey and international field with this culture. Growing is only one of them.

You are mentioning that the business model you have developed has a huge effect on your success. You founded a kind of ecosystem in healthcare sector. Could you please inform us about this model? We developed a 360° model that is focused solely on health to meet all needs in this field. This model was so striking that JP Morgan, one of the important global investment banks, presented this model as an example to the world in 2007. Yes, we literally created an ecosystem. A component of this ecosystem is an integrated structure that provides the patients with necessary services at hospitals and outpatient clinics. “APlus” that deals with catering, cleaning, laundry services in international standards, “Acıbadem Mobile” that offers home care and emergency healthcare services and “Acıbadem Labmed” rendering laboratory services as well as “Acıbadem Project Management” that constructs “turn-key” hospital/ clinic, “Acıbadem Technology” that develops and produces healthcare software and technological products and “Acıbadem University” that supports education of healthcare professionals are all improving and supporting services rendered at hospitals and outpatient clinics in this integrated structure. Those companies not only supply services to Acıbadem, but they

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also produce services to meet needs of major international brands.

You also have a University focusing solely on health sciences; can you please briefly inform us about Acıbadem University and the synergy it created with the Group? Acıbadem University is actually our social responsibility project. It is one of the best health sciences universities around the globe. This university educates more than 4.000 students in 100.000 square meters of indoor and focuses solely on the health sciences. Health professionals of the future are educated in this university thanks

to its world standard academic and technologic infrastructure. Accordingly, Acıbadem University undertakes an important function, namely educating qualified human resource that can compete with the rest of the world for both the Group and healthcare sector. International students also apply to Acıbadem University due to our quality of education. Along with our strong academic staff, we also have The Clinical Simulation and Advanced Endoscopic-Robotic Surgery Education Centre – CASE which is one of the most developed medical simulation training centers in the world. Moreover, our research laboratories that

Turkey. Services provided to patients and guests are mostly introduced to Turkey for the first time by Acıbadem. The first and the most important value offered to its patients, also the “essential” one, is “patient safety and satisfaction”. Each detail, including but not limited to doctors and nurses, technicians and support personnel as well as infrastructure and medical technology, is planned and applied to ensure that our patients receive better and more reliable healthcare service. Employee satisfaction is also attached enormous importance. enable any and all research in the field of life sciences and cutting-edge student laboratories providing applied trainings in vocational and undergraduate programs reveals out our difference. CASE, our clinical simulation centre, has been accredited by Europe and the U.S. It is also one of the two centers with certificate of excellence in the world. One of these certificates is in Acıbadem University and the other one is possessed by Toledo University, U.S. We organize and hold various trainings in this centre and we gather many applications. We educated and trained more than 15.000 international physicians in 4 years in this simulation center. Moreover, School

of Medicine of Acıbadem University is admitting the students with highest scores in university entrance exam of Turkey.

Can you mention about the “essential” principles of service approach in Acıbadem? Acıbadem is a pioneer group in its field of business, which has created its own culture. Our major priority includes patient safety, patient satisfaction and employee satisfaction. Acıbadem Healthcare Group is an organization that works and renders services round-the-clock in the field of health. Moreover, the Group competes with itself as the leader of the sector in

How did Acıbadem start its international investments and what is your strategy abroad? Healthcare investments of Acıbadem beyond Turkey started after Acıbadem Sistina Hospital in Skopje, Macedonia was acquired in 2011. Investments in Bulgaria in 2016 accelerated Acıbadem’s journey to success. Following acquisitions of Tokuda Group and City Clinic Group in Bulgaria, Acıbadem merged them under a single roof and became the leading healthcare service provider in a foreign country. Recently, the footprints of the Group have extended to Europe in 2017 thanks to Acıbadem International Medical Center in Amsterdam. Acıbadem shares its knowledge with international healthcare service systems and creates synergies in fields of operation and productivity. Considering our strategy in international investments... Regarded as a model brand in Turkish private healthcare sector, Acıbadem targets to carry its 28-year know-how primarily to the countries where the healthcare sector is still developing. Thus, we aim to contribute to the development of healthcare sector in those countries and provide the most qualified service to the population. Moreover, among

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our strategies are creating value in the market of developed countries and getting positive outcomes in such countries by introducing service quality of Acıbadem to the developed countries. Hence, our hospital in Amsterdam already serves for this purpose. We hope to improve this operation to a certain point and repeat foundation of such clinics in the countries with similar economic structure. We prefer to proceed both in our country and abroad with both new hospital construction projects and possible acquisition projects pursuant to our growth strategy. When we make a decision on investments, we especially focus on type, location and probable partnership structures. We attach importance to proceed by investing in profitable companies and the ones that we can add value following the acquisition in our fields of operation pursuant to the growth strategy of Acıbadem.

Can you please tell us about the last 3 years of your growth in the sector and inform us about your future growth strategies?

MAY.JUNE 2019

I can very briefly touch on our growth within the last three years. As I mentioned above in 2016, we have become the largest healthcare group of Bulgaria following the acquisition of 4 hospitals and 5 Medical Centers. We put Acıbadem International Medical Centre (AIMC) in Amsterdam into service in 2017. We doubled the number of operating theatres to meet the demand within a short time and in-

creased number of beds by 5 times. In Turkey, on the other hand, Acıbadem Altunizade Hospital with 350 beds and 98.000 square meters of indoor area was opened in March 2017. Next, we enlarged the Acıbadem Maslak Hospital from 45.000 square meters of indoor area to 106.000 square meters in order to meet the patient demand. Our Group targets to grow twice in the next 5 years. We prefer to proceed both in our country and abroad with both new hospital construction projects and possible acquisition projects pursuant to our growth strategy to realize this target. When we make a decision on investments, we especially focus on type, location and probable partnership structures. In conclusion, I can say that we do care about growing, but, we attach importance to progress with a growth model that fits the ecosystem created by our own brand, while the international quality in health is also conserved. Our growth strategy is focused on regions close to the geographies, wherein Acıbadem has operations, rather than specific countries. In this end, the Balkans as well as Middle

and Eastern Europe, Middle East and Northern Africa are regions we are interested in with this regard.

What is the Acıbadem culture and Turkish cultural values carried to these markets by Acıbadem while growing in international arena? The principal component of our culture is the patient satisfaction. You can see this clearly while our international patients are provided services at our hospitals in Turkey as well as in our services rendered in countries other than Turkey. We are known for our hospitality, our patients are our guests and we try to make them feel at home rather than being in a hospital.

You say that your Group has deep knowledge in healthcare. What are the reflections of this knowledge at international platforms? Yes, we transmit our 28-year knowledge to international platforms in the most effective way. We also take important initiatives and establish cooperation to be more effective. I can give many examples, especially for the

recent period. One of the most important examples is the hospital management contract for Faruk Medical City founded in Sulaymaniyah, Iraq in 2013. Subsequently, we provide 17 publicly-owned laboratories of the United Arab Emirates with consultancy services since 2017 to restructure these laboratories. Moreover, we installed Acıbadem’s Cerebral Plus system in a state hospital in Riyadh within the scope of digitalizing Saudi Arabian State Hospitals and creating a fully digital environment in the hospital. We successfully treated 27 financially disadvantaged patients with bone marrow transplantation in cooperation with H.H Sheikh Sultan Bin Khalifa Al Nahyan Humanitarian And Scientific Foundation. This success has been awarded within the scope of “Sultan bin Khalifa 3rd International Thalassemia Awards” in Abu Dhabi. We will continue expanding the brand and the quality of Acıbadem both in our country and to new locations in close geographies pursuant to our strategic goals.

What are your future strategies in

Gulf countries as Acıbadem? Acıbadem Healthcare Group is open to take advantage of different opportunities in Gulf countries. Our strategy is to meticulously evaluate cooperation opportunities in the region, provide all healthcare services required directly or indirectly at the highest global standards and we request to take a strong position in the Gulf Region, as we had already achieved in other regions. We, of course, target to take other steps to realize our strategy; we want to found hospitals and provide managerial counseling services, business and affiliation services in the region as long as it is feasible. Moreover, we aim to be the preferred destination for treatments that are not available in Gulf countries especially in specialized disciplines and for complex therapies. Another goal is to be a reference center in the delivery of supportive services in the healthcare. As I also mentioned above, Acıbadem has affiliated companies that deal with supportive services such as ambulance, home care and emergency health services, catering, cleaning, laundry services at international standards, laboratory services, design and project management of safe and comfortable hospitals and medical centers, health software and technologic solutions. We want to support Gulf countries with the services rendered by these firms. Another important field is the cooperation in academic education. In Acıbadem University, medical and non-medical health professionals can be educated, applied trainings on occupational information, procedures and skills can be provided in the field of health at Clinical Simulation and Advanced Endoscopic Robotic Surgical Training Centre (CASE) which is one of the most sophisticated simulation centers of the world, bilateral contracts

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can be signed by means of academic cooperation and joint R&D studies can be carried out.

Numerous patients from the Arabic region prefer Turkey and Acıbadem for treatment. What would you like to say about underlying causes of this preference? Undoubtedly, we have historical and cultural bonds to the Arabic geography. This cultural affinity is associated with certain facilitations. Religious affinity also makes the people, who travel from there, feel better. For example, they feel more assured regarding halal foods. We will also welcome Ramadan in May. I would like to take this opportunity to celebrate the month of Ramadan of all Muslims. The extremely distinguished success of Acıbadem Healthcare Group is the high patient safety and satisfaction rates. We created a culture that is constructed on patient safety, patient

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satisfaction and employee satisfaction. Because people trust us for their health or their loved ones. It is very important to deliver services with the highest quality using the most recent facilities of medicine, make patients feel at home and have the patients feel the same level of trust at both admission and discharge to sustain this trust. From the perspective of employees, we had/are educated/educating and trained/training our own managers and directors.

What would you like to say about your vision that promoted Acıbadem into the most reliable brand of Turkey and also an important brand abroad? We dreamed to be a global player, when we established Acıbadem, and we also acted in line with this dream. However, I can express that the most remarkable impetus, which made our dream comes true, is the passion for excellence that we already had. This

would be the primary legacy I would like to leave to the next generations; performing the job with a passion, but a passion for excellence… If you want to be excellent at your job, you need to be visionary and innovative. You need to plan and implement all relevant components, such as thinking about each detail of your job, creating models and taking action quickly. If you want to do a job excellently, you do think about each detail and take steps that will transfer you to the success. This passion for excellence is the principal source of my motivation. This passion has also laid the background for all steps taken to proceed from a small district hospital to a global brand. The second important point is to desire to see the big picture. We develop a model that would work in all fields of health and as I also mentioned above, we can develop and render services in each field of health thanks to this model that creates its own ecosystem.

PIONEER IN HEALTHCARE • • • • • • • • • • • • • • • • • •

Acıbadem Healthcare Group has always led the sector and set the priorities by pioneering the innovations. Our “Firsts”… First company to create an “ecosystem in healthcare”. First healthcare organization traded at Istanbul Stock Exchange Market (IMKB) in 2000. First healthcare company to attract international private equity investment - Abraaj Capital. First healthcare provider to affiliate with Harvard Medical International. First healthcare provider to offer know-how from Turkey to a hospital abroad (Sistina Hospital, Skopje, Macedonia). First Turkish healthcare provider listed among the largest healthcare groups of the world thanks to the agreement with IHH Berhad. First healthcare group to be the contractor of “project, construction, operation and management of a hospital abroad” – Faruk Medical City in Northern Iraq. First and the only Sports Medicine Center with the title of FIFA-accredited Center of Excellence in Turkey. First privately-owned healthcare provider that operates outpatient treatment center. First healthcare provider with a 7/24 Call-Center in Turkey. First healthcare provider with a heliport that provides air ambulance service. First healthcare group to convert Patient Services into a “profession” in Turkey in order to manage patient relations with higher quality. First healthcare provider that produced the first 100% locally sourced digital technology device by creating the brand “Astore” that had made an overwhelming impression in “Drug Management System”. First healthcare provider that established the first ISO 15189-accredited clinical laboratory of Turkey, namely Acıbadem Labmed. First healthcare provider that established the first and the only Integrated Digital Pathology System of Turkey. First healthcare provider that delivered first digital radiology and paperless service in Turkey. First healthcare provider that is qualified as Turquality – the first and the most comprehensive state-funded brand improvement program of the world – in 2018. First Healthcare Provider that make strategic partnership with IHH Healthcare which is the largest healthcare group in Far east and Asia. – Acıbadem became part of world 2nd largest helthcare group.

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An open heart surgery at age 11 after a liver transplantation LITTLE MUSTAFA GOT HEALTHY AGAIN IN TURKEY

Professor Tayyar Sarıoglu, M.D

Head of Pediatric Cardiovascular Surgery Department Acıbadem University, School of Medicine

raveling from Egypt to Turkey with the hope of cure, 11-yearold Mustafa Mezeid got healthy again after an open heart surgery was successfully performed by Professor of Cardiovascular Surgery Tayyar Sarıoğlu from Acıbadem Bakırköy Hospital. Qualified as “a very smart and cute child” by his doctor, Mustafa has undergone liver transplant surgery at age 3 and major heart surgery at age 11, but he can now run and play with pleasure.

Undergone liver transplant surgery at age 3 Mustafa was born with “hypercholesterolemia” – high cholesterol concentration in blood – that is inherited from his family. When hepatic dysfunction developed due to this disease, he needed to undergo liver transplant surgery at age 3. However, the disease not only involves liver, but it also negatively influences all blood vessels, including coronary arteries, and destructs internal organs. Coronary arteries of Mustafa stiffened substantially throughout the 3 years

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spent with this disease and thus, blood flow into heart muscles became significantly troublesome. This also increased the risk of myocardial infarction substantially. He had only one option: Open heart surgery. Parents of Mustafa decided to visit Acıbadem Hospital in Turkey for this operation.

Heart valve is replaced with an artificial valve; stenotic vessels are dilated “Calcium deposits and stenosis were noted in the aortic valve, wherein the aorta originates, due to very high cholesterol concentrations. Calcium deposits were also present in the ostium of coronary arteries that

feed the heart. Moreover, a critical stenosis developed in the greatest artery of the body, called aorta, immediately upstream to the valve secondary to calcium deposits” says Professor of Cardiovascular Surgeon from Acıbadem Bakırköy Hospital who made the following statements about the operation that enabled little Mustafa get healthy again: “We performed an open heart surgery that eliminated the stenosis both in the valve and in the aorta. We removed the aortic valve that was involved by the disease and we placed an artificial valve. We also reconstructed and dilated the greater artery that is originating from the heart, namely aorta. Thus, the heart could be restored to a normal and healthy condition”.

Now, he can run and play as his peers Stating that open heart surgery is a very rare incident in patients who had undergone liver transplant surgery, Professor Sarıoğlu added that Mustafa can resume a normal life just as his peers, if no liver-related problem is faced. “His awareness on health problem is very high although he is too young” says the Professor, and he adds “I hope all his dreams come true”.

The hope of chidren with heart disease within the region: We provide advanced treatment options for pediatric heart patients in two of our Acıbadem University affiliated hospitals (Acıbadem bakırkoy and Acıbadem Atakent). In our Children’s Heart Center, our specialists, who have at least 25 years of experience in each of them, performed more than 13,000 cardiovascular operations to date. Only in the last 5 years, more than 3.500 pediatric heart patient from all age groups, including newbowns, and from countries like Iraq, Egypt, Cyprus, romania, Azerbaijan, Bosnia Herzegovina, Turkic Republics…etc came to Acıbadem Children Heart Center to regain their health.

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ONE DONOR, ONE SURGERY, TWO ORGANS Rare case of combined organ transplantation

Ayham Hamdan

Halil Hamdan, father

yham Halil is a 13-year-old Jordanian child. He traveled from Jordan to Turkey with this family for the treatment of renal failure when he was 11 years old. When he was examined here, it was revealed that Ayham required both kidney and liver transplants. Headed by Prof. Remzi Emiroğlu, M.D., a team that included Professor of General Surgery Hamdi Karakayalı, Professor of Pediatrics Vildan Ertekin and Associate Professor of Pediatric Nephrology Burcu Bulum Akbulut from Acıbadem Atakent Hospital carried out successful liver and kidney transplant surgeries at Acıbadem Atakent Hospital in Istanbul for Ayham. Donating one of his kidneys and a piece of his liver to his son Ayham,

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Halil Hamdan and Ayham’s mother İtisam Abu Raliya thanks God and prays for doctors who ensured that their son survives a routine life again.

very hard for two years to make him recover, but our efforts failed”.

“There were many questions in his mind when we traveled to Turkey”

Heading the team that managed the treatment of Ayham Halil and the chain of complex operations which involved Ayham’s father, Professor of General Surgery Remzi Emiroğlu from Acıbadem Atakent Hospital stated that “primary hyperoxaluria” may be diagnosed even in very small babies and says: “We face many side effects secondary to accumulation of oxalate due to long-term dialysis therapy. Oxalate not only influences the kidney, but it also effects all other organs. For instance, it causes fractures in legs or it accumulates in the heart. Therefore, we perform, first,

Stating that his son had many questions in his mind while they traveled to Turkey, Ayham Halil’s mother İtisam Abu Raliya says: “He asked questions such as: “Mom, will I be healthy again and will I ever go back to school?” It was very difficult to operate on my spouse and child concomitantly, but they succeeded”. Emphasizing his sorrow while telling about the days when his son was ill, Halil Hamdan says: “My son required dialysis therapy every day. We strived

“It was a tremendous chain of operations”

liver transplant surgery to decrease level of oxalate for the patient with this diagnosis and next, we carry out kidney transplant surgery”. Stating that Ayham was lucky as pre-admission dialysis therapy was not too long and tissue compatibility with his father was detected, Prof. Remzi Emiroğlu, M.D., adds that they decided to perform liver and kidney transplant surgeries sequentially in the same session.

“First, we focused on successful completion of liver transplant surgery” Being a member of the team that performed liver transplant surgery from the father of Ayham Halil followed by the renal transplant surgery, Professor of General Surgery from Acıbadem Atakent Hospital reports that although they planned to perform surgeries sequentially,

they aimed to excise a piece of the liver from his father and transfer it to Ayham in a flawless manner. “We performed 4 different operations sequentially in the same session; we excised the left lobe of his father’s liver, while blood vessels and bile ducts are not damaged in order to ensure transfer of the liver graft to the patient, and next, the right lobe of liver is left in the father’s body, while all vessels and the anatomy are conserved again. First, we transferred the liver without any problem. Next, we performed the kidney transplant surgery” says Prof. Hamdi Karakayalı, M.D. Being discharged 25 days after the surgery following final medical checks, Ayham states that he feels very well, he missed his school and his friends very much and he is very

happy, as he will be able to play with them. Prof. Remzi Emiroğlu, M.D., specified that comparing to European countries, far more kidney and liver transplant surgeries are carried out in Turkey and living donor transplants account for 85% of all transplant cases. He added that patients are assessed by a multidisciplinary team and patients are followed up for a long period after the transplant surgeries. He also stated: “Simulatenous liver-kidney transplantation is much harder and complex compared to normal transplantations. Problems that may occur due to either one of the organs can lead to the loss of both organs. Therefore, this type of transplants from living- donor can only be done in highly experienced centers.”

Organ Transplant Team 23

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What are the symptoms of cerebral palsy? nancy. In Turkey, the most common cause of cerebral palsy in a baby is lack of sufficient oxygen supply during birth. The brain tissues of babies who are born blue, as well as babies whose umbilical cords get stuck around their necks and babies who are unable to cry right after birth, are the ones that suffer injury due to insufficient oxygen supply. The most common problems leading to cerebral palsy during the neonatal period, on the other hand, are infections such as meningitis.

Professor M. Memet Özek, M.D Head of Neurosurgery Department Chief, Division of Pediatric Neurosurgery Acıbadem University, School of Medicine

regnant women are just as careful and caring for their babies as the ones who have given birth. However, there are some circumstances which lead to irreversible consequences outside of their control. One of these is cerebral palsy, also known as brain paralysis. The most common result of cerebral palsy is spasticity, which involves restriction of muscle movements. Encountered in premature babies in particular, cerebral palsy can occur during pregnancy, birth or the neonatal period. Professor Memet Özek, Acibadem Mehmet Ali Aydinlar University, Chief of Pediatric Neurosurgery Department, provides information on cerebral palsy, which is caused by permanent damage in the brain, and cerebral palsy-associated spasticity.

The causes of cerebral palsy Infections in the brain tissue of the baby due to infections in the mother, as well as embolisms and hemorrhages that occur while the baby is in the womb are among the causes of cerebral palsy that develops during preg-

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Observe the movements of your baby well! It is possible for parents to detect cerebral palsy in the early stage (0 to 9 months) by observing the differences in the natural movements of the child. Babies with this condition either have hypotonia, which limits arm and leg movements due to low muscles tone and makes them look “floppy”, or spasticity, which limits movements due to muscle stiffness. The brain tissue of such children fails to move the limbs at the desired speed. Delays in development can also be signals indicating the disorder. For instance, failure to control the head at the end of the 3rd month, sit down with support at the 5th or 6th month and sit down without support at the 7th or 8th month are good causes for suspicion.

Cerebral palsy treatment can even begin in the incubator! If the baby has been born before the end of 30 gestational weeks... Just like any other disorder, early diagnosis and treatment are very important in cerebral palsy as well. In babies who are growing and developing, the functions of the dead cells in the brain, which cause cerebral palsy, can be transferred to the surround-

ing cells; this method is referred to as “neuroplasticity”. This can only be done if rehabilitation practices are started very early. In babies with serious risk, the rehabilitation can even be started in the incubator. The rate of incidence for cerebral palsy is particularly high in babies born before the end of 30 gestational weeks and babies who have brain hemorrhages during premature birth. Therefore such babies need to be treated as potential patients. Definitive diagnosis requires brain MRI.

Surgical intervention for spasticity

The treatment of babies diagnosed with cerebral palsy-associated spasticity begins with physiotherapy. If the condition is mild, it is possible to overcome it with physical therapy. What is important here is for physical therapy to be performed regularly, every day. In such cases, the problem is resolved without the need for any additional treatment. However, in cases where it is believed that the condition cannot be resolved with physiotherapy only, surgical options are available. It is essential for the surgical interventions for spasticity to be performed without delay. Spasticity operations should not be postponed until after the ages 3 to 6. On the other hand, interventions that are too early and orthopedic interventions that are performed before the age of 7 or 8 should also be avoided. In other words, if the treatment fails to be performed on time, spasticity will pose even more problems as the child grows. Spastic muscles fail to grow as the child ages while the bones continue to develop naturally. Therefore, the restriction of movement becomes worse as the child gets taller.

COVER

MRIdian

New Era in Cancer Treatment

Professor Enis Özyar, M.D Head of Radiation Oncology Department Acıbadem University, School of Medicine

RIdian, which is used in radiotherapy, does not cause any damage to the surrounding tissues by precise radiation delivery. Radiotherapy is frequently used in cancer treatment. 90 percent of the treatment are carried out with the LINAC device called linear accelerator.

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The device, which produces X-rays from electrical energy and conducts it to the patient, has a smart scanning system to pick up the right points to shoot. Professor Enis Özyar, Radiation Oncology Specialist in Acıbadem Maslak Hospital said that such imaging work was carried out by taking films with devices integrated in the machines. Then we were introduced with tomography. However, none of these imaging methods perfectly screened the patient’s tumour or the normal tissues around. Therefore, tumour was tried to be seen indirectly by placing some metal markers into the relevant area by the aid of a needle. The images were taken according to the bones due to insufficiency of the application in showing the soft tissues and tumour. The new device brings together the MRI and the LINAC devices, which provides the best imaging today. The first version of the device used in 2015 for the first time in the world used to work with cobalt 60 instead of an X-ray. Then the upgraded version of the device working with X-ray was de-

veloped. This device which is used only in America, Netherlands and Germany is now at the service of our patients in Acıbadem Maslak Hospital in Turkey.

INSTANT IMAGING CAPABILITY Professor Özyar said that they were able to catch the most ideal image by MRIdian. “When the patient is placed in the device, MRI is taken first to be able to see the tumour. Then the irradiation takes place. Images are instantly taken as both photo and video. Specialist is able to check whether the tumour is moving or not as long as the patient lies in the machine. When necessary, the patient is required to hold his breath in order to stop the motion of tumour. But in some cases the tumour may keep moving even if the patient holds his breath. But they can all be traced through this method” explains Professor Özyar.

TUMOUR IS CAUGHT & IRRADIATED Although linear accelerator can be used to detect all types of tu-

mours, lung, prostate, intraabdominal tumours, liver metastases, pancreatic cancers and some other tumours are amongst the list of the most useful application areas. In the treatments performed following the scanning by MRIdian, the most successful results are reported to be obtained in pancreatic cancers. The success rate is reported to increase from 10 percent to 90 percent. It is thought that this success, which is considered as a great revolution in treatment, can be applied in other tumours. Because this device and the system allow the specialists to adjust the best dosage to be delivered to the tumour of which the location is detected perfectly. Thus, better treatment can be carried out. Enabling the specialists to see the location of the tumour with bare eyes is another great feature of the device. “In the past, a safety border was allocated around the tumour. Such part of body actually had healthy tissues! MRIdian enables us to see the tumour

first and then perform the irradiation work. It is of great importance to see the target during the point-shoot. This can only be achieved by MRI, as the treatments can now be carried out by pinpoint operations enabling us to complete the work without harming the healthy tissues surrounding the tumour” says Professor Dr. Özyar.

“WHEN THE PATIENT IS PLACED IN THE DEVICE, MRI IS TAKEN FIRST TO BE ABLE TO SEE THE TUMOUR. THEN THE IRRADIATION TAKES PLACE. IMAGES ARE INSTANTLY TAKEN AS BOTH PHOTO AND VIDEO”. SUCCESSFUL RESULTS IN SPITE OF A LONGER TREATMENT PERIOD In the past, surgeons had to open a certain area to see the tumour in place in order to remove it out of the body. Professor Enis Özyar emphasised that MRIdian device transformed the radiation oncology specialists into surgeons and he continued “In

the previous years, we were unable to give effective radiation because we could not see the tumour area properly. Now we are able to see the tumour as if we are performing a surgical operation and can protect the healthy tissues surrounding the tumour while giving a high-dose beam during scanning. Moreover, we perform this at every session as the treatment of a patient to receive 30 sessions in normal radiotherapy was considered to be the same throughout the whole period. However, the shape and movements of the tumour could always change and the surrounding organs could also enter into the tumour area. MRIdian can see all such changes and offer the possibility of patient-specific treatment at each session. The duration of the treatment is longer than the others due to MRI scanning. Although the re-planning each time extends the process period, it is worth spending such time to have such precious results when compared with those of the other methods” says Professor Özyar.

MRIdian Radiation Oncology Team Professor Banu Atalar, M.D Professor Enis Özyar, M.D Professor Fulya Ağaoğlu, M.D Professor Meriç Şengöz, M.D Professor Ufuk Abacıoğlu, M.D

OUTSTANDING FEATURES • All tumours can be destroyed by pinpoint irradiation. • The tumour can instantly be seen visually and clearly during treatment. • Thanks to the features allowing to catch the instant images of moving tumour that can be taken continuously, the beam can be re-targeted according to such movements of the tumour • Sensitive irradiation can be applied to the tumour without damaging the surrounding tissues. • This method ensures a precise irradiation of the tumours located in moving organs, especially in the lungs and abdomen. • High-dose beam can be applied to the tumours.

MEDICAL INSTITUTIONS

Baylor St. Luke’s Medical Center A decade ago, gospel singer Otis Wimberly was sidelined from his usual full-throated, energetic performances

is arms and legs had ballooned. He could barely walk a few steps without stopping and gasping for five or six deep breaths. No matter how much he wanted to lie down, that wasn’t an option because “it felt like I was drowning,” he said. The symptoms and a subsequent diagnosis of congestive heart failure meant the humble, Texas resident couldn’t fully participate in The Wimberly Family Gospel Singers, which was founded in 1976 in New Orleans. Over the last four decades, the group has delighted listeners at local churches, concerts and music festivals, including the inimitable New Orleans Jazz & Heritage Festival (Jazz Fest). “I couldn’t sing. I couldn’t play,” he said, with a timbre of disappointment in his deep, mellifluous voice about an interruption of decades of music. Approximately 5.7 million American adults suffer from heart failure, with about half of them dying within five years of being diagnosed, according to the U.S. Centers for Disease

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Control and Prevention. During his childhood in New Orleans, Otis Wimberly and his brothers would sneak upstairs to play their father’s guitar while the patriarch was at work and their mother was cooking downstairs. “My mom caught us one day. She came upstairs and said, ‘I thought I left the radio on. That was y’all playing?’” Wimberly said. “Every day, when my dad left, she had us practicing.” When the elder Wimberly heard them play, he was astonished by his sons’ natural musical talent and immediately purchased a trailer full of music equipment. “We’ve been singing and playing ever since,” Wimberly said.

A new lease on life Weeks, years and decades of singing came to a halt for Otis Wimberly in 2008, when pain caused him to seek treatment and medication. Still, his condition worsened. By the time he became a patient at the Texas Heart Institute in the Tex-

as Medical Center, his heart’s pumping ability was at just eight percent. “He was really out of it—just barely fighting to live,” said his wife, Shannon Wimberly. During a July 2011 surgery at Baylor St. Luke’s Medical Center, prominent heart surgeon O. H. “Bud” Frazier, M.D., connected Otis Wimberly’s failing heart to a left ventricular assist device (LVAD). The implanted pump, which whirls instead of beats, takes over cardiac circulation for a patient who has end-stage heart failure as a bridge to a transplant. “I was really in a bad place,” Otis Wimberly recalled. “Too weak to have the surgery and too far gone not to.” The pump gave the gospel singer a new lease on life. Everywhere he went, he carried a bag containing two batteries and the controller for the LVAD. It was cumbersome and earned him the nickname “battery man” from his family and friends, but—compared to heart failure—the LVAD was exactly what he needed while he waited on a new heart. He even rejoined his family group, making a powerful performance at Jazz Fest in the spring of 2018 wearing his gear in a backpack.

A heartbeat returns Shannon Wimberly had turned in for the night on Oct. 17, 2018, as her husband nestled in his chair in the living room to watch the latest episode of the CW’s The Flash. Then, his phone rang. Doctors finally had a heart for him. “We got the call,” Otis Wimberly said. “I tell ya, it was exciting.” They grabbed clothes and other

MEDICAL INSTITUTIONS

necessities they had prepared for this moment. Too excited and nervous to drive, so they called his daughter, who lived nearby, to take them to the hospital. The next evening, two days before his 53rd birthday, Otis Wimberly went into surgery to receive his new organ. Over the course of four hours, Frazier and his team opened the gospel singer’s chest and carefully removed the mechanical pump with its valves and lines. Then, they took out his weakened heart and replaced it with a healthy one. After seven years, Otis had a heartbeat again. “You really can’t top that as far as birthday gifts go,” his wife said.

April is National Donate Life Month Otis Wimberly doesn’t know much about his donor—other than that he was a young, male athlete in his 20s—

but he’s already thinking about what he would say to the donor’s family. “I would first give my condolences on the loss,” he said. “Then I would let them know that a part of their son is alive in me.” April is National Donate Life Month. The demand for organ donations far exceeds the available supply. Today, 113,727 patients are waiting to receive a new organ. According to the U.S. Department of Health and Human services, another patient is added to the waiting list every 10 minutes. Each day, 20 people in the United States die waiting for a transplant. “One of the problems that we’ve had as the population grows is that we have fewer donors. Of course, that’s good because we have fewer deaths from car accidents,” Frazier said. “All those are good things, but if you need heart transplant, it’s not. … You have to depend on someone else’s misfor-

tune to get a heart. I’d like to see that day come to an end.” Being able to “have these pumps that we can just pull off the shelves” to replace the heart, as Frazier puts it, is a goal he is actively working on. For years, Frazier has been collaborating with fellow Houston heart surgeon and medical device inventor William “Billy” Cohn, M.D., and biomedical engineer Daniel Timms, Ph.D., on the BiVACOR, a next-generation, total artificial heart that could replace heart transplants. It will be a few years before the BiVACOR is available, but in the meantime, patients—like Otis Wimberly—are alive today thanks to the LVAD. “Seeing him at his weakest moments and watching him progress, become stronger and do better did my heart all the good,” Shannon Wimberly said. The Wimberly Family Gospel Singers were scheduled to perform in the Gospel Tent at this year’s Jazz Fest on April 25.

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

#LivingWithEczema: Dr. Anwar Al Hammadi Leads First-Ever Awareness Network for Atopic Dermatitis in the UAE

he growing need to raise awareness in the UAE around the often-overlooked condition of Atopic Dermatitis (AD) -- more commonly known as eczema – is being addressed by Dr. Anwar Al Hammadi, Consultant Dermatologist and President of the Emirates Dermatology Society, who officially launched the #LivingWithEczema network and campaign today. A first-of-its-kind nationwide initiative, #LivingWithEczema aims to raise awareness of the impact of AD. “The network will grow to include other stakeholders representing the government, media, patients and thought leaders, to address the complex nature of the condition,” said Dr. Al Hammadi at the launch of the campaign. The #LivingWithEczema network and campaign has been established to give members of the community suffering from AD the knowledge and confidence to tackle their condition, whilst also serving as a platform to drive the conversation around it. “Atopic Dermatitis remains the most common skin condition and yet,

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there are still many misconceptions surrounding its symptoms and management. This can perpetuate stigmatisation and lead to adverse effects for those who endure it. We believe that raising awareness of Atopic Dermatitis is the first step towards equipping patients with the right information to ensure safe and effective disease management, educating their family and friends to increase support, and enabling healthcare professionals to take informed decisions to properly manage the condition,” he explained. AD is a chronic, immune-mediated disease that is systemic and visible on the skin. In moderate-to-severe cases, its symptoms can include an intense, relentless itch, skin dryness, cracking, redness, crusting and oozing. “AD affects 10 to 25 per cent of children, around 10 to 20 per cent of adults globally. These individuals are not only battling physical symptoms but are also dealing with its impact on their mental wellbeing and quality of life, which is an important aspect to address. Our aim is to own the conver-

sation and help lift the current stigma around the condition,” he added. The network is being supported by Sanofi and will reach the local community via a dedicated Facebook and Instagram page titled ‘LivingWithEczemaNetwork’, which were launched during the inaugural meeting. “At Sanofi, we are constantly looking at ways to create value in patients’ lives, and within the healthcare community. We are looking forward to our collaboration with Dr. Anwar Al Hammadi. His passionate and prolific work in raising awareness of Atopic Dermatitis will help to greatly amplify the reach and effect of this network, making an impact on people with the condition, their loved ones and the community” said Jean-Paul Scheuer, Country Chair and General Manager, Gulf Countries, Sanofi. Led by Dr. Al Hammadi, the network will meet every quarter to discuss actions, deliverables and progress, and will soon reveal their first plan of action. Visit Facebook and Instagram to follow the coalition’s news and updates.

We offer personalized medicine where specialists use your genetic makeup to help select the best course of therapy, targeting the specific characteristics unique to the cancer. Our experts at the NCI-designated Dan L Duncan Comprehensive Cancer Center at Baylor St. Luke’s Medical Center offer the latest innovations in cancer treatment—many of which stem from our own internationally recognized research. That’s our answer to cancer.

Tel: 1.800.670.3924 Email: International@stlukeshealth.org StLukesInternational.org Texas Medical Center, Houston, Texas – U.S.A.

Baylor St. Luke’s Medical Center

NEWS

Clemenceau Medical Center affiliated with Johns Hopkins International Best Hospital in the World for Medical Travelers

lemenceau Medical Center (CMC) affiliated with Johns Hopkins International, has been crowned the Best Hospital in the World for Medical Travelers, scoring a major achievement. CMC is the first Lebanese hospital to receive this accolade, which reflects its relentless effort in attracting and providing the best of healthcare to international patients and medical travelers. The medical center has been in the top 10 list since 2016 while rising through the

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ranks, landing the number 2 spot for the past two consecutive years and making it to this year’s number 1 spot. With this international distinction added on to CMC’s long list of recognitions and accreditations, the hospital proves once again that Lebanon is accurately depicted as “the Middle East Hospital” owing to its advanced health sector that makes it unique in its surrounding. Dr. Mounes Kalaawi, Co-Founder & CEO of CMC, stated: “We are honored to receive this prominent recog-

nition for our hard work to provide high-value healthcare of world- class quality; and the growing awareness of the Lebanese healthcare sector’s notable capability to deliver excellent medical services”. In selecting the hospitals for this list, MTQUA goes beyond high-quality medical treatment and accreditation to include criteria developed for the needs of medical travelers and international patients, which include communication, transparency, privacy, security, marketing, ethics and leadership.

NEWS

First Global Ahrend Healthcare Innovation and Inspiration Studio Opens in Dubai Design District

oyal Ahrend, an international leader in office furniture and Massa Design have joined forces to create a state-of-the-art healthcare innovation and inspiration studio in the heart of the Dubai Design District. The new healthcare studio officially opened on 25 April 2019 in a ceremony under the patronage of his Excellency Mr. Hans Sandee, Consul General of the Kingdom of the Netherlands to the UAE; Mr. Eugene Sterken, CEO Royal Ahrend and Ms. Khadija Al Bastaki, Executive Director of Dubai Design District. The studio was designed to enable healthcare providers to experience and see: • A fully functional interior environment that meets all the demanding healthcare requirements and regulations. • Establish an innovative and timeless space complying

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•

with the wellbeing design principles. Improve healthcare design-oriented solutions for that meet today’s patient’s demands . Showcase the latest equipment and sustainable materials.

Our aim was to create a space that is warm, welcoming and comfortable for both patients and caregivers as well as being functional and compliant with healthcare regulations,” says Mr. Karim Khemakhem, Managing Director Massa Design. “The design utilizes curved corners creating a smooth transition of surfaces and a selection of materials with anti-microbial properties.” Showcasing around 20 different healthcare equipment and material suppliers, the studio encompasses a

waiting area, separate meeting room and Doctor’s office. It also incorporates a fully-fitted patient room with caregiver zone. “The studio is the first global Ahrend Healthcare Studio and we extremely excited to showcase both Royal Ahrend furniture, and leading global medical equipment and healthcare material suppliers in one location,” says Mr Ahmad Zaarouri, Regional Healthcare Manager Royal Ahrend. Healthcare providers recognize that interior design plays a critical role in the success of patient treatment and overall recovery and wellness. The new permanent healthcare studio will not only enable Ahrend, Massa and their healthcare partners to showcase their interior design solutions and products, but it will also act as a knowledge and training center.

NEWS

2019 International Hospital Federation Awards now open

ntry submissions for the 2019 International Hospital Federation Awards is now open. Hospitals and health service providers can nominate their outstanding and innovative projects and programs for a chance to be recognized internationally in one of the four awards. The IHF/Dr Kwang Tae Kim Grand Award is open only to IHF Full and Associate Members and their mem-

bers. This recognizes excellence and achievements at health system or facility level in multiple areas including quality and patient safety, corporate social responsibility, innovations in service delivery at affordable costs, and healthcare leadership and management practices. The Excellence Awards are open to both IHF Member and non-member public and private healthcare providers. The IHF/Bionexo Excellence Award for Corporate Social Responsibility is for excellent projects that provide quality healthcare services at affordable costs, promote volunteer contribution to community care, uphold sustainable environment, energy and green initiatives, reduce inequalities in healthcare service delivery to the community and advance healthcare for emerging and developing nations. The IHF/EOH Excellence Award for Leadership and Management in Healthcare recognizes outstanding projects that

enhance governance, leadership, management policies and practices, foster new culture of service, effectively manage finance and resources, and for major breakthroughs in productivity improvements or innovations in healthcare delivery or process management. The IHF/Austco Excellence Award for Quality & Safety and patient-centered care recognizes exceptional programs that promote quality and safety, enhances patient education, engagement and empowerment, and promote ethical approaches and evidence-based practices. Winning an IHF Award is a prestigious accolade in the industry and all public and private healthcare service providers are encouraged to join. Submitting an entry is the first step in an extensive process to determine this year’s award winners, who will be announced at the Awards Ceremony during the 43rd World Hospital Congress in Muscat, Oman on 6-9 November.

Department of Health reviews standard for antidote stocks in emergency departments

he Department of Health—Abu Dhabi (DoH), the regulator of healthcare sector in Abu Dhabi, has updated its standard for antidote stock in healthcare facilities across Abu Dhabi. The standard provides a comprehensive guide for healthcare providers to ensure the continuous supply, safe access and use of antidotes in the case of a poisoning emergency. Set to come into effect within six months of the circular announcement, the revised standard includes an updated list of required antidotes and levels to be maintained, used and monitored by emergency departments

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and urgent care centers. According to the revised standard, DoH has specified a number of requirements and responsibilities for healthcare facilities to ensure a continuous supply of antidotes when needed. Dr. Khaled Al Jaberi, Director of Healthcare Licensing & Medical Education Division at DoH commented, “Antidotes are effective in reversing and neutralising the effects of poison when used appropriately and at the right time to save patients’ lives. Thus, it is necessary for healthcare facilities and emergency divisions to have ample levels of antidote stock available at all times.” “The standard’s revision is

part of DoH’s efforts to ensure locals and residents in Abu Dhabi will continue to have access to world-class and safe healthcare services. The revisions outline required stock levels, antidotes types, and a recommended dosage. The revised antidote lists include newly approved antidotes that align with international guidelines for stocking of antidotes and balancing between the importance of availability and the financial burden of stocking antidotes” Al Jaberi added. Healthcare facilities, who have licensed emergency services, are urged to submit periodical reports to DoH that include existing stock levels.

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INTERVIEW

Regional Managing Director of Boehringer Ingelheim (Middle East, Turkey and Africa (META) region)

Enrique Manzoni “Across the region, we aim to drive programs that fulfil unmet medical needs and help save lives” MAY.JUNE 2019

INTERVIEW

oehringer Ingelheim, one of the world’s leading research-driven pharmaceutical companies headquartered in Germany, is committed to improving patients’ lives. “Hospitals” magazine had the privilege to meet with Enrique Manzoni, Boehringer Ingelheim’s Regional Managing Director (Middle East, Turkey and Africa (META) region) to talk about his journey with the prestigious company and discuss the healthcare sector in the region as well as digital technologies among others. Below is the full interview:

Can you give us a brief about yourself and your journey with Boehringer Ingelheim? I have been in the field for almost 40 years and with Boehringer Ingelheim for more than 30 years, working across a number of leadership functions while also running various investment portfolios with the underlying aim developing successful operating business models. I first joined the company’s office in Argentina before moving to the company’s headquarters in Ingelheim, Germany in 1992.At that time, I was responsible for providing global controlling support for the pharmaceutical production business, covering over 20 plants worldwide. Following that, my responsibilities were further expanded to manage the full range of finance and administration activities in Greece then, Italy. Prior to joining the region, I had the responsibility to manage the company’s regional business volume of €700 million in Belgium, Denmark, Finland, Greece, Netherlands, Norway, Portugal and Sweden, based in Amsterdam, including 1600 employees and four

manufacturing facilities. Specifically, in META, Middle East, Turkey and Africa region, I am the Regional Managing Director. My role is to help drive the company’s growth and partnership initiatives across various business areas for human pharma and animal health.

Can you describe the healthcare sector situation in the region and how do you evaluate the role of Boehringer Ingelheim in impacting the sector? With a focus on personalizing care delivery for patients, our strategy to reach our innovations to patients in the region is three-part- driving awareness and preventing disease; boosting partnerships and increasing local manufacturing and accessing new markets. Across the region, we aim to drive programs that fulfil unmet medical needs and help save lives- to support economies with the growing burden of long-term chronic disease and increasing costs. Analysts expect the pharmaceutical market in the region to grow to around $50 billion by 2025. Recognizing the potential of the region and to bridge its unmet medical needs, we are committed to introducing the latest innovations and solutions here. In 2019, the company is planning 12 new launches and a registration of 61 products across META. In Africa, we launched the ‘In Reach Africa’ program, which is an initiative that aims at facilitating quality and innovative human and animal healthcare access across the African continent. It includes a range of key elements that aim at adding more value to overall health systems, in an effort

to drive access to care, support with the development of innovative health solutions, creating community-based partnerships and raising awareness around key disease areas as well as prevention mechanisms. On a market level, in Algeria, we have partnered with our partners, Abdi Ibrahim Remede Pharma, to produce our innovative hypertension medication. This investment seeks to enhance the technological capabilities and capacity building with Algeria. Moreover, production of our type 2 diabetes medication is well on its way in 2019 as part of our plans to expand on the company’s portfolio of innovative therapies. Moreover, in Egypt, we continue to support patients and healthcare specialists through The Angels Initiative by support in enhancing and certifying stroke units in hospitals, as well as providing the necessary training for medical professionals and aligning them to global stroke management protocols. Furthermore, Saudi Arabia, a strategic market for Boehringer Ingelheim, is focused on ensuring access to healthcare and medication to the patients in need. We have adopted a robust approach towards our local investments and continue to align our objectives with the Kingdom’s Vision 2030. We are committed to the development of integrated, people-centered health solutions to help equip underserved communities with sufficient knowledge, expertise, infrastructure and means to ensure their ongoing access to health. Research especially within cardiovascular diseases, immunology and oncology, will continue to support our growth. At

INTERVIEW

2.8 billion euros, research and development investments in human pharmaceuticals corresponded to a 22.1% share of human pharmaceuticalsâ€™ net sales. We continue to develop breakthrough therapies and healthcare solutions in areas of unmet medical needs; access remains the core of our business and values.

What are your expectations for the current year 2019 for the region? In 2018, Boehringer Ingelheimâ€™s performance in the META region has resulted in the company becoming recognized as the 3rd fastest growing pharmaceutical multinational across the region for the human pharmaceuticals business. We have also achieved a strong performance amongst top 20 corporations compared to overall market performance with a growth rate of 15.5% vs 13.9% in the region. In 2019, we are confident about our future outlook in the region positioned for further growth. During this year, we are planning 12 new launches and a registration of 61 products across the region. In addition, Boehringer Ingelheim will continue to drive its footprint across Africa by investing in access to healthcare programs to drive innovative healthcare solutions for low-income patients and enhance the sustainability of healthcare in the African content under the InReach Africa Program. Globally, the digital transformation is being harnessed across the different phases: Research, pre-clinical development, clinical development and post approval phase to support our ability to reach even more HCPs and patients.

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Digitalisation is changing the healthcare sector, how Boehringer Ingelheim is taking advantage of the digital technologies in improving patientsâ€™ life? We are driving the digital transformation with many different initiatives in all business areas. Over the course of 2018, Boehringer Ingelheim has strengthened its HCP-facing digital capabilities significantly in the META region, by adding multiple platforms that focused entirely on customer experience and education. For example, we developed the IPF application (Idiopathic pulmonary fibrosis (IPF) is a type of chronic lung disease characterized by a progressive and irreversible decline in lung function., Boehringer Ingelheim META developed a tool designed for doctors, which displays key information on how to diagnose, treat, and manage patients and more. It also provides interactive tests for healthcare professionals to get a better understanding of what IPF-positive results are like. The application facilitates two-way feedback in should doctors have questions that need to be answered. To address patient concerns, we developed an SMS tool which gives healthcare professionals a direct supporting platform to educate patients with COPD. The PATSU program directly helps patients see and understand how to use their medication through an interactive video delivered on their phone, by their doctor, or through the PATSU online tool. The tool has already been trialed and launched in Lebanon and will be rolled out to other markets in META.

Do you think the Middle East is ready to embrace the changes that the digital transformation is about to make in the healthcare industry? Absolutely. The region is more than ready to embrace and integrate technology in healthcare. Globally, mobility is a major part of the overall digital healthcare solutions market. So the impact, and opportunity are huge. According to industry experts, Middle East healthcare providers will spend over $80 billion in technical capability expansion and digital innovation under healthcare services. Moreover, consumers and healthcare professionals believe that use of mobile devices can help clinicians better coordinate care. While, overall the infrastructure is yet to be developed, we continue to see advancements that are driven by the UAE and KSA in particular. Some key trends in the region include smartphones, apps and wearables will empower patients, doctors and care givers. Big data will also uncover patterns, problems and opportunities in healthcare, and telemedicine will expand healthcare into our homes and beyond.

In your opinion, how are pharma companies investing in the digital transformation, and do you see Boehringer Ingelheim being a pioneer in shaping the industry? Technologies that help facilitate digital transformations will fundamentally reshape how the industry operates from portfolio planning, to drug development, consumer marketing, to finance and other business functions. For Boehringer Ingelheim, digital transformation helps us to improve

INTERVIEW

efficiency, pharmacovigilance, uncover business opportunities, and build a stronger relationship with patients and healthcare professionals. Globally, we are using a wealth of digital solutions to foster innovation along the entire pharmaceutical value chain. From research to production, patient care and in our work environment, we use digital transformation to innovate faster and better - for the benefit of humans and animals. For example, in clinical trials, globally, we are currently exploring ways that could potentially change mental health illness diagnosis. Using artificial intelligence technology, we have been developing digital speech analysis tools that could potentially bridge the existing gap and allow for a much earlier diagnosis and identification of patients with diseases like schizophrenia and Alzheimerâ€™s in the future. Globally as well as regionally, various online platforms are supporting knowledge dissemination, boosting learning and virtual workshop possibilities, encouraging the advancement of the industry overall, changing how we operate and how we deliver value to patients and healthcare professionals.

NEWS

Cleveland Clinic Abu Dhabi to Build First-of-its-Kind Oncology Center in Nation’s Capital GROUNDBREAKING NEW APPROACH TO FIGHTING CANCER IN UAE

leveland Clinic Abu Dhabi has broken ground on a state-of-theart oncology center, bringing an integrated and transformative approach to diagnosing and treating cancer to the UAE. Modelled on Cleveland Clinic’s Taussig Cancer Center, ranked number five in the United States, the hospital’s new 17,000-square-meter purpose-built center will provide patients with comprehensive, personalized care at a single location, as well as expand the range of cancer treatments available. Cancer is the third leading cause of death in Abu Dhabi and the main reason patients travel abroad for treatment. “This expansion of cancer services at Cleveland Clinic Abu Dhabi marks a significant step in the fight against the disease in the UAE. Patients will now have access to centralized oncology services, complementing the existing healthcare landscape, as we continue to build a world-class network of healthcare facilities for the people of this nation,” said Waleed Al Mokarrab Al Muhairi, Chairman of Cleveland Clinic Abu Dhabi and Deputy Group Chief Executive Officer and Chief Executive Officer of Alternative Investments & Infrastructure, Mubadala. Designed to meet the specific needs of cancer patients and their treatments, the seven-story facility will have dedicated clinical practice areas for advanced imaging, infusion, radiation, and chemotherapy, as well as a connection to the main hospital’s surgical areas. The practice areas will have space for subspecialized nurses,

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social workers, and other key team members. The layout of each floor unites a range of complementary specialties, enhancing collaboration and enabling patients to receive most of their treatment in one area – a unique approach for patient care in the region. The center will have 24 exam rooms, 24 infusion rooms, two procedure rooms, and an area devoted to specialty women’s services. “As part of our commitment to tackling the most pressing healthcare needs in our community, we are expanding our oncology services to provide a complete, integrated, and personalized approach to the disease right here in the heart of Abu Dhabi. Building on a proven approach, the Oncology Center promises to transform cancer care in the UAE,” said Dr. Rakesh Suri, Chief Executive Officer at Cleveland Clinic Abu Dhabi. The building is designed to ensure the most comfortable flow for patients, provide an abundance of natural light, and offer the optimal

combination of clinical care with support services, including a spa service and prayer rooms for patients. It will be also be a home for cancer research in the region, with a centralized hub for existing high-level treatment technology. “Receiving a cancer diagnosis is a tremendous upheaval in a person’s life. Perhaps more than many others, it requires significant emotional support from a person’s family and friends. Bringing Cleveland Clinic’s proven model of cancer care to Abu Dhabi means patients will be able to embark on their journeys to recovery closer to home, surrounded by their family,” said Dr. Suri. Cleveland Clinic Abu Dhabi’s current cancer services include Positron Emission Tomography and Computed Tomography (PET-CT) for cancer diagnoses, and minimally invasive robotic surgery for their treatments. In certain cases, the hospital complements its advanced surgical offerings with chemotherapy.

360 care around you

Early Mobilization with LINET Improve Early Mobility in your unit

Level 1

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Level 2

Immobile ICU patients can experience trunk or core weakness, reducing their ability to support themselves in an upright position. The full chair and reverse Trendelenburg positions help with muscle strengthening exercises as well as hemodynamic and orthostatic training.

Level 3

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Level 4

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www.linet.ae

NEWS

WCM-Q research: minorities disproportionately affected by heat-related illness areas with poor access to air conditioning, and higher rates of employment in outdoor and physically demanding labor. The research has now gained mainstream attention after being featured in a report by Reuters, the global news agency.

CM-Q research has shown that some ethnic groups are disproportionately affected by heat-related illness. The research, conducted by Dr. Grigory Ostrovskiy, Assistant Professor of Emergency Medicine, Dr. Ziyad Mahfoud, Associate Professor of Healthcare Policy and Research, and student Rana Abualsaud, showed that emergency room visits in California for heat-related illness like heat exhaustion and heatstroke rose by 35 percent over a decade. The increase was higher among African Americans, Asian Americans and Hispanics than in the overall population. The study, which was published in the journal Wilderness & Environmental Medicine, found that between 2005 and 2015 heat-related emergency department visits rose by an average of 67 percent for African Americans, 53 percent for Asian Americans and 63 percent for Hispanics. These visits increased by only 27 percent among whites. The rates for African Americans and Asians were always higher than for the overall population across the decade, while Hispanic populations and white

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populations had similar increases in rates until 2013, after which the rates diverged. The study notes: “The overall trend shows an increase in presentation during the last few years for all ethnicities, which may be explained by a common risk factor such as increase in peak temperature and heat intensity. The disproportionate increase [among minorities] prompts the search for ethnicity-based factors that affect heat vulnerability.” The research was based on data drawn from the California Environmental Health Tracking Program, which logs emergency room visits and hospitalizations due to heat-related medical conditions. California has particularly high-quality, freely available data on heat-related illness, making the state an attractive target for researchers in this area. The WCM-Q team aimed to gain insights from the California data that could help them understand the pattern of emergency room visits caused by heat-related illness in Qatar. The study suggested a number of factors that might account for the disparity, such as lower socioeconomic status, living in densely populated

Dr. Ostrovskiy said: “We are glad this research has been highlighted by Reuters. Global warming will lead to more heat-related illness in the future and further research is needed to make sure we understand the factors that lead to the more vulnerable populations being disproportionately affected. This study is also relevant to Qatar as it shows how an environmental tracking program could be very useful in this country, which can get very hot.” Dr. Mahfoud emphasized that results of such studies can help policy makers allocate appropriate funds to address such health disparities by understanding the factors and establishing interventions for prevention. Class of 2019 student Rana Abualsaud presented the research at the annual meeting of the Society for Academic Emergency Medicine (SAEM), a leading professional body for academic Emergency Physicians. The authors noted limitations of the study, titled Ethnicity-Based Inequality in Heat-Related Illness is on the Rise in California, including inconsistencies in the quality of data collection over time and across different counties, changes in access to care, and migration of individuals to hotter counties within or outside California.

NEWS

‫َر ْبط الصحة‬ ‫والتعليم‬ ‫والبحوث‬ Linking health, education and research

.‫ لكل مريض من مرضانا‬،‫وفعالة‬ ،‫ وحانية‬،‫تقديم أفضل رعاية صحية آمنة‬ َّ Providing the safest, most effective and most compassionate care to each and every one of our patients.

www.hamad.qa

NEWS

Qatar Genome programme joins forces with Genomics England MoU strengthens research capacity to provide new medical insights into genomics ing common frameworks to standardize genomic strategies for healthcare implementation; the evaluation of new technologies for whole genome sequencing; the cross-analysis of both national datasets; and the exchange of expertise related to educational programs.

atar Genome Programme (QGP), a member of Qatar Foundation (QF) and part of Qatar Foundation Research, Development and Innovation, has signed a strategic research and development agreement with Genomics England, aimed at enabling novel scientific discoveries and providing medical insights in genomics and precision medicine.

The Memorandum of Understanding (MoU) was signed at the 2015 building (QF Headquarters) by Dr. Richard O’Kennedy, Vice President for Research, Development, and Innovation at Qatar Foundation, and Professor Mark Caulfield, interim CEO and Chief Scientific Officer of Genomics England. The agreement lays the foundation for Qatar and the UK to develop a joint collaboration focusing on areas of research in genomics that can have a global impact.

Commenting on the importance of the agreement, Professor Asmaa Al Thani, Board Vice-Chairperson of Qatar Biobank and Chairperson of QGP, said: “This agreement will see our two projects benefiting from a strategic alliance and the pooling of research talent and resources from both nations. The programme will also hopefully generate key industrial partnership opportunities enabling vital medical insights and breakthroughs.” “This partnership aims to foster our shared goals for advancement of precision medicine and to facilitate common genomic research initiatives,” said Dr. O’Kennedy. “Together we can push the boundaries further towards a new era of medical practice, where genomics can play a central role.” Professor Caulfield said: “Genomics is a global, multi-stakeholder endeavour transforming healthcare. This collaboration will help expand the legacy of the 100,000 Genomes Project beyond the UK, and will allow us to better serve the diverse population of the UK. We are excited to share our expertise, and equally excited to learn from the approach of the Qatar Genome Programme.” The MoU outlines a number of research activities between QGP and Genomics England, such as establish-

Attending the signing ceremony, His Excellency Mr. Ajay Sharma, Her Majesty’s Ambassador to the State of Qatar, said: “I am delighted that the Qatar Genome Programme and Genomics England are signing this Memorandum of Understanding. The partnership between these leading institutions in genomic research will, I am sure, make an important contribution to tackling the healthcare challenges of today and tomorrow. “This is another example of how the UK and Qatar are working together on Qatar National Vision 2030; and how this collaboration is of benefit to both our countries and others.” The two entities will work together to share ideas, policies and regulations, technical expertise, and bioinformatics tools, and also to exchange staff, data and expertise in the field of genomics.

NEWS

Hotel-Dieu de France Unveils Its Newly Renovated Emergency Department

oday, one of Hotel-Dieu de France’s (HDF) main pillars has been redesigned to meet modern medical needs and requirements. This renovation is part of the Vision 2020 strategy set up by the hospital in 2010 in order to reshape healthcare services it provides and to better suit our society. It is no surprise that HDF pours so much efforts and energy into developing its Emergency Department. This department has been part of the hospital since it opened in 1923. During the war of 1975, and given the hospital’s location right on the demarcation line, the ER at HDF was one of the most active and renowned ER departments in Beirut. After ten long years of hard work and preparation, HDF’s flagship department is now finally ready. The newly renovated Emergency Department at Hotel-Dieu de France (HDF) will fully open to receive its patients in May 2019. Having been designed to meet the latest international accreditation requirements, the new department is equipped to handle any type of emergency. While providing a decontamination room, an isolation room, central monitoring and an all-round centralized work flow, this new department will be able to manage any ER visit. The revamped design created a more spacious area that contains now up to 30 beds and could hold up to 20 more in case of an outbreak or catastrophe. Each room is endowed with the latest medical equipment, a hygiene station and is designed to give patients their privacy. In addition, the hospital felt it necessary to incorporate a pediatric

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section into the new department; which is why while designing this modern ER, the needs and requirements of pediatric care were heavily taken into consideration. By incorporating the pediatrics section into the ER, the hospital was able to optimize its resources and improve its services. The centralized reception area will serve as a reception, sorting and orientation station that helps patients to swiftly go about their paperwork; while the centralized medical monitoring will allow our staff to promptly receive any updates regarding any of the patients. Finally, both the medical and administrative staff have been expanded and will therefore cater much more effectively to the patients’ needs. Emergency rooms are widely associat-

ed with stress and contingency, making them an unpleasant environment for many. In an effort to help manage this situation, HDF has based its new emergency department on human contact, communication and effectiveness. The combination of a warm, welcoming reception and a skilled staff will take away any stress and successfully handle any medical urgency. Thanks to Vision 2020, renovations at Hotel-Dieu de France have been a recurrent theme this last decade, with the Emergency Department being only one out of many future improvement plans. The hospital is well on its way to becoming an advanced institution that invests in the training of its students and in clinical research all the while providing top quality care.

A PLANETREE PERSON-CENTERED CARE CASE STUDY

How Bellevue Medical Center Became the First Hospital in Lebanon to Introduce Shared Medical Records, Open Visitation and Bedside Shift Report

BELLEVUE MEDICAL CENTER HAD A VISION FOR DELIVERING HEALTHCARE DIFFERENTLY. PLANETREE CERTIFICATION OFFERED THE PLAN TO ACHIEVE IT.

AT A GLANCE 

130-bed family owned teaching hospital, with a 450 person staff

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Located in Beirut area, Lebanon

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Services offered include general medicine and surgery, maternity, dialysis, diabetes center, and behavioral medicine

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Accredited by Joint Commission International (2012, 2015, 2018)

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Awarded Lebanon’s Best Health Care Operator of the Year in 2017 by International Finance Magazine

Located on the outskirts of Beirut in a green valley, Bellevue Medical Center is a state-of -the-art, tertiary care hospital that opened in 2009 with a vision of being a truly healing hospital. From the onset, planning efforts emphasized patient safety as a core value that was embedded into the hospital’s design, systems, procedures and practices. This non-negotiable insistence on quality and patient safety earned Bellevue Medical Center Joint Commission International Accreditation for patient safety and quality just three years after it opened. At the time, it was one of only three Lebanese hospitals to meet the rigorous JCI standards. The hospital’s patient satisfaction exceeded 90%. Patient safety and infection control indicators were consistently best in class, and the hospital had earned a reputation as a hospital and employer of choice. And yet, the Bellevue team was eager to hold itself to a new standard: to do more than keep patients safe and satisfied, but to also keep them (and their loved ones) informed, involved and engaged.

“The JCI standards that focus on systems and processes for patient safety and to ensure clinical quality are important, but they are not enough. On their own, they will not increase doctors’ satisfaction. They will not look at how well our staff is doing or look at wellness programs or how we are involving staff in task forces. The added value of Planetree has been the partnerships with patients and staff, and engaging with them to make this hospital better.” — Rémie Maalouf, Executive Manager and Planetree and Person Centered Care Coordinator

A Path Forward Planetree provided a clear path forward to achieving that vision in the Person-Centered Care Certification framework. The criteria offered up concrete markers of what to expect in a person-centered hospital: shared medical records, bedside shift report, accommodations for family caregivers, patient-directed visitation, complementary therapies and more. Importantly, though, the criteria also established expectations for planning and executing these hallmark person-centered practices not just for patients and families, but with them.

“We consider accreditations and certifications the best learning methodologies. For somebody who wants to build a person-centered care culture, the Person-Centered Care Certification helps to train staff and build the culture in a fast period of time. If we didn’t have the Certification, we would go about it at our own pace and rhythm. It would have taken us more time.” — Nayef Maalouf, President & CEO, Bellevue Medical Center CHANGE FROM THE INSIDE OUT Guided by the Certification standards, this change would occur from the inside out — starting with engaging leadership and frontline caregivers, listening to patients and staff to better understand their experiences, and finally bringing all these distinct points of view together to partner in ongoing quality improvement.

A NEW NORMAL FOR PATIENT CARE These behind-the-scenes processes soon gave way to noticeable changes in patient care. Family caregivers — who culturally had long been expected to accompany their loved one at the hospital — were formally enlisted as Care Partners and generalized visiting hours were eliminated to better accommodate families’ needs. Today, care partners’ names are posted on communication boards in patient rooms and they are included in patient education and discharge planning in far more intentional ways. Nurses’ shift-to-shift report was relocated to the bedside, providing the opportunity for the patient and family caregiver to participate. And a system was enacted to provide patients real-time access to their medical record while in the hospital. As the first hospital in Lebanon to enact such changes, Bellevue did not have any local examples to model their effort on. Instead, the Bellevue team consulted with Planetree for best practices from around the world that could be adapted to accommodate specific cultural nuances.

“Planetree changed our management approach. Before implementing any system or big project like complementary therapies, opening up visiting or giving patients access to the medical record, we conduct a focus group, we consult our Patient and Family advisory council (PFAC) who truly help us in understanding patient needs, and we do an assessment and ask patients and their families how they see us implementing it. The feedback of patients has pushed us to do more. And it helped with staff — especially those who were resistant at first — because this is what our patients want. Planetree may require it, but we do it because it is what our patients want.” — Remie Maalouf, Executive Manager and Planetree and Person Centered Care Coordinator

PERSON-CENTERED CARE OUTCOMES

A SUM GREATER THAN THE PARTS: WHEN A CULTURE OF SAFETY MEETS A CULTURE OF PERSON-CENTERED CARE Introducing these person-centered practices had far-reaching effects. Patients quickly began commenting about how their experience at Bellevue differed from other hospitals. Family members reported feeling more confident in their caregiving role. When they were invited to actively participate in their care by signing off on an integrated care plan and sharing their own assessment of their progress during shift report, patients and families began speaking up more. They communicated their preferences and concerns. They asked questions. They corrected misinformation. The result? Patient safety and quality got even better as staff accepted greater accountability for communicating effectively, for coordinating care and promoting continuity.

A hospital poised to thrive while others are 

Patient satisfaction at 95.5% in 2018

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94% patient satisfaction with the discharge follow-up process and education process

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50% increase in community activities after Planetree implementation

trying to survive Despite a challenging economic environment, Bellevue Medical Center has thrived. Leaders attribute this, in part, to the adoption of Planetree. Though it is nearly impossible to quantify, the medical center’s leaders are positive they have avoided what could have been costly mis-steps because of their person-centered management approaches. Designing initiatives in partnership with patients and families from the onset takes the guess work out of what patients and families will want and what will be of most value to them. It has accelerated Bellevue’s ability to create change that can be sustained over time — while reducing the costs many hospitals incur when they need to double-back and re-engineer a process discovered retroactively to be flawed. In addition, the hospital’s reputation for providing best in class patient experience has attracted patient from all over the country and the region. In recent years, Bellevue Medical Center has experienced a surge in the demand for healthcare services during the peak of the touristic season of Lebanon.

A CULTURE THAT ATTRACTS TOP TALENT The hospital’s ability to recruit and retain top talent further positions it for success. Knowing that ultimately staff are the embodiments of the organization’s values and culture, the hospital developed a customized screening tool was developed to vet candidates for their fit with the Bellevue culture. Indeed, Bellevue is uncompromising when it comes to finding the right staff who not only possess the necessary technical skills, but also meet the requirements for kindness, customer service and teamwork.

“Many hospitals may use the terminology ‘person-centered care,’ but this Certification tells the world that we are really and truly implementing it.” — Remie Maalouf, Executive Manager and Planetree and Person Centered Care Coordinator

Be the Person-Centered Change You Want to See Person-centered care is more than just healthcare best practice — it is the future of wellness. To bring these outcomes to your own healthcare facility, or to learn more about the process of becoming Planetree Person-Centered Care Certified, contact Planetree today. planetree.org/certification│ 203.732.1365

©Planetree 2019

NEWS

InterSystems appoints Ali Abi Raad as its Country Manager for the Middle East Abi Raad will use InterSystems’ substantial success in the Middle East to build a platform for collaborative innovation with clients and partners South Africa and India. “Ali’s proven business approach over the past 5 years at InterSystems has earned him the trust of our clients and partners. He builds long-term partnerships that put our customers’ success first every time, and this is the main driver for his well-deserved new appointment.”

nterSystems, a global leader in information technology platforms for health, business, and government applications, has promoted Ali Abi Raad to the position of Country Manager. Abi Raad’s leadership integrates the sales, implementation and customer relations functions to focus on meeting client needs across the Middle East. “The Middle East healthcare market has the vision and leadership to innovate. Ali’s appointment and the hiring of 24 new staff members will further expand our young, energetic team to ensure InterSystems can help realize this potential,” said Michel Amous, InterSystems’ Managing Director for France, Italy, Middle East,

MAY.JUNE 2019

In his new position as InterSystems Country Manager for the Middle East, Abi Raad will: • Continue to enable the delivery of high-value, sustainable care through the adoption of InterSystems TrakCare® health information system, the world’s most proven EMR system. With a focus on TrakCare as a service with its integrated Revenue Cycle Management that delivers faster time to value with a flexible Pay-Per-Usage financial model. • Expand beyond delivering hospitals and laboratories solutions. Ali Abi Raad will help organizations and communities fully realize the value of their health data and connect and standardize processes for improved operational efficiencies, insight, and better population health. He will achieve this using the InterSystems HealthShare® family of connected health products. These provide configurable solutions for care

•

coordination; personalized population health management; analytics assisted by artificial intelligence; health information exchange, and interoperability. Help partners innovate by using InterSystems IRIS for Health™, the world’s first and only data platform specifically engineered to develop open, standards-based solutions that extract the full value of healthcare data.

Before joining InterSystems, Abi Raad was a senior executive at Cerner Middle East and held roles in sales and business development in multiple regional and multinational organizations. He holds a B.S. in Computer Science from the American University of Beirut.

InterSystems InterSystems is the information engine that powers some of the world’s most important applications. In healthcare, finance, government, and other sectors where lives and livelihoods are at stake, InterSystems has been a strategic technology provider since 1978. InterSystems is a privately held company headquartered in Cambridge, Massachusetts (USA), with offices worldwide, and its software products are used daily by millions of people in more than 80 countries. For more information, please visit www.intersystems.com.

INTERVIEW

How can digital transform the way healthcare is delivered in the region and how does GE help enable this transformation?

President and CEO of GE Healthcare, Eastern Growth Markets

Elie Chaillot “Discussions with our partners to transform into entire health systems”

E Healthcare is moving towards precision health which is another common trend—ensuring that the right actions are taken at the right time, for each and every patient, as per Mr. Elie Chaillot, President and CEO of GE Healthcare, Eastern Growth Markets, during his interview with “Hospitals” magazine.

MAY.JUNE 2019

Hospitals are generating massive amounts of healthcare data. This data requires analysis to get the right information to the right person at the right time. Applied intelligence uses analytics—such as artificial intelligence, machine learning and deep learning algorithms and models to identify insights, patterns and suggestions. These insights can then be deployed through applications, devices and services to help enhance and augment clinical, financial and operational decision-making. Let’s look at the x-ray as an example. A collapsed lung, or pneumothorax, is a condition which strikes countless patients each year and can be deadly if not diagnosed quickly and accurately. GE’s Critical Care Suite on our Optima XR240amx X-ray machine is designed to identify cases with the critical condition of pneumothorax at point-of-care to enable prioritization of image review. This is but one example AI in action—leveraging the power of data to help healthcare providers deliver faster, more precise care to the patients that need it most.

The Middle East and Turkey are key markets for GE Healthcare. What is it about healthcare in this region that makes these markets a priority? Today our partners are talking to us about what we can do to help transform into entire health systems. What we see in these discussions is that technology is often part of a much larger and more complex delivery model that requires an ecosystem built around it, supported by sus-

INTERVIEW

tainable financing and skills development. From consortium structures, risk-sharing models and outsourcing, to infrastructure design solutions, we are partnering with our customers to share risk, reward, and a combined commitment to solving harder, bigger problems. A recent example we’re particularly proud of is from Turkey. Last month with our partner CCN Holding, I attended the inauguration of the Bilkent Integrated Health Campus, the state-of-the-art 3,711 bed healthcare facility in Ankara. The $1.3 billion campus becomes Turkey’s largest public private partnership to date and one of the world’s largest public hospitals ever constructed in a single phase. Now citizens from across the country and region benefit from greater access to higher quality healthcare, at one state-of-theart, centrally located facility.

Could you tell us more about GE Healthcare’s Edison platform? We were excited to unveil Edison in the region. What makes Edison unique is that it is the most holistic and integrated digital platform in healthcare. Clinical partners will use the platform to develop algorithms, and technology partners will work with GE Healthcare to bring the latest advancements in data processing to Edison applications and smart devices. These new technologies improve scan consistency, help clinicians detect and prioritize acute cases and extend the lifecycle of devices. In short, the platform helps accelerate the development of artificial intelligence technology that empowers providers to deliver faster, more precise care.

The UAE is one of the most advanced markets in terms of

healthcare. What is your vision for this sector? The UAE is a pioneer in healthcare transformation. The nation’s visionary leadership has prioritized healthcare and is investing in the development of a sustainable ecosystem that allows for the provision of high-quality care to its 1 million citizens and over 9 million residents. I touched earlier on the importance of partnerships in enabling change. I see great opportunity in the UAE for private sector players like GE to create capacity and make healthcare systems more productive, at scale. We’ve seen firsthand how innovative public private partnerships can help address healthcare challenges, combining the best in public-sector execution models with private sector competencies.

Based on your work at GE, where do you see the most opportunity in the healthcare sector across the region? The region’s healthcare sector is undergoing tremendous change, not just in where care is being delivered, but also in the efficiency of care required to get rising healthcare costs under control. Ministries of Health and private sector providers are increasingly demanding ‘return on investment solutions’ that can create better operational efficiencies and better financial outcomes. As a traditional healthcare equipment provider, we’ve had to really evolve and become true development partners. Technology improves decision-making. It is also about improving the patient experience, building a stronger and closer relationship between patient and clinician. This is where the private sector can play

a critical role—driving sustainable, high-quality healthcare delivery.

You’ve worked in healthcare in Europe, Asia Pacific and the Middle East. How does healthcare differ between markets and regions? I think there are more commonalities than differences in healthcare delivery. One of the major differences, however, are the population demographics. Here in the Middle East we have a burgeoning population—the rates of population growth across most of the region are still increasing and are not showing any signs of slowing down. Recent reports indicate that nearly 60% of the population in the Arab world is under the age of 25. Contrast this with the ageing, shrinking population demographics across most of Europe, North America and Asia Pacific. As healthcare systems here look to add capacity, in other parts of the world healthcare systems are more focused on efficiency and productivity. There are several common themes that drive healthcare around the world, regardless region: access, cost and efficiency; how you can do more with less, while improving outcomes. One common trend is the transition of healthcare delivery from expensive, unnecessary hospital-based acute care to appropriate, lower-cost settings like outpatient and community clinics, hospices or even using telemedicine for primary care. Precision health is yet another common trend—ensuring that the right actions are taken at the right time, for each and every patient. Done right, and done at scale, precision health delivers on healthcare’s triple aim: better quality, at lower cost, with access for millions of people.

MEDICAL INSTITUTIONS

MedsBla

PREPARED FOR THE SECOND GENERATION OF ARTIFICIAL INTELLIGENCE

he business world is full of information and data that is difficult for humans to manage. So far, artificial intelligence has been able to process huge amounts of quantitative data, i.e. structured data. But what about unstructured data? Unstructured data is text, and textual information is 80% of the value of business, that is, of knowledge. Reports, legal documents, public tenders, market studies, information from social networks, e-mails, etc. All these unstructured data provide valuable information for business

MARCH.APRIL 2019

decision-making if you know how to handle it with the help of artificial intelligence. But what does it take for all these ingredients to cook into a tasty dish? You need certain processes to understand the text in order to save time and money; that is, a new generation of artificial intelligence like MedsBla that helps you decide. MedsBla, the platform developed by MMG (MedLab Media Group) has set out to revolutionize information management through a new generation of artificial intelligence. Its avant-garde technology is designed

to process all this textual information inaccessible to human beings. If this is applied to the health sector, it can be observed that any hospital or health institution generates large amounts of information among its members. However, this volume makes it practically impossible to structure, so it goes unnoticed by health managers. MedsBla has come to solve this problem and make the business world easier. This platform (which we have mentioned previously) allows you to view all this information in an orderly, detailed and relevant way in your spaces.

MEDICAL INSTITUTIONS

Private spaces: Agility and security MedsBla is a messaging system where different types of users coexist: doctors, other health professionals, patients, medical students and administrative profiles. The latter includes all those users within a hospital or clinic who manage a private license account. The app allows healthcare professionals to separate their personal communications from the professional ones within a guaranteed secure environment. Its latest novelty is the self-configurable control panel. With it, the manager will be able to create and personalize his own ecosystem and create administrative groups, by floor, by specialty... all according to his needs. These private spaces comply with the highest security standards and comply with the strictest data protection regulations: the GDPR (General Data Protection Regulation) and the HIPAA (Health Insurance Portability and Accountability Act). This space has an additional layer of security: Blockchain technology. With it, doctors and patients validate and verify health-related data using digital identities that is impossible to manipulate. In this way, the transparency and security of the exchange of sensitive information is guaranteed. From the MedsBla application,

managers will have access to the dashboard with basic information about what is happening: which groups exchange the most messages, which type of files are the most shared, at which time there is the most activity, which clinical practice support tool is the most widely used, and so on. This information will be reflected in an updated, clear and intuitive dashboard that will facilitate decision-making. Besides this, managers will observe the advantages of offering this application in there organizations, offering a direct channel for everyone in an orderly, effective and encrypted way; notice how infrastructure costs are reduced or storage costs due to the low use of other communication channels (emails for instance). On the other hand, normal users will have access to the encrypted communication channel and a bunch of specialized tools, among them: news by medical specialties, 3D anatomy, calculators and an intelligent search engine.

Technology in constant learning In order to take artificial intelligence to the next level, large progress is being done on the semantic analysis of unstructured data. A heterogeneous team from different

sciences (mathematicians, linguists, physicists, engineers...) are in charge of preparing and training the neural networks in order to obtain answers and predictions of value. The traditional systems of artificial intelligence, for instance machine learning processes, constitute an untapped brute force that needs to be guided along the way, a phase in which MedsBla currently finds itself. In this teaching stage, artificial intelligence is being prepared to relate concepts (ontologies) in order to contextualize learning and obtain precise results in the shortest possible time. MMG defends the idea that excellence regarding management of medical knowledge is necessary in the industry, which is why the company has developed such an advanced technology of knowledge representation (a discipline that is encompassed within artificial intelligence and cognitive computing). This technology seeks to imitate the human brain in order to exploit sensitive data to make its daily medical practice much simpler. Its technology can process natural language and generate new models of knowledge, since it will be able to simulate brain cognitive processes. Thus, it optimizes the doctorâ€™s decisions and saves him time and money that he can invest in his

MEDICAL INSTITUTIONS

healthcare practice. Obtaining information by means of data extraction has been the first step towards creating a technological framework designed for the healthcare sector.

Quantum computing The desire to improve has led MMG to start an ambitious project focused on quantum computing. In January 2019, the company embarked on a new line of research aimed at developing quantum algorithms. These algorithms will solve computer problems related to Medicine, which until now were impossible to manage with traditional computers. But the health sector is not the only one in which quantum computing will have an application: science in general and the business world will be part of a new era of knowledge management. This new computing paradigm applies its fundamentals to information processing, around which a whole quantum theory revolves. Quantum computing solves previously impossible problems, such as the processing of massive sets of data. Quantum processing allows the management of huge amounts of information in a few minutes, something impossible with the current technology. In a first phase, the company will focus on treating medical information relating Physics

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and Medicine but does not rule out its use in other sectors. Although quantum computing may now seem like a chimera, MMG bets hard on it. For this reason, a multidisciplinary team of scientists has begun to promote scientific research to speed up quantum computing by uniting two worlds that have hitherto been disconnected: Physics and Medicine.

The white paper, a reference in the health sector Last month MMG published its white paper on artificial intelligence, a compilation document on how to manage knowledge. The manual

represents the start-upâ€™s vision of cognitive computing. It also offers its point of view on the disruptive technologies applied by the company in the handling of large amounts of data. According to the white paper, the limitations of Deep Learning come to the end of an era and cognitive computing could become the new paradigm of artificial intelligence. This science seeks to explain human thought and develop new artificial intelligence solutions. The commitment to disruptive technologies such as cognitive computing has placed MMG in the ranking of the 10 best Spanish start-ups in artificial intelligence, according to CrunchBase.

Shaping the industry, keeping the patient first.

A unified voice for the regionâ€™s MedTech industry. Add your voice by joining the Mecomed Medical Technology Association Middle East & Africa

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NEWS

Biogen Announcement Highlights Where the Industry is Going Wrong

Dr. Omar El-Agnaf

r. Omar El-Agnaf, Executive Director of Qatar Biomedical Research Institute at Hamad Bin Khalifa University, explains why the pharmaceutical industry needs to change its strategy to find an effective drug to tackle Alzheimer’s disease In the past 20 years, there have been more than 100 attempts to develop an effective drug to treat Alzheimer’s disease, but only four have been approved by the US Federal Drug Authority (FDA) for instance.In fact, there are currently only two classes of drugs available, and both aim to treat certain symptoms of Alzheimer’s, rather than finding a cure for the disease. Alzheimer’s is a major worldwide problem. It is a degenerative brain disease and the most common cause of dementia. The most typical early symptom of Alzheimer’s is difficulty remembering recent events. As the disease advances, symptoms can include problems with language, disorientation (including easily getting lost), mood swings, loss of motivation, not managing self-care, and behavioral issues. Alzheimer’s is ultimately fatal, with people in the final stages of the

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disease being bed-bound and requiring around-the-clock care. Worryingly, the success rate of clinical trials for Alzheimer’s is extremely low, and not enough is being learned from these failures. This was perfectly demonstrated recently when American multinational biotechnology company Biogen announced that they were halting their clinical trials of a drug that targets amyloid plaques, which are clumps of beta-amyloids that destroy connections between nerve cells. People with Alzheimer’s have large amounts of amyloid plaques in their brains, so it is essential that research and clinical trials are conducted to enable us to target them. Biogen, and its Japanese partner Eisai, said they were halting two latestage clinical trials of the experimental drug Aducanumab after concluding that it was unlikely to benefit patients. This announcement represents further devastating news for patients with Alzheimer’s disease and their families. It confirmed yet again the complexity of the disease and the need for increased knowledge of the disease biology. In my opinion, the mistake Biogen made from the start is that they seemed to turn a blind eye to previous failed clinical trials. The industry needs to pay more attention to previous trials if we are to move forward. For instance, what if some of the failed drugs worked in a subset of patients at the right time? It is time to learn from oncology about how best to conduct trials, and the drug industry should give greater consideration to early detection for early intervention. It is widely known that beta amyloid

- peptides of 36–43 amino acids that are the main component of amyloid plaques - begin to accumulate two decades or so before any sign of clinical symptoms, by which time it is too late to stop the disease’s progression. We also know that many Alzheimer’s patients at an advanced stage develop not only amyloid plaques and neurofibrillary tangles - aggregates of hyperphosphorylated tau protein - but also other pathologies that are associated with other neurodegenerative diseases and therefore make the treatment of such patients more complicated. These other pathologies include Lewy bodies associated with dementia with Lewy bodies - a type of dementia that is accompanied by changes in behavior, cognition, and movement; and TDP-43, which plays a pathogenic role in both amyotrophic lateral sclerosis and frontotemporal dementia. Therefore distinguishing between different types of neurodegenerative conditions is important as it enables us to determine the best approach to treatment. If there is a positive outcome from this latest devastating news for Alzheimer’s patients and their families, it is that it may force the pharmaceutical industry to focus on other strategies. It is time to step away from the ‘one size fits all magic bullet’ approach of developing Alzheimer’s drugs, and instead adopt Alzheimer’s precision medicine. Precision medicine has led to breakthroughs in the treatment of cancer, but it can also help foster innovative thinking to tackle a wide range of complex diseases, including Alzheimer’s.

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Al Ahli Hospital Endocrinology & Diabetes clinic offers expert care for various metabolic, pituitary, thyroid & diabetes-related conditions

he team at Endocrinology and Diabetes clinic is committed to delivering compassionate care, educating and spreading awareness, diagnosing and treating endocrine and diabetes disorders.

Gestational hypertension The clinic consists of three highly qualified consultants with extensive experience in the field of endocrinology and diabetes. “In endocrinology and diabetes clinic we care about everything related to increasing the awareness of the guests and treating their disorders,” said Dr. Maher Ahmed Irshaid Consultant Endocrinologist and In-charge of the Endocrinology and Diabetes clinic at the Al Ahli Hospital. “Our mission is inspired by Outlook basic institution which seeks in every way to educate and provide comprehensive medical care and distinctive to our guests and their families,” he added. The clinic sees about 1100 patients in a week. “We offer the most advanced treatment methods for diabetic and other endocrinology problems like thyroid,” said Dr. Irshaid. “We are dealing with adult people above the age of 15 years old. The majority have diabetic and other endocrinology problems like thyroid. Our aim is to educate patients and give them the best treatment. Because if they develop complications its more difficult to treat them,”he added. Researchers have predicted that type 2 diabetes prevalence in Qatar will soar from 17% in 2012 to at least 24% by 2050.

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Qatar is already one of the countries most affected by type 2 diabetes worldwide and, according to findings published in Diabetes Research and Clinical Practice, it is set to worsen in the next three decades, driven by the aging of the population and high levels of obesity. The key scientific findings of the study are that the fraction of Qataris with type 2 diabetes is forecast to grow by 43% by 2050; the annual number of new type 2 diabetes cases is forecast to grow by 147% by 2050; Type 2 diabetes is forecast to consume one-third of Qatar’s health expenditure by 2050 and obesity is the main driver of the type 2 diabetes epidemic, causing two-thirds of all new cases. “Your chances of getting it depends on a combination of risk factors such as your genes and lifestyle. The risk factors include having prediabetes, which means you have blood sugar levels that are higher than normal but not high enough to be called diabetes,” said Dr. Irshaid. Being overweight or having obesity, being age 45 or older, a family history of diabetes, having high blood pressure, a history of diabetes in pregnancy and an inactive lifestyle also increase the chances of getting diabetes. “Prevention of diabetes is very important. We can even see a rise in diabetes type 2 among children due to obesity. Adopting a healthy lifestyle can hugely impact on reducing the chances of getting diabetic,” said Dr. Irshaid.

Diabetes mellitus Diabetes is a condition where the body fails to utilize the ingested

glucose properly. This could be due to lack of the hormone insulin or because the insulin that is available is not working effectively.

The term diabetes is the shortened version of the full name diabetes mellitus. Diabetes mellitus is derived from: •

• •

•

The Greek word diabetes meaning siphon - to pass through. The Latin word mellitus meaning honeyed or sweet. This is because in diabetes excess sugar is found in the blood. As well as the urine. It was known in the 17th century as the «pissing evil».

Diabetes Epidemiology Diabetes is the fastest growing long-term disease that affects millions of people worldwide. According to the charity Diabetes UK, more than two million people in the UK have the condition and up to 750,000 more are unaware of having the condition. In the United States, 25.8 million people or 8.3% of the population have diabetes. Of these, 7.0 million have undiagnosed diabetes. In 2010, about 1.9 million new cases of diabetes were diagnosed in population over 20 years. It is said that if this trend continues, 1 in 3 Americans would be diabetic by 2050.

Types of diabetes There are two types of diabetes - Type 1 and type 2. Type 1 diabetes is called insulin-dependent diabetes mellitus and occurs at a younger age

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or childhood. In these patients, there is a complete lack of the hormone insulin that mandates external administration of the hormone regularly as treatment. Around 85% - 90% of people with diabetes have type 2 diabetes mellitus. This was earlier termed non-insulin dependent diabetes mellitus (NIDDM) or maturity-onset diabetes mellitus. The number of people with type 2 diabetes is rapidly increasing. In type 2 diabetes, not enough insulin is produced or the insulin that is made by the body is insufficient to meet the needs of the body. Obesity or being overweight predisposes to type 2 diabetes.

Gestational diabetes Gestational diabetes occurs in pregnant women who have never had diabetes before but who have high blood sugar levels during pregnancy. Gestational diabetes affects about 4% of all pregnant women. After childbirth, the mother may go on to develop type 2 diabetes.

How is blood sugar regulated normally? When food is taken, it is broken down to smaller components. Sugars and carbohydrates are thus broken down into glucose for the body to utilize them as an energy source. The liver is also able to manufacture glucose. In normal persons, the hormone insulin, which is made by the beta cells of the pancreas, regulates how much glucose is in the blood. When there is excess glucose in the blood, insulin stimulates cells to absorb enough glucose from the blood for the energy

that they need. Insulin also stimulates the liver to absorb and store any glucose that is excess in blood. Insulin release is triggered after a meal when there is a rise in blood glucose. When blood glucose levels fall, during exercise, for example, insulin levels fall too. A second hormone manufactured by the pancreas is called glucagon. It has the opposite function of stimulating the liver to release glucose when necessary.

Symptoms of diabetes The main symptoms of diabetes are three - polydipsia, polyphagia and polyuria. These mean increased thirst, increased hunger and increased frequency of urination. In addition, patients complain of feeling very tired and weight loss and loss of muscle bulk. Type 1 diabetes can develop quickly, over weeks or even days whereas type 2 diabetes may develop gradually.

What happens in diabetes? Due to lack or insufficiency of insulin, there is high blood glucose in diabetes. Excess glucose in the blood can damage the blood vessels. This leads to several complications like heart disease, kidney damage, nerve damage, eye damage and blindness, impotence and stroke. Diabetes, when not controlled, may raise the propensity for infections. Infections and gangrene of the lower limbs are common in uncontrolled diabetes. This may necessitate an amputation if severe. People with diabetes are also 15 percent more

Dr. Maher Ahmed Irshaid Consultant Endocrinologist and Incharge of the Endocrinology and Diabetes clinic at the Al Ahli Hospital likely to have an amputation than people without the condition.

Prevention, treatment and care The risk of complications with diabetes can be reduced by adhering to medical advice and keeping diabetes under control. Blood sugar should be regularly monitored so that any problems can be detected and treated early. Treatment involves both a healthy diet and exercise as well as oral medications to regulate blood sugar. In all type 1 diabetics and in severe uncontrolled type 2 diabetics one or more injections of insulin a day may be needed.

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When Light becomes Darkness (mzul aswad/azraq) = glaucoma

magine sitting in a completely dark room with your eyes shut. This means you perceive only black, no grey. Wherever you move your eyes or your head, nothing will change that impression. Glaucoma does not itch, burn, or hurt, seldom causes headaches and is not visible from outside. With glaucoma, you can see well - until it is too late. Glaucoma is a disease of the nerve with which we see. The nerve is part of the brain and cannot be repaired or replaced. Every nerve fiber that is lost - is lost, 100% forever. Only prevention can avoid blindness. Prevention means an examination by an eye doctor of all individuals from 40 years up (or from the age of 20, if somebody in the family is affected already). Very precise measurements going down to a 1/1000 mm by costly high-tech machines are mandatory to diagnose glaucomas and to monitor treatment effectiveness. The full spectrum of essential equipment is available in very few locations in Qatar. Today, the decision to apply drops or perform surgery does not rely on a doctor’s impression of gut feeling, but on sound computerized measurements and change analysis.

What are the glaucomas? Glaucomas (mzul aswad/azraq)

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is the most frequent cause of noninfectious blindness in the Arab world. Glaucomas are eye diseases, which destroy the optic nerve. Cataracts (mzul abiad) on the other hand can be operated and patients can be fully rehabilitated after surgery. The optic nerve damage is mostly due to high pressure in the eye, the cause of which is complex and not obvious. The normal pressure in the eye (10-21mmHg) is maintained by a balanced circulation. In the ciliary body (3) behind the iris (4) fluid is continuously produced, flows around the lens (1) and the backside of the cornea (2) and then out into the chamber angle and the main bloodstream (5). There are glaucomas that are hereditary and exist from birth, and those that develop later in life. In this contribution, we just deal with the adult types, because blindness resulting from these can mostly be prevented.

Why are glaucomas so dangerous for us? Late perception of visual field decrease: Since we have two eyes, the visual fields normally overlap. If asymmetrically defects appear, they can be easily compensated by the fellow eye for a long time. Late decrease in visual acuity: The second point is the central

visual acuity, which remains excellent, because the nerve fibers radiating from the optic nerve are first affected, and not the ones that lead directly to the area of sharpest vision. Retinal problems: in a significant percentage of eyes blood vessels may occlude, and cause a slow deterioration of vision because of a loss of retinal function.

Predisposing factors in adults! There are several visible predisposing factors. One of them is frequent in the Middle East and can be seen early by an ophthalmologist. It is a whitish-greyish mass, which is produced in a normal-sized eye. This material is deposited all over the interior of the eye. It can result in a weak lens and cornea, and a blockage of the outflow of the intraocular fluid causing very high pressure. It does not cause a “red eye”, and pressure spikes often go unnoticed during night time. Central vision is not disturbed in the beginning a fact that makes the disease so dangerous. This particular glaucoma is a very fast and frequent way into blindness. In an eye, which is relatively small, but has a big lens, or as a result of blood in the eye due to an injury, the outflow of water in the eye can be blocked (called: “angle closure glauco-

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ma”). The production of intraocular fluid continues and the pressure can rise up to 60-80 mmHg inducing nausea, headaches and severe radiating pain that can even be mistaken for gallbladder stones or a heart attack. The eye appears red and feels hard, the vision is blurred. If this situation is not treated immediately by medication and surgery, the eye will be blind within several hours. In some normal-sized eyes the “chronic open-angle glaucomas” can develop with a pressure rise of between 22 and 35 mmHg. These glaucomas mostly develop in patients age 40 and above, and can easily be detected by an ophthalmologist when the first reading glasses are prescribed. This form of glaucomas is also very prevalent in Qatar.

How are glaucomas diagnosed? The pressure of the eye can be easily measured from outside. However, the pressure is normally measured by indentation. Indentation is influenced by the thickness of the membrane, which is indented. Thus, measurements in thick corneas are too high, in thin corneas too low. Corrections must be made according to additional high precision measurements of the cornea. This is done in a few places in Qatar. Second, the eye doctor will examine the complete eye at the slit-lamp (a special lamp with magnifying lenses), look for glaucoma-predisposing factors and glaucoma damage. Before damage occurs and can actually be seen, however, psychophysical functions may deteriorate. One of these is the recognition of low-contrast high

velocity moving objects, which can be measured by specific advanced instruments (Frequency doubling technology and multifocal visually evoked potentials). Next is the evaluation of the optic nerve head by sophisticated equipment in order to see if any nerve fibers coming from the brain are deficient and if the sensitive layers of the retina are still in good shape. Special computerized programs can analyze and detect even the most minimal changes during treatment. Finally, a visual field test is necessary to diagnose the damage. The instrument must follow international standards so that the exam may be comparable with others and in the future, a fact that is not well understood by some. The main drawback of visual fields is the lack of sensitivity regarding early glaucoma changes. They show apparent defects only if a significant amount of nerve fibers has been lost already. So, if there are any doubts concerning the possibility of glaucoma, a battery of high-tech investigations is mandatory to be performed.

What to do for treatment? Once diagnosed, excessively high pressure in the eye can be treated and lowered by eye drops that need to be taken regularly life-long, and/or by special laser treatment and/or by regular surgery. The eye drops either reduce the water production in the eye or they increase the outflow or they have even properties to protect the nerves. If several eye drops in combination are not successful or the compliance is low, laser treatment is the first choice. For that, new technologies like the micropulse lasers

Prof. Dr. Alexander Arthur Bialasiewicz Head of Ophthalmology Department at the Al Ahli Hospital for selective laser trabeculoplasty are available in Qatar, which might help the patient prevent or postpone “real” surgery for some time. If surgery is considered, the optimal timepoint should not pass by. Surgery can involve stents, a new outflow, or valves. All of these carry significant risks of failure due to many reasons and are performed in specialized centers.

Can glaucoma be cured? No. Glaucoma, once it is diagnosed, accompanies you life-long. The doctor’s advice and permanent monitoring should not be neglected as the disease can develop into a serious condition without the patient noticing. If optic nerve damage has occurred, this damage can never be repaired. Only with sufficient treatment monitored with sophisticated diagnostic equipment, ophthalmologists can in many but not all cases can stop the progression towards blindness.

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Which food may be beneficial or harmful for your teeth and gums?

t is useful to know the effect of food that you eat on your general health, teeth, and gum. Teeth and gum are essential for chewing and swallowing so they should be maintained for a lifetime. Both children and adults need a well-balanced diet which contains all the food groups to maintain good health and strong teeth, but children especially need a healthy diet for growth.

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How to choose your food? •

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Eat a lot of vegetables and fruits that contain a high percentage of water such as pears, watermelon, cucumbers & others. Reduce the intake of bananas and raisins since they contain concentrated sugar or you can clean your teeth after ingestion. Vegetables and fruits contain sugars but water and fiber balance the sugars and help clean the teeth. They are also rich in vitamin C which is important for healthy gums & rapid healing of wounds, and vitamin A which is a key nutrient in building a dental port. Eat foods rich in calcium such as cheese, plain milk, yogurt, calcium-fortified tofu, green leafy vegetables, and almonds. Cheese also helps to stimulate the flow of saliva, which helps to wash food particles away from the teeth. Choose Food rich in phosphorus and protein, such as meat, poultry, fish, milk, and

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•

eggs. Phosphorus and calcium are minerals that protect and rebuild the dental port. Choose at least half the number of carbohydrates from whole grains, such as whole wheat, brown rice and oats, and reduce refined bread, pastries and chips. Eat as few snacks as possible because frequent snacks are a constant fuel to feed bacteria. Try to eat only a snack or two a day and then clean the teeth if possible. Eat the main meals and leave 4 hours between them allowing time between meals for saliva to wash food particles that may be fed by bacteria. If you want to eat sweets, preferably after the main meal directly and not as a snack, to allow for a large amount of saliva to wash the mouth. Choose non-sweetened foods & beverages and if you want to chew a gum choose sugar-free. It has been shown that xylitol reduces the number of bacteria in the mouth and chewing increases the flow of saliva. Avoid chewy & hard candies, caramel, cakes and raisins that may stick to your teeth, then the sugar will feed bacteria in your mouth and excrete acids leading to tooth decay and risk of the cavity. Avoid sweetened juices, soft drinks, acidic lemon juice, syrups, sweetened coffee and

Hania Kreidieh Clinical Dietician at the Al Ahli Hospital tea that are high in sugar & will surround your teeth with sugar. In addition, the number of times you drink sugary and acidic drinks will affect tooth decay. The World Health Organization (WHO) recommends limiting the intake of simple sugars to less than 10%, but ideally to less than 5% of total energy consumption, to reduce the risk of dental diseases. We recommend reading food labels to limit the amount of sugar to the minimum daily intake, plan your main meals and include all healthy nutrients mentioned above, select your snacks to include vegetables, fruits, low-fat milk, or nuts, and drink water in sufficient quantity. In addition to cleaning the teeth twice a day for two minutes to remove sugars and food particles, exercise at least two and a half hours a week for better health.

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How medical tourism is developing regionally?

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edical tourism market is registering a regional growth faster than it is expanding globally. Since long, the growth of medical tourism has been viewed on the global plane but in reality, there is a strong undercurrent of region-based growth. A medical tourist is not always willing to travel to the other end of the globe seeking high-quality and low-cost healthcare assistance. Emerging factors that play a significant role are cultural affinity and geographical proximity. These are outplaying the cost and quality factors. Other significant destination parameters include image, infrastructure and environment of the destination and logistics convenience along with the risk and rewards associated with medical travel.

CULTURAL AFFINITY AND GEOGRAPHICAL PROXIMITY ADD TO PATIENTâ€™S CONVENIENCE: While destinations mostly market quality and affordability over others, they need to consider other patient-convenience factors. Patients have different thoughts while accessing cross-border healthcare services. How convenient will it be for me to reach that place? Will it be a few hours journey or will it take long flight hours to reach the destination? Will the destination understand and respect my culture? Will the destination understand my language? Will I get the required support and cooperation in all respects? That cultural and geographical factors matter a lot to medical travelers is reflected from the fact that the biggest proportion of medical tourism involves the crossing of just one national border. The American Journal of Medicine reports over 1.4 millions of Americans

in 2017 sought a range of medical services around the world. The same report also mentions that US medical travelers are more likely to visit South America, Central America and the Caribbean Islands for medical tourism. According to a report from USITC, South America stands as the most preferred destination for the US medical travelers welcoming 26% of the total visitors. This is followed by Central America (constituting 22% of the US medical travelers) and the Caribbean constituting 20% of them. And who doesnâ€™t know of Costa Rica, Panama, Mexico, Brazil and Columbia as top-ranked global medical tourism destinations? The numbers also include the diaspora of communities residing in the US preferring healthcare services in the home country. An estimated 92,000 Californians visit Mexico for healthcare services of which nearly 50% are Mexican immigrants residing in the US. A similar trend is also observed in Europe. Medical travelers from developed European nations are traveling to Poland, Romania, Croatia and other eastern European countries. Just crossing the Adriatic Sea by ferry from the Italian coast, it is quite easy for Italians to avail top quality dental care in Croatia. No hassles in travel. It is pretty easy to get a quality job done at a much lesser cost.

MIDDLE EAST - THE BRIGHT EXAMPLE OF REGIONAL MEDICAL TOURISM DEVELOPMENT BASED ON CULTURAL AFFINITY AND GEOGRAPHICAL PROXIMITY: Middle East countries since long are under a tremendous healthcare expenditure burden owing to government funding of overseas treatments for their patients. A survey report showed UAE alone spent $2 billion in

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

abroad healthcare closely followed by Kuwait spending $1.8 billion. But the situation is changing. Middle East countries have been somewhat successful in reversing the outbound medical tourism trend with appreciable investments in advanced healthcare infrastructure that would serve both domestic and international patients. Asia Insurance Review reports of 700 healthcare projects valued $60.9 billion in various phases of development expected to raise the quality and scope of healthcare services in the GCC region. Middle East countries have included medical tourism in the

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policy-framing with Dubai and Abu Dhabi leading in attracting maximum medical tourists. The results are showing up. Millions of Dirhams spent on abroad medical funding is seeing a downtrend. According to the Dubai Annual Statistical Report 2017 released by Dubai Health Authority (DHA), the number of patients sent overseas in 2017 was 1582 a drop from 1994 in 2016. Cultural affinity and geographical convenience are well playing their part. According to the numbers released by Dubai Health Authority, the city welcomed 326, 649 medical travelers in 2017, 9.5% up from the previous year. Asians constituted 37% of the medical travelers, Arabs and GCC nationals constituted 31% of them while 15% were from Europe.

TAPPING THE INTRAREGIONAL MEDICAL TOURISM POTENTIAL- THE GOLDEN OPPORTUNITY FOR ME: In view of the growing trend of regional medical tourism, ME region has vast opportunities to tap. They need to focus on key strategies like:

• Promoting region-based services: Thomson Reuters in its 2014 report says, $142 billion are spent by Muslims around the world on travel excluding Hajj and Umrah. They rank third in the global community in travel spend next to China and America. A report released by Euromonitor International, Middle East has the high potential for Halal Tourism boom. The 3rd edition of the Global Halal Tourism Summit has been an important feature in this year’s Arabian Travel Market. Hotels that do not serve alcohol, pork and have a separate

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spa and swimming facilities for men and women will create a comfort zone for Arabian medical travelers. Hotels can arrange for prayer rooms, announcements of prayer timings and broadcasting religious programs. Halal tourism also includes the provision of flights with no alcohol and pork served.KSA has the potential to attract 1.6 billion Muslims riding on religious and medical tourism. The government has already made substantial investments in revamping healthcare infrastructure and is currently running the highest value of healthcare projects in the GCC region. People often seek refuge in religious practices in times of health crisis. The country known for the Land of Two Mosques can secure its position in medical tourism map by clubbing religious and medical tourism.

• Developing regional associations: Strong associations between neighboring countries can further help in developing intra-regional medical tourism, a win-win situation for both the destinations and medical travelers. This would include teaming

up with top class medical facilities, airlines, hotels and other stakeholders that will add more credibility ensuring best service to medical travelers.

• Improved networking: Associations cannot be formed without strong networking. Increased B2B events, workshops, conferences and meets can help in unearthing the trends and issues related regional medical tourism. These can serve as strong idea-sharing and strategy-creating platforms to support and further expand region-based medical tourism.

• Marketing strategy: The patients’ convenience factor has contributed to the growth of regional medical tourism. Destinations should be more specific in identifying the target market and develop products and services based on it. This will help in creating the right image for the destination and providing more clarity to medical travelers. Requirements of every customer should be given due importance. For the smaller customer segment, a separate marketing strategy for different products and services would work.

ARTICLE FEATURES . The Automated Lab

Artificial Intelligence AT THE SERVICE OF MEDICAL LABS An Automated Operating System Capable of Integrating & Analyzing Data

he term â€œartificial intelligenceâ€? has entered the world of medicine and become an indispensable necessity nowadays due to the facilities provided at all medical levels, such as surgery, diagnostics, data analysis, and others. Artificial intelligence is one of the new pathways in the field of medical laboratories that have benefited from this development. Today, we hear about the creation of laboratories that simulate mental abilities, assist in data analysis, and provide a

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vision for predicting and supporting smart diagnoses of incurable diseases and helping in clinical decision making using artificial intelligence technology. Today, medical laboratories have a great opportunity to benefit from artificial intelligence techniques, emerging techniques, and the significant medical and technical development. Some hospitals around the world have begun to adopt fully automated medical laboratories to analyze many

medical cases. One of the benefits of artificial intelligence in this field is its ability to integrate a lot of data, analyze them, and detect accurate patterns, which contributes to alerting doctors about the physiological changes in the patientâ€™s body and dealing with them. The potential of artificial intelligence contributes to raising the efficiency of medical laboratories and achieving a revolution in diagnosing diseases and analyzing patient data.

ARTICLE FEATURES . The Automated Lab

With an increased volume of patient healthcare data and a continuous rise in patient expectations, artificial intelligence will be a driving force for improvement across all stages of health care, especially diagnostic ones.

Automation of medical laboratories Large investments in medical laboratory technology have contributed to the transformation of the laboratory mechanism from manual to automated; maintaining and analyzing information are carried out through the so-called â€œinformation automationâ€?. This term includes the use of advanced techniques such as robots to carry out highly efficient diagnostic tests on humans. The importance of the automation of medical laboratories and its enormous benefits made it an essential service indispensable in any clinical laboratory. This can lead to the acquisition of advanced techniques and the advantages that come with them in many laboratories, especially with the breakthrough we are currently witnessing in producing equipment and techniques by the most famous medical companies. This may contribute to coping with current challenges, such as the scarcity of skilled laboratory technicians working 24 hours a day, 7 days a week, and the need to deliver high-quality results in terms of traceability, standardization of work, and reliability. This technique, represented by automation, robotics, and laboratory information systems, is currently dominating medical laboratories, which contributes to testing samples and prepare reports about them faster and with lower costs and higher accuracy. Since diagnostic tests are a key

link in the healthcare chain, the automation of clinical laboratories plays a key role in reducing human mistakes and cases of delay in avoidable diagnoses, in addition to fast delivery of results, therefore increasing productivity, optimizing resource utilization, and, most importantly, enhancing the safety of the patients. This field forebodes many benefits, including improved resources and enhanced accuracy and efficiency of laboratory operations.

The Automated Lab Advanced techniques in the field of medical laboratories have provided the opportunity in many countries to establish automated laboratories with the lowest number of human beings. The automated laboratory depends on examining samples automatically without human intervention, which contributes to improving the accuracy of results and examining the largest possible number of samples in record time. These characteristics will reduce the burden on laboratory personnel. Worldwide, many transformational development procedures are

taking place by adopting revolutionary artificial intelligence techniques in medical laboratories. Some sophisticated clinical laboratories today use robots to test accurate amounts of blood, serum, and other body fluids from thousands of samples in one day to give very accurate and repeatable answers to clinical questions. It does not stop here. Medical companies have introduced more sophisticated techniques into the work of medical laboratories by establishing medical programs designed to support the decision of doctors in diagnosing the pathological condition. The automated laboratory can now have a system that tells the doctor if the patient is at risk of developing a disease. This system contains global risk indicators that predict a heart attack. Once the results of medical and diagnostic tests are introduced into the system, the doctor is warned that the patient is at risk. This type of modern techniques in medical laboratories is based on analyzing information regarding the diagnostic tests performed on the patient such as radiographs, blood tests, and

ARTICLE FEATURES . The Automated Lab

other tests, which have been entered into the electronic record and on the basis of which the patient is alerted if there is an imminent danger or not. It should be emphasized in this context that the goal is to support medical and diagnostic decisions taken by the treating physician.

Digitization Advances in IT have allowed for relatively seamless digitization of patient information. Hence, the term â€œdigitizing informationâ€? arose, which led to faster work performance with

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fewer mistakes, where handwritten information was replaced with digital information. By having an electronic record for each patient, a doctor or nurse can access the file and examine the patientâ€™s tests, medical condition, and know whether he or she is suffering from a chronic illness or a particular medical condition, which would reduce medical mistakes. Digitization-based programming has replaced many human tasks and decisions in the clinical laboratory, leading to faster workflows and fewer mistakes. Digitization has replaced the

handwritten results to be compiled and forwarded to doctors. Technology has evolved in this framework to include automated verification of laboratory results with minimal human intervention and high efficiency. This automated laboratory program can perform the required tasks frequently, thus increasing productivity. Medical companies in this field have taken into account the ongoing maintenance of these techniques and the optimal time to maintain them before they lead to unexpected problems.

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ARTICLE FEATURES . Asthma

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ARTICLE FEATURES . Asthma

sthma is a chronic disease of the airways. The disease causes inflammation and narrowing inside the lung, restricting air supply. The symptoms of asthma often present in periodic attacks or episodes of tightness in the chest, wheezing, breathlessness, and coughing. During the development of asthma, the airways swell and become extremely sensitive to some of the substances a person might inhale. When this increased sensitivity causes a reaction, the muscles that control the airways tighten. In doing so, they might restrict the airways even further and trigger an overproduction of mucus. With proper asthma treatment, you can live well with this condition. Inadequate treatment of the disease limits the ability to exercise and be active. Poorly controlled asthma can lead to multiple visits to the emergency room and even hospital admission, which can affect your performance at home and work.

Asthma Attacks LThe set of inflammatory events in the respiratory system can lead to the severe symptoms of an asthma attack. Asthma attacks occur when symptoms are at their peak. They might begin suddenly and can range from mild to severe. In some asthma attacks, swelling in the airways can completely prevent oxygen from reaching the lungs, which also stops it entering the bloodstream and traveling to vital organs. At the start of an asthma attack, the airways allow enough air into the lungs, but it does not let the carbon dioxide leave the lungs at a fast enough rate. Carbon dioxide is poisonous if the body does not expel the gas, and a prolonged asthma attack

might lead to a build-up of the gas in the lungs. This might further reduce the amount of oxygen entering the bloodstream. People with clear symptoms of asthma should visit a doctor. They will provide treatments and advise on management techniques, as well as identifying potential triggers for asthma symptoms and how to avoid them. The doctor will also prescribe medications to help reduce the frequency of attacks asthma. Effective asthma control reduces the impact of the condition on everyday living. Children are more likely to have an intermittent form of asthma that presents in severe attacks. Some children might experience daily symptoms, but the common characteristic among children with asthma is a heightened sensitivity to substances that cause allergy.

Treatment Plan and Asthma Management Successful asthma management requires the development of a treatment plan appropriate to the condition of the patient, who will learn how to follow up on his condition and will avoid everything that triggers asthma attacks. You should use a written asthma action plan that includes all the information you need to look after your asthma well, so you’ll have fewer symptoms and significantly cut your risk of an asthma attack. If you use a written asthma action plan, you’re four times less likely to have an asthma attack that needs emergency hospital treatment. Take your medicine as prescribed, go for regular asthma reviews and know your triggers. If you have asthma, you should know about the most effective asthma treatments for short-term relief

and long-term control. Understanding asthma treatments will enable you to work with your asthma doctor to confidently manage your asthma symptoms daily. When you do have an asthma attack or symptoms, it’s important to know when to call your doctor to prevent an asthma emergency. Thus, when learning how to prevent it, asthma patients can lead a normal life since they know how to manage and control their condition thanks to a successful treatment plan. Prevention and long-term control are key in stopping asthma attacks before they start. Treatment usually involves learning to recognize your triggers, taking steps to avoid them and tracking your breathing to make sure your daily asthma medications are keeping symptoms under control. In case of an asthma flare-up, you may need to use a quick-relief inhaler, such as albuterol. The right medications for you depend on a number of things — your age, symptoms, asthma triggers and what works best to keep your asthma under control. Preventive, long-term control medications reduce the inflammation in your airways that leads to symptoms. Quick-relief inhalers (bronchodilators) quickly open swollen airways that are limiting breathing. In some cases, allergy medications are necessary. Taking steps to reduce your exposure asthma triggers is a key part of asthma control, including the use of air conditioner in order to lower indoor humidity and reduce your exposure to dust mites. Maintain optimal humidity, prevent mold spores, reduce pet dander, clean your home at least once a week and cover your nose and mouth if it’s cold out. If your asthma is worsened by cold or dry air, wearing a face mask can help.

ARTICLE FEATURES . Asthma

Peak flow meter A peak flow meter is a portable, easy-to-use device that measures how well your lungs are able to expel air. By blowing hard through a mouthpiece on one end, the peak flow meter can measure the force of air in liters per minute and give you a

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reading on a built-in numbered scale. If you have asthma, your doctor may recommend that you use a peak flow meter to help track your asthma control. Regular use of a peak flow meter can help keep tabs on your asthma by detecting airway narrowing even before you feel any symptoms, giving

you time to adjust your medication or take other steps before your symptoms get worse. A peak flow meter allows you to measure day-to-day changes in your breathing. Using a peak flow meter can help you track the control of your asthma over time, show how well your

ARTICLE FEATURES . Asthma

treatment is working, recognize signs of a flare-up before symptoms appear, know what steps to take when you have signs of an asthma flare-up and decide when to call your doctor or get emergency care. Work with your doctor to make sure you get the right type of peak flow meter. Peak flow meters are available over-the-counter and can be purchased at a pharmacy. There are several types of peak flow meters available, and all of them work basically the same way: You blow a fast, hard breath into a mouthpiece and record the resulting score. For the most accurate reading, be sure your peak flow meter is clean and, if applicable, fully charged. Once you and your doctor have established your peak flow zones, you’ll use a color-coded system based on your symptoms and your peak flow. This system tells you what to do when you are in each zone. Your doctor will use your personal best to set your peak flow zones. Each zone is determined by your peak flow rate and symptoms.

•

before symptoms appear. You may need to increase or change your asthma medication. Red zone: Your peak flow rate is less than 50 percent of your personal best, an indication of a medical emergency. You may have severe coughing, wheezing and shortness of breath. Stop whatever you’re doing and use a bronchodilator or other medication to open your airways. Your asthma action plan will help you decide whether to call your doctor, take an oral corticosteroid or seek emergency care.

The importance of recording the patient’s peak flow zones lies in the possibility of obtaining the appropriate treatment for his condition according

to the signs of his condition or the frequent occurrence of asthma attacks.

Taking medication during recovery Most adults should have an asthma review with their doctor at least once a year. This is a good opportunity to check you’re taking the using your inhalers correctly, and taking the right medicines at the right doses. Your treatment should be flexible and based on changes in your symptoms, which should be assessed thoroughly each time you see your doctor. Then your doctor can adjust your treatment accordingly. If your asthma is well-controlled, your doctor may prescribe less medicine. If your asthma isn’t well-controlled or is getting worse, your doctor may increase your medication and recommend more-frequent visits.

The color code for each zone reflects progressively more-severe symptoms: •

•

Green zone: Your peak flow rate is 80 to 100 percent of your personal best, an indication that your asthma is under control. You probably have no asthma signs or symptoms. Yellow zone: Your peak flow rate is 50 to 80 percent of your personal best, an indication that your asthma is getting worse. You may have signs and symptoms such as coughing, wheezing or chest tightness — but your peak flow rates may decrease

ARTICLE FEATURES . Asthma

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ARTICLE FEATURES . Asthma

sthma and allergies are very much interrelated to the extent that there is no scientific difference between them. Their mechanisms are the same. The difference lies in the narrowing of the airways which is worse during asthma. However, allergies are better than asthma regarding the severity of the disease and overcoming it. An allergy is a reaction of the immune system to irritants and triggers. Asthma is a chronic disease that makes breathing difficult due to the narrowing of the airways caused by the tightening of the muscles around them. This leads to the secretion of a lot of mucus that protects the airways from infections. In most cases, asthma and allergies go hand in hand. When a person has an allergy, a reaction happens when the proteins in the immune system falsely detect a harmful substance such as pollen and consider it attacking the body. Antibodies attack then the substance causing the allergy, and the immune system secretes chemicals that appear through allergy symptoms, mainly congestion, runny nose, and itching in the eyes. As a result, asthma symptoms begin to appear.

What Are the Irritants?

ing a runny nose, etc. Strong odors, perfumes, chemicals, detergents, and cigarette smoke are all irritants that cause an asthma attack or an allergy which severity can increase or decrease according to the case. The acidity of the stomach, excessive belching and vomiting, and gastric secretions that occur as a result of the loosening of the esophageal sphincter, cause an asthma attack and GERD, especially at night. Being exposed to air pollution and working in chemical, gas, and plastic industries contribute to an asthma attack as well. Some people are also allergic to some medications that can cause acute asthma attacks. Stress can also be a trigger in chronic asthma patients.

Most Prominent Treatments Although asthma is a chronic disease that worsens when exposed to irritants, medical intervention is necessary to control the condition, maintain the functions of the lungs, and avoid side effects of medications. It should be mentioned that medications are not the only way to control asthma, it is also important to avoid the triggers that irritate the airways. If the patient does not commit to appropriate medications or inhalers, there is a higher chance of having

more frequent asthma attacks every now and then, with a smaller interval between them. Inhalers are the core of asthma treatment since they contribute to inhibiting hyper responsiveness and removing acute symptoms. Therefore, as soon as an asthmatic feels the start of an attack, he promptly uses the inhaler to reduce it. Hence, it is a must for him to have an inhaler with him wherever he is and whatever the circumstances. Steroid inhalers are considered the best to inhibit hyper responsiveness and the secretion of chemicals that cause allergic rhinitis. They are safe and it is enough to take a small dosage to control the condition. Their negative symptoms are far fewer than those of asthma, on a short and long term. The most common side effect is the possibility of fungi in the mouth; therefore, the patient is advised to mouthwash after using them. Other conditions require the patient to regularly use long-term controller medications, even if the asthma symptoms are gone, in order to reduce chemicals involved in allergic rhinitis in a way that prevents chronic changes in the wall of the bronchus and maintain the function of the lungs.

Acute and frequent asthma attacks happen due to the exposure to a lot of irritants, some of which cause allergies, such as pollen in spring, animal dander, fungi, mold, dust at home, and some types of food. Viral infections, such as cold and flu, can also trigger acute asthma attacks because they irritate the respiratory system. Sinusitis is one of the major irritants that cause a severe allergic reaction. The condition gets worse for asthmatics because of the secretion of mucus and sputum, hav-

ARTICLE FEATURES . The Fecal Immunochemical Test

The Fecal Immunochemical Test (FIT) A screening test for colon cancer

he fecal immunochemical test (FIT) is a screening test for colon cancer. It tests for hidden blood in the stool, which can be an early sign of cancer. FIT only detects human blood from the lower intestines. Medicines and food do not interfere with the test so it tends to be more accurate and have fewer false positive results than other tests. Talk with your doctor about when to begin colon cancer screening. Guidelines generally recommend that colon cancer screenings begin around 50. He may also recommend more frequent or earlier screening if you have other risk factors, such as a family history of the disease. Colorectal cancer is the third leading cause of cancer-related deaths in men and in women, and the second most common cause of cancer deaths when men and women are combined. Surgery can cure about 90% of colorectal cancers when they are found early. Early detection is crucial as it saves the patientâ€™s life and reduces his suffering. The sooner the disease is detected, the higher the chance of treatment, and undergoing the FIT test annually saves the lives of many patients. The doctor should determine when the test should be repeated, depending on the patientâ€™s age and risk factors. Therefore, the colon cancer awareness has gained special attention in recent years and there was a major focus on regular screening tests that should be adopted after the age 50 given the importance of early detection. The FIT test is the most

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important one for early detection and the doctor will then determine other tests or colonoscopy, according to the test results. It is enough to get a very small amount of stool to detect the hidden blood, which appears through the chemicals used by the laboratory specialist. The doctor recommends this test to detect colon cancer if the patient has some risk factors such as a genetic factor, or if he is over age 50.

How to prepare for the test For the fecal immunochemical test (FIT), which is the preferred test, no preparation is necessary. For the guaiac-based FOBT (gFOBT, FOBT), you will be instructed to avoid certain medications and follow certain dietary restrictions for several days before collecting the stool samples to obtain accurate results. Preparation for the test is primarily by avoiding certain fruits or vegetables, including cauliflower, turnip, red meat, hot radish; in addition to those foods, the patient should stop taking supplements containing vitamin C, and painkillers. This test should be done to all healthy people after age 50 in order to detect early signs of colon cancer. In most cases of early-stage colorectal cancer, the wall of the colon is injured, causing a small amount of blood to be excreted with the stool. Because it is small, it is not possible to see it with the naked eye, but with the chemicals in the lab in order to obtain evidence of bleeding. A normal result means the test did not detect any blood in the stool. However, because cancers in the colon

may not always bleed, you may need to do the test a few times to confirm that there is no blood in your stool. If the FIT results come back positive for blood in the stool, your doctor will want to perform other tests, usually including a colonoscopy. The FIT test does not diagnose cancer. Screening tests such as a sigmoidoscopy or colonoscopy can also help detect cancer. Both the FIT test and other screenings can catch colon cancer early, when it is easier to treat. Studies have shown that guaiac FOBT, when performed every 1 to 2 years in people aged 50 to 80 years, can help reduce the number of deaths due to colorectal cancer by 15 to 33%.

How the test is performed You will be given the test to use at home. Be sure to follow the instructions provided. The way a stool sample is obtained plays an important role in the accuracy of the outcome. The stool sample should be taken in a clean, covered plastic container and the patientâ€™s data should be placed on the container. It is important to warn the patient not to mix the stool sample with urine. The laboratory specialist should immediately examine the sample and check its appearance to get a complete idea of it before the preparation process. Before starting the analysis, it is important to make sure that the microscope is suitable for use in terms of safety and lens cleanliness etc. Take about three samples from the patient, examine more than one part of the sample and choose different places to get an accurate and certain result.

ARTICLE FEATURES . The Fecal Immunochemical Test

ARTICLE FEATURES . infertility

What are the causes of infertility in women?

nfertility in women is a major medical problem that disturbs the couple if they have not conceived after one year of trying. Overall, onethird of infertility cases are caused by male reproductive issues, one-third by female reproductive issues, and one-third by both male and female reproductive issues or by unknown factors. There are numerous and diverse causes of infertility among women, but the important thing is that modern medicine in gynecology has witnessed radical developments that have contributed to finding treatments for many cases; on the other

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hand, the chances of pregnancy are possible through IVF or artificial insemination, which are advanced techniques that have contributed to solving the problem of reproduction in many couples. So, one year after getting married without conceiving, the couple goes to the gynecologistâ€™s office to look for the cause and seek appropriate treatment.

Ovarian insufficiency and polycystic ovary syndrome are the main causes of infertility Premature ovarian failure, also called primary ovarian insufficiency, is usually caused by an autoimmune

response or by premature loss of eggs from your ovary (possibly from genetics or chemotherapy). The ovary no longer produces eggs, and it lowers estrogen production in women under the age of 40. Signs and symptoms of premature ovarian failure are similar to those of going through menopause and are typical of estrogen deficiency. They include: Irregular or skipped periods (amenorrhea), which might be present for years or develop after a pregnancy or after stopping birth control pills, difficulty conceiving, hot flashes, vaginal dryness and decreased libido. Polycystic ovarian syndrome (PCOS) is a common health problem

ARTICLE FEATURES . infertility

caused by an imbalance of reproductive hormones, which affects ovulation. PCOS is associated with insulin resistance and obesity, abnormal hair growth on the face or body, and acne. Itâ€™s the most common cause of female infertility. The higher amounts of androgens that happen in PCOS can interfere with egg development and release. Instead of the eggs maturing, sometimes cysts (little sacs filled with liquid) develop. Then, instead of an egg being released during ovulation as in a normal period, the cysts build up in the ovaries. Polycystic ovaries can become enlarged. Women with PCOS are not ovulating or releasing an egg each month, so many have irregular or missed periods. Irregular uterine bleeding from PCOS is usually due to lack of ovulation. Under this circumstance, the fragile lining of the uterus (endometrium) becomes thickened from excess estrogen and is not corrected by the monthly production of progesterone from the ovary that normally follows ovulation. The imbalance caused by PCOS may prevent the development and release of mature eggs. Without a mature egg, neither ovulation or pregnancy can occur. With polycystic ovary syndrome the egg may not develop as it should or it may not be released during ovulation as it should be. PCOS can cause missed or irregular menstrual periods. It can also lead to severe mental health issues including anxiety, depression, and eating disorders. Couples struggling to conceive can resort to IVF or artificial insemination. High levels of insulin causes the ovaries to produce too much testosterone, which interferes with the development of the follicles (the sacs in the ovaries where eggs develop)

and prevents normal ovulation. Insulin resistance can also lead to weight gain, which can make PCOS symptoms worse, as having excess fat causes theÂ body to produce even more insulin. Elevated levels of male hormone may result in physical signs, such as excess facial and body hair (hirsutism), and occasionally severe acne and male-pattern baldness. To help decrease the effects of PCOS, try to maintain a healthy weight and be active. Exercise helps lower blood sugar levels. If you have PCOS, increasing your daily activity and participating in a regular exercise program may treat or even prevent insulin resistance and help you keep your weight under control and avoid developing diabetes. The doctor may prescribe medications to stimulate the ovaries to produce more eggs. A surgical procedure called laparoscopic ovarian drilling may be recommended in some cases to improve fertility. During this procedure, cysts in the ovaries are cauterized, which can have the effect of stimulating ovulation. This procedure

is usually only recommended when all other forms of treatment to increase fertility have been ineffective.

Repeated infections may destroy the reproductive system Some infections can affect the womenâ€™s reproductive health in the long term. According to doctors, not all types of inflammation prevent pregnancy; however, the occurrence of infections during the months of pregnancy may lead to premature birth, requiring regular follow-up with the doctor throughout the pregnancy and immediately after noticing symptoms of inflammation such as itching, abnormal discharge or foul smell. Recurrent UTIs can affect the upper tract, that is, the fallopian tubes, uterus and the kidneys and increase the risk of infertility. Urine tests can determine the underlying cause of UTIs. Chlamydia is the most frequently reported bacterial sexually transmitted infection. A large number of cases are not reported because most people with chlamydia are asymptomatic and do not seek testing.

ARTICLE FEATURES . infertility

Early-stage chlamydia trachomatis infections often cause few or no signs and symptoms. When signs or symptoms occur, they usually start one to two weeks after exposure to chlamydia. Even when signs and symptoms occur, they’re often mild and passing, making them easy to overlook. Symptoms of chlamydia in women include painful urination, pain during sex, lower belly pain, abnormal vaginal discharge (may be yellowish and have a strong smell) and bleeding between periods. Chlamydia trachomatis can be associated with pelvic inflammatory disease (PID). PID is an infection of the uterus and fallopian tubes that causes pelvic pain and fever. Severe infections may require hospitalization for intravenous antibiotics. PID can damage the fallopian tubes, ovaries and uterus, including the cervix. Chlamydia infections — even those that produce no signs or symptoms — can cause scarring and obstruction in the fallopian tubes, which may make women infertile. Chlamydia can be easily treated with antibiotics after consulting with a physician to determine the best and most appropriate treatment; if left untreated, chlamydia can cause pelvic inflammatory disease in women, which can lead to chronic pain and infertility. Urinary tract infections also affect a woman’s ability to conceive, including cervical, vaginal and ovarian infections. Bacterial infection is the main cause of genital tract infection, most notably fungal infection and genital herpes. Recent studies show that about 47% of women of childbearing age may suffer from vaginitis annually, and symptoms may include abnormal vaginal discharge, foul odor, vaginal itching and burning. On the other hand, inflammation of the cervix,

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which affects more than 50% of women annually is the main cause of poor fertility in women, because of the parasites and bacteria that kill the sperm. The first step of the treatment is to accurately diagnose the type of existing inflammation through the symptoms such as the color of vaginal discharge, itchiness and foul odor. The doctor should know all this information in order to give the patient appropriate treatment of anti-inflammatory drugs, injections or suppositions. However, the key to preventing these infections or at least avoiding their recurrence is through following your doctor’s instructions.

Problems in the fallopian tubes cause infertility For pregnancy to occur, every step of the human reproduction process has to happen correctly. One of the two ovaries releases a mature egg, the egg is picked up by the fallopian tube. Sperm swim up the cervix, through the uterus and into the fallopian tube to reach the egg for fertilization. The fertilized egg travels down the fallo-

pian tube to the uterus. The fertilized egg implants and grows in the uterus. Damaged or blocked fallopian tubes keep sperm from getting to the egg or block the passage of the fertilized egg into the uterus. Causes of fallopian tube damage or blockage can include pelvic inflammatory disease, an infection of the uterus and fallopian tubes due to chlamydia, gonorrhea or other sexually transmitted infections. Previous surgery in the abdomen or pelvis, including surgery for ectopic pregnancy, in which a fertilized egg implants and develops in a fallopian tube instead of the uterus. The fallopian tubes play an important role in conception because they are where most eggs are fertilized. If any part of the fallopian tube is damaged, for example by surgery or an infection, they can become blocked by scar tissue. Endometriosis, the growth of endometrial tissue outside the uterus, can also block the fallopian tubes causing infertility. The fallopian tubes are exposed to inflammation, which accounts for 20 percent of the causes

ARTICLE FEATURES . infertility

of delayed reproduction in women. Statistics have shown that if a woman suffered from an inflammation of the fallopian tubes only once, it can lead to a drop of fertility by 15% and it will increase to 50% if there was a second recurrence and 75% for the third recurrence.

Cervix Disorders If cervical mucus is abnormal, it may prevent sperm from entering the uterus or may promote the destruction of sperm. Cervical mucus is secreted by glands in the cervix (the lower part of the uterus that opens into the vagina). Normally, this mucus is thick and impenetrable to sperm until just before release of an egg. Then, just before ovulation, the mucus becomes clear and elastic (because the level of the hormone estrogen increases). As a result, sperm can move through the mucus into the uterus to the fallopian tubes, where fertilization can take place. Abnormal mucus may not change at ovulation (usually because of an infection), making pregnancy unlikely,

allow bacteria in the vagina, usually those that cause infection in the cervix, to enter the uterus, sometimes resulting in the destruction of sperm and contain antibodies to sperm, which kill sperm before they can reach the egg. However, problems with cervical mucus rarely impair fertility significantly, except in women who have chronic cervicitis or a cervix that has been narrowed (called cervical stenosis) by treatment for a precancerous abnormality of the cervix (cervical dysplasia). Causes of infertility related to the uterus include the presence of polyps, fibroids, cancer or adhesions due to inflammation, previous surgical interventions or congenital malformations and all this hampers the nesting of the fertilized egg in the wall of the uterus. Intrauterine adhesions form when scar tissue builds up between the inner walls of the uterus causing the walls to bind together. Endometriosis is a condition in which cells from the lining of the uterus (the endometrium) migrate to other parts of the pelvis. It can damage the fallopian tubes

and the ovaries, and significantly alter the movement of the egg and sperm. Even if the fallopian tubes and ovaries are not damaged, endometriosis can affect the movement of sperm, egg pick-up by the tube, egg fertilization, embryo growth and implantation. The most common cause of intrauterine adhesions is injury following a surgical procedure involving the cavity of the uterus. Intrauterine adhesions may form following a D&C performed for pregnancy complications, such as uterine bleeding following childbirth or miscarriage or, less commonly, for gynecologic problems that involve the uterus such as abnormal bleeding. Other, less common, possible causes of adhesion formation are infections of the uterine lining (endometritis), surgical removal of fibroids in the cavity of the uterus, cesarean sections, and endometrial ablation (a surgical procedure that is used to intentionally damage the uterine lining to make menstrual periods lighter or eliminate them entirely). Cervical cancer is one of the main problems in reproductive health, especially for women in developing countries. Cervical cancer begins when healthy cells acquire a genetic change (mutation) that causes them to turn into abnormal cells. Before cervical cancer develops, cells in the cervix go through several changes over many years. Early cancer cells that are restricted to a very local area are present in the layer of cells that line the cervix. This type of cancer is called carcinoma in situ. These cells are non-invasive because they have not invaded healthy tissues. Most women have no symptoms until the cancer invades healthy tissue. At this point, the cancer is described as invasive. Cervical cancer can be fatal, especially if it is not detected in the early stages.

ARTICLE FEATURES . Weight Loss

Weight Loss

Optimal step for diabetes treatment

iabetics are unable to properly use glucose, the bodyâ€™s main source of energy. Insulin is a hormone that is responsible for allowing glucose in the blood to enter cells, providing them with the energy to function. A lack of effective insulin plays a key role in the development of

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diabetes. The diabetic must therefore realize that losing excess weight will help him improve insulin secretion and receptivity. In this context, the World Health Organization urged to fight against the growing obesity epidemic. Studies

have shown an association between weight loss and the ability to control blood sugar level. The benefits of weight loss, especially in type 2 diabetes, may actually be able to reverse the disease; for some, it will reduce the risks of common but serious complications.

ARTICLE FEATURES . Weight Loss

In fact, weight loss is the optimal step for diabetes treatment. Inactivity and having excess weight go hand-in-hand with a diagnosis of type 2 diabetes. Muscle cells have more insulin receptors than fat cells, so an individual can decrease insulin resistance by exercising. Being more active also lowers blood sugar levels by helping insulin to be more effective.

don’t react to insulin. Unfortunately, weight gain in this case makes the patient more likely to have a higher diabetes rate to the extent that it may be difficult to control. Type 2 diabetes is more common in people who don’t do enough physical activity, and who are overweight or obese. It is strongly associated with high blood pressure, abnormal cholesterol levels, and an ‘apple’ body shape, where excess weight is carried around the waist.

healthy diet rich in fiber as it slows the absorption of sugar in the blood and thus prevents its spike. In order for a diabetic to avoid the risks of blood sugar spikes or gaining weight, he should follow a specific diet through a dietician who reduces his calorie intake by about 500 calories a day, while reducing protein, carbohydrate and fat.

Treatment of type 2 diabetes is different than type 1 diabetes given that it affects the way the body uses insulin. While the body still makes insulin, unlike in type I, the cells in the body do not respond to it as effectively as they once did. In addition to drug therapy or insulin injections to control diabetes, the treatment is to stop unhealthy habits first, start exercising, stop consuming sugary foods, and eating foods rich in vitamins and important nutrients. Obesity usually occurs due to accumulation of body fat resulting from an imbalance between calories consumed and calories expended. The fat around the pancreas presses on beta cells in the organ that controls blood sugar levels. Thus, the cells stop producing enough insulin, which leads to high blood sugar levels that will be difficult to control.

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Weight and Type 1 Diabetes Type 1 diabetes occurs as a result of the body being unable to produce insulin, which moves glucose out of the blood and into your cells to be used for energy. Without insulin, your body will break down its own fat and muscle, resulting in weight loss. This can lead to a serious short-term condition called diabetic ketoacidosis, where the bloodstream becomes acidic and you develop dangerous levels of dehydration. Type 1 diabetes is an autoimmune condition, where the immune system mistakes the cells in your pancreas as harmful and attacks them. Therefore, once a patient has been diagnosed with type 1 diabetes and began receiving the appropriate treatment, his weight will return to normal. Although type 1 diabetes is not associated with weight gain, maintaining a healthy weight helps treat type 1 diabetes, as the accumulation of body fat makes it difficult for insulin to work well, thus making it difficult to control the disease.

Overweight and Type 2 Diabetes In type 2 diabetes, the body either doesn’t produce enough insulin to function properly, or the body’s cells

Steps for successful weight loss A person with diabetes should be aware that the more moderate his blood sugar levels the more he will avoid and delay the complications of the disease and their emergence. Maintaining a healthy weight is the beginning to reach the desired goal. Diabetic patients must follow a

Calories for adults should be distributed as follows: 45 to 55% of carbohydrates. 25 to 35% fat. 10 to 35% protein.

It is noteworthy that carbohydrates have the greatest effect on blood sugar levels, especially those containing fiber such as whole grains and bread, which are much better than eating sugary or starchy carbohydrates, because they are less likely to have sudden blood sugar spike and drop. The lifestyle changes to be made include exercising, provided that it is not a heavy sport; walking regularly or doing other light activity that contributes over time to burning fat and removing excess calories. These two steps must be accompanied by taking the drugs prescribed by the doctor and which have a key role in controlling blood sugar levels. Following these steps will allow the diabetic patient to enjoy a fairly normal life, as the effect of exercise and diet on his body is equivalent to the effect of the drug. This also has far more benefits than maintaining a healthy blood sugar level, as it prevents high blood pressure or cholesterol, as well as it gives more energy and a better mood.

ARTICLE FEATURES . Ramadan

Chronic Diseases during Ramadanâ€Ś When Should Patients Break the Fast?

asting the month of Ramadan carries many health benefits on the human body and is an opportunity to detoxify it. Long hours of abstinence from eating are an opportunity to repair cells, adjust hormone levels, and promote the rate of burning fat stored by the body, which eventually contributes to the development of atherosclerosis. Despite the great benefits of this Holy Month, there is a category of

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patients who are forbidden to fast, and another category that requires an intensive follow-up with the treating physician in order to keep the situation under control. We are talking about patients suffering from a chronic disease. Patients suffering from diabetes or from a heart or kidney disease wonder about the possibility of fasting during this Holy Month. The doctors agree that they should deal with each patient according to his/her condition and overall health.

DIABETICS AND THE EFFECTS OF FASTING Diabetes is one of the most common chronic diseases. The majority of diabetics refuses the doctorâ€™s advice not to fast during Ramadan and insists on doing so regardless of the results. But, are all diabetics prohibited from fasting? Doctors agree that determining or not the fasting of a diabetic depends on the patient himself/herself in terms of the blood sugar level, the possibility of regulating it, the adopted treatment, etc. However, the most important thing is the intensive follow-up with the treating physician, informing the latter of the details of the situation, making sure that the blood sugar level is being checked five times a day, and breaking the fast immediately in case of severe hypoglycemia, even if it is iftar time soon. It is also recommended that the diabetic delay the pre-dawn meal (suhur) that should include equal parts of carbohydrates, proteins, and vegetables

ARTICLE FEATURES . Ramadan or fruits, frequently drink water, avoid sugary drinks and sweets of all kinds, and not increase the dose of treatment without consulting the doctor.

How does fasting affect the diabetic? During the long hours of fasting, the blood sugar level decreases, leading thus to a decrease of insulin secretion and an increase of the level of glucagon, the hormone produced by the alpha cells of the pancreas in case of hypoglycemia; it raises the concentration of glucose in the bloodstream. Catecholamines, which are hormones produced by the adrenal gland, such as adrenaline, also increase, leading to the breakdown of glycogen which is used by the body to store energy and convert it into glucose. In type I diabetes, the pancreas may fail to increase the secretion of glucagon to face hypoglycemia. These patients have a low blood sugar level and do not produce enough insulin due to autonomic neuropathy. In patients with severe insulin deficiency for long periods, fasting may lead to increased breakdown of glycogens and ketones, leading to an increase of blood sugar level and ketones. During Ramadan, diabetics may experience low blood sugar levels due to low food intake. On the other hand, they may experience an increase of blood sugar levels by five times, possibly due to low dose of medicine and consumption of large amounts of sugar. The patient may also suffer from dehydration and blood clotting due to the lack of fluid intake during fasting hours. High blood sugar levels may lead to increased urination, leading to an increased risk of dehydration. Blood clotting occurs due to increased coagulation factors and the lack of self-coagulation factors. Increased blood viscosity also leads to dehydration and blood clotting.

When is a diabetic prohibited from fasting? Doctors do not treat patients with diabetes as one category regarding fasting during Ramadan. There are three groups of patients. The first group includes high-risk diabetics who should never fast, such as uncontrolled type I diabetics and patients who were exposed before the onset of fasting to complications of diabetes, kidney patients, and uncontrolled type II diabetics who are being treated with insulin. The second group includes medium-risk diabetics. This group can fast provided that necessary precautions are taken regarding the treatment and fasting system through consulting the treating physician, such as patients adopting a treatment and taking certain types of diabetes drugs such as long-acting insulin. The third group includes low-risk diabetics who control their diet and take some types of oral treatments, which do not lead to low sugar during fasting. The conditions in which diabetics are not allowed to fast are: • Type II diabetes, especially in

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• •

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the advanced stages, which results in nephropathy and other complications. Patients with a continuously unstable blood sugar levels, exceeding 300 mg/dL. Patients who depend on insulin and need 3 to 4 doses daily, or patients who use insulin pump. Pregnant or nursing woman with diabetes. Diabetics suffering from other diseases such as high blood pressure, heart or kidney diseases, gastric ulcers, etc. A diabetic patient who has had a diabetic coma shortly before Ramadan. Frequent decrease in blood sugar levels in the last three months before Ramadan. Children with diabetes.

Golden tips for safe fasting There is still a small group of diabetics who can fast provided that they follow the doctor’s advice and guidance in general and monitor the situation closely. The most important tips to follow during Ramadan:

ARTICLE FEATURES . Ramadan

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Measuring the blood sugar level several times during the day. Doctors prefer about five times a day or just when the person feels the level of blood sugar is decreasing. Breaking the fast immediately in case of hypoglycemia or hyperglycemia, in other terms, if the blood sugar level is less than 70 mg/dL or more than 300 mg/dL. The symptoms of hypoglycemia are severe hunger with tremors, sweating and nervousness, rapid pulse, and heart palpitations. Avoiding dehydration when fasting by avoiding salty foods such as salted nuts and high-protein diets or meat, reducing the intake of caffeine-rich drinks and soft drinks, and not eating salty spices to avoid thirst. Eating moderately, and eating fiber-rich food because it is slow to absorb and slowly supplies the body with

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energy. Suhur meal should be delayed to avoid a reduction in the blood sugar level throughout the next day. Eating fast-absorbing carbohydrates when the blood sugar level is low, such as water with sugar, honey, fruit juice, or eating 3 to 4 tablets of glucose or 3 to 4 tablespoons of sugar, and eating carbohydrates afterwards. Having suhur a short time before dawn to reduce fasting hours and making sure it is rich in proteins, such as beans, because it helps fasting during the day without increasing blood sugar level. Exercising two hours after iftar and not during fasting hours because working out leads to the loss of a large amount of fluids. Drinking a lot of water from sunset to dawn to avoid thirst and dehydration during the day.

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Abstaining from sugary drinks and replacing them with low-sugar drinks. Avoiding carbohydrates and sugary and fatty foods at iftar because they increase sugar levels and weight. Eating a lot of vegetables because they are healthy and low-calorie.

KIDNEY PATIENTS DURING RAMADAN Kidney patients are affected by their dietary pattern. Their condition may improve or worsen according to what they eat and drink. However, kidney patients are generally advised not to be exposed to high temperatures, avoid eating salty foods, use a cup to drink water so as not to increase the amount of fluids required, and should eat low-fat foods and less sweets. Kidney stones are so common. People with kidney stones can fast provided that they drink plenty of fluids to avoid dehydration which may increase deposits and renal colic.

ARTICLE FEATURES . Ramadan

Patients with acute kidney failure are critically ill, and are prohibited from fasting until their kidneys improve and return to normal. There are different stages of nephropathy in patients with chronic kidney disease. Patients with kidney disease of the third degree and above are not advised to fast because the kidneys at this stage are unable to retain body fluids, which may cause severe failure in their functions and lead to a significant kidney damage. However, fasting for a long time considerably reduces body fluids, and patients should consult the treating physician to know the extent of kidneys injury and the impact of fasting on them. Dialysis patients who purify their blood three days a week can fast the rest of the week. The purifying process consists of giving the patient an intravenous solution, breaking thus the fast. In peritoneal dialysis, patients cannot fast because the dialysis solution contains nutrients. In case of fasting, dialysis patients

should be careful about the amount of water they drink after iftar (not more than 1 liter per day) in order to avoid its accumulation in the heart and lungs. However, peritoneal dialysis patients may drink two liters of water per day depending on the amount of fluid that comes out with the solution used during the purifying process. Kidney transplant patients are advised not to fast because the transplanted kidneys are affected by the lack of fluids and because they have to take medicines regularly and at specific times. Also, the majority of these patients have a certain disease. In general, kidney patients have to be careful and not neglect the suhur in order not to let the body weaken.

When Are Kidney Patients Prohibited from Fasting? Cases in which kidney patients are prohibited from fasting: • Patients with kidney failure because their abstinence from drinking liquids for a

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long time may lead to severe complications. The issue here is not the ability to fast or not, but the problems that happen due to fasting. Dialysis patients and those who suffer from kidney cirrhosis. In case the cirrhosis causes renal failure, the person should abstain from fasting, especially if he/she resorted to dialysis. Kidney patients who have a heart problem or diabetes are also prohibited from fasting because they are vulnerable to strokes due to the lack of fluids that may cause blood viscosity.

Cases in which fasting is allowed but on conditions: •

People with kidney failure (first or second degree) and do not suffer from any other health problem provided that they follow up on the

ARTICLE FEATURES . Ramadan

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kidney functions weekly. If the patient notices that the quantity of the urine is less than the usual, he/she should get examined because he/she may be vulnerable to dehydration. Breaking the fast is thus recommended. People with kidney infections that affect kidney functions and cause a failure of the first or second degree. The patient should be examined especially that he/she needs antibiotics to treat the inflammation. Breaking the fast is recommended if the patient is suffering from severe pain and renal colic. People with kidney stones that are affecting the kidney functions means that there is a kidney failure. Breaking the fast is recommended if the patient has blood in the urine, lost the consciousness, or has severe renal colic.

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Fasting is permitted for patients who have only sand-like particles in the urine provided that they drink plenty of water during iftar hours.

General pieces of advice for kidney patients during Ramadan •

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Consult the treating physician specialized in kidney diseases and identify the steps to be followed when fasting. The patient should know how to behave in the event of dehydration during the day. Patients suffering from kidney diseases during Ramadan are often allowed to fast, but dehydration should be avoided because it may lead to severe damage of kidney functions. Continue to take regular medicines during the fasting period, obviously according to the instructions, and drink

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enough fluids. Consult the treating physician or the doctor specialized in kidney diseases to continue taking medicines such as diuretics which may lead to severe kidney damage in the event of dehydration, although mild.

HEART PATIENTS DURING RAMADAN Studies indicate that fasting is beneficial for people with stable heart diseases. During the fasting hours, the body consumes substances accumulated in it, such as fat stuck to the walls of the blood vessels. This leads to its complete removal, and thus the blood flow increases in these vessels. The amount of oxygen and food arriving to the cells also rises up, increasing thereby the vitality and function of the cells. Fasting does not adversely affect heart patients who have a stable condition and those who do not have

ARTICLE FEATURES . Ramadan

frequent symptoms such as chest pain or difficulty in breathing. In most cases, it is beneficial because it reduces the amount of food and reduces smoking and stress, which reduces the general risks caused by heart diseases, and has a positive impact on the health of the heart patient. The heart pumps blood to various organs of the body. The digestive system receives 10% of the blood, but when fasting, it relaxes and the heart stops pumping this amount. This helps improving the health of heart and angina patients who fast. Fasting leads to the decomposition of damaged cells which are replaced by new and active cells. This increases the strength and the work of different functions of the body. That’s why, at the end of the fast, the person feels serene, more energetic, and with a pure body. Fasting increases the body’s burning rate of fats and sugars, which leads to the reduction of cholesterol and weight gain, both of which

increase the risk of heart diseases. It also helps detoxify the body and increases the secretion of the growth hormone that burns fat.

However, some heart patients are prohibited from fasting: • • •

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Patients with frequent chest pain. Patients with myocardial insufficiency. Patients with malignant heart arrhythmias treated with medication. Cardiac patients who need to remain under observation within the hospital. Heart attack patients, especially those who had an attack a few weeks before the month of Ramadan. Heart surgery patients who cannot usually fast during the first six weeks following the surgery. Patients with a valve stenosis or severe inflammation of the valves.

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Patients taking anticoagulants.

A heart patient who is able to fast the month of Ramadan should follow these dietary tips: •

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Eat vegetables and fruits daily, because they contain antioxidants beneficial for cardiovascular health. Avoid foods that contain saturated fats and eat healthy fats found in nuts and fish. Eat grilled fish at least twice a week. Avoid fried food and replace it with grilled food. Do not add salt and avoid salty food. Avoid canned and processed food because it contains a large amount of salt. Eat red meat and remove chicken skin before eating. Drink water regularly during iftar hours and avoid drinking large amounts at once.

ARTICLE

Overcome thirst during Ramadan between facts and myths!

ith the beginning of the Holy Month of Ramadan, and it coincided with the hours of working days in the summer, thirst has become an essential concern to many because of the high temperature and the length of the fasting period to more than 16 hours a day so that the individual loses large quantities of water in the form of sweat and the bodyâ€™s attempt to compensate periods of water cuts during fasting to withdraw water from the cells and the blood. To help our bodies maintain hydration and push away the feeling of thirst and reduce its severity, kindly follow the basics of healthy nutrition during the month of fasting, because spending some effort to avoid thirst is easier than enduring the suffering of feeling it!

Fasting people turn dramatically and intensely to cold Ramadan drinks during the Holy Month, including: tamarind, carob, and of course kamarelddin and aljellab. These beverages high in calories -at least 200 calories- and sugar urges the body to diuresis and weight gain and the feeling of thirst during fasting hours. These drinks can be replaced with fresh unsweetened juices like orange juice, lemon mint and mint with ginger drink, etc. Because they contain minerals and vitamins in a condition to not exceeding one cup per serving. For example, the hibiscus drink soaked is useful for patients with high blood pressure, also keeps the body from dehydration, one cup of hibiscus drink provides 25 calories only, and preferably not to add sugar to avoid increasing its calories content.

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Water cannot be replaced by another drink and advised to take two liters of it daily. Usually, people drink a large amount of very cold or iced water at the start of Iftar and during eating and directly after it, which causes some digestive disorders because the large amount of water prevents the secretion of gastric juices; for this mineral water must be mild or moderate cold, and drink small amounts of water about two hours after Iftar, in the intervals of the night until Suhoor and not only on Suhoor without relying on feeling thirsty for drinking. Preferably, delay Suhoor as much as possible to after midnight, the Suhoor meal can be a light meal of proteins, complex carbohydrates that stay long in the intestines, and fresh fruits and vegetables that contain good amounts of water and fiber; thereby reducing the feeling of hunger and thirst. The vegetables and fruits contain potassium responsible for maintaining water balance within cells, such as tomatoes, potatoes, white beans and of course banana, dried apricots and dates ... and potassium is also important for the metabolism of sugars elements and the action of insulin in the body especially the diabetics type II. Eating, in moderation, fruit-filled with water and vitamins like watermelon, oranges and grapes instead of Ramadan sweets high in sugars can prevent you from severe weight gain and severe thirst. It should also be noted that there are many food items that increase water loss from the body leading to thirst, for instance sodium as an ingredient of salt and salty food like pickles

Farah Kalakech Dietician at the Al Ahli Hospital increases the body need for water, so it is advisable to avoid adding too much salt to food, and stay away from these foods. Strong spices and seasonings require drinking large amounts of water; because when consuming these foods, water is absorbed from the pharynx, mouth and stomach; so the fasting person should avoid eating spicy foods, especially in Suhoor meal. Tea and coffee contain caffeine, which enhances the role of kidney to get rid of the water; and soft drinks containing carbon, which prevents the body from using fluid, so it is advised to reduce drinking these stimuli, especially on Suhoor. Fasting is a cure for the body and it is also essential to make Iftar rich in food elements that prevent certain diseases and follow healthy eating habits that enable us to continue fasting in this Holy Month.

ARTICLE FEATURES . Stroke Rehabilitation

Stroke Rehabilitation

It is an important part of recovery after stroke

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ARTICLE FEATURES . Stroke Rehabilitation

aving a stroke breaks vital connections between your brain and your muscles, therefore, it is the leading cause of long-term disability and almost always results in some loss of mobility and movement. However, this loss isn’t necessarily permanent. In fact, rehabilitation is especially crucial during the early stages of recovery, when patients have little to no control over their affected muscles. No matter where you are in your journey toward recovery, your long-term progress will depend on a consistent physical therapy regimen. The goal of stroke rehabilitation is to help you relearn skills you lost when a stroke affected part of your brain and it can also help you regain independence and improve your quality of life. The severity of stroke complications and each person’s ability to recover vary widely. Researchers have found that people who participate in a focused stroke rehabilitation program perform better than most people who don’t have stroke rehabilitation. In the first weeks and months of recovery, physical therapists work with stroke survivors to keep these muscles toned and stimulated – even before they regain voluntary movement. If and when function does return, physical therapy allows patients to relearn everyday skills and retrain their healthy brain cells to control the affected body parts. This is part of the various services offered for stroke recovery including occupational therapy, rehabilitation nursing and speech therapy.

others. Post-stroke rehabilitation is a huge part of this recovery process, and it often begins as early as 24 hours after stroke. Stroke physical therapists are able to stimulate affected muscles and nerves to maintain circulation and prevent stiffness, then guide patients through the stages of stroke recovery as they relearn basic muscle movements. Today, many physical therapists specialize in stroke and other types of neurological trauma. These therapists know how to help patients relearn complex bodily movements and avoid complications that could derail their progress later. After stroke, improving your balance, coordination, and other basic skills is essential to your overall quality of life. There are many approaches to stroke rehabilitation. Your rehabilitation plan will depend on the part of the body or type of ability affected by your stroke.

Physical activities might include: •

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Physical Therapy The patient’s journey to the rehabilitation program begins with sessions of physiotherapy that appear arduous at first, but with time there will be a significant improvement that limits the patient’s dependence on

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Motor-skill exercises: These exercises can help improve your muscle strength and coordination. You might have therapy to strengthen your swallowing. Mobility training: You might learn to use mobility aids, such as a walker, canes, wheelchair or ankle brace. The ankle brace can stabilize and strengthen your ankle to help support your body’s weight while you relearn to walk. Constraint-induced therapy: An unaffected limb is restrained while you practice moving the affected limb to help improve its function. This therapy is sometimes called forced-use therapy. Range-of-motion therapy: Certain exercises and treatments can ease muscle tension (spasticity) and help you regain range of motion.

Speech Therapy After a stroke it is very common to have communication problems. This condition known as aphasia can affect your ability to find the right words, to understand what others are saying and/or reading and writing. Speech exercises are a great way to improve aphasia, especially when you practice them with heavy repetition. Repetition helps activate neuroplasticity, the method that your brain uses to rewire and restructure itself. Practicing speech therapy exercises is a must for improving speech after stroke or brain injury. Occupational therapy and speech therapy can help you with lost cognitive abilities, such as memory, processing, problem-solving, social skills, judgment and safety awareness. Speech therapy can help you regain lost abilities in speaking, listening, writing and comprehension. Your emotional adjustment might be tested. Your doctor might recommend an antidepressant or a medication that affects alertness, agitation or movement. Speech therapy programs focus on teaching the patient how to use pronunciation and communication functions in general from listening, understanding, reading and writing. The programs include various exercises that rehabilitate areas of the brain responsible for communication processes and train the patient to use and implement those functions. Like physical therapy, it is very important to do these exercises over and over again. The more intensive these exercises and rehabilitation programs, the better and faster the results will be. The length of time required varies depending on the patient’s condition and the level of damage, as some may need to undergo more than one rehabilitation program.

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EXHIBITIONS

MEDICA 2019: Clear focus on future topics & growth markets Exhibitors use the new hall structure to re-organise their presence tion and communication technology segment will be moved from Hall 15 to Hall 13, where it has a direct connection to the halls for medical technology and electromedicine (Halls 9 to 14). The communication and information platforms MEDICA CONNECTED HEALTHCARE FORUM and the MEDICA HEALTH IT FORUM will also be located in Hall 13 in the future. These forums both attract a lot of attention, drawing in at least 10,000 visitors at the last trade fair, and are established audience magnets with sessions and presentations on all of the relevant digital healthcare trends. The same applies to the MEDICA START-UP PARK, the platform for the digitally-driven start-up scene, as well as the large joint stand for the wearables technology show.

s a result of the final phase of exhibitor registrations for the world’s leading medical trade fare MEDICA 2019 in Düsseldorf (running between 18 and 21 November), one thing is already apparent: Exhibitors have a positive view of the updated allocation of subjects to the trade fair halls and are aligning their participation to the new structure with regard to target group orientation and placement and are also, in part, expanding their presence. Despite a market environment that is becoming increasingly demanding, Messe Düsseldorf once more expects participation of over 5,000 exhibitors from more than 60 countries. “Increasing trade restrictions, higher margin pressure and Brexit – conditions on the market demand that

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our exhibitors pool their strengths, as must MEDICA, as well. There is a clear focus on future topics and growth markets,” explains Wolfram Diener, Managing Director at Messe Düsseldorf. Digitalization clearly sets the pace for market development and MEDICA takes this into account, which is reflected in the new hall structure and the programs of the accompanying conferences and forums, says Diener. “In future, the healthcare industry and medical technology will only remain competitive if they keep up with digital change consequently and strategically.” Based on this development and the increasing convergence of software and hardware, especially in the fields of medical technology and electromedicine, the MEDICA informa-

Manufacturers of surgical instruments, on the other hand, will leave Hall 13 to move thematically closer to providers of imaging technology (e.g. endoscopy) as well as complete solutions for modern hybrid operating rooms in Halls 10 and 11. “With regard to performance and cost aspects, the operating room segment is possibly the most relevant interface of every treatment workflow and therefore particularly important for a clinic’s success. At MEDICA, we show top decision makers state-of-the-art technology and operating room organisation with short distances in concentrated spaces,” says Wolfram Diener, emphasising the clear benefits the new hall structure offers visitors.

Digital change as an opportunity – MEDICA is the right platform

EXHIBITIONS

KUKA and HUR are among the companies that view digital change in a competitive environment as a particular opportunity and see MEDICA as the right platform for international businesses. Computer-assisted training devices, for example, are at the core of HUR’s activities. For the Finnish company, taking part in MEDICA is a tradition – and for good reason, as Lena Karjaluoto, Executive Vice President at HUR, explains. “Here, we present our innovations, meet customers from around the world, train distributors and regularly make new contacts.” KUKA is also active around the world. The company specialises in automation and robotics and at MEDICA 2018 presented the LBR Med, a sensitive lightweight robot with various fields of application in medical technology. Subsequently, KUKA now plans an especially grand performance. As part of MEDICA 2019, they will present the “KUKA Innovation Award 2019”. “Healthy Living” is the motto of this year’s award, which is endowed with 20,000 Euros. KUKA consequently will be awarding the prize as part of the No. 1 international medical trade fair. The prize is addressed to developers, graduates and research teams in companies and at universities and aims to accelerate the speed of innovation in the field of robot-based automation and strengthen the technological transfer from research to the industry. The five finalists have already been chosen. They will present their concepts live at MEDICA 2019. The scope of their topics ranges from robot-assisted intestinal cancer diagnostics and robotic support in neurosurgery to robot-assisted treatment of microfractures in the spine.

Expanding presences and renowned returnees Mindray and Zimmer MedizinSystems are among the exhibitors that are flying their flags and further expanding their presence at MEDICA. To address the target groups of different disciplines selectively and optimally, medical technology company Mindray will present their broad range of products at two booths: the familiar booth in Hall 9 as well as in the new Hall 1. The latter focuses on applications for laboratory medicine. Their good experience with MEDICA caused Zimmer MedizinSystems to also book space for a second booth. As a full-range provider for diagnostics, therapy and aesthetic medicine, Zimmer will not only be present at their booth in Hall 9 (electromedicine and medical technology segments) bus also in the physiotherapy segment in Hall 4. With a record seven digit turnover in 2018, the company’s trade fair success did not come out of nowhere: In the previous year, 20,000 doctors and therapists received ticket vouchers in advance. “Accordingly, our booth was well attended. MEDICA has accompanied us for years, here, we reach all our goals,” summarises Armin Zimmer, CEO International at Zimmer Group. The list of the most renowned returnees among the exhibitors is enriched by Abbott and Euroimmun. Together with every exhibitor in MEDICA’s area for laboratory technology and diagnostics, they will benefit from the upcoming completion of the new South entrance and the new Hall 1, where they will be presenting their innovative solutions. The main focal points at MEDICA 2019 are: Laboratory technology / di-

agnostics (Halls 1 and 3), physiotherapy / orthopaedic technology (Halls 3 to 5), commodities and consumables (Halls 5 to 7 and 7a), electromedicine / medical technology, information and communication technology, medical furniture and specialist furnishings for hospitals and practices (Halls 9 to 17).

The schedule for the conferences has been set In addition to the trade fair, the conference programme is also one of the main pillars of MEDICA. The schedule for these has now been set for 2019. To name a few, DiMiMED, the conference for disaster and military medicine will take place in the Congress Center Düsseldorf (CCD Süd) on 18 and 19 November and the MEDICA MEDICINE + SPORTS CONFERENCE (20 and 21 November) will focus on aspects of prevention and sports medicine treatment concepts . The 42nd German Hospital Conference, a leading communication platform for decision-makers from hospitals, primarily addresses a German-speaking specialist audience (18 to 21 November / CCD Ost) as does the MEDICA PHYSIO CONFERENCE. With its treatment-oriented presentations, it is directed towards the professional scene of physiotherapists, sports medicine specialists and orthopaedists (20 and 21 November 2019 / CCD Süd). COMPAMED 2019 will also take place alongside MEDICA 2019, on all four days (18 to 21 November) in Halls 8a and 8b. With around 800 exhibitors, COMPAMED is the leading international market platform for suppliers of the medical technology industry. Last year’s MEDICA and COMPAMED counted a total of 120,116 trade visitors from 155 countries.

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The Economist Events’ War On Cancer Middle East 2019 Explores Strategies for Successfully Tackling the Growing Cancer Concern in the Middle East

he Economist Events’ second annual War on Cancer Middle East 2019, held in Dubai on Tuesday 12th March brought together global leaders in healthcare, policymakers and prominent thinkers to explore strategies to tackle the rising incidence of cancer in the region. Discussions at the conference this year focused around how a cancer-care pathway should be designed, funded and implemented across the Middle East. Healthcare stakeholders also discussed what needs to be done to improve prevention, screening, ear-

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ly detection and treatment as well as ways to educate the population about healthy lifestyle choices. Dr. Younis Mohammed Amin Kazim, Chief Executive Officer, Dubai Healthcare Corporation (DHA), said: “Dubai is emerging as a population hub within the UAE, with 29 percent of the country’s population. This share is expected to increase in future due to economic growth, and greater insurance penetration. Dubai is witnessing growing burden of morbidity and mortality related to oncology. Oncology care in Dubai is available, but currently fragmented.

“We are working to enhance current cancer care in Dubai to offer a world-class internationally recognised service to Emiratis, expatriates and foreign healthcare tourists. To deliver the services in the most financially optimal way we have to enhance collaboration with the private sector. This will minimize the outflow of patients seeking care abroad and utilise the savings to deliver cost effective improvements in local care,” added Dr. Kazim. Her Royal Highness Princess Dina Mired of Jordan, president, Union for

EXHIBITIONS

International Cancer Control (UICC), speaking at the conference said: “We need strong and people-centred health systems, at the heart of which are empowered individuals and communities. In order to achieve this, we have to address the social determinants of health that create the large disparities in access to quality cancer treatment and care. We also need to adopt an all-of-society approach where governments, private sector and civil society work collaboratively to bring to life innovative, sustainable and appropriately resourced life-saving solutions for cancer.” Dr. Tareef Yousef Alaama, deputy minister for therapeutic services, Ministry of Health, Kingdom of Saudi Arabia, said: “Awareness is the responsibility of the whole community. We need to start a dialogue and keep it going. The Middle East suffers from many cancer risk factors such as obesity, smoking, infections, and genetics. The good news is that many of these are reversible or even preventable. The key to this is strong public health policies and initiatives.” Other speakers at the War on Cancer Middle East conference included Dr. Omar Nimri, head of cancer prevention and control department, Ministry of Health, Jordan; Dr. Asem H. Mansour, Chief Executive Officer and Director-General, King Hussein Cancer Center; Zanubia Shams, Co-chairperson, Zulekha Healthcare Group; Wahid Al Kharusi, President, Oman Cancer Association and Sima Jeha, Director, Eastern Mediterranean Region, St. Jude Global, St. Jude Children’s Research Hospital. As part of The Economist Events’ War on Cancer Middle East conference, the Economist Intelligence Unit (EIU) presented a preview of the find-

ings of the Index for Cancer Preparedness. Alan Lovell, Senior Associate, health policy and clinical evidence, EIU, said: “Effective cancer control happens within the context of good, ideally universal, healthcare. Cancer planning and investment need to build up general resources and embed prevention, diagnosis, treatment and post-treatment interventions within wider primary, secondary and tertiary care. An important tool in this is building intelligence through high-quality population-based cancer registries. Creative use of a growing number of additional data sources should also provide invaluable further insight.” Sima Jeha, Director, Eastern Mediterranean Region, St. Jude Global, St. Jude Children’s Research Hospital, explained: “Many children with cancer lack the access and the financial means to get accurate diagnosis and quality care. The Millennium Development Goals resulted in reductions in infant mortality and

deaths from communicable disease over the past two decades. This means children will live long enough to develop cancer. In many low- and middle-income countries, healthcare systems are not ready to adequately address non-communicable diseases such as childhood cancer. St. Jude helped develop a cooperative regional network of healthcare providers in the Middle East, POEM: Pediatric Oncology in East and Mediterranean Group (poemgroup.org), to build sustainable programs that strategically increase access to quality care for children with cancer in the region.” War on Cancer Middle East 2019 is supported by St. Jude Children’s Research Hospital. Other supporting organisations include the Union for International Cancer Control (UICC), AmCham Abu Dhabi, British Business Group Dubai & Northern Emirates, the European Association for Cancer Research and The Economist Intelligence Unit Healthcare.

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Article

Dubai-Based Fitness Enthusiast & Cancer Survivor Max Fardan Listed Down 10 Tips On Maintaining A Healthy Lifestyle

ou know that feeling when you want to hit the gym after work but always end up in your bed— tiringly asleep? Or want to prepare a healthy dinner but just too exhausted to even think about it? With a hectic work schedule which can sometimes be a little too demanding, how do you manage and still find time for yourself? “The short and simplest answer is work-life balance,” says Max Fardan, a Dubai-based fitness enthusiast and breast cancer survivor. “After I survived my breast cancer diagnosis, I’ve learned to value and take my health seriously. That’s when I knew I had to be physically active and live a consistent healthy lifestyle,” he added.

free life as much as you can. Because when stress becomes too much for you to handle, it wears you down both physically and mentally. Try to destress and do something that relaxes your body and mind at least once a week—a soothing spa maybe?

9. EAT HEALTHIER Fruits and vegetables are not just for kids. In fact, World Health Organization recommends eating fruits and veggies as a regular part of your diet to help fight diseases and illnesses. A little trick: try drinking a mixed fruit & veggie smoothie to make it a little more interesting. Trust me, you just might get hooked.

8. MOVE IT Max was diagnosed with breast cancer, an illness more common in women, when he was 24. According to World Health Organization, breast cancer is the most common cancer among women worldwide, claiming the lives of hundreds of thousands of women each year and affecting countries at all levels of modernization. And although breast cancer in men is rare, an estimated 2,470 men are diagnosed with breast cancer and approximately 460 die each year according to nationalbreastcancer.org. Max was lucky to have survived this illness and therefore advocates that we, regardless of gender, start living and maintaining a balanced and healthier lifestyle. Here, he listed down 10 useful tips to help you get started:

10. DESTRESS Living a healthy lifestyle is not limited to just being physically fit and active, it also means having a stress-

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Exercising is equally just as important as eating healthy. If treadmills and dumbbells don’t excite you, try an alternative—it can be dancing, yoga, hiking or even karate.

7. DRINK UP Now it’s time to drink up and stay hydrated. By drinking the recommended 64 ounces of water a day, you’re not just flushing out toxins from your body, you’re actually saving a lot of money too as water helps improve your overall health.

6. MENTAL HEALTH Being in tip-top condition means being healthy in mind and body. You should always consider your thinking, mood, behaviour and feelings. If something keeps on bothering you, take immediate action. The easiest way is to let go of the things that trouble and burden you. Think positive, learn to say no and take a break.

5. MAINTAIN HEALTHY RELATIONSHIPS As what most people say - you don’t need hundreds of friends, you just need a few who you can really count on. Try to keep your circle small. If the relationship becomes too toxic, let go without second thoughts. This will help you maintain healthy relationships and focus your energy on the people who really care about you.

4. GET CHECKED No matter how consistent you are with your healthy-lifestyle journey, you still need professional advice. Make it a habit to have yourself checked with a professional doctor at least once a year.

3. QUIT NOW If drinking and smoking are your thing, then I have a bad news for you: Quit now, while you still can. These vices are known to be addictive, so before you actually reach that stage, help yourself and stay away.

2. SLEEP Sleep. Yes, sleep. People tend to forget the importance of getting enough rest and try to over-work and exhaust our bodies. This is the case for most of us. Like computers, we need to reboot to refresh our systems too.

1. START NOW Probably the most important tip I can give you is to start today. Because no matter how many tips I give you or how good my advice were, if you don’t actually start doing and putting it to heart, it will just be a waste. As Maxwell Maltz said, “It takes 21 days to form a new habit.” One down today, 20 more days to go.

BD CAN HELP YOU GET YOUR TECHNOLOGIES ON THE SAME PAGE, AND YOUR TEAM DOING WHAT MATTERS MOST. At BD, we know medication management is incredibly complex. Aligning people, technologies and systems to get a single medication safely to a patient is daunting. But there’s a better way, one that helps hospitals get all the players, parts and processes on the same page. At the heart of it is the BD HealthSight™ platform, our integrated approach that connects the BD Alaris™ and BD Pyxis™ solutions with each other—and with the EMR. Combine this with BD Rowa™ technologies to manage inventory more effectively. The result? Improved efficiency and greater visibility across your enterprise, so you can get back to what matters most: your patients. Discover medication management that takes less management. Discover the new BD.

Discover more about how BD can help you evaluate and improve your medication management system by calling +971 4 559 2555 or visiting our Center for Safety and Clinical Excellence, Dubai MMS.EMA@bd.com or bd.com/MM-Arab 108