HOSPITALS Magazine issue 48 by The Arab Hospital Magazine

Issue 48 / 156 SEP-OCT 2019

THE ARAB HOSPITAL APPLICATION IS AVAILABLE

Artiﬁcial Intelligence in Healthcare

ROBOTIC SURGERIES

contributed signiﬁcantly to the limited surgical intervention

Saudi Health Sector in the Light of Vision 2030

Spine Diseases Vary according to the symptoms

Diabetes and Pregnancy Guidelines for a safe pregnancy

Women in the Health Sector Leading Role in Healthcare

Automate Patient Management Across the Continuum of Care

Patient SafetyNetâ&#x201E;˘*

> Displays near real-time information from any connected Masimo device at a central view station > Allows alarms and alerts from bedside devices to be sent directly to clinicians > Simplifies workflows with ADT integration

For more information, visit www.masimo.co.uk * The use of the trademark Patient SafetyNet is under license from University Health System Consortium

PLCO-003145/PLMM-11183A-0919 PLLT-10316D

> Automates data transfer from connected devices directly to EMRs

Medical Errors

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

Deaths due to medical error are high in most parts of the world, including in developed countries. In the United States, for instance, it is estimated that up to 98,000 patient deaths occur in the U.S. per year due to medical errors. Medical errors have several causes including technical error, which is related to the basics of the profession, and occur when violating the profession’s scientific and technical rules and regulations. A physical error, which is related to the exercise of caution while performing the duty of the doctor towards the patient. But sometimes error is due to medical equipment malfunctions used for examination and treatment, which is beyond the control of the treating health practitioners. Hence, we can conclude that medical errors can be reduced but cannot be eliminated. This does not, in any way, negate the importance of careful follow-up, nor allows complacency or neglect. It is fundamental to regularly monitor the operation of medical equipment, ensuring accuracy and improving results. These incidents seem to occur less in the Arab world than in other developed countries such as the United States. This is a highly regarded testimony given the level of medical progress in the region. However, the relatives of the deceased patient often explain his death as a medical error. Even though the doctor had done everything possible to save the patient’s life, and did not succeed given that the patient had been suffering from a terminal illness. Hence, it is necessary to distinguish between fate and the doctor’s ability. The Publisher

Photographer Hanna Nehme Copy Editor Jessica Achkar Editors Aline Debes, Mark Steven, Don Karn, Andrew Weichert, Colette Semaan, Abbas Moussa Advertising & Marketing advertising@tahmag.com Mirna Khayrallah mirna@tahmag.com Business Development Manager Ralph Rahal tahmag@tahmag.com Offices & Adresses AHMC, Lebanon Mansourieh High way, Jihad Wakim center, 3rd floor. T/F: +961 4 53 40 58 M: +961 3 60 61 00 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

SEPT . OCT 2019

NEWS

6 Select Clinicians From Four Major Healthcare Providers Start Employing Malaffi for the First Time in Abu Dhabi 8 Malaffi Welcomes Over 800 Delegates to a Series of Onboarding Workshops in Abu Dhabi 10 Artificial Intelligence a Key Growth Enabler for UAE’s Healthcare Sector: Al Zahra Hospital 14 Abu Dhabi Health Services Company (SEHA) invests in training future doctors 16 Registration for 8th Pan Arab Human Genetics Conference is now open 32 Ras Al Khaimah Medical District Reveals Plans for Upgrading Trauma & Operations Departments at Saqr Hospital 36 Clemenceau Medicine Group Expands its service excellence and expertise to serve patients in the Arab world 40 Weill Cornell Medicine-Qatar (WCM-Q) teams with US pharma company to develop new cholesterol drug 44 Minister of Health in sultanate of Oman President of Supreme Council of the Arab Board of Health Specializations 90 Sidra Medicine delivering outstanding care for newborn babies 114 Kuwait’s participation in China forum strengthen ties

MEDICAL INSTITUTIONS

48 ACIBADEM HEALTHCARE GROUP TURKEY

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86 FEATURES

54 Artificial Intelligence in Healthcare 64 Saudi Health Sector 68 A leading Saudi step in the health sector 74 The most common spine diseases in the world 82 Diabetes and Pregnancy 86 Sarcoma 96 Women in Healthcare

ARTICLES

58 Thumbay Medicity Introduces a Whole New Healthcare Experience with AI, VR & Robotics Enabled Technologies

60 Cook Children’s Healthcare System Providing Telehealth & Virtual Medicine Care For Patient Families Across The Globe 62 Not science fiction anymore, The emergence of AI and Robotics in Healthcare 92 MedsBla A communication space for each healthcare environment 106 Hospitals should embrace cross-cultural understanding 110 Breastfeeding 112 Tinnitus

INTERVIEWS

100 Dr. Maya Mallat Yassine 102 Dr. Mariam Matar

NEWS

Select Clinicians From Four Major Healthcare Providers Start Employing Malaffi for the First Time in Abu Dhabi

alaffi, the new Abu Dhabi Health Information Exchange platform, and the Department of Health - Abu Dhabi (DOH), have marked a significant milestone. Select clinicians from four major healthcare providers - SEHA, Cleveland Clinic Abu Dhabi, Danat Al Emarat Hospital and Oasis Hospital in Al Ain – have successfully started utilising the platform. Established as a Private-Public-Partnership (PPP) between the DOH and Injazat Data Services, Malaffi is the Middle East’s first Health Infor-

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mation Exchange (HIE) platform, that will securely connect all public and private healthcare providers in the Emirate of Abu Dhabi to create unified patient records to improve healthcare quality and patient outcomes. The Malaffi onboarding process consists of several stages which healthcare providers must undertake before they can begin to utilise the platform. To facilitate the process, Malaffi’s team is continually working closely with the providers to support them in their efforts to start utilising Malaffi by December 2019, as designated in the recently published

Malaffi launch schedule (https://www. malaffi.ae/en/launch-schedule.html). The Malaffi database already contains up to five years of patient demographic and clinical data, for 2,3 million unique patients. This information is backloaded to the platform from the Electronic Medical Records (EMR) of the four healthcare providers, whom were among the first six to sign the Participant Agreement and will provide instant value to the providers as they start using Malaffi. As more clinicians start utilising the platform and exchanging information, the amount of patient data

NEWS

securely and safely stored in Malaffi will increasingly continue to grow and be available for clinicians to use to advance the health of their patients. H.E Mohamed Al Hameli, Undersecretary of Department of Health, commented: “With the ‘Malaffi’ health information exchange platform centralising data from all health facilities in the emirate, we will soon be living a future that reflects our ambitions in the healthcare sector, especially that four major healthcare providers have successfully started utilising the platform, enabling their physicians to make sound decisions based on transparent and complete patient records. This will ensure the continuous delivery of exceptional healthcare services to locals and residents.”

SELECT CLINICIANS FROM FOUR MAJOR HEALTHCARE PROVIDERS - SEHA, CLEVELAND CLINIC ABU DHABI, DANAT AL EMARAT HOSPITAL AND OASIS HOSPITAL - HAVE STARTED UTILISING THE MALAFFI PLATFORM “We are extremely proud of having achieved so much since we launched Malaffi in January this year. The fact that we now have a live connection with four major healthcare providers, whose clinicians have successfully begun utilising the platform, is a very important milestone. Remarkable efforts have been made by the providers in order to achieve this milestone, that will transform the way healthcare is delivered to patients within the Emirate,” said Atif Al Braiki, the Chief Executive Officer of Abu Dhabi Health Data Services, the operator of Malaffi.

“Our recognition goes to the Department of Health – Abu Dhabi, and its honourable representatives, H.E. Sheikh Abdulla Bin Mohamed Al Hamed, Chairman of the DOH, and H.E. Mohamed Al Hameli, Undersecretary of the DOH, for their efforts to create world-class healthcare services in line with international standards. Malaffi is an innovative health information exchange portal that the DOH has launched as a service to the health sector, which will enable clinicians to have convenient and timely access to patient health records. This platform will have a significant positive impact on providing quality healthcare, based on accurate data and documented medical records,” stated Dr. Gareth Goodier, Group CEO of SEHA. “Cleveland Clinic Abu Dhabi is proud to support this innovative new platform that represents an important step forward in patient care for Abu Dhabi. Ensuring providers have a more complete view of a patient’s health, no matter where they have been treated previously, will uplift the level of care offered across the Emirate, allowing physicians to better tailor treatments to patients’ individual needs,” said Dr. Rakesh Suri, Chief Executive Officer of Cleveland Clinic Abu Dhabi. Mr. Mohammed Ali Al Shorafa Al Hammadi, CEO of United Eastern Medical Services, said “We are indeed proud to support Malaffi launch in the Emirate of Abu Dhabi, and that Danat Al Emarat Hospital is one of the first hospitals to implement Malaffi platform. The preparation for this milestone was smooth and the communication between our clinicians and

Malaffi and DOH has been streamlined. At the end, we all join hands for the benefit of our patients and the population of Abu Dhabi sharing the same vision of uplifting the healthcare delivery system in the Emirate. In addition, we are getting UEMedical’s other facilities including HealthPlus Network of Specialty Centers ready for the implementation soon, being the first outpatient network to implement Malaffi. I believe the launch of Malaffi will not only serve to the best of our population but also the overall healthcare system.”

MALAFFI’S DATABASE CONTAINS BACKLOADED PATIENT DATA FOR 2.3 MILLION UNIQUE PATIENTS FROM THE FOUR HEALTHCARE PROVIDERS TO PROVIDE IMMEDIATE VALUE FOR PROVIDERS THAT WILL START USING THE PLATFORM “We, at Oasis Hospital, feel very privileged to be part of this visionary Abu Dhabi Government initiative. The launch of Malaffi under the inspiring leadership of the Department of Health in partnership with Injazat is a remarkable achievement. We are excited about the numerous benefits this brings to our patients and the Abu Dhabi healthcare sector, such as integrated care, improved resource utilisation, and cost-reduction. Malaffi will be particularly useful to Oasis Hospital as we continue to grow as a highrisk maternity referral hospital. We are confident that the Department of Health-led project has paved the way for all other healthcare organisations to now join Malaffi,” noted Alex Jankuloski, Chief Executive Officer of Oasis Hospital.

NEWS

Malaffi Welcomes Over 800 Delegates to a Series of Onboarding Workshops in Abu Dhabi

arlier this year, Abu Dhabi welcomed the launch of Malaffi, the region’s first Health Information Exchange (HIE) platform that will create a centralised database of unified patient records in the Emirate. By the end of 2019, approximately 2,000 healthcare providers from Abu Dhabi are expected to have started utilising Malaffi. To support providers during their onboarding journey, in cooperation with the Department of Health – Abu Dhabi (DOH), during June and August, Malaffi hosted a series of workshops to welcome over 800 delegates. The workshops focused on the different aspects of the onboarding process, especially the technical components, briefing the provider’s representatives on the IT specification, as well as the technical

SEPT.OCT 2019

and security requirements needed to onboard Malaffi. The workshops also acted as a forum for the providers to have their questions answered by Malaffi’s and DOH’s experts, to ensure smooth provider onboarding and help the

providers to comply with the Malaffi Launch Schedule, available on Malaffi’s website - www.malaffi.ae. For any questions, healthcare providers can contact onboarding@ malaffi.ae.

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NEWS

Artificial Intelligence a Key Growth Enabler for UAE’s Healthcare Sector: Al Zahra Hospital image discrepancy from 8 to 2% and achieve its same day MRI objective by reducing the MRI wait list. An additional 20 patients will benefit daily from the latest MRI MAGNETOM Vida equipped with the BioMatrix artificial intelligence technology,” added Dr. Mohaymen.

l Zahra Hospital Dubai (AZHD), striving to embody the principles propagated by the ‘UAE Vision 2021 National Agenda for Health’, is aiming to be one of the early adopters of Artificial Intelligence (AI) backed technologies. To fasttrack this process, AZHD has further strengthened its partnership with Siemens Healthineers’, one of the largest healthcare providers in the world. Healthcare specialists are often challenged with unwanted variability and inconsistent results, when people of different physiologies and anatomies are examined during MRI examinations and ultrasound imaging. In an attempt to overcome these challenges, clinicians have traditionally compromised on ultrasound image resolution, or penetration of their ultrasound imaging. “Around 47.5 percent of UAE residents are overweight, and close to 13 percent are obese. To address this challenge on an urgent basis, AZHD’s adoption of Siemens Healthineers’ newly released ACUSON Sequoia

SEPT.OCT 2019

ultrasound system, with its higher penetration capabilities, now equips the hospital to accurately diagnose patients with larger body types,” stated Dr. Mohaymen Abdelghany, CEO of Al Zahra Hospital Dubai (AZHD). ACUSON Sequoia’s new BioAcoustic imaging technology accurately represents human biology and tracks the ultrasound signal throughout the signal path for a high-quality image. “AZHD will be one of the early adopters in the UAE to install the state-of-the-art high-tech MRI and Ultrasound systems to provide accurate diagnostic support to its different current and future certified centers of excellence in AZHD such as orthopaedics and sports injuries, bariatrics and metabolic surgery, minimally invasive gynaecology, oncology and cardiology in a major step to pursue our vision of leading the region in clinical outcome and patient experience.” “Fast MRI sequences and protocols will enable AZHD to increase imaging quality, minimize post-surgical

The MAGNETOM Vida, aims to personalise MRI scans by overcoming patient biovariability, that is the individual’s unique characteristics rather than being seen as an impediment when it comes to MRI scanning. MAGNETOM Vida with BioMatrix Technology gives reproducible image quality and comprehensive clinical information irrespective of the patient or system operator. “We have long years of experience in healthcare and are proud of the high standard of healthcare service we provide. Our philosophy is patient-centric care and focus on the clinical outcome. We are excited about the plans to continue the growth of our hospital, emphasizing our commitment to providing the best healthcare to our community,” added Dr. Mohaymen. Ole Maloy, Managing Director, Siemens Healthineers Middle East and Southern and Eastern Africa, “Improving patient experience is an integral part of our company values and is deeply embedded within our DNA. At Siemens Healthineers, our mission is to enable healthcare providers to deliver high-value care. We are extremely proud to collaborate with Al Zahra Hospital Dubai by providing them with innovative technology and supporting them in their journey to provide the best healthcare for UAE.”

NEWS

SEPT.OCT 2019

NEWS

Abu Dhabi Health Services Company (SEHA) invests in training future doctors

bu Dhabi Health Services Company (SEHA), the largest healthcare network in the UAE accepts 158 candidates for the 2019-2020 residency and fellowship programs that include 23 residency programs and 9 fellowship sub-programs in 20 specializations, held to the highest international standards. The programs are held in 6 teaching facilities that offer specializations including but not limited to Anesthesiology, Dermatology, Emergency, Family medicine, General Surgery, Internal Medicine, Pediatrics, Gynecology, Obstetrics and Cardiology. Dr. Ali Al Obaidli Chief Academic Affairs officer at SEHA said: â&#x20AC;&#x153;We are keen to develop the healthcare sector in Abu Dhabi in accordance with the objectives set by our government. Our technologies, and medical infrastructure are reaching world-class with significant investment, which

SEPT.OCT 2019

provides excellent academic environments as there is great synergy between academic and healthcare quality. Graduate Physicians enrolled in these programs spend four to five years in training with an additional year dedicated to studying for the board exams intended for their specialization. This month, around 124 doctors, including 84 Emiratis, will complete the additional year and graduate as specialists. To allow young Emirati Cadre to join and support the UAE healthcare sector in various medical specialties. Graduates are classified as per their career aspirations into: 1. Those planning to join their specialty workforce. 2. Those wishing to do additional subspecialty either into fellowship available at SEHA or through scholarship into top academic medical centers abroad.

3. Those who completed their medical training and they consider other professional career goals like (Medical Research, healthcare quality and different health administrative fields.) Give the increasing number of graduates and competitiveness of the application and to maintain training capacity, SEHA has developed new criteria for those graduates wishing to join academic faculty in addition to practice their specialties while others join SEHA community hospitals or join workforce outside SEHA network across UAE. So far, SEHA has trained over 660 physicians with graduate numbers gradually increasing. The number of medical students enrolled are projected to increase significantly with the opening of the College of Medicine at Khalifa University. This year, an unprecedented number of 134 Emirati doctor are enrolled to start their medical internship program on September 1st. SEHA is currently working with colleges in UAE universities to develop teaching opportunities for graduates of the SEHA Medical Residency Programs. These doctors specialize in hospitals like Sheikh Khalifa Medical City, Mafraq Hospital, Corniche Hospital, Tawam Hospital and Al Ain Hospital and AHS to gain qualifying, hands-on experience. The program has a very strict criteria for specialization evaluated through periodic tests comparable to those in the United States of America.

NEWS

Registration for 8th Pan Arab Human Genetics Conference is now open

he Center for Arab Genomics Studies, a division of the Sheikh Hamdan bin Rashid Al Maktoum Award for Medical Sciences, have announced that registrations for the 8th PAHGC are now open, the conference will be held from 17th to 20th January 2020 at the Roda Bustan Hotel, Dubai. The theme of the conference in its 8th edition is the (clinical Genomics) and the main topics to be discussed in the conference include, next generation sequencing, neurodevelopmental disorders, metabolic disorders, dysmorphology, as well as population genomics and human disorders.

The first two days of the conference will be dedicated to a workshop on genomic data analysis for gene discovery and variant interpretation. This workshop is being organized by CAGS in association with the European School of Genetic Medicine, and will take place at the Mohammed Bin Rashid University of Medicine and Health Science. The course will see instructors from around the world offering hands-on training to a limited number of genetics and genomics professionals working in human genetics within the research or clinical diagnostic setting. Dr. Mahmoud Taleb Al-Ali, the Director of the Center for Arab Genomic

Studies and the Chairperson of the Scientific Committee of the conference, said “CAGS has endeavored to bring together diverse expertise and resources pertaining to the field of medical genetics in the Arab World, through the organization of the Pan Arab Human Genetic Conference, in the hopes of facilitating multidisciplinary research. “This conference series continues to successfully provide a platform for regional and international researchers and professionals in genetics where constructive dialogue and views are shared. We continue our efforts in this direction with the 8th PAHGC.” He added.

NMC ProVita provides more home dialysis machines

MC ProVita International Medical Center, a subsidiary of the UAE & Middle East largest private healthcare provider - NMC Healthcare, offers home Dialysis service to patients in UAE. In the United Arab Emirates (UAE), there are reports of more than 2,000 patients receiving dialysis, and this number is expected to increase by 100% by 2023. The high incidence of chronic kidney disease (CKD) in the UAE has been attributed to the prevalence of diabetes, obesity and hypertension. To meet the growing demand of home Dialysis Machines, Reaya Mumayaza for hemodiyalsis services managed by NMC ProVita International Medical Center, announced it has entered an agreement to provide more Home Dialysis Machines, which ensures quality healthcare for those who need it the most- at the right time and place.

SEPT.OCT 2019

Home dialysis offers greater scheduling flexibility, fewer food restrictions and better outcomes. The treatment can also be administered for longer times and more frequently, which is less stressful for the patient’s body. For the majority of people, dialysis involves being connected to a machine in hospital three to four times per week for at least three hours each time, and some patients have to travel long distances to receive the treatment. Dr. Khaled Aboeldahab, said, “The prevalence of diabetes, obesity and high blood pressure increases the incidence of chronic kidney disease. The home dialysis service we have started to provide, has contributed to offering customized care and personalized services to promote community healthcare. Through the home dialysis service, we provide each patient his own Home Dialysis Machine, which in turn, reduces

the risk of infection. This service also provides greater timeliness, fewer dietary constraints and greater results. Treatment can also be administered for longer periods of time and with more frequencies, making it less stressful for the patient’s body in the long run.” NMC ProVita International Medical Center launched this service with the aim of improving the efficiency of medical care provided to patients in the UAE, while reducing unnecessary travel time and reducing the burden on dialysis centres within the UAE. According to the National Kidney Foundation, 10 percent of the world’s population is affected by CKD. While home dialysis is relatively new here, however, in Australia, Canada, Denmark, Finland, Iceland, Mexico, the Netherlands and New Zealand, around 20% of the people who receive dialysis opt for home dialysis.

PAN ARAB HUMAN

GENETICS CONFERENCE Dubai - United Arab Emirates

2020

Clinical Genomics Conference Themes

17th - 20th January, 2020

Next Generation Sequencing Neurodevelopmental Disorders Metabolic Disorders Dysmorphology Population Genomics and Human Disease Pre-conference workshop on NGS Limited seats available

NEWS

Ground-breaking trial demonstrates potential of blood test which harnesses the power of the immune system to reduce late detection of lung cancer

Prof. Frank Sullivan

Adam Hill

ncimmune Holdings plc (AIM: ONC.L), a leading global immunodiagnostics group, welcomes the presentation of data today by Professor Frank Sullivan (Chief Investigator on the ECLS trial) which has demonstrated the potential of Oncimmune’s EarlyCDT® Lung test to reduce the incidence of patients with late-stage lung cancer at diagnosis, compared with standard clinical diagnosis. In a randomised controlled trial of 12,209 people in Scotland at high risk of developing lung cancer, it was shown that more people were diagnosed at an early stage of the disease in the two years after taking the EarlyCDT Lung test than those in the control arm who received standard clinical care. The findings, presented at the 2019 World Conference on Lung Cancer hosted by the International Association for the Study of Lung Cancer (IASLC) in Barcelona today, are an important validation of Oncimmune’s diagnostic platform technology which harnesses the power of the immune

SEPT.OCT 2019

system, to detect evidence of the body’s natural response to cancer. The technology can detect cancer four years or more before standard clinical diagnosis. Oncimmune’s patented technology works by detecting the presence of autoantibodies generated by the body’s immune system as a natural defence against cancer cells. Lung cancer was chosen as the first target of the technology because it is the world’s leading cause of cancer-related death and is often detected at an advanced stage with approximately 85% of patients in the UK undiagnosed until the disease has spread to other parts of the body.1 The ECLS trial is believed to be the largest randomised controlled trial for the detection of lung cancer using biomarkers conducted anywhere in the world. Among those people who received the EarlyCDT Lung test and went on to develop lung cancer within the next two years, 41.1% were diagnosed at an early stage (stage 1&2) of the disease, compared with 26.8% among the control group subject to standard

clinical practice. This resulted in a 36% reduction in late stage presentation after 2 years of follow up in subjects randomised to the EarlyCDT test. The trial also showed a lower rate of deaths among people in the intervention arm of the trial after two years compared with people in the control group. Lung cancer-specific deaths were also lower in the intervention group. This suggests that the EarlyCDT Lung test followed by CT imaging could produce a mortality benefit, although the trial was not powered to demonstrate such a trend after two years. The next step is to move to a larger population-based evaluation in up to 200,000 patients to assess the implications of diagnosis with EarlyCDT Lung on survival and mortality in a real-world setting. Adam Hill, Chief Executive Officer of Oncimmune, commented: “We are thrilled that the ECLS trial has demonstrated so clearly the potential of our EarlyCDT technology platform to transform the way cancer is diagnosed. We look forward to working with health authorities in Scotland and beyond to roll out EarlyCDT Lung more widely, with the aim of saving lives and reducing costs for the NHS and other healthcare systems around the world. Meanwhile, we are continuing to test our technology on other forms of cancer, including liver, ovarian, breast and prostate, in pursuit of our ambition to build the leading immunodiagnostic platform in the field of oncology.” Professor Frank Sullivan, Professor of Primary Care Medicine at the

University of St. Andrews, the Chief Investigator for the ECLS trial, commented: “These landmark findings are likely to have globally significant implications for the early detection of lung cancer by showing how a simple blood test, followed by CT scans, is able to increase the number of patients diagnosed at an earlier stage of the disease, when surgery is still possible and prospects for survival much higher.”

Details of the ECLS trial Today’s Presidential Symposium presentation at the IASLC World Conference on Lung Cancer builds on positive top line results announced in June and confirms that the ECLS trial met its primary endpoint. The trial was open to adults aged 50–75 considered to be at high risk of lung cancer because of smoking and family history, and

healthy enough to undergo potentially curative therapy. The intervention was the EarlyCDT Lung test, followed by X-ray and computerised tomography (CT) scan in those with a positive test result. The comparator was standard clinical practice in the UK. The primary endpoint was the difference, at 24 months after randomisation, between the rates of patients with stage III, IV or unclassified lung cancer at diagnosis in the intervention arm and those in the control arm. There are also a number of secondary endpoints, details of which will be provided when the trial is fully reported. The trial was sponsored by the University of Dundee and NHS Tayside and co-funded by the Scottish Chief Scientist Office, Scottish Government and Oncimmune. It was headed by Chief Investigators Professor Frank Sullivan, Professor of Primary Care Medicine at the University of St.

Andrews, and Dr Stuart Schembri, until recently consultant Physician in Respiratory and General Internal Medicine at NHS Tayside. The oral presentation was made by Professor Sullivan in the Presidential Symposium of the World Conference for Lung Cancer 2019, the world’s largest meeting dedicated to lung cancer and other thoracic malignancies, hosting more than 7,000 delegates from more than 100 countries. A submission on the full ECLS trial is currently being prepared for a leading peer-reviewed medical publication.

Reference 1. Early Detection of Cancer of the Lung Scotland (ECLS): Trial results. (2019). IASLC 2019 World Conference on Lung Cancer. Abstract available from 10:15 CEST, 09 Sep 2019 https://bit. ly/2ky8Glo.ly/2ky8Glo

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NEWS

Mafraq Hospital leads successful hand replantation

Procedure utilizes cutting edge microscopic technology, delivered by local experts in her lungs able to safely restore it. In some cases, if an injury takes place and the severed body part is preserved properly in a cold container within two hours, it may be salvaged. This is the seventh case I have conducted at Mafraq hospital over the last four years. Two of the injured are citizens, where hand amputation is considered a rare injury according to global studies.”

pecialists at Mafraq Hospital, part of Abu Dhabi Health Services Company (SEHA), the UAE’s largest healthcare network, have successfully replanted a severed hand using world-leading technology and microscopic transplant techniques. The male patient was transferred to Mafraq hospital immediately after being involved in a workplace accident. The incident created a complicated medical challenge due to multiple crushed bones and the severing of all ligaments, arteries and nerves feeding the hand. Medical staff at Mafraq

completed the complex procedure using microscopic surgery techniques that successfully restored blood flow and hand hydration and reinstated the bones, arteries and ligaments to save the hand. Dr. Muqdad Al-Hammadi, Consultant and Head of Plastic Surgery, Burns and Hand surgery at Mafraq Hospital, said: “The success of the hand replantation depends on the extent of tissue damage, which is directly impacted by time. Since the patient and his hand arrived at the hospital within seven hours, we were

At Mafraq Hospital the facility has a 100 per cent success rate for replantation procedures. Medical professionals attribute this achievement to the use of world-class techniques and technology as well as rapid intervention and adherence to clear treatment plans, including intensive physiotherapy to restore the functions and aid healing. There are many causes of amputation injuries, including the lack of proper safety measures when cycling and driving. UAE workplace labor laws help minimize occupational risk and remain a key component in preventing injuries of this nature. Dr. Muqdad Al-Hammadi also praised the assistant medical team of anesthesiologists, nurses and Dr. Mona Al-Atrash for providing high medical service to ensure the success of the operation.

Sharjah’s primary healthcare centres add 7 new health screenings

he Ministry of Health and Prevention (MoHAP), represented by Sharjah Medical District, announced that it has added seven new health services - provided by primary healthcare centres - in the emirate. These services include screenings for cervical and colon cancer, premarital testing, the Itmenan service (preventative screening), medical examination for residency, health services for pilgrims and evening dental clinics. Dr. Hussein Abdel Rahman Al Rand, Under-Secretary of the Ministry’s Health Assistant Sector, Health Centres and Clinics, said, “Through these services, we aim to reinforce our people’s health and happiness, as part of MoHAP’s concerted efforts to update its medical facilities and simplify access to primary and specialised medical services.”

SEPT.OCT 2019

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Alisha Moopen appointed as the Deputy Managing Director of Aster DM Healthcare of success. The appointment was approved by the Board of Directors of Aster DM Healthcare during their meeting on 7th August, 2019.

Alisha Moopen

lisha Moopen, Executive Director and CEO of Hospitals and Clinics-GCC, has been promoted to the role of Deputy Managing Director of Aster DM Healthcare. Working closely with Dr. Azad Moopen- Founder, Chairman and Managing Director of Aster DM Healthcare, Alisha Moopen would be leading the growth strategy for the company and steering the organisation to newer heights

Speaking on the occasion, Dr. Azad Moopen said, “The appointment is a part of our long-term strategy to create a sustainable business that is well-equipped to meet the needs of the market and the people. Having seen Aster DM Healthcare being built brick by brick over the last three decades, Alisha has been ingrained with the values and purpose of the organisation. A qualified Chartered Accountant with over 7 years of experience working with leading financial organizations in UK and USA, before joining Aster DM Healthcare, she brings in the talent and capabilities required to take our organization to the next level. Having worked within the company for the last 7 years and leading the success story in many of our markets, Alisha has been elevated to this position based on her performance and capabilities. We are

confident that she would continue to build the legacy of Aster with the brand promise of ‘We’ll Treat You Well’ and lead the organisation to be in the forefront of healthcare providers through digital transformation and make it future ready.” “I am so humbled and honoured with this opportunity to continue the legacy of Aster and serve our mission in healthcare. Many companies aspire to change the world but very few have all the elements required: talent, resources, and compassion. Aster has proven that it has all three in abundance and as the Deputy Managing Director, I can’t ask for a better foundation. My dream for the future and our collective goal as an organisation is to build the healthcare model of care that is centred around wellness and superior clinical outcome to ensure people’s wellbeing to live a happy and fulfilled life thereby building a success story on impact and sustainability in this ever-evolving world,” said Alisha Moopen.

New guidelines rolled out in bid to attract more dentists to Dubai

ubai’s dentistry regulations have been revamped in a bid to meet a growing need for care in the emirate. Dubai Healthcare City Authority is to allow dentists with qualifications from a number of international examination boards to practice without the need to sit a previously mandatory online exam. The authority hopes the move will help to cut waiting times and drive up standards as Dubai braces itself for a 156 percent increase in demand for dentistry services by 2025. “Having a healthy number of

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general dentists within our ecosystem allows for the availability of faster appointments with less waiting time, helping create a better patient experience,” said Dr. Ramadan AlBlooshi, from Dubai Healthcare City Authority. “A general dental practitioner is trained to deliver a range of services, procedures, and treatments, while a specialist covers a narrower field.” There are currently more than 4,200 healthcare professionals working in the free zone, Dubai Healthcare

City, but fewer than five percent are providing dental services. The revised guidelines will now allow general dentist graduates from the National Board Dental Examination; Australian Dental Council; National Dental Examining Board of Canada; and Dental Council Examination, Ireland, to be licensed in DHCC without taking the online test. The World Health Organisation has said oral and dental diseases are some of the fastest-growing global non-viral illnesses.

Best practice SLNB for more patients, at any hospital, at any time Many treatments for early-stage cancer involve ‘sentinel lymph node biopsy’, or SLNB. This method, which identifies the lymph nodes with the highest potential for harbouring metastases, helps to determine the nodal stage of the cancer and make informed decisions for surgery and subsequent treatment. Standard SLNB uses radioisotopes for sentinel node localisation. We oﬀer an eﬀective clinical solution that uses safe magnetic fields instead. This eliminates concerns related to the safety, workflow and availability associated with ionising radiation. Best practice SLNB is now possible everywhere, with no time restrictions. Our system consists of the Sentimag® probe and the Sienna+® magnetic tracer. First, the tracer is injected into the interstitial tissue to provide a traceable signal. Next, using the Sentimag® probe, you locate the sentinel lymph nodes to determine how far the cancer has spread.

Sentimag® – An eﬀective clinical solution n Perform best practice SLNB in any clinical setting n Eliminate issues with radioactive materials; reach

equivalent clinical outcomes [1 – 2] n As a surgeon, organise and manage the SLNB

procedure to suit your needs n Inject the tracer at the best moment, up to seven

days in advance n No evidence of anaphylaxis with interstitial tracer

injection n Sentimag

and Sienna+® are CE-approved for SLN localisation ®

As eﬀective as the radiotracer, as easy as blue dye With the Sentimag® /Sienna+® system, you can quantify the amount of tracer located in a specific node relative to others. This higher tracer loading is a hallmark of the sentinel node identification process and is similar to the radioactive method. With Sienna+®, however, neither you nor your patients are exposed to radiation at any stage.

Magnetic SLNB procedure Sienna+® is injected into the interstitial tissue

follows drainage path to nearest lymph nodes As eﬀective as the radiotracer, as easy Tracer as blue dye Draining lymph nodes are detected with Sentimag®

® ® ® WithAthe Sentimag system, you can quantify tracer is that it can be Magnetic SLNB procedure unique benefit/Sienna+ of the Sienna+ the amount located a specific nodeThanks relative injected of uptracer to seven daysin before surgery. toto this OSNA orishistological analysis of sentinel lymph nodes Sienna+ injected into the interstitial tissue others. This workflow, higher tracer loading is a no hallmark of thebetween flexible which requires scheduling sentinel node identification and is similar to the departments and almostprocess no pre-operative preparation, ® Lymph nodes show path to nearest lymph Lymph nodes show Tracer follows drainage nodes , however,per neither you radioactive With Sienna+ you canmethod. arrange more SLNB procedures day, help no signs of malignancy signs of malignancy nor those your patients aretreatment exposed to radiation any stage. who need sooner, and at conduct more ®®

out-patient surgery. A unique benefit of the Sienna+® tracer is that it can be injected to aseven days beforeuser, surgery. Thanks If youupare gamma system you will havetonothis issues ® flexible workflow, which requires no scheduling procedure as the between probe adapting to the Sentimag departments and almost no pre-operative preparation, handling is remarkably similar. This also means you will you need can arrange SLNB procedures per day, almost more no additional training. There arehelp no special those who need treatment sooner, and conduct more procedural requirements either, such as darkening the out-patient surgery.for fluorescent localisation systems. room required If you are a gamma system user, you will have no issues adapting to the Sentimag® procedure as the probe handling is remarkably similar. This also means you will Technique/ Sentimag® Gamma Fluorescent need Benefit almost no additional training. There systemare no special system procedural requirements either, such as darkening the Quantifiable √ √ x roomSLNs required for fluorescent localisation systems. Avoids radiation

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Draining lymph nodes are detected with Sentimag® Remaining regional nodes Clinicians follow their are not removed standard protocol OSNA® or histological analysis of sentinel lymph nodes

Lymph nodes show no signs of malignancy

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Clinicians follow their standard protocol

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Weill Cornell Medicine-Qatar (WCM-Q) study reveals role of chlamydia infections in infertility among women in MENA region

esearchers at Weill Cornell Medicine-Qatar (WCM-Q) have discovered unexpectedly high levels of chlamydia infection among the general population in the Middle East and North Africa (MENA), and higher levels still among women in the region who are infertile or suffer pregnancy complications.

college’s Infectious Disease Epidemiology Group (IDEG). The research, which was based on an in-depth multi-year investigation using data from more than 250,000 individuals from 20 out of the 23 MENA countries, marks the first time in which a detailed characterization of chlamydia infection levels in the region has been reported.

The research, published in the prestigious UK journal The Lancet Global Health, reports that chlamydia infection appears to be responsible for a substantial proportion of infertility cases among women in this part of the world. Chlamydia is a bacterial reproductive tract infection that is often symptomless, and which is usually, but not always, transmitted sexually. When a woman acquires the infection, the pathogen travels to the internal reproductive organs, damaging them and making it difficult for an infected woman to conceive a baby. If an infected woman does manage to conceive, the infection can cause miscarriage or preterm labor and delivery, or the baby can be infected leading to low birth weight or death of the fetus before delivery. Chlamydia can also cause neonatal infections such as conjunctivitis and pneumonia in babies after birth. Because chlamydia is often symptomless, most women are unaware of their infection unless they have been screened using a diagnostic test. If diagnosed, chlamydia infection can be easily treated with a course of a specific antibiotic. Despite chlamydia infection being well-studied globally, the rates in the MENA region were poorly known before the WCM-Q study, which was conducted by the

“Rates of infertility among women in MENA are the highest worldwide, but the causes of such rates remain poorly understood. It was striking for us to discover that chlamydia infection appears to be a major cause of infertility in this region,” said Hiam Chemaitelly, co-lead author of the study and Senior Epidemiologist at WCM-Q.

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The study indicated that three percent of the population of the MENA region is currently infected with the chlamydia bacteria, a rate comparable to that found in other regions. The rates of infection were also found to be stable for at least the last three decades. Meanwhile, the infection rate in infertile populations was 11 percent and the rate in women who had experienced miscarriage was 12 percent, highlighting the toll of this pathogen on women’s reproductive health. Despite this pressing health problem, there are virtually no public health programs in MENA countries to tackle chlamydia infection. “Our study shows that even though chlamydia may be hidden to the public eye, its complications are easily seen, but are not linked to the real cause. The impact of these complications on women are far-reaching,

especially in a region where fertility, children and family values are highly regarded,” said Dr. Alex Smolak, colead author of the study and Research Fellow at WMC-Q. Although chlamydia screening and treatment programs are a standard practice in many developed countries, such programs very rarely exist in the MENA region. The study indicated that the virtual absence of these programs is probably behind the unexpectedly high levels of this infection; infected individuals carry the bacteria for a long time, thus passing the infection to more individuals before the infection is cleared. “When we started this study nearly a decade ago, the last thing we expected was to be confronted with these high chlamydia levels,” said Dr. Laith Abu-Raddad, principal investigator of the study and Professor of Healthcare Policy and Research at WCM-Q. “We cannot escape the need for programs to tackle this infection, which are common practice in other parts of the world. Otherwise the region will continue to endure serious health and social complications, and will fail to reach the World Health Organization’s goal of eliminating this infection as a public health threat by 2030.” The study, ‘Epidemiology of Chlamydia trachomatis in the Middle East and North Africa: a systematic review, meta-analysis, and meta-regression’, was conducted at WCM-Q with funding from Qatar National Research Fund, a Qatar Foundation member, through the National Priorities Research Program (NPRP 9-040-3-008).

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Ras Al Khaimah Medical District Reveals Plans for Upgrading Trauma & Operations Departments at Saqr Hospital Increasing the Hospital Capacity

r. Abdullah Al Nuaimi, Director of Ras Al Khaimah Medical District, has revealed the district’s plans for developing, expanding and maintaining Trauma and Operations Departments at Saqr Hospital. The plan comes in line with the Ministry of Health and Prevention’s (MoHAP’s) vision to provide comprehensive and innovative healthcare services and to enhance the hospital’s role as a reference one that receives various medical conditions. Dr. Abdullah Al Nuaimi underlined that the services provided by both departments will not be affect-

ed throughout the development work, pointing out that the hospital has provided all the possible alternatives to ensure offering the medical services to their fullest extent. He also shed light on MoHAP’s keenness to constantly follow up on the maintenance works not only at Saqr Hospital but also at all Ras Al Khaimah Medical District’s hospitals and medical centers. “MoHAP also spares no effort to provide the comfort for all patients and follow up on all needs and requirements, so as to provide unique health services in accordance with the best international standards,” Al Nuaimi noted.

Mohammad Rashid Bin Arshid, Director of Saqr Hospital, explained that the quality of services provided by the hospital will not be affected during the maintenance operations. Arshid added that the developments of trauma and operations departments aim at ensuring the continuity of providing high-level administrative, medical and therapeutic services, noting that the development stages will continue for three months and will include expanding the waiting rooms and rising their capacity. Saqr Hospital provides its services as per the best international standards, thanks to the provision of new medical devices in the last years, in addition to the existence of a distinguished team of specialists and consultants. The total number of beds in the hospital is 124 beds with an occupancy rate of 59%, while the total number of specialized clinics visitors reached 25,946 in the first half of this year, 47517 to emergency departments and 3952 inpatients. While the number of surgeries conducted during the same period reached 1229 surgeries.

Expo 2020 Dubai Nine Medical Conferences about the cutting-edge innovations

xpo 2020 Dubai will organize a series of 9 medical conferences and specialised events during the six-month long event. The events – which will be held at the co-located Dubai Exhibition Centre – will focus on high-tech healthcare innovations including virtual reality,

SEPT.OCT 2019

robotics, pediatric, orthopedic and surgery technology, as well as 3D printing and wearable health-tech. The conferences will be organized by the Dubai-based Medetarian Conference Organizing MCO, which will lease a cumulative 160,000 sq m of space. The announcement came just weeks after it unveiled its state-of-the-art on-site

emergency center that includes an isolation room, emergency care room and a helicopter pad. The conferences, which will focus on technological advances in health care, will include a Virtual Reality and Robotics Expo with artificial intelligence, 3D printing and wearable technology being the subject of several panel discussions.

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NEWS

Greiner Bio-One supports the Swiss Red Cross in Lebanon enough available or it needs to be paid for. There is a need to raise awareness here and encourage people to donate blood for others outside their own families. “If somebody needs my blood, I’m there for them,” says Said Mrad, a voluntary Lebanese blood donor. The 26-year-old is giving blood for the fourth time. Thanks to the work of the SRK in cooperation with the Lebanese Red Cross, he now sees it as completely natural to give his blood for other people.

reiner Bio-One is supporting a Swiss Red Cross (SRK) project to modernise the blood donor service and the provision of safe blood supplies for Syrian refugees and the wider public in Lebanon. Greiner Bio-One has been a project partner of the Swiss Red Cross since May 2019. Due to its extensive and long-term experience, SRK is in a strong position to provide support to several countries in establishing a

professional blood donor service. One of these countries is Lebanon. In addition to promoting quality assurance in the blood donor service, the goal of the Swiss Red Cross is to increase the stock of blood through regular donations. Because safe blood saves lives!

Giving blood is not (yet) necessarily the norm everywhere In some regions of the world, people often only donate blood for family members so there is therefore not

Blood supplies need to be safe A professional blood donor service not only needs donors but it also needs suitable products and expert knowledge to ensure high-quality standards, maximum safety and wide coverage for this vital service. The SRK’s international experience helps the Lebanese Red Cross a great deal as it establishes this valuable service. Greiner Bio-One is supporting this project through its financial contribution, its products and its expertise.

Amman held the 7th International Allergy Congress

eputising for HRH Princess Muna, Health Minister Saad Jaber opened the 7th International Allergy Congress, which was held for three days by the society at the Jordan Medical Association. More than 35 percent of Jordan’s population has suffered from allergies, whether temporarily or chronically, President of the Jordanian Society for Allergy and Immunology Hani Ababneh said during the 7th International Jordanian Congress of Allergy and Immunology held in Jordan. Ababneh also said that there are over a billion people who suffer from

SEPT.OCT 2019

allergies in the world, which is why the society is working on establishing a national electronic database of foods and materials that cause allergies in Jordan. In his opening speech, Ababneh said that 420 million people in the world suffer from what is known as “hay fever” or scientifically known as “allergic rhinitis” while 335 million people suffer from asthma, pointing out the society aims at exchanging expertise with advanced countries to reduce treatment costs for allergy patients. The society also aims at bringing devices that measure the level of dust and allergy-causing materials in the air in order to install unified protocols for

diagnosis and treatment, in addition to making available injections called EpiPen that could save the lives of those who might suffer from a sudden and deadly allergic reaction. The congress included 13 sessions with 57 research papers in the fields of immunology and allergies, as well as the use of stem cells, with the participation of researchers from the US, Romania, Turkey, the UAE, Saudi Arabia, Egypt, Lebanon and Libya. More than 400 doctors from the Royal Medical Services, the Ministry of Health, Jordanian Universities, the King Hussein Cancer Centre and the private sector took part in the event.

NEWS

Clemenceau Medicine Group Expands its service excellence and expertise to serve patients in the Arab world

Mr. Maher Aboughazaleh

lemenceau Medical Center affiliated with Johns Hopkins International (CMC Beirut), the top medical institution in Lebanon with multiple international awards and accreditations, celebrates a new major milestone in Q4 2019 with the opening of its successful CMC Hospital expansion projects. For 14 years, the hospital has experienced continuous growth in Lebanon and solidified itself as the leading institutional healthcare provider in the region. CMC Beirut and its international consultancy arm Clemenceau Medicine International (CMI) are owned by the Abughazaleh family and their partners. The founder Mr. Maher Abughazaleh presides as the chairman and majority shareholder of CMC Beirut. Operational since 2005, CMC is the manifested vision of Mr. Maher Aboughazaleh and the hospital has fostered the rise of a unique health-

SEPT.OCT 2019

care service in Lebanon and the region. Its success story as a top medical institution and health provider led to the creation of CMI, which enabled Mr. Maher Aboughazaleh to take his CMC brand international. Through CMI’s technical assistance consultancy and expert healthcare management services, the Group will oversee the completion of both CMC Dubai & Riyadh by the end of 2019. CMI will continue to provide management services for both projects to maintain the quality and continuity of the CMC brand in the region. Local partners in Dubai and Riyadh share Mr. Maher Aboughazaleh’s vision and benefit from being an integral part of a growing regional network of hospitals, where the fundamental objective is to leverage knowledge and experience gained in Lebanon and apply it internationally while sharing resources, technologies, doctors, and specialized healthcare.

CMC Founder and Chairman Mr. Maher Aboughazaleh expressed his en- thusiasm and said, “CMC strives to be the hub and center of medical excellence in Lebanon and the Middle East. It aims to spread its clinical expertise through technology and innovation, that will improve the quality of life for all its patients. Our latest investments and affiliations in the Gulf and Jordan will enable us to provide world-class healthcare to the entire Arab region.” The new Abdali Medical Center in Jordan is yet another proud achievement of the Abughazaleh family. This new 200-bed hospital towers over the Abdali District in central Amman and will provide high-quality and accessible health services to its patients starting in Q3 2019. The project benefited from CMI’s technical assistance services and is furnished with state-ofthe-art technologies and world-class Jordanian and international doctors.

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EU announces 550m euros to save lives from AIDS, tuberculosis, malaria ship to fight against AIDS, tuberculosis and malaria around the world. Its work has already saved 27 million lives since it was created in 2002.

he EU announced a 550 million euros pledge to The Global Fund during the G7 summit in Biarritz. The Fund is an international partner-

European Commission President Jean-Claude Juncker said on this occasion: “The EU has been a strong supporter of the Global Fund since its creation, when the AIDS, malaria and tuberculosis epidemics seemed to be unbeatable. And today we are announcing a record contribution of a further 550 million euros. We hope the international community will follow suit and step up the fight to fulfil the Fund’s target of ending these diseases’ epidemics by 2030.”

European Council President Donald Tusk representing the EU at this year’s G7, made the announcement in Biarritz. It comes ahead of the Global Fund donors’ conference that will take place in October in Lyon, as more support is needed so that developing countries can improve their health systems, reach universal health coverage and help end the 3 epidemics by 2030. The Global Fund seeks to raise at least 12.6 billion euros ($14 billion) for the period 2020-2022. By 2023, these funds should help save an additional 16 million lives, avert 234 million infections, cut the mortality rate from AIDS, tuberculosis and malaria in half, and build stronger health systems.

Zulekha Hospital Sharjah gets BFHI accreditation

ulekha Hospital, Sharjah is the first private hospital in UAE to be certified with the Baby-Friendly Hospital Initiative (BFHI) accreditation by UNICEF and WHO. The Baby-friendly Hospital Initiative (BFHI) was launched by WHO and UNICEF in 1991, following the Innocenti Declaration of 1990. The initiative is a global effort to implement practices that protect, promote and support breastfeeding. Zanubia Shams, Co-Chairperson, of Zulekha Healthcare Group said: “We understand how important this bonding is at an early stage and therefore encourage mothers to consult our lactation consultants free of cost even after their post-natal stay at

SEPT.OCT 2019

the hospital. This supportive educational journey can continue till the time a mother is lactating. We ensure education material related to BFHI is handed over to mothers during the sessions for reference and right practices.” Being based out of the Baby-friendly city Sharjah and in line with the vision of founder and chairperson Dr. Zulekha Daud, the hospital extensively advocates breastfeeding and imparts breastfeeding education and awareness to expecting mothers and the community at large. Doctors and nurses are encouraged to undergo the Lactation Consultant Training Programme and today the hospital has seven Lactation Consultants on board who provide free education

and guidance to mothers round the clock. Dr. Kranti Jadav, Specialist Gynecologist said: “Breastfeeding is the natural way of providing infants with the nutrients they need for health group and development. Exclusive breastfeeding should start within one hour after birth until a baby is six months old, followed by nutritious complimentary foods to be added while continuing breastfeeding for up to two years or beyond. Mothers require active support for establishing and sustaining breastfeeding practices although it is a natural act and that is why as a BFHI accredited hospital we can provide the required support and promote breastfeeding.”

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Weill Cornell Medicine-Qatar (WCM-Q) teams with US pharma company to develop new cholesterol drug likely to develop conditions such as metabolic syndrome, type 2 diabetes and cardiovascular disease. A safe and efficacious new therapy capable of enhancing the body’s own lipid clearance mechanisms would have the potential to further reduce the residual risk of developing these conditions and improve the health and quality of life of individuals already at elevated CVD risk.

Dr. Hani Najafi

eill Cornell Medicine-Qatar (WCM-Q) has signed a research agreement with pioneering US biotechnology company Moderna, Inc. to develop a new cholesterol-controlling drug that could lead to radically improved treatments for type 2 diabetes and cardiovascular disease. Under the agreement, Moderna, which is based in Cambridge, Massachusetts, will sponsor a study by WCM-Q researcher Dr. Hani Najafi to develop and test a new therapy for rebalancing levels of circulating blood lipids by effectively increasing the clearance of atherogenic lipids and enhancing the production of functional, anti-inflammatory lipid species. Individuals with a high ratio of LDL (low-density lipoprotein) to HDL (high-density lipoprotein) are at an elevated risk for developing cardiovascular disease (CVD) and far more

SEPT.OCT 2019

The new experimental therapy will be based on the interactions of microRNA and messenger RNA, one of the most exciting and promising targets of drug research, and a field in which both Moderna and Dr. Najafi specialize. MicroRNA is a type of naturally occurring molecule that influences the way genes are translated from code into the proteins that make up an organism. It does this by interacting with another type of RNA, called messenger RNA (mRNA), which contains a set of instructions for turning the code held in DNA into proteins. Dr. Najafi and the scientists at Moderna theorize that novel microRNA-mRNA interactions could be produced in the lab and used in patients to further reduce the levels of circulating blood lipids with beneficial effects on health. Dr. Najafi said: “This is an attractive approach for targeted gene therapy where we don’t need to manipulate the DNA permanently. Instead, we can potentially use a small RNA (microRNA) to precisely fine-tune and influence mRNA expression and control the way lipid genes are regulated on a transient basis in response to lifestyle and diet. This novel approach has the potential of reducing unwanted

circulating lipids and vascular inflammation in a manner and to a degree that has never been seen. This would give us a highly effective tool for treating or even helping to prevent the development of conditions like type 2 diabetes, metabolic syndrome and cardiovascular disease.” Established in 2010, Moderna has developed what is widely considered to be the pharmaceutical industry’s leading technology platform for developing mRNA-based therapies. Dr. Khaled Machaca, Senior Associate Dean for Research, Innovations and Commercialization at WCM-Q, said: “We at WCM-Q are absolutely delighted to be working with Moderna on this exciting project. The combination of Moderna’s groundbreaking mRNA technology platform and our world-class expertise and facilities here at WCM-Q gives us a great foundation for developing novel therapies that could one day make a real difference to many people’s lives.” Dr. Machaca also hailed the role of WCM-Q’s annual Industry Academia Alliances event for bringing Dr. Najafi and Moderna together. The event is designed to provide a forum for international biomedical companies and WCM-Q researchers to meet and hatch collaborative projects. Dr. Machaca said: “This is an important moment for the Biomedical Research Program at WCM-Q as we look to move our discoveries from the lab to the marketplace to help Qatar’s sterling efforts to diversify its economy. We are very pleased that the Industry Academia Alliances event played a key role in this collaboration.”

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Adding Clinical Variables Improves Accuracy of Lung Allocation Score lung transplant in several ways. “They are younger, often have more infections and multiple organs that are affected by their disease,” Dr. Lehr said. “While many of these problems progress during a patients’ life, they are not adequately factored into the lung allocation score.”

mplemented back in 2005, the lung allocation score is used to prioritize patients awaiting lung transplants in the United States. Sicker transplant candidates have a higher calculated score and are placed at the top of the list. But a recent study led by Maryam Valapour, M.D., MPP, Director of Lung Transplant Outcomes in Cleveland Clinic’s Respiratory Institute, found including new clinical variables helped to better identify the sickest cystic fibrosis and chronic obstructive pulmonary disease (COPD) patients awaiting transplants. The paper was published in the American Journal of Respiratory and Critical Care Medicine. Dr. Valapour, who is also the senior investigator for lung transplant for the U.S. Scientific Registry of Transplant Recipients (SRTR), worked

SEPT.OCT 2019

on behalf of the U.S. Department of Health and Human Services. The Cystic Fibrosis Foundation (CFF) and Cleveland Clinic physicians Carli Lehr, M.D., MS and Elliott Dasenbrook, M.D., MHS, also collaborated on the study. “Lung transplant is a life-saving procedure for patients with end-stage lung disease and these patients have no alternative treatment available to them if an organ doesn’t become available in time,” Dr. Valapour said. The study merged patient data from the SRTR and the CFF Patient Registry from January 2011 to December 2014. It included 9,043 patients on the lung transplant waiting list and 6,100 lung transplant recipients. Once merged, cystic fibrosis-specific variables were added into the lung allocation score calculation. People with cystic fibrosis differ from the average patient awaiting a

This study marked the first time researchers could review a cystic fibrosis patient’s entire clinical history. That’s because the CFF registry captures all clinical data for almost all cystic fibrosis patients in this country from birth onwards while the SRTR includes clinical data on all patients starting from when they are placed on the waiting list to transplant and beyond. Results of the data merge not only showed improved accuracy of the lung allocation score for cystic fibrosis candidates, but the re-evaluation of the pulmonary function testing also helped patients with COPD. “We believe the database we used more accurately identifies candidates likely to benefit the most from a transplant,” Dr. Valapour said. Today, more than 30,000 people are living with cystic fibrosis in the United States. Described as a progressive, genetic disease, cystic fibrosis causes persistent lung infections and limits the ability to breathe over time. The average life span for people with cystic fibrosis is about 37 years. Because almost all individuals with cystic fibrosis die of respiratory failure, lung transplant is a vital therapeutic option for patients with advanced lung disease.

NEWS

Minister of Health in sultanate of Oman President of Supreme Council of the Arab Board of Health Specializations

. E. Dr. Ahmed bin Mohammed al Sa’eedi, Minister of Health in sultanate of Oman has been elected as the president of Supreme Council of the Arab Board of Health Specializations (ABHS). H. E. Dr. Sa’eedi was elected at the meeting of ABHS which was held at the Secretariat General of the Arab League headquarters in Cairo, Egypt.

Dr Haifa Abu Ghazalah, A ssistant Secretary-General and head of the Social Affairs Sector at the Secretariat General of the Council of Arab Minis-

SEPT.OCT 2019

ters of Health said that this meeting is following up the implementation of Decision No 1 of the 52nd Ordinary Session of the Council of Arab Ministers of Health held in May in Geneva, Switzerland. Dr. Haifa added that the meeting is discussing many issues including the draft statutes and the council’s rules of procedures. The Supreme Council of ABHS holds meeting annually in the presence of most members including the president or vice president who are elected by the members.

The decisions of the Supreme Council are taken by a majority vote of the attendees. The High Commission consists of six of the Arab Health Ministers selected by the Council of Arab Health Ministers, the Minister of Health in the country of the headquarters, two representatives of each Arab country, as well as an Arab representative of the Regional Office for the Eastern Mediterranean of the World Health Organization, and theSecretary-General of the Union of Arab Doctors.

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Stroke Victims See New Hope Of Recovering Lost Movement Thanks To Cleveland Clinic Research In conjunction with intensive rehabilitation, patients have recovered some of the movement they had lost as a result of their strokes since undergoing the procedure. “The challenge for us now is to examine why some patients recovered more movement than others and determine what governs the extent of their recovery as a guide to helping more patients. We’re studying how their brains are changing following the procedure. I’m optimistic that this is going to lead to a treatment that could help people who don’t currently have much hope of further recovery and may even lead to new treatments for other conditions,” continues Dr. Machado.

hysicians at Cleveland Clinic in Ohio have been trialing the use of deep brain stimulation in helping patients regain movement lost following a stroke, a leading cause of permanent disability worldwide. The trial comes after a decade of laboratory work to identify how the nervous system recovers and after a neurological injury. Researchers discovered that the deep brain stimulation technology it has used to treat Parkinson’s disease for over twenty years could be adapted to help patients recover lost movement following a stroke. Rather than blocking rogue signals that cause tremors – as in Parkinson’s disease – Cleveland Clinic is using electrodes implanted into specific areas of the brain to instead

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spur new activity, supporting the brain’s natural recovery process. “We wanted to leverage our experience with deep brain stimulation to see if we could use it to try to help patients we couldn’t help before. After ten years in the lab, we’ve given this treatment to six patients, most of whom have recovered some of the movement they’ve lost. This is the first use of this technology in stroke patients and we’re very encouraged by the results,” says Dr. Andre Machado, Chair of the Neurological Institute at Cleveland Clinic. The six patients who have received the experimental treatment had all undergone physiotherapy following their strokes with limited success. All the patients had suffered strokes more than one year before undergoing deep brain stimulation.

Physicians at Cleveland Clinic’s Neurological Institute are working closely with their colleagues at Cleveland Clinic Abu Dhabi to introduce deep brain stimulation for Parkinson’s disease. The introduction of the treatment could open the door to stroke patients in the UAE being offered deep brain stimulation to aid their recovery once the treatment has exited the trial phase. “We have a deep and very strong collaboration with the team at Cleveland Clinic. Their knowledge and advice are invaluable and, as the designated stroke center for Abu Dhabi, we are keenly following their advances in adapting the technology to treat stroke patients,” says Dr. Florian Roser, Chair of the Neurological Institute at Cleveland Clinic Abu Dhabi.

MEDICAL INSTITUTIONS NEWS

ACIBADEM HEALTHCARE GROUP TURKEY An ECOSYSTEM that sets an example for the world in healthcare service…

eveloping rapidly since 1991, Acıbadem Healthcare Group became one of the leading institutions in Turkey in the field of private healthcare services, and now moves forward globally with its partner IHH Healthcare Berhad, one of the biggest groups in the Far East, in 2012. Comprised of 21 hospitals and 14 medical centers, Acıbadem has become a part of the world’s second largest Healthcare Chain with this agreement under the auspices of IHH Healthcare Berhad. Each year, many patients from different parts of the world choose Turkey to receive treatment, and they prefer Acıbadem which provides services using the most advanced technology worldwide featuring an expert team meeting international quality standards. Its quality of the services also supported by independent institutions; Joint Commission International (JCI) and “ISO 15189 Clinical Laboratory Accreditation Certificate”.

Globally competitive integrated healthcare services in Healthcare Apart from hospitals and medical centers, Acıbadem Healthcare Group offers a worldwide example setting integrated special healthcare system model, and includes various healthcare support institutions.

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MEDICAL INSTITUTIONS NEWS

Multidisciplinary Centers of Excellence

All of the hospitals within ACIBADEM Group that meet the global standards, also stand out with the Centers of Excellence: 16 Heartcare Centers (pediatric and adult cardiology and cardiac surgery), 13 In Vitro Fertilization Centers (infertility - IVF), 11 Cancer Centers (surgery, radiotherapy, chemotherapy), 10 Organ & Tissue Transplantation Centers (liver, kidney, bone marrow), 9 Spine & Neurosurgery Centers, 6 Robotic-assisted Surgery Centers and 1 Sports Medicine Center accredited by FIFA are all among the nationally and internationally accredited and qualified centers due to their advanced technology equipment and experts that have significant experience in their own fields.

MEDICAL INSTITUTIONS

Professor Cem Alhan is the first and the only “Ozaki Method Trainer” in Europe

A NEW METHOD UNITING TWO BROTHERS WHO ARE CARDIOVASCULAR SURGEONS

econstruction of a heart valve with native or autologous pericardium rather than a prosthetic valve left its mark in the history of cardiovascular surgery. Devising this novel method 12 years ago that was named after his surname, Doctor Shigeyuki Ozaki visited Turkey in order to certify Professor Cem Alhan, who traveled to Japan and learned and successfully performed the method. Dr. Ozaki answered questions of his colleagues in the live surgery carried out at Acıbadem University Atakent Hospital. He also met the Turkish patients who underwent surgery with the same technique and got well. Dr. Cumhur Alhan is a Turkish cardiovascular surgeon, who resides in London and was operated on by his brother Professor Cem Alhan due to a heart valve problem, and his vote of thanks to Japanese Doctor Ozaki pulled heartstrings of the participants.

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MEDICAL INSTITUTIONS

The diagnosis of “cancer” that was established for the Turkish Cardiovascular Surgeon Cumhur Alhan, who resides in London, turned over an unexpected leaf in his life. When he was evaluated before the anti-cancer treatment, a problem was detected in his heart valve. It was impossible to proceed to the anti-cancer treatment before this problem was corrected. Instilling hope of life to other hearts for many years, Dr. Cumhur Alhan would, this time, strive for the treatment of his heart. However, he traveled to Turkey in no time flat. Because his brother was a cardiovascular surgeon and he was sure that he would do his best for his brother in his difficult times. Professor of Cardiovascular Surgery Cem Alhan from Acıbadem Maslak Hospital informed his brother about the method that would ensure his heart beats healthily with joy of life in the way it used to be: Ozaki… Cardiovascular Surgeon Cumhur Alhan, M.D., was operated on with this technique that was devised by Japanese Professor Shgeyuki Ozaki, M.D. It is significantly advantageous, as the damaged heart valve is reconstructed with the pericardium of the patient or an autologous tissue without use of a prosthetic valve. Thus, there is no risk of infection or a disadvantage, such as use of blood thinners, as the body is not exposed to a foreign material. Professor Ozaki visited Turkey to share his experiences in a live surgery carried out at Atakent Hospital, Acıbadem University and answered questions of his colleague. The other

reason of his visit was to give the trainer certificate to Professor Cem Alhan, who is a faculty member in Cardiovascular Surgery Department of Acıbadem University and Cardiovascular Surgeon in Acıbadem Maslak Hospital, to indicate that he is the only trainer for Ozaki Technique, which is performed for adults, in Europe. Thus, Professor Cem Alhan will educate and train cardiovascular surgeons, who want to learn this technique, all over Europe.

“A vitally important method for certain patients” Being awarded the title “the Only Ozaki Trainer of Europe”, Professor of Cardiovascular Surgeon Cem Alhan pointed out that this method is vitally important especially for too old patients, babies, infants, women who plan pregnancy and also the patients with congenital stenosis of aortic valve. This technique also resolves the problem of a future redo operation for too old or too young patients. Ozaki method saves expectant mothers from risks of serious anomalies in babies secondary to blood thinners. Cardiovascular Surgeon Cumhur Alhan, who is brother of Professor Cem Alhan and was diagnosed with an aortic valve problem while he was evaluated for the diagnosis of lymphoma, is also a patient who has a heart valve reconstructed with Ozaki method. Working in the U.K. for a long time, Dr. Cumhur Alhan says “He is only three years younger than me. Our father and older brother were also doctors, who inspired us. However, Cem is the golden boy of not only our family, but also this country.

I trusted him very much. Therefore, I preferred to have this surgery in Turkey rather than the U.K. and my mind was totally at peace while I was leaving my life to his hands”, while Professor Cem Alhan responds “In fact, my brother leaves me far behind in his career. First, he attended School of Mechanical Engineering in Boğaziçi University and he completed his education in the Netherlands. Next, he studied medicine and he became a cardiovascular surgeon. Later, he studied master’s degree in philosophy. He is a marvelous person and a very good brother”. Stating details of his brother’s operation, Professor Cem Alhan believed that Ozaki technique was the best method for him and he performed the operation based on this belief: “Undoubtedly, you feel strong emotions before the operation, if the patient is your first degree relative, but you do not think about who you operate on once anesthesia is administered and this emotional state continues until the patient is recovered from anesthesia. It was very important to have heart of my elder brother beat healthily and keep him away from potential problems that a prosthetic valve may cause. Because he will be started on anti-cancer treatment and unfortunately, it is not an innocent therapy. It challenges some organs. Therefore, it was very important to restore full capacity of his heart. We restored his cardiac health thanks to Ozaki method. Now, it is time for other treatments…” Undergoing an aortic valve surgery one year ago, Dr. Cumhur Alhan is still maintained on treatment of lymphoma.

MEDICAL INSTITUTIONS

THE SURGEON WHO PERFORMED 1500 ROBOTIC SURGERY OPERATIONS IN 12 YEARS!

he da Vinci robotic surgery method is currently deemed as the “golden standard” in the fields of gynecological diseases, general surgery, cardiovascular surgery, otorhinolaryngology and, in particular, urology. The reason behind this is the advantages robotic surgery provides for patients, which are vitally important. Robotic surgery, which is the most developed one of surgery methods, is applied successfully in the state institutions, universities and private hospitals of our country. The leading field in which robotic surgery, which has a history of 12

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years in Turkey, is most widely used is urology. Professor Ali Rıza Kural, the urologist of Acıbadem Maslak Hospital who has broken a record in Turkey, Eastern Europe and the Middle East by performing 1500 operations in the field of urology in our country, is also an academic consultant at Acıbadem University. Due to his achievements in robotic surgery, the Robotic Surgery Training Center of Clinic Simulation and Advanced Endoscopic-Robotic Surgery Training Center (CASE) which operates under the roof of Acıbadem University

and considered to be one of the first 4 centers of its kind in the world, was named after Professor Kural. Professor Ali Rıza Kural states that they continue giving training in this field in both Turkey and abroad, and says, “Apart from Acıbadem University, we also train national and international specialists who apply to the 6 centers in the public and private hospitals of our country. We provide training abroad as well. For instance, we performed over 100 robotic surgery operations in Greece alone. When the operations during training sessions outside of our center are counted as

MEDICAL INSTITUTIONS

well, the number of cases exceeds 1700. This number places us among the top 5 in Europe”.

Record-high number of robotic surgery operations Robotic surgery is successfully used particularly for radical prostatectomy (removal of the prostate), the surgical treatment procedure for prostate cancer, as well as many other urology operations. Acıbadem Maslak Hospital Urologist Professor Ali Rıza Kural, who has performed urologic robotic surgery operations of a record-breaking number in Turkey, Eastern Europe and the Middle East, points out that Turkey has achieved a really good position in robotic surgery in the field of urology. Stating that they performed their first robotic surgery operation in 2005, Professor Ali Rıza Kural says that the number of cases he and his team have handled so far is 1500. Urologist Professor Ali

Rıza Kural states that most of these operations are prostate cancer procedures and says, “a large number of the rest is kidney cancer and uretero-pelvic obstruction operations. There are also some bladder cancer operations”.

Each stage is performed with high precision In reality, robotic surgery is the next level of laparoscopy. Robotic surgery differs from conventional laparoscopy in that it involves a three-dimensional image which is magnified by 12 times on the console. The da Vinci robotic surgery system has 2 fiber optic cameras with high resolution. The surgeon sitting at the operation console is given a three-dimensional image that also provides a sense of depth. The said cameras are able to magnify the surgery area by 10 to 12 times. This ensures for the surgeon to see the surgery area more clearly and in greater detail. Further-

more, the robotic instruments at the arms of the system which can rotate at an angle of 540 degrees are able to reach areas that cannot be accessed manually and provides surgeons with a much greater ability to move than conventional surgery. These features enable for each stage of operations to be performed with great precision.

What are the advantages of robotic surgery? • • • •

• •

Smaller incisions and aesthetic advantages as a result. Less loss of blood. Less pain. Recovery in a shorter period and ability to return to normal life faster. Easier operation procedures for overweight patients. Ability to start post-operative treatment right away for patients who need radiotherapy or chemotherapy.

Urologist Professor Ali Rıza Kural Urologist Professor Ali Rıza Kural performed 1500 robotic surgery operations and achieved this number in only 12 years! With this number, a record has been broken in Turkey, Eastern Europe and the Middle East. Professor Ali Rıza Kural, who achieved a rank among the top 5 surgeons in Europe, has been accepted for honorary membership with the title of FRCS-Honorary by Royal College of Physicians and Surgeons Glasgow-Glasgow which directs the British medicine for more than 400 years and was founded to maintain the profession of medicine at higher standards. This medical society (formerly named as Glasgow Faculty) was first founded by King of Scotland, James the 6th, in 1599 and it has transformed into a more prestigious institution after its name was changed as “Royal Faculty of Physicians and Surgeons of Glasgow” by the Royal Family in 1909. Finally, the institution was gathered under the same roof with other Royal Medical Faculties on Great Britain in 1962 and was named as “Royal College of Physicians and Surgeons Glasgow”.

ARTICLE FEATURES . Artificial Intelligence in Healthcare

ith the advancement of technology and the use of computers in the health sector, medicine has witnessed a radical transformation with the use of Artificial Intelligence (AI) techniques in assisting physicians in diagnosis, which pushed the field of healthcare and medicine forward. These techniques only supported the doctor but did not replace him.

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This support provided to the doctor by Artificial Intelligence techniques played a pivotal role in supporting the diagnosis of diseases and became more accurate, which contributed to reducing the psychological pressure on the doctor as well as the physical effort to reach his goal, which reflected positively on strengthening the communication and interaction between him and the patient while

boosting patient morale in general. Powerful AI techniques can unlock clinically relevant information hidden in the massive amount of data, which in turn can assist clinical decision-making, making the next diagnosis using the patient’s medical AI techniques more accurate because of having a previous comprehensive idea of the patient’s health history. There is no doubt that AI and

ARTICLE FEATURES . Artificial Intelligence in Healthcare

robots together shape the future of the healthcare sector. Hospitals in the Middle East and the Gulf States have been aware of this new reality since its inception and have worked to introduce state-of-the-art and sophisticated technologies. Our Arab world today is full of technologies and robots urging the patient not to travel abroad to get the medical service that he wants given its possible availability

in his country. Artificial intelligence has contributed to radical change through its applications in all fields of medicine, for example, supporting decision-making processes, analyzing diagnostic images, and sorting patients based on the need for medical care. It also helps doctors make clearer decisions while providing medical care to patients, which contributes to facilitating the procedures of patient

examination and raising the level of accuracy while reducing fatigue and exhaustion in doctors. Accurate diagnostics and machine learning techniques, for instance, have the ability to pinpoint health problems on diagnostic images, help with patient screening procedures, and benefit from valuable information from the vast amounts of data available in the doctorâ&#x20AC;&#x2122;s electronic medical records.

ARTICLE FEATURES . Artificial Intelligence in Healthcare

Artificial intelligence analyzes the data available in electronic medical records, which in turn helps the doctor to make appropriate decisions and analyze the patientsâ&#x20AC;&#x2122; diagnostic images. Healthcare institutions seek to harness artificial intelligence techniques to serve patients, use and analyze their data, focus on and inter-

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act with data even after the patient is discharged from hospital. Services are not limited to treatment but also on integrated healthcare and patient welfare. The components of artificial intelligence in medicine are beyond what people might think. AI can quickly and more accurately spot signs of disease in medical images. Hence, doctors can make quicker

decisions and patients can be diagnosed faster and can begin treatment sooner. AI will assist doctors and not replace them. When artificial intelligence is used correctly, doctors can detect diseases at an early stage, thus reducing expenditures on governments as this field holds great potential for growth in the healthcare sector.

ARTICLE FEATURES . Artificial Intelligence in Healthcare

Robots in the Operating Room Robots are used during surgery, called “robotic surgery”. It is an advanced form of minimally invasive or laparoscopic (small incision) surgery where surgeons use a computer-controlled robot to assist them in certain surgical procedures. The robot’s “hands” have a high degree of dexterity, allowing surgeons the ability to operate in very tight spaces in the body that would otherwise only be accessible through open (long incision) surgery. Remote surgery (or telesurgery) is the ability for a doctor to perform surgery on a patient even though they are not physically in the same location. It requires the availability of the latest communication technology and the effective exchange of management information systems. Other future applications include the implementation of microprocessors or secondary treatments in the body to perform medical and surgical functions, as well as the use of biological sensors that can read and convert responses to natural and chemical changes for patients with chronic diseases. Surgeons who use the robotic system find that for many procedures it enhances precision, flexibility and control during the operation and allows them to better see the site, compared with traditional techniques. Using robotic surgery, surgeons can perform delicate and complex procedures that may have been difficult or impossible with other methods. Often, robotic surgery makes minimally invasive surgery possible. The benefits of minimally invasive surgery include fewer complications, such as surgical site infection, less pain and blood loss, quicker recovery and smaller, less noticeable scars.

To operate using the robotic system, your surgeon makes tiny incisions in your body and inserts miniaturized instruments and a high-definition three-dimensional camera, and sometimes skin incisions are not required at all. Then, from a nearby console, your surgeon manipulates those instruments to perform the operation. Compared to traditional techniques, the very small incisions created by robotic surgery drastically reduce patients’ time in the hospital and their risk of infections. The use of high-definition 3D cameras allows surgeons close-up views of areas they aren’t able to see during open surgery. Fully articulating robotic arms mimic the movement of hands, allowing surgeons to have greater dexterity and control than is possible with conventional laparoscopic instruments.

Virtual Healthcare Telemedicine is the remote delivery of healthcare services, such as health assessments or consultations, over the telecommunications infrastructure. It allows healthcare providers to evaluate, diagnose and treat patients using common technology, such as video conferencing and smartphones, without the need for an in-person visit. It is often a time-saving way for a consumer to see and speak to a clinician for minor and non-urgent medical needs instead of going to a primary care physician’s office or emergency department. Information and communications technology in the field of health and telemedicine (virtual healthcare) aims to increase access to quality health services for people in rural areas in order to reduce treatment and travel expenses while helping the patient

avoid the difficult access to treatment centers in the cities. Hospitals can be linked to each other through a communications network that enables doctors to diagnose diseases by sharing photos and reports as well as providing medical advice in complicated cases. A remote patient monitoring device collects data on a patient–such as weight, blood sugar, heart rate, etc.–and submits it to a nurse, doctor, or caregiver in another location. This helps eliminate the need for frequent travel and makes it easier for older adults to live independently longer.

Cloud Computing in Healthcare Healthcare institutions that use cloud computing with the aim to improve their performance are the most successful, especially as the sector shifts to value-based healthcare. Cloud computing is the delivery of different services through the Internet. These resources include tools and applications like data storage, servers, databases, networking, and software. Cloud-based storage makes it possible to save files to a remote database and retrieve them on demand. Cloud computing is an important technology that provides the storage, operation flexibility, and analytical capabilities necessary to implement and operate AI systems, machine learning and innovation. The AWS cloud platform facilitates data assimilation and processing, whether coordinated or not or continuously streaming, as well as the ability to simplify the process of developing, training and spreading models based on machine learning technology. This technology will also allow medical centers to maintain patient data while allowing health clinics around the world to share information on genetic medical tests.

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Thumbay Medicity Introduces a Whole New Healthcare Experience with AI, VR & Robotics Enabled Technologies healthcare and research, Thumbay Medicity is one of the latest additions to the UAE’s healthcare sector; the first such project in the private sector. Located in Ajman, Thumbay Medicity features advanced technology and global expertise, and can serve a floating population of 20,000+ people with its advanced facilities in education, healthcare, research, leisure, luxury, fitness, entertainment, etc., built with an investment of over a billion Dirhams. Thumbay Medicity houses the Gulf Medical University, Thumbay University Hospital, Thumbay Dental Hospital and Thumbay Physical Therapy and Rehabilitation Hospital and outlets of Thumbay Pharmacy and Thumbay Labs, in addition to Body & Soul Health Club and Spa, Thumbay Food Court, The Terrace Restaurant, Blends & Brews Coffee Shoppe, and the upcoming Thumbay Housing Project to accommodate 2500 staff and students.

Technological Superiority One aspect which differentiates the hospitals at Thumbay Medicity is their technological superiority in terms of patient convenience, treatment modalities and efficiency of operations. The VR and AI-based technologies at the three hospitals, the robotics pharmacy and the dedicated pneumatic tube systems for sample handling at the diagnostic labs and the use of robotics and VR in rehabilitation and medical education are cases in example.

Improved Accuracy and Better Outcomes through Robotics

rtificial Intelligence (AI), Robotics and Virtual Reality (VR) are rapidly changing our lifestyles and the way we access services. One industry where this change is most pronounced is the healthcare sector, where innovative technologies have not only brought about more precision and efficiency, but have also led to significant savings in terms of time and operational costs. It is in this context that we take a look at the state-of-the-art facilities at Thumbay Medicity – a regional hub of medical education, healthcare and research – where cutting-edge technology combined with top-notch professional expertise has created a futuristic healthcare model. Established by the Dubai-based business conglomerate Thumbay Group with core interests in medical education,

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One of the most remarkable entities of Thumbay Medicity is the state-of-the-art robotic pharmacy – Thumbay Pharmacy – located in Thumbay University Hospital. The pharmacy features advanced robotics technology for preparing and dispensing medicines, eliminating the chances of human errors and ensuring patient safety. It also achieves significant reduction of waiting times, as it is fully automated for faster processing of orders. Spread across 4700 sq. ft. area, it is equipped with robotic and pneumatic tube system, and has been designed for high density storage up to 42,000 units and hassle-free retrieval of medications. Robotics is also used at Thumbay Physical Therapy & Rehabilitation Hospital, especially in the form of wearable technology such as bionics suit, smart glove etc. They not only aid optimal motor and/or cognitive functional recovery for persons with impairments, but also support indepen-

ARTICLE dent living of persons with chronic or degenerative limitations in motor and/or cognitive abilities, such as the elderly and persons with severe disabilities.

Artificial Intelligence for Greater Efficiency AI-based technology is yet another area where Thumbay Medicity stands out. Thumbay University Hospital uses face-detection system for patient medical records, based on which patient records are easily retrieved with a face scan, ensuring safety and safeguarding against mishandling of patient data. Also, the new robotics pharmacy features the EvoTec System which optimizes storage with artificial intelligence algorithms for smart loading, unloading and delivery at the pharmacist counter. It is equipped with medication safety bar-code scanning, ensuring that the medications and strengths are correct during both the carousel stocking and dispensing process. The hospital also has a full-fledged radiology department with PET-CT scan, a first of its kind in the UAE’s northern Emirates, enabling better and faster diagnosis. Technologies for GAIT analysis and Sensory Feedback at the rehabilitation hospital help patients effectively undergo physical therapy, leading to speedy and complete recovery.

The Virtual Reality Edge The Thumbay Physical Therapy and Rehabilitation Hospital at Thumbay Medicity makes extensive use of Virtual Reality to ensure optimal recovery and rehabilitation. Various VR technologies used at the hospitals provides comprehensive neurocognitive training to children and adults, in addition to aiding performance enhancement and recovery/ pain/stress management. The hospital is equipped with cutting-edge VR-based applications like driving simulators, J Dome and specialized technology for stimulating various senses in adults and kids. The Gulf Medical University (GMU), a leading medical university in the region located at Thumbay Medicity uses VR in training its students, in the form of Virtual Patient Learning (VPL), becoming the first University in the region

to introduce this technology which is a Problem-Based Learning (PBL) application invoking critical thinking, clinical reasoning, and communicational skills amongst students. The program gives the students authentic medical problems including history and clinical examination, investigations, lab results, vital signs, X-rays, and interaction with virtual patients to obtain information that would help them correctly identify medical problems of each case and prescribe treatments. GMU also has the distinction of being the first medical university in the region to introduce 3D Digital Learning, with basic medical sciences, anatomy, physiology and biochemistry presented in immersive technology in high definition, for the benefit of students.

Technology’s Growing Role The world over, healthcare systems are undergoing a shift towards technological innovation for improving care delivery. While technologies like AI, VR and Robotics are among the fastest growing areas of healthcare investment and technology research, they are unlikely to completely replace the human healthcare professionals. However, there is no denying the fact that these technologies mark the advent of a whole new era in healthcare, characterized by improving the quality, efficiency and accessibility of healthcare, in addition to aiding in training and research. Commenting on the growing role of technology in healthcare, Dr. Thumbay Moideen, the Founder President of Thumbay Group says, “With recent survey results suggesting that a majority of the Middle East’s public are happy to see AI systems being used in healthcare, new doctors with the ability to use AI tools will replace the old doctors who don’t use these AI techniques. There are so many potential applications for robotics, AI and VR in healthcare, and some of the changes we can expect to see in the future include AI-based screening of diseases like cancer, development of chatbots that permit quick at-home clinical assessments and diagnoses, etc. The bottom line is that change is coming- and that means it’s a very exciting time for the healthcare industry.”

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Cook Children’s Healthcare System Providing Telehealth & Virtual Medicine Care For Patient Families Across The Globe

ook Children’s Healthcare System, is a non-profit organization working towards improving the health of every child. Based in Fort Worth, Texas they offer professional consultation and exams in real time thanks to the Telehealth Technology tool. Virtual medicine is not new to Cook Children’s, in fact, Cook Children’s specialists have been conducting telemedicine visits in various clinics for more than 10 years. But it’s grown to be so much more than that.

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From providing specialty care for patient families across the globe, consulting with physicians in outlying areas to conducting virtual visits in school nurse’s offices or after-hours in a patient’s home, telehealth and virtual medicine program become a daily action at Cook Children’s. Telemedicine is the practice of connecting with a Cook Children’s healthcare professional virtually through real-time audio and video

conferencing. In addition to talking remotely to nurses, physicians and other healthcare professionals, specialized devices are used for diagnostic purposes. These can include an otoscope for the ear, stethoscope for heart and lung sounds and a close-up exam camera that can take video of the skin, eyes, and mouth. Cook Children’s specialty clinics throughout North Texas are equipped with cameras, microphones, TV

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monitors and specialized equipment, which means patient families can receive consultations and exams in real time without having to go to the inconvenience or expense of traveling far from home. A method that some of the Gulf Counties, such as Kuwait already adopted. Based on the diagnosis, a patient may have to be seen in person for

an initial visit. Specialties currently offered through Cook Childrenâ&#x20AC;&#x2122;s outpatient specialty care telemedicine include: Cardiology, Endocrinology, Gastroenterology, Genetics, Hematology and Oncology, Infectious Diseases, Nephrology, Neurology, Neuropsychology, Psychology and Rheumatology. In addition to these specialties, the Pediatric Hospital offers tele-

health services, which give parents and children opportunities to learn from Cook Childrenâ&#x20AC;&#x2122;s health professionals, such as dietitians, social workers, psychologists or counselors for patient education, dietary consultations and more. Cook Childrenâ&#x20AC;&#x2122;s is now partnering with in-patient all across the globe to provide them with access to more than 240 specialists.

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NOT SCIENCE FICTION ANYMORE The emergence of AI and Robotics in Healthcare

ince the invention of computers and machines, their ability to perform various tasks have grown exponentially through the years. Machines are best at digesting massive amounts of data and picking out patterns that the human brain cannot fathom. Artificial Intelligence (AI) pursues in creating machines and systems that are ultimately more intelligent that humans itself. It is based on the principle that human intelligence can be elucidated in such a way that a machine mimics and executes functions, from the most simple to the most complex.

In Healthcare, data is crucial and thus digitization of records may serve as a powerful research warehouse for clinical data. The potential for AI is getting increasingly sophisticated at a bare minimum cost with researchers and clinicians looking at the technology to aid in training, research, early detection, diagnosis, treatment and care. The use of AI in healthcare today looks at one vital vision: treating patients is both art and science; consequently making healthcare more efficient for patients due to its improving accuracy, precise diagnosis, remote treatment and augmentation of human abilities like supporting mental health to daily

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tasks. The greater adoption of Artificial Intelligence, robotics and automation will be a boon for businesses especially in the healthcare industry with an impactful global change. Top nations like Germany, Singapore and South Korea have adopted AI and robotics into the healthcare sector. Korea is the leading nation for AI adoption followed by Singapore, China and Taiwan according to an ITIF report. Healthcare systems around the world, notably the UKâ&#x20AC;&#x2122;s National Health Service, have already engaged the use of AI health assistant programs to modify the clinical process with the help of applications and programs to

give their patients information as well as facilitate meetings with clinicians. An Indian software company Sigtuple, created an AI-based telepathology system that automates their smart microscopes to take pictures and upload on cloud. This allows efficiency among pathologists for their diagnosis. Recently, the US market has seen higher adoption of AI to decrease the cost of care and improve the outcomes, which was driven by regulatory push for value-based healthcare. This forced providers to adopt EHR (Electronic Health Records) platforms to leverage medical data efficiently. Within two years, it is expected that 35% of

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healthcare organizations will adopt AI to improve their patient experience. The healthcare sector in Saudi Arabia is one of the main focuses of the Saudi Vision 2030 and the National Transformation Program 2020. Saudi Arabia is currently seeking to be a global leader in the application of technology related to AI and has highest efficiency in the healthcare industry. With a physician patient ration of 2.57/1000,Artificial Intelligence will allow Saudi Arabiaâ&#x20AC;&#x2122;s focus on digital healthcare innovations for better accuracy and better patient outcomes. 46% jobs in Saudi Arabia are susceptible to automation and

with the help of AI and robotics the increase for employment opportunities for students as well as doctors arises. 55% of the respondents of the doctors at Saudi Arabia are in willingness to adopt to AI and Robotics in their healthcare system. Considering above 30% of the population is over the age of 50 accounting to about 10 Million people, AI could bridge the gap between the number of patientsâ&#x20AC;&#x2122; requiring treatment and available qualified specialists. AI could aid in early detection and diagnosis putting the emphasis on treating patients who are more in need. In light of these rapid develop-

ments, Value-Based Healthcare Summit 2019 offers a premier platform to engage in knowledge sharing and discuss goals, visions, trends and challenges in making healthcare services smarter, more affordable and accessible in the era of digital transformation. Leading regional and international industry experts will deliver insightful presentations on pertinent topics through keynote presentations and interactive panel discussions. Come and watch the best minds in the Healthcare sector from across the pan-Saudi region, as well as the rest of the world, convene on a single platform on September 18th, 2019 in Jeddah, KSA.

ARTICLE FEATURES . KSA Health

THE FUTURE OF

he health sector in the KSA has witnessed a dynamic development in the last few years under the constructive initiatives taken by the government and its future vision, alongside promoting private sector investments and urging it to provide more opportunities in accordance with the Saudi Vision 2030 and the National Transformation Program (NTP). The Ministry of Health is expected to spend close to US$71 billion by 2020.

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This upward trend of the health sector reflects the size of the completed and ongoing projects, as well as the sectorâ&#x20AC;&#x2122;s huge investments that aim to increase the absorptive capacity of the hospitals in both the public and private sectors and to provide high-quality medical services in accordance with the global transformations and the digital technologies in the health sector. The Kingdom has been able to make significant strides

achieve the Saudi Vision 2030. The budget included the completion of establishing and equipping hospitals and primary healthcare centers across the Kingdom. Currently, 35 new hospitals in the Kingdom are being implemented and developed with a capacity of 8850 beds. According to the 2019 budget statement, the number of hospitals receiving patients during the period 2016 - 2020 will be about 30 hospitals,

ARTICLE FEATURES . KSA Health

to improve health care and enhance patient safety, as it is of paramount importance in the healthcare system, which is a key component of the NTP in the health sector. Within this framework, the KSA has been keen to implement the most important international standards in terms of quality of health services, allowing its hospitals, especially in Riyadh and Jeddah, to obtain world-class accreditation that has contributed to its status as one of the best hospitals in the region and the world.

2019 Annual Budget and New Hospitals The health sector holds the third largest share in the budget expenditure of 2019, following the education and military sectors. The budget allocation for the sectors of health services and social development is around SAR172 billion, including about SAR47.7 billion for initiatives to

ARTICLE FEATURES . KSA Health

which is 70% of the total planned for the five-year period, with a capacity of about 6950 beds. Based on a report by Ardent Advisory & Accounting, the Saudi health sector is at the top of the healthcare sectors in the Gulf States, accounting for about 48% of the overall health care expenditures of the Gulf governments, and followed by the UAE (26%). This enhances investment opportunities in this sector.

Private Sector Partnership Partnership and privatization between the public and private health sectors are evolving under the Saudi Vision 2030 within several health fields revolving around health centers, operating hospitals and new medical cities, radiology, rehabilitation, health care, home care, laboratories, and pharmacies. The private health sector in the Kingdom has played an active role in achieving an increase in the overall health services provided in the medical centers and hospitals, obviously according to a system of work and integrated plans provided by the Ministry of Health. The health sector in the Kingdom is today one of the large economic and investment tributaries due to its importance in attracting domestic and foreign capital. The goal of the Saudi Vision 2030 in terms of privatizing the health sector is to provide the citizens with the best services in the field of health care, serve as many patients as possible across the Kingdom, update and establish new health care centers, enhance efficiency and quality, establish a competitive market to provide healthcare services in order to meet the growing needs in the sector, establish and maintain an efficient logistics system that serves the sector

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in the Kingdom, and ensure the development of services to the highest international practices and standards.

Role of Ministry of Health The health sector’s priority at the level of investments, expansions, and modern health projects reflects how much attention the human health is getting in the Kingdom and the role of the Ministry of Health in supporting the health sector by developing skills, attracting highly qualified workers to the health sector, implementing initiatives aimed at improving the service level, raising public awareness, disseminating the culture of prevention and primary health care, and most importantly, implementing decisions related to the effective health care insurance sector that apply the latest global standards.

7 Private Sector Hospitals in Riyadh Within the framework of supporting and encouraging investment projects in health services in Riyadh, the Riyadh Development Authority announced at one of its recent meetings that it has approved the establishment of 7 hospitals across the city in the neighborhoods of: Al Aziziyah, Al Jazirah, Al Falah, Namar, Laban, Al Yarmuk, and Qurtubah. These projects are considered to be an important addition to the health services in Riyadh, providing a total of 340 new beds, as well as contributing to the private sector’s contribution to providing health services to the residents, providing new job opportunities to the citizens, and increasing coverage of health services across the city.

Public Health System As the Ministry of Health seeks to achieve the Saudi Vision 2030 through the theme “Vibrant Society”, it has be-

gun to prepare the public health system that aims to identify public health priorities and general needs, align with international health systems to promote international cooperation in global health, and work towards unified efforts between ministries and associations to achieve public health goals in the Kingdom. The system also aims to provide the necessary protection and to urge individuals, families, and all social levels to maintain their health. It will also provide a framework for legal governance and assign different roles and responsibilities to stakeholders. It will be implemented in three stages: 1. to study the current status of Saudi regulations and laws, 2. to develop a detailed plan for the formulation of the system, 3. to formulate the public health system and its executive regulations. In the framework of upgrading the quality in hospitals, the quality and safety development project in the health sectors, prepared by the General Secretariat of the Council in cooperation with the relevant governmental and private health sectors, was adopted to develop quality and safety in accordance with the goals of the NTP 2020. This will be achieved through an elaborate health system that puts the patient at the forefront of priorities, the application of the regulations and principles of quality and patient safety management in the health sectors in the Kingdom, in addition to disseminating the culture of quality within healthcare institutions, involving them in the development of this culture and embracing it, and developing the required competencies.

ARTICLE FEATURES . KSA Health

Currently, 35 new hospitals in the Kingdom are being implemented and developed with a capacity of 8850 beds

ARTICLE FEATURES . KSA Health

A LEADING SAUDI STEP IN THE HEALTH SECTOR Hospitals shift to companies and e-prescriptions are used in 800 health centers

n the framework of the ongoing development of the health system in Saudi Arabia, the Ministry of Health has confirmed that its hospitals and health centers started shifting completely to companies under the umbrella of Health Holding Company. The Ministry is awaiting the approval for the establishment of this company and stated that electronic prescriptions will be implemented in 800 health centers by the end of this year and the patient can use them in any private pharmacy. These steps fall within the context of an integrated plan to develop the health sector to better serve the citizens as part of a comprehensive strategy to promote all sectors in the Kingdom.

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Saudi King Salman Bin Abdulaziz had previously agreed to adopt the transformation of government hospitals into companies, and making public health a policy and priority in all laws and regulations. This requires the work of all government parties to achieve this goal so that health becomes a priority in all policies. Accordingly, the Ministry of Health, represented by the Vision Realization Office, called for participation in the pre-qualification program for companies in preparation for the submission of proposals in the â&#x20AC;&#x153;Job Transfer Planâ&#x20AC;? project within the objectives and initiatives of the National Transformation Program and the framework of general competition.

The ministry explained that the project aims to establish a complete set of specifications required to manage the transfer of 220,000 employees from the current to the future health system, indicating that the transfer process would provide a clear approach and implementation plan for the job transfer, including linking existing employees to future jobs, determining staff options as well as areas with excess or shortage of staff, preparation of evaluation methods and the establishment of a staff database. The ministry said that the project will be presented later, noting that the deadline for the submission of the qualification files ended on March 14,

ARTICLE FEATURES . KSA Health

2019, making the beginning of the contract during the current year, with a 10-month duration. It also stressed that the plan should be implemented with a trial launch on specific segments of employees while using the trial results to improve the overall administrative staff transfer process. The ministry added that the objectives of the trial launch were to develop and plan the transfer of personnel and service providers from the current Ministry of Health, taking into account existing capacities, required competencies in the future and staff options. According to the published data, it announced in 2017 that hospitals and health centers will be separated from the ministry and they will be converted into public sector companies to compete with one another on the basis of quality, efficiency, productivity, reducing wastage, speedy decision-making and decentralization. The ministry will focus on its supervisory and organizational roles once health centers and hospitals are separated from it.

Regarding the electronic medical file, Dr. Khalid Al Shaibani, Deputy Minister of Health for Planning and Director Vision Realization office, explained that this project is of interest to the Ministry. We aim by 2020 to have 40 percent on an electronic file, although we have so far achieved 21 percent, and we are working on this vital and important project. As for the electronic prescription and its use in private pharmacies, Al Shaibani stressed that the trial work started with the coverage of 80 health centers in the Eastern region. We will have 800 health centers in different regions by the end of the year, where the patient will be given the e-prescription â&#x20AC;&#x153;Wasfatyâ&#x20AC;? to be used in any private pharmacy.

A New Economic Vision Converting hospitals into government companies means separating health services from the ministry, which will focus on its supervisory and organizational roles. A statement previously issued by the ministry,

ARTICLE FEATURES . KSA Health

explained that this decision “aims to apply the private sector methods in terms of efficiency, increasing productivity, reducing wastage, speedy decision-making and decentralization.” The provision of services will be through groups consisting of primary care, public and specialized hospitals serving a population. Companies in the Kingdom will manage these groups, which will increase the ministry’s focus on its supervisory role. Saudi Arabia has recently started the implementation of a new economic vision aimed at reducing dependence on oil and rationalizing government spending. There were also clarifications to dispel fears of Saudi citizens that this would eventually lead to the privatization of the health sector. But Ministry of Health spokesman Mishal Al-Rubaian said that “the decision of the Ministry of Health to convert its affiliated hospitals into government companies means the shift of performance to the corporate system and not privatization,” explaining that the disbursement of financial budgets to these hospitals will change. Saudi Arabia has thus reinforced the steps of implementing its strategy of diversifying the economy by moving the health sector to a new stage through transforming health facilities into companies that resemble private companies but are managed by the state. Experts stress that this pattern will reduce the burden on the state budget and will increase revenues, create new job opportunities and contribute to the development of health services. According to official statistics, there are 288 state-owned and 127 private hospitals. The Ministry of Health aims to improve the effectiveness of these facilities and increase

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their focus on the supervisory and regulatory roles to boost the entire health sector, with the government retaining full ownership. The important strategic objectives of the National Transformation include increasing the private sector share of spending through alternative financing methods and service provision, increasing the efficient utilization of available resources and improving the efficiency and effectiveness of the healthcare sector through the use of information technology and digital transformation. “The shift in the health sector will make a quantum leap in the quality and speed of service and focuses on enhancing the health of citizens and preventing them from diseases,” said the Minister of Health Dr. Tawfiq bin Fawzan Al-Rabiah in a series of tweets on his official Twitter account. Minister Al-Rabiah says that the transition process in the health sector will be gradual over several years because it requires a change in many policies, procedures and regulations. A local media had earlier quoted a source from the ministry as saying: “The program will be implemented in six phases, which will take three years, and the first phase will be implemented in Jeddah.” Saudi economists say this shift in the sector is one of the main objectives of Saudi Vision 2030, which is about changing the strategic methods of managing the country’s sectors in the future and increasing their efficiency.

Ongoing quality services This new transformation will not affect the services provided to the Saudis as Mishal Al-Rubaian confirmed the continued provision of free treatment services to citizens following the plan to develop the public hospital

management system in the Kingdom. He explained that the government companies that will own the hospitals under the new plan will be treated according to the system of outputs and not inputs and will receive their financial budgets from the state according to the performance and service provided to citizens. He said that the implementation of the transition into companies will take years and there are committees working at the moment to implement this plan. He also stressed that the concept of buying the service from government companies that will be established, reflects the budgets that will be paid to companies that will manage public hospitals, in relation to their performance in the service of citizens. The government allocated 120 billion riyals ($ 32 billion) in the 2017 budget for healthcare and social development. The Ministry of Health stated that a “health insurance program and purchase of health services” will be established in order to implement a new mechanism for financing companies in accordance with the strategic procurement methods. According to the National Transformation Program, the private sector’s contribution to healthcare is targeted to rise from 25% in 2017 to 35% by 2020, bringing new opportunities for private hospitals. A report issued by experts at NCB Capital considered the health sector a defensive sector supported by growth prospects and strong demand amid the increasing population. Healthcare spending accounts for 48% of the Saudi 2018 budget, according to ARDENT Advisory & Accounting. One of the main objectives of Saudi Vision 2030 is to increase the contribution of the private sector in various areas of the economy.

ARTICLE FEATURES . KSA Health

Benefits and profits Economists stressed that this approach will raise the level of competition in the quality of performance, health services and buildings, while it will stop the waste of national wealth. Experts noted that there would be no place for health authorities that show no interest in quality in the presence of health insurance and mandatory health insurance. They pointed out that the management of hospitals will be through a holding company and about 5 subsidiaries in different regions. The Ministry of Health announced that it was determined to establish a health insurance program and to formulate and implement a new mechanism for financing companies through the purchase of health services. Experts welcomed the ministry’s new approach, which focuses on the concept of quality in service and reduces the waste of national wealth, pointing out that the Ministry of Health is one of the largest ministries that deplete the budgetary resources as a result of the spread of health services in all regions, cities and villages. Health services in several hospitals did not meet the quality requirements as a result of inefficient hospital and health services management, despite huge spending on healthcare. They pointed out that the statement of the Ministry of Health on the transformation of hospitals and health centers into companies, included the transition to practical application to what has been previously announced in this regard to promote competition in the health sector on the basis of quality that will be in favor of the consumer or beneficiary. They said that the aim is to stop the major waste in the state budget allocated to this sector and remove part of the burden on the state to

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become the sector’s supervisor and observer, to work efficiently and effectively to achieve the best performance by adopting the quality in service. Insurance companies will be an important player at this stage, thus, insurance will be the basis of service provision. They pointed out that the idea of converting hospitals into public sector companies came from the idea that services related to the citizen cannot be managed efficiently and effectively through the public authorities, not only in Saudi Arabia but worldwide, so countries that turn to the privatization in healthcare are progressing significantly in this field, because government hospitals that have recently turned into private-sector hospitals have found themselves competing with private hospitals. Studies indicate that many investments have been directed to the establishment of state-of-the-art hospitals, in addition to the reconstruction and maintenance of existing hospitals and clinics to keep pace with the approach of ministries of health,

as the quality of service and buildings should only be a top priority.

Economists have reached 9 benefits to guide the public health sector to work in the corporate system: • • •

• • •

•

• •

educing the major waste of R state resources. Raising the level of health and therapeutic services. Competing on the basis of quality in favor of the beneficiary. Improving the quality of medical buildings. Reducing medical errors caused by low quality. The Ministry of Health will focus on its supervisory role, which will help in efficient management. Strengthening health insurance programs for an organized service provision. Speed in decision-making, especially in urgent matters. Decentralization gives freedom to compete between the health sectors in the regions.

YOUR SOURCE FOR HEALTHCARE NEWS IN THE MIDDLE EAST

ARTICLE FEATURES . Spine Diseases

Scientific developments in spine surgery have led to amazing results

The most common spine diseases in the world

he spine is important in protecting the spinal cord, rib cage and nerves. Thirty-three ring-shaped bones called vertebrae form the spine and protect the spinal cord from injury. These vertebrae protect the brain stem and the spinal cord, support the skull, and allow for a wide range of head movement.

uses small tubular system or micro incisions, assisted with an endoscope for visualization. This type of minimally-invasive spine surgery provides patients with quicker recovery and less pain than traditional spine surgery. Before talking about diseases, it is necessary to explain the anatomy of the spine and its importance in the body.

Spinal diseases vary according to the symptoms and location of the injury. Therefore, the doctor starts with the initial and physical treatments and the last resort would be surgery, which witnessed a remarkable development in recent years that led to performing some operations with local anesthesia and some are done by endoscopy. Endoscopic spine surgery is a type of state-of-the-art surgery that

Your spine is made up of a column of bones called vertebrae. Between each vertebra is a shock-absorbing disc that prevents the bones from rubbing together. The intervertebral discs are designed to absorb pressure and keep the spine flexible by acting as cushions during body movement. Inside the disc is a gel-filled center called the nucleus, much like a tire tube.

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ARTICLE FEATURES . Spine Diseases

Degenerative spine conditions Degenerative disc disease (DDD) affects the discs that separate the spine bones. As you age, the spine begins to show signs of wear and tear as the discs dry out and shrink. These age-related changes can lead to arthritis, disc herniation, or spinal stenosis. Pressure on the spinal cord and nerves may cause pain. Physical therapy, self-care, medication, and spinal injections are used to manage symptoms. Surgery may be an option if the pain is chronic. Degenerative disc disease (spondylosis) can occur in any area of the spine (cervical, thoracic, lumbar), but is most common in the low back. It’s not actually a disease, but rather a condition in which your discs “degenerate” and lose their flexibility and height to cushion the spine. Discs have a limited blood supply, so once injured they can’t repair themselves easily. Age-related changes to discs include discs dry out and shrink - the disc nucleus is made of about 80% water. As you get older it slowly loses water and flexibility, which puts more stress on the disc annulus. Small tears occur in the annulus - sometimes the gellike nucleus pushes through a tear in the wall and touches nearby nerves. This material has inflammatory proteins that

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can irritate nerves and cause pain. The tears also affect tiny nerves in the annulus and cause discogenic pain with small micro-motion instability of the disc. Over time the proteins dry up, and the discs become stiffer. Disc gets thinner - due to the loss of water, the discs get thin and the distance between vertebrae begin to collapse. Which is why we get shorter as we age. Bone spurs grow – without the discs holding apart the vertebrae, they can rub on each other causing abnormal bone growths. Excess motion – abnormal rubbing adds stress to the facet joints. Pinched nerves may result in back or leg pain (sciatica). Spinal canal narrows – the added stress causes the ligaments and facet joints to enlarge (hypertrophy) as they try to compensate and spread the load over a larger area. This over-growth causes the spinal canal to narrow, which can compress the spinal cord and nerves causing pain. The symptoms of a degenerative disc vary from person to person. Many people with deterioration have no pain, while others may experience pain so intense that it interferes with daily activities. Pain often starts in one of three ways: a major injury followed by sudden and unexpected pain, a trivial injury followed by sudden back pain or pain that starts gradually and gets progressively worse.

ARTICLE FEATURES . Spine Diseases

Usually, the pain begins in the lower back, and may be felt in one or both of your legs and buttocks (sciatica). It’s often described as pressure or burning pain. You may also feel numbness or tingling in your leg and foot, which usually is not a cause for concern unless you have weakness in your leg muscles. You may have chronic underlying pain that is a nagging annoyance, and occasional episodes of intense muscle pain from time to time. These episodes last from a few days to a few months. Sitting usually causes the most pain because in this position your discs have more weight on them. Activities such as bending or twisting usually make your pain worse, and lying down tends to relieve the pain. You may actually feel better if you walk or run rather than sit or stand for too long.

Herniated Disc With continued stress on the spine, the inner nucleus pulposus may actually rupture out from the annulus. This is a ruptured, or herniated, disc. The fragments of disc material can then press on the nerve roots located just behind the disc space. This can cause pain, weakness, numbness, or changes in sensation. Most disc herniations happen in the lower lumbar spine, especially between the fourth and fifth lumbar vertebrae and between the fifth lumbar vertebra

and the first sacral vertebra. A herniated disc can irritate nearby nerves and result in pain, numbness or weakness in an arm or leg. On the other hand, many people experience no symptoms from a herniated disc. Most people who have a herniated disc don’t need surgery to correct the problem. Disc herniation is most often the result of a gradual, aging-related wear and tear called disc degeneration. As you age, your spinal discs lose some of their water content. That makes them less flexible and more prone to tearing or rupturing with even a minor strain or twist. Sometimes, severe injury can cause a normal disc to herniate. Injury may also cause an already herniated disc to worsen. Most herniated discs occur in your lower back (lumbar spine), although they can also occur in your neck (cervical spine). The most common signs and symptoms of a herniated disc are arm or leg pain, if your herniated disc is in your lower back, you’ll typically feel the most intense pain in your buttocks, thigh and calf. It may also involve part of the foot. If your herniated disc is in your neck, the pain will typically be most intense in the shoulder and arm. This pain may shoot into your arm or leg when you cough, sneeze or move your spine into certain positions. People who have a herniated disc often experience numbness or tingling in the body part served by the affect-

ARTICLE FEATURES . Spine Diseases

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ARTICLE FEATURES . Spine Diseases

ed nerves. Muscles served by the affected nerves tend to weaken. Herniated discs can occur in any part of the spine and are more common in the lower back (lumbar spine), but also occur in the neck (cervical spine). The area in which pain is experienced depends on what part of the spine is affected. Several words are used to describe the extent of a disc herniation seen on MRI examination. A disc herniation occurs when the soft cushion between the spinal bone ruptures. A portion of that disc can herniate, or push outwards, against the spinal cord or the spinal nerves. The pressure on the nerves causes the symptoms typical of a disc herniation. The types of disc herniation that occur include: • Disc Protrusion: Commonly called a disc bulge, a disc protrusion occurs with the spinal disc and the associated ligaments remain intact but form an outpouching that can press against the nerves. • Disc Extrusion: A disc extrusion occurs when the outer part of the spinal disc ruptures, allowing the inner, gelatinous part of the disc to squeeze out. Disc extrusions can occur with the ligaments intact, or damaged. • Disc Sequestration: A disc sequestration occurs when the center, gelatinous portion of the disc is

not only squeezed out but also separated from the main part of the disc.

Spinal Stenosis Spinal stenosis is a narrowing of the spaces within your spine, which can put pressure on the nerves that travel through the spine. Spinal stenosis occurs most often in the lower back and the neck. Some people with spinal stenosis may not have symptoms. Spinal stenosis is most commonly caused by wear-and-tear changes in the spine related to osteoarthritis. In severe cases of spinal stenosis, doctors may recommend surgery to create additional space for the spinal cord or nerves. Causes of spinal stenosis may include overgrowth of bone, herniated discs, thickened ligaments, tumors and spinal injuries. Symptoms of the stenosis include numbness or tingling and weakness in a hand, arm, foot or leg, problems with walking and balance, bowel or bladder dysfunction (urinary urgency and incontinence), pain or cramping in one or both legs when you stand for long periods of time or when you walk, which usually eases when you bend forward or sit. Treatment of stenosis includes surgery, muscle relaxants, steroid injections, or NSAIDs. The types of spinal stenosis are classified according

ARTICLE FEATURES . Spine Diseases

to where on the spine the condition occurs. It’s possible to have more than one type. The two main types of spinal stenosis are: • Cervical stenosis. In this condition, the narrowing occurs in the part of the spine in your neck. • Lumbar stenosis. In this condition, the narrowing occurs in the part of the spine in your lower back. It’s the most common form of spinal stenosis. Most people with spinal stenosis are over the age of 50. Though degenerative changes can cause spinal stenosis in younger people, other causes need to be considered. These include trauma, congenital spinal deformity such as scoliosis, and a genetic disease affecting bone and muscle development throughout the body. Spinal imaging can differentiate these causes. Rarely, untreated severe spinal stenosis may progress and cause permanent numbness, weakness, balance problems, incontinence, paralysis.

Spinal Osteoarthritis Osteoarthritis of the spine is a breakdown of the cartilage of the joints and discs in the neck and lower back. Sometimes, osteoarthritis produces spurs that put pressure on the nerves leaving the spinal column. This can cause weakness and pain in the arms or legs. In general, osteoarthritis happens as people get older. Younger people may get it from one of several different causes including injury or trauma to a joint or a genetic defect involving cartilage. For people younger than age 45, osteoarthritis is more common among men. After age 45, osteoarthritis is more common among women. Osteoarthritis occurs more often among people who are overweight. It also occurs more frequently in those who have jobs or do sports that put repetitive stress on certain joints. Osteoarthritis of the spine is caused by osteoporosis where the bones become porous and weaker, increasing the risk of fractures, especially in the hip, spinal vertebrae, and some peripheral joints, such as the wrists. Osteoarthritis of the spine may cause stiffness or pain in the neck or back. It may also cause weakness or numbness in the legs or arms if it is severe enough to affect spinal nerves or the spinal cord itself. Usually, the back discomfort is relieved when the person is lying down. Some people experience little interference with the activities of their lives. Others become more severely disabled. In addition to the physical effects, a person with osteoarthritis might also experience social and emotional problems. For instance, a person with osteoarthritis that hinders daily activities and job performance might feel depressed or helpless.

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Spinal Tumors A spinal tumor is an abnormal mass of tissue within or surrounding the spinal cord and/or spinal column. These cells grow and multiply uncontrollably, seemingly unchecked by the mechanisms that control normal cells. Spinal tumors can be benign or malignant. There are some types of tumors that start inside the bones of the spine such as chordoma, cartilaginous sarcoma, osteosarcoma, plasmacytoma, and Ewing sarcoma. Spinal tumors can be benign or malignant; primary tumors originate in the spine or spinal cord, and metastatic or secondary tumors result from cancer spreading from another site to the spine. About one-third of primary spinal cord tumors arise in cells within the spinal cord. Syringobulbia is a neurological disorder characterized by a fluid-filled cavity (syrinx) within the spinal cord that extends to involve the lower brainstem (medulla). It usually occurs as a slit-like gap within the lower brainstem that may affect one or more of the cranial nerves. Intramedullary tumors are rare, accounting for only five to 10 percent of all spinal tumors. Benign tumors such as meningiomas and neurofibromas account for 55 to 65 percent of all primary spinal tumors. A metastatic tumor is one that has spread from cancer in another part of the body. A metastatic spinal tumor, therefore, is a tumor that first started in another place in the body and spread to the spine. A metastatic tumor is sometimes called a secondary tumor. The original tumor, located elsewhere in the body, is called the primary tumor. The metastatic spinal tumor grows in the spine, but it is composed of cells from the primary tumor. As metastatic spinal tumors grow, they may weaken the vertebrae. A compression fracture may eventually occur in the weakened vertebrae. In some cases, a compression fracture is the first symptom of a metastatic spinal tumor. Sometimes these tumors cause pain as they grow. This pain is usually described as an aching pain in the bones that is not relieved by rest. If the growing tumor compresses the spinal cord or nerve roots, it may cause problems with movement or sensation (clumsiness, numbness, pins-and-needles) in the arms or legs. In severe cases, bowel or bladder control may be compromised. Depending on the type of tumor, radiation therapy and chemotherapy may be used to slow, stop, or shrink it. Surgical removal of metastatic spinal tumors can rapidly and effectively relieve pressure on the spinal cord or nerve roots. This generally provides relief from neurological symptoms like radiating pain, numbness, weakness, clumsiness, etc. If the tumor compromises the stability of the spine, surgery to stabilize the spine with metallic implants may be useful.

ARTICLE FEATURES . Spine Diseases

ARTICLE FEATURES . Diabetes and Pregnancy

Diabetes and Pregnancy

Tips and guidelines for a safe pregnancy

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ARTICLE FEATURES . Diabetes and Pregnancy

woman with diabetes can conceive and deliver healthy children provided that she controls and monitors her blood sugar levels three months before planning for pregnancy as well as during pregnancy. Whether the woman has type 1 or 2 diabetes, she can conceive with continuous medical follow-up, commitment to the doctorâ&#x20AC;&#x2122;s advice, and while maintaining a healthy diet and lifestyle in order to control her diabetes. On the other hand, some unstable conditions are characterized by fluctuations in the blood sugar levels, making women more susceptible to health problems related to the reproductive system, such as infections and fungi that delay pregnancy; however, this does not mean that the diabetic woman cannot get pregnant but her illness requires continuous treatment and follow-up in order to avoid any health problems or complications, for her and the baby. If you use insulin to control your diabetes, your doctor can tell you how to adjust your dose. Your body will probably need more while youâ&#x20AC;&#x2122;re pregnant, especially during the last 3 months. If you take a pill, you may need to switch to insulin. It may not be safe to use some drugs, or you may get better sugar control. If you have type 1 or type 2 diabetes, you may be at higher risk of having a large baby â&#x20AC;&#x201C; which increases the risk of a difficult birth, having your labour induced or needing a caesarean section, risk of preeclampsia, premature birth or defects in the nervous system and the heart.

Preparing for pregnancy The first step in preparing for pregnancy is to talk to your healthcare provider. He might recommend

ARTICLE FEATURES . Diabetes and Pregnancy

changing medications. If you take oral diabetes medication, you might need to switch to a medication that is safer for use in pregnancy or make other changes to your diabetes treatment plan before you conceive. If you also have high blood pressure, your blood pressure medications will need to be reviewed. Certain medications to treat high blood pressure — aren’t recommended during pregnancy. If you have high blood pressure or signs of heart, eye, nerve or kidney disease — or other diabetes complications that could be aggravated by pregnancy — preparing for pregnancy might include treatment for the condition before conception. Your healthcare provider might suggest scheduling preconception appointments with an obstetrician, a diabetes educator, a registered dietitian or other specialists. Controlling your blood sugar level is the best way to prevent diabetes complications. When you’re preparing for pregnancy, blood sugar control

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is more important than ever. Your healthcare provider might want you to reach a specific hemoglobin A1C level — a reflection of your blood sugar level for the past two to three months — before pregnancy. Your healthcare provider will help you establish your target blood sugar range. He will also evaluate your diabetes treatment plan and consider any changes that might be needed to improve it. The goal is to keep your blood sugar level as close to normal as safely possible. Keeping up a healthy diet is key when preparing for pregnancy. If you’re having trouble keeping your blood sugar level in your target range or you want to lose excess pounds before pregnancy, consult a registered dietitian. He can help you customize your diabetes meal plan to meet your pre-pregnancy needs. Physical activity is another important part of your diabetes treatment plan. When you’re preparing for pregnancy, try to keep stress under control. Too much stress can inter-

fere with your blood sugar level and make it harder to take good care of yourself — and your baby. High blood glucose levels in late pregnancy can also increase the risk of stillbirth. Most women with diabetes need more insulin during pregnancy, especially during the last one-third of pregnancy (approximately 26 to 40 weeks of pregnancy) because the body becomes resistant to insulin as the pregnancy progresses. Managing your diabetes well, before and during your pregnancy, will help to reduce the risks related to the disease.

During Pregnancy When pregnancy is confirmed, regular follow-up with the endocrinologist and the gynecologist is absolutely necessary, especially in the first seven weeks, the period of fetal development. In pregnancy, the hormones that are secreted by the placenta make the mother’s body less responsive to insulin, thus leading to high blood sugar level.

ARTICLE FEATURES . Diabetes and Pregnancy

In this case, doctors emphasize on the importance of undergoing fasting blood sugar tests regularly in order to avoid any surprises, stressing the need to adhere to taking insulin injections only because it is the only treatment allowed during pregnancy. In line with the treatment, a healthy diet is very important in maintaining blood sugar levels and pregnant women should follow a healthy lifestyle in order to keep diabetes within the normal range. A good meal plan is designed to help you avoid high and low blood glucose levels while providing the nutrients your baby need to grow. Pregnancy diet in patients with diabetes should be healthy and balanced and contains all nutrients such as protein, iron and calcium, especially in the early stages of pregnancy, when many pregnant women experience vomiting and nausea, making them lose a lot of minerals. Hence, the pregnant woman should discuss this issue with a nutritionist to give her appropriate alternatives. Doctors recommend eating complex carbohydrate foods as they contain fiber, vitamins and minerals, and they take longer to digest â&#x20AC;&#x201C; which means they have less of an immediate impact on blood sugar, causing it to rise more slowly. The carbs in some foods (mostly those that contain simple sugars and highly refined grains, such as white flour and white rice) are easily broken down and cause blood sugar levels to rise quickly. Nutritionists recommend replacing them with brown bread. You should also avoid eating saturated fats, spicy and salty foods, as well as canned foods. Dairy foods, such as milk, yogurt and cheese are good dietary sources of calcium, protein and vitamin D. In addition to a healthy diet, pregnant women also need to take a daily prenatal vitamin

to obtain some of the nutrients that are hard to get from foods alone, such as folic acid and iron. Doctors advise pregnant women with diabetes to exercise regularly as they did before pregnancy; walking and swimming are considered among the best exercises for pregnant women.

Childbirth & postpartum period Patients with diabetes are encouraged to enter the hospital 24 hours before labour to keep blood sugar level within the normal range and perform some necessary tests. The birth is often performed via C-section because the size of the fetus is greater than normal. After birth, doctors closely monitor blood glucose levels in the mother in order to protect her from any possible complication and will carefully monitor the cesarean incision for signs of infection. The same applies for the newborn, as doctors will closely monitor his breathing and blood sugar levels, especially that babies born to diabetic mothers have a lower blood sugar level due to medicines taken during pregnancy. In the postpartum period, the mother needs less insulin and will return to her pre-pregnancy condition. After your baby is born, your diabetes

will probably return to its original patterns. If you have type 2 diabetes, your doctor will decide which medication you should take after delivery. You will usually be able to go back to the same medications you were taking before pregnancy, as long as they were controlling your diabetes well. This may be modified if you are breastfeeding. After birth, the patient with diabetes needs careful monitoring by the treating doctor because she is prone to blood sugar level fluctuations for several reasons, including having different hours of sleep, preoccupation with the newborn and the required effort. The mother at this stage may also experience mood swings namely postpartum depression, which increases blood sugar levels instability. Therefore, it is necessary to constantly monitor blood sugar levels. Breastfeeding is good for women with diabetes, but it may make your blood glucose a little harder to predict. To help prevent low blood glucose levels due to breastfeeding, plan to have a snack before or during nursing, drink enough fluids, keep something to treat low blood glucose nearby when you nurse, so you donâ&#x20AC;&#x2122;t have to stop a feeding to treat low blood glucose levels.

ARTICLE FEATURES . Sarcoma

Sarcoma

Causes, types and treatments

arcoma is a type of cancer that can occur in various locations in your body. Sarcoma is the general term for a broad group of cancers that begin in the bones and in the soft (also called connective) tissues (soft tissue sarcoma). Soft tissue sarcoma forms in the tissues that connect, support and surround other body structures. This includes muscle, fat, blood vessels, nerves, tendons and the lining of your joints.

Itâ&#x20AC;&#x2122;s not clear what causes most sarcomas. In general, cancer forms when changes (mutations) happen in the DNA within cells. The DNA inside a cell is packaged into a large number of individual genes, each of which contains a set of instructions telling the cell what functions to perform, as well as how to grow and divide.

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Mutations might tell cells to grow and divide uncontrollably and to continue living when normal cells would die. If this happens, the accumulating abnormal cells can form a tumor. Cells can break away and spread to other parts of the body. Signs and symptoms of sarcoma include a lump that can be felt

through the skin that may or may not be painful, bone pain, a broken bone that happens unexpectedly, such as with a minor injury or no injury at all, abdominal pain and weight loss. People with soft tissue sarcomas often have no symptoms. There may be no signs until the lump grows to a large size and can be felt; however,

ARTICLE FEATURES . Sarcoma

even this may go unnoticed. Bone and soft tissue sarcomas are the main types of sarcoma. Soft tissue sarcomas can develop in soft tissues like fat, muscle, nerves, fibrous tissues, blood vessels, or deep skin tissues. They can be found in any part of the body.

Soft tissue sarcoma Although there are more than 50 types of sarcoma, they can be grouped into two main kinds: soft tissue sarcoma and bone sarcoma, or osteosarcoma. A soft tissue sarcoma may not cause any signs and symptoms in its early stages. As the tumor grows, it may cause a noticeable lump or swelling and pain, if a tumor presses on nerves or muscles. The type of cell that develops the genetic mutation determines what type of soft tissue sarcoma you have. For example, angiosarcoma begins in the lining of blood vessels, while liposarcoma arises from fat cells. Some types of soft tissue sarcoma include: • Angiosarcoma • Dermatofibrosarcoma protuberans • Epithelioid sarcoma • Gastrointestinal stromal tumor (GIST) • Kaposi’s sarcoma • Leiomyosarcoma • Liposarcoma • Malignant peripheral nerve sheath tumor • Myxofibrosarcoma • Rhabdomyosarcoma • Solitary fibrous tumor • Synovial sarcoma • Undifferentiated (pleomorphic sarcoma) Because there are so many different types of soft tissue sarcoma, it’s important to determine the exact nature of each tumor so that the best

treatments can be chosen. If a soft tissue sarcoma is suspected, it’s often best to seek care at a medical center that sees many people with this type of cancer. Experienced doctors will select the best biopsy technique to ensure proper surgical treatment and planning. Options include core needle biopsy in which tiny tubes of tumor material can be obtained by this method. Doctors typically try to take samples from several sections of the tumor. Surgical biopsy, in some cases, your doctor might suggest surgery to obtain a larger sample of tissue or to simply remove a small tumor entirely. In the lab, a doctor trained in analyzing body tissues (pathologist) examines the tissue sample for signs of cancer. The pathologist also analyzes the sample to understand the type of cancer and to determine whether the cancer is aggressive. Your treatment options for soft tissue sarcoma will depend on the size, type and location of your tumor. Surgery is a common treatment for soft tissue sarcoma. Surgery generally involves removing the cancer and some healthy tissue surrounding it. When soft tissue sarcoma affects the arms and legs, radiation and chemotherapy may be considered to shrink the tumor to avoid amputation. Chemotherapy is a drug treatment that uses chemicals to kill cancer cells. Chemotherapy can be administered by pill or intravenously. Some forms of soft tissue sarcoma respond better to chemotherapy than do others. For instance, chemotherapy is often used to treat rhabdomyosarcoma. Radiation therapy involves treating cancer with high-powered beams of energy. Options include before surgery that can help shrink the tumor so that it’s easier to remove. During

surgery, intraoperative radiation allows a higher dose of radiation to be delivered directly to the target area, while sparing surrounding tissues and after surgery as postoperative radiation can help kill any remaining cancer cells.

Osteosarcoma Osteosarcoma is the most common type of bone cancer, which begins in cells that form bones. In very rare instances, it occurs in soft tissue outside the bone. Osteosarcoma is most often found in the long bones — more often the legs, but sometimes the arms — but it can start in any bone. Sarcomas grow in connective tissue, cells that connect or support other kinds of tissue in your body. These tumors are most common in the bones, muscles, tendons, cartilage, nerves, fat, and blood vessels of your arms and legs, but they can also happen in other areas of your body. Most high-grade bone sarcomas, including Ewing’s sarcoma and osteosarcoma, are much more common in children and young adults. The cause of osteosarcoma is not clear and most cases appear to occur sporadically, but some factors may increase the risk. These factors increase the risk of osteosarcoma: previous treatment with radiation therapy and certain inherited or genetic conditions. Osteosarcoma can spread from where it started to other areas, making treatment and recovery more difficult. Surgery that removes the tumor and spares the limb is most often the norm. But certain patients may require amputation of the affected part of the limb and then need to learn to use an artificial limb (prosthesis). The first steps in seeking a diagnosis typically include a physical

ARTICLE FEATURES . Sarcoma

exam, discussion of medical history and lab tests. The doctor may recommend one or more of these imaging tests to locate the cancer and find out if it has spread. Over the years, major advances have been made in treating osteosarcoma. Treatment typically includes limb-sparing surgery and chemotherapy. Chemotherapy uses drugs to kill cancer cells. Doctors often recommend using chemotherapy before sur-

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gery for osteosarcoma, to reduce the size of the tumor, and after surgery, to kill any cancer cells that may remain. The goal of surgery is to remove the cancer cells, but surgeons also perform operations to maintain function and minimize disability. The extent of surgery for osteosarcoma depends on several factors, such as the tumor size, location and the personâ&#x20AC;&#x2122;s age. In most cases, surgery for osteosarcoma focuses on removing the tumor and

sparing the limb so that function can be maintained. Whether this is feasible depends, in part, on the extent of the cancer and how much muscle and tissue need to be removed. With advancements in limb-sparing surgery, the need for amputation â&#x20AC;&#x201D; removing a limb or part of a limb â&#x20AC;&#x201D; has greatly reduced over the years. If amputation is necessary, advances in prosthetic joints can significantly improve outcomes and function.

NEWS

Sidra Medicine delivering outstanding care for newborn babies

ewly released figures from Sidra Medicine show the hospital is delivering world-class care for newborn babies requiring major surgery, excelling some of the worldâ&#x20AC;&#x2122;s top medical institutions in certain surgical procedures. The hospital has assembled a prestigious team of expert neonatologists, anesthetists, nurses and surgeons from around the world, giving newborn babies born with serious surgical conditions the very best chance to survive, thrive, and giving parents the confidence that their children are

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receiving the best available care in the world. The neonatal intensive care unit (NICU) opened in April 2018 and since then 94 newborn babies requiring surgery have been admitted and more than 140 surgical operations have been carried out on these babies. Many of the children admitted were born prematurely and weighed less then, 1kg, meaning they represent the youngest and most vulnerable patients in modern medicine. Dr. Helmut Hummler, Division Chief of Neonatology at Sidra Med-

icine, said: â&#x20AC;&#x153;We have set up a worldclass NICU service to provide specialist care for critically ill newborn babies who need the highest level of care. Our multidisciplinary-based approach means that babies, especially those requiring surgery, have an excellent team assigned to care for them and their families. This includes surgeons, anesthesiologists, operating room staff, allied healthcare professionals, radiology and laboratory services, neonatologists and neonatal nurses.â&#x20AC;? Other pediatric subspecialist experts are involved in the multidisciplinary care as needed for cases with spe-

NEWS

cific diseases. Figures for the first 12 months of the NICU’s operation show that almost 99% of babies with life-threatening conditions survived the most critical 30-day period following surgery. This is comparable, and in some cases surpasses, the world’s leading hospitals. Prof. Ziyad M. Hijazi, Executive Chair of Pediatric Medicine at Sidra Medicine said: “This rate compares very favorably, if not better than, the most advanced and well-established units in the world. Every life is important, and our team works extremely hard to ensure excellent neonatal outcomes. These outcomes are the result of exceptional teamwork. Our healthcare professionals with their combined expertise have joined together from a range of international backgrounds, with the common aim of delivering the highest quality care to the babies and families of Qatar.”

life-saving care and treatment. Now, we are proud to say that Sidra Medicine offers hope to many families with babies with complex conditions.” Dr Basem Khalil, Director of Neonatal Surgery at Sidra Medicine said: “We are very pleased with these world-class results in our youngest babies. The successful care of the tiniest babies requiring major surgery in a sustainable manner is one of the signs of an advanced health care system and currently the State of Qatar can stand proudly amongst the most advanced nations on the planet. The achievement in such a short span of time is phenomenal and Sidra’s vision

to be a top world-class hospital is being realized.” Dr. Robert Crone, Acting CEO at Sidra Medicine, said the results are a remarkable achievement. Dr. Crone said: “Sidra has only been operational for a short time, but we are already seeing patient outcomes on a par with some of the world’s best hospitals. I would like to congratulate everyone working at Sidra; medicine and patient care is very much a team effort and I am very pleased that we have such diligent, talented and hard-working doctors, nurses and support staff, translating the vision and mission of Sidra.”

Surgical operations performed by the NICU team, which has almost 200 well trained nursing staff, included major surgery in the abdomen, lungs and the diaphragm including the use of the artificial lung machine known as ECMO. The work receives expert support from Sidra’s Maternal Fetal Medicine Unit, which provides pre-natal assessments and can manage cases even before birth. Dr. Mansour Ali, the Executive Chair of Surgery at Sidra Medicine said: “Our surgeons, who are truly world-class in their fields, have been working closely with the NICU and wider pediatric healthcare teams to deliver treatment programs to ensure the maximum quality of life. “Some of the babies are just days old when they have to undergo life-saving surgery. In the past, many of these babies would have had to travel abroad to seek

MEDICAL INSTITUTIONS

MedsBla

A communication space for each healthcare environment

ommunication is basic in any type of relationship. Specially, in areas such as health, where people are a fundamental value. In order to facilitate it, many companies offer tools that allow conversation, sharing documents, etc. The problem is that these tools do not usually respect data protection laws. This is an essential aspect in the health sector, given the sensitive nature of the information handled. MedsBla, a platform developed by MMG, offers a secure communication channel that health organizations can also customize according to their needs. It is available in English and Spanish and has a presence in 150 countries.

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What MedsBla offers MedsBla is a secure communication system that offers useful tools for clinical practice. It is available for mobile (iOS and Android) and desktop. Any user can register for free and access the secure communication system, where contact between doctors, medical students, patients and other health professionals is possible. The platform also includes useful tools for clinical practice. Among them, the user can find medical calculators, a pharmacological guide, a 3D anatomy system (BioDigital) and specialized news. It also has a semantic search engine based on its own artificial intelligence technology (DeepAIMed).

This search engine uses graph and hypergraph theory, Kernel theory and natural language processing (NLP) to analyze scientific texts in search of known concepts and relate them to each other, generating, in turn, new concepts. In this way, it is able to offer physicians information of interest from contrasted and specific sources in the medical sector. On the other hand, MedsBla offers a premium version of the communication system designed for administrations and health institutions. In this case, the platform offers managers the possibility of creating their own private spaces, adding users and managing all their communications

MEDICAL INSTITUTIONS

in an agile and efficient way. Thus, in addition to guaranteeing the security of messaging, resources are optimised and productivity is increased. Similarly, it is possible to improve the doctor-patient relationship and adherence to treatment. All of this translates into improved healthcare and an increase in the organisation’s operating income. “MedsBla protects the most sensitive data of an organization, but in MMG we aim to go further and not stay on the surface. We understand the clinical environment perfectly and thus create products that satisfy very specific needs”, says Alberto Cueto, Head of Business Development Department at MMG.

Private spaces The administrator of a premium account can personalize the platform, creating his own private spaces according to his needs. For example, a hospital group can create a private space for each of its centres and add the professionals who work in them, without the need for them to have previously registered with MedsBla. Once added, users access the secure communication system and can contact any other member of the private space of which they are a part. They can also create groups, just like the administrator of that space. The administrator can manage from his account both individual users and groups, as well as send notifications to groups or users. The dashboard allows to consult the information in a detailed and organized way. For example, it is possible to see the total data consumed per user, the daily cost per user in each private space, which devices are used more every day, what are the roles of registered users (students, doctors,

other health professionals or patients) or the percentage of messages sent in direct conversations or groups. This information will be reflected in an updated, clear and intuitive scheme that will make it easier for managers to make decisions. “Our communication platform centralizes all the insights for managers, but also increases the productivity and efficiency in the day-to-day of doctors, who are our end users. This is achieved, for example, by offering immediate answers about medicine with direct channels of communication between specialists. These tools help to yield the best results for the organization but also enhancing patient satisfaction”, adds Cueto. The price of this version of MedsBla depends on the volume of users of the account. The license of the customized platform has a cost per user that varies depending on the total number and storage space available in the cloud. In principle, in the premium version each user has 3GB per month that can be extended. All billing data can also be managed via the administrator account. Institutions interested

in contracting the service can do so through the tool’s website or by contacting the company, which offers the possibility of a demonstration.

Data protection Unlike other applications, MedsBla’s communication system complies with the General Data Protection Regulation (GDPR) and the Health Insurance Portability and Accountbaility Act (HIPAA). These are the European and American data protection regulations respectively, the strictest in the world in this field today. In this way, healthcare professionals can share sensitive information securely through this tool, designed for the physician of the future. In addition, since the beginning of the year MMG enhanced its potential by obtaining the ISO27001 certification of computer security, which is a further guarantee of security in healthcare for the users of its application. According to Ricardo de Lorenzo, director of the New Technologies Area of the law firm De Lorenzo Abogados, specialized in Health Law, the use of instant messaging systems to exchange patient information with a third party does not in itself imply

MEDICAL INSTITUTIONS

penalization or sanction. However, it is very likely to violate data protection by using unverified tools as a method of corporate communication. Such a breach can lead to legal problems, as well as damage the image of an organization or institution. “If you want to use these messaging systems to communicate with other health professionals, when it comes to obtaining the patient’s consent, you must be informed in detail about the possible participants who will have access to personal data, being prohibited the transfer of data to subjects who do not need access to information depending on the purpose of the provision or that have not been previously detailed in the information provided”, says the lawyer. The problem lies in the fact that, in order to be able to use this type of tool,

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express consent is necessary, in accordance with the GDPR. Many professionals obtain their patient’s consent to provide healthcare, but not to be able to communicate with them through these channels. Therefore, in order to be able to use this type of tool, express consent will be required. In that sense, it is vitally important that the courier service used complies, as MedsBla does, with the obligations set out in the legislation. Complying with these rules also implies a guarantee of confidentiality that will reinforce the institution’s commitment to data security.

Behind MedsBla The communication platform MedsBla is part of the solutions offered by MMG, a Spanish start-up that was born at the end of 2015 to offer the doctor of the future tools that facilitate daily clinical practice and decision-making. Since then, it

has broadened its horizons, making artificial intelligence (AI) the basis of its technology. With more than 60 highly specialized employees in fields such as information technology, research, design, journalism and business, the company has its headquarters in Madrid (Spain) and offices in Dubai (United Arab Emirates), Mumbai (India) and Mexico City (Mexico). It has the institutional support of CONFEMEL (Confederación Médica Latinoamericana y del Caribe) and works with public and private organizations, such as the Rey Juan Carlos University, the Colegio Médico de México or Sentinel. In January of this year, Oleg Vorontsov, CEO of MMG, signed a memorandum of understanding (MoU) with the Saudi company Advances AI LLC for both entities to work together. Work is underway on a joint laboratory for IA in Saudi Arabia to create products based on Natural Language Processing.

emtechmena.com

ARTICLE FEATURES . Women in Healthcare

PIONEERING WOMEN in the Health Sector

omen in the health sector have made several achievements and have taken a leading role in this sector through their active role in promoting health and therapeutic services, in addition to the ambitious strategies and plans that have resulted in the advancement of the health sector. The Arab world is replete with pioneering women whether they work in this humanitarian profession, be it a doctor, nurse and researcher, or support this sector through their work. The GCC and the Middle East are distinguished by their First Ladies and Ministers of Health who distinctively supported the health sector. Women have been able to overcome obstacles and prove their competence and efficiency as we now see a health minister who leads the health sector in her country or a doctor who runs a medical center or a huge project. The world is full of many women who have made medical achievements that changed the face of modern medicine. Today, there are many women who offer a rare combination of knowledge and scientific competence on the one hand, and kindness and psychosocial care for patients on the other. Some women have reached a prominent position with their achievements and obtained numerous scientific qualifications.

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Doctors Today, a female doctor is a source of confidence for many patients, as the prevailing concept that patients do not trust a female doctor has changed. There are brilliant names of female doctors who have provided health and medical services through their hard work in the development of the medical field, the discovery of medicines and the treatment of many diseases. The efforts of women in their work as doctors needed concerted efforts to overcome the professional difficulties and prove their talent and competence as well as accomplish further achievements. Although womenâ&#x20AC;&#x2122;s contributions have been slim in the past due to social, religious and cultural obstacles, but what they have reached today proves the high ability and professionalism in this humanitarian profession. Obstacles that prevailed among female doctors in the community did not prevent them from providing patients with the best healthcare, according to some studies that showed that female doctors are stricter than male doctors in adhering to the clinical guidelines, provide more preventive care, and communicate more with patients compared to male doctors.

Women in Nursing The nursing profession is one of the most important professions that women have practiced. Females make

ARTICLE FEATURES . Women in Healthcare

up the majority of the field of nursing, putting them in direct contact with the patient. It is a profession that needs compassion as well as care and women have always been in a powerful and influential position to improve the experience of patients, the quality of care and health outcomes and managed to overcome all obstacles. The nursing profession is one of the basic needs required by society, and the female nurse is the link between the patient and the doctor. Her role is a key pillar that helps in the advancement of medicine and health. Hence, her work is not limited to helping the doctor or taking care of the patient, but also involves writing diagnostic reports on patients’ conditions, reviewing medical reports and carry out experimental research. In the beginning, the role of the female nurse was to treat wounds, care for the injured and provide them with assistance, especially during the war. But with the development of the profession, the role of the nurse has expanded and now includes verifying the cleanliness of hospital rooms and equipment, taking notes and feeding, cleaning the wounded and helping them to go to the toilet, helping them to move around and putting them in their beds.

Qatari Women in Medicine The role of women in medicine in Qatar exceeded all aspirations and it was clear after receiving great support from the wise leadership helping women reach the highest positions. Qatari women continued their work in the health field in which they held senior positions that demonstrated their success in development and work. Today, the Ministry of Health is led by Dr. Hanan Al Kuwari, who has contributed to the development of ambitious health strategies in addition to the

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introduction of further developments through new health projects and the expansion of existing ones. Through her position, Dr. Al Kuwari aims to develop an integrated healthcare system in terms of health, preventive and therapeutic services in accordance with the best international standards and quality in order to improve the health of the Qatari community and meet the needs of citizens and residents alike.

Emirati Women in Medicine The career of women in the medical profession has witnessed great achievements in the United Arab Emirates and has played a prominent role in the renaissance of the country thanks to the unlimited support of Her Highness Sheikha Fatima bint Mubarak, President of the General Women’s Union, Chairwoman of the Family Development Foundation, and Chairwoman of Motherhood and Childhood Supreme Council “Umm Al Emarat”. Her efforts contributed to removing obstacles facing women and that prevent them from entering the medical profession. We see today UAE

female doctors occupying advanced leadership positions, in light of the suitable environment provided by the wise leadership in addition to the supportive and solid base, and multiple resources in all stages, whether in the availability of the best educational opportunities, or job opportunities, which support women in reaching the highest positions, and participate positively in the development process, especially in the health sector. Women in the health sector have proven their status nationwide at various levels, whether administrative or professional; the UAE female doctor has made remarkable achievements and proved her ability to keep abreast of the development in the sector and play a pivotal role in ensuring its sustainability while continuing to provide healthcare services according to the highest international standards. Today, Emirati women confirmed the importance of their role in this humanitarian profession through their participation in the health market and their achievements in it, as they became an integral part and a key foundation of the health system.

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INTERVIEW

Group Quality Director - SEHA

Dr. Maya Mallat Yassine “Women played a central role in the development of the healthcare industry”

r. Maya Mallat Yassine - Group Quality Director at Abu Dhabi Health Services Company - SEHA, believes that women played a central role in the development of the healthcare industry over the past years. ‘Hospitals’ magazine had the opportunity to meet Dr. Mallat Yassine.

You have an honorable career in the medical field and we would like to shed light on your career in the health sector? What are the main achievements? I started my career in the health sector early on, right after I completed my first Master’s degree, which was in genetics and cellular biology. I was hired by an international consulting firm operating in multiple sectors of activity, including healthcare. I received hands-on training and intensive coaching on various topics such as hospital accreditation, quality management systems, restructuring and reengineering of processes, targeting performance enhancement etc. A few years later, I progressed to working full-time within hospitals. This was vital to gain frontline experience and understand the daily struggles faced by healthcare professionals. I then joined the regulatory body of Dubai Healthcare City (DHCC) responsible to manage the licensing, compliance and continuous quality improvement of the services offered by the DHCC hospitals, outpatient medical clinics and diagnostic laboratories. The exposure and opportunity

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to work with global names such as Harvard Medical International, the International Society for Quality in Health Care and many others was truly a rewarding experience. I was then fortunate to be hired by Abu Dhabi Health Services Company (SEHA) at the time where the company was undergoing considerable growth. Given that SEHA is the largest healthcare network in the UAE with 12 hospitals, more than 40 healthcare centres and over 18,000 professional staff, the opportunities were endless. I would say that my main career achievements were accomplished at SEHA, where I was able to help establish an integrated quality and patient safety framework that has significantly contributed to improving patient care outcomes. With the help of incredibly talented team members, we progressively established the pillars of the SEHA quality program, including a state-of-the-art performance monitoring system, a full-fledged automated incident management system and a comprehensive continuous quality improvement program to name a few. On the personal side, the accomplishment of my doctoral degree from

the Grenoble Ecole de Management in France was particularly gratifying. Juggling intensive studies with a fulltime job and a family really pushed me to the limits of mental, physical, and emotional endurance. Although the journey was one of the most intense experiences I ever lived, the attainment of this degree was a pivotal point in my career.

We hear a lot about leading Arab women in the medical field. In your opinion, what is the importance of their presence and how have they contributed to the development of health strategies in place? His Highness Sheikh Mohammad Bin Rashid Al Maktoum, Vice-President and Prime Minister of the UAE and Ruler of Dubai once said, “A place without women is a place without spirit.” I couldn’t agree more. Women are the primary healthcare decision-makers at home, making 80% of buying and usage decisions. It is also important to highlight that they constitute over 70% of the healthcare workforce, which is considerably high in comparison to other

INTERVIEW

industries. Yet globally, they are underrepresented in healthcare leadership. In the United States for example, women make up only 30% of C-suite executives and 13% of CEOs, according to a report by global management consulting firm Oliver Wyman. The same report highlights that healthcare, unlike other industries, does not have a “women in healthcare” problem, but a “women in healthcare leadership” problem. As per a McKinsey report from 2015, women are significantly underrepresented in C-suites and corporate boards across the GCC states. They are however making strides as companies in the region are increasingly recognizing the potential of women leaders to enhance organizational effectiveness.

Based on your years of experience, how do you assess the reality of women in the health sector today at the regional level? I have personally had the opportunity to work with many of the most brilliant female healthcare leaders including Chief Executive Officers, Chief Medical Officers, Chief Quality Officers, Chief Nurses etc. over the past few years. These outstanding women executives and high achievers were instrumental in leading change and guiding healthcare delivery improvement across the country. In fact, the flagship hospital of the health system I currently work for has a C-suite constituted of women in majority. Many of the health system’s hospitals also include women in their senior leadership teams and as chairs and directors of departments. Regionally, more countries are elevating women to positions of power. This does not only apply in the healthcare industry. A great example is Raya

al-Hassan, recently appointed as the world’s first Arab female interior minister in Lebanon. Women may still be underrepresented in healthcare leadership positions however the future, in my opinion, looks bright.

simultaneous issues. I am surrounded by many women leaders with such noteworthy attributes. They truly create a great place to work and get the best out of employees to achieve operational excellence.

How did women contribute to the development of this field in the past years?

To what extent did the presence of women in leadership positions contribute to improving and enhancing the outcomes of the health system?

I firmly believe women played a central role in the development of the healthcare industry over the past years. I have met so many exceptional female physicians and nurses practicing in the toughest fields of medicine as well as numerous talented and passionate pharmacists, allied health professionals and administrators. Aside from their technical expertise, many have undeniable potential and are particularly poised for success in leadership roles for multiple reasons. The traits these natural leaders have in common are described in a book by Esther Wachs entitled “Why the Best Man for the Job is a Woman: The Unique Female Qualities of Leadership”. The author examined the careers of fourteen top female executives to learn what makes them so successful. She discovered that women have many essential qualities as leaders, including those they use to keep families together and to organize volunteers to unite and make change in communities. Women usually have an inclusive, team-building leadership style and possess a unique ability to leverage traits such as empathy and transparency to lead organizations. Their strong communication skills make them highly persuasive and enable them to effectively get others to buy into their visions. Another extraordinary skill is their innate ability to multitask and quickly address

A Forbes report highlighted that women are at the centre of healthcare decisions in the family unit and experience the full spectrum of healthcare delivery. As leaders, women can bring first-hand customers views to improve experiences and make the healthcare system more user-friendly, convenient, and efficient. The gradual inclusion of women in senior management teams has undeniably helped to ensure that healthcare decisions and policies are inclusive and representative. Additionally, studies have shown that companies with greater gender diversity at all levels and more specifically among senior leaders have better results and are more profitable. I am privileged to be part of today’s transformational generation, which is progressively letting go of the gender role stereotypes. I am inspired day in and day out by role models who wear many hats and balance careers and households among other things. These women leaders dream big, challenge conventions and encourage others to follow in their footsteps. Their dedication, passion and drive bolster the importance of women in the workplace and help to progressively shift the perspective so that, quoting Sheryl Sandberg, “In the future, there will be no female leaders. There will just be leaders”.

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INTERVIEW

r. Mariam Matar, Founder and Chairperson of UAE Genetic Diseases Association, is one of the most prominent Emirati scientists and the most important founders of the Society of Genetic Diseases. She is leading the scientific and healthcare community of the Arab region through a fundamental progressive shift in thinking about genetics and preparing the stakeholders to embrace the science of genetics, technology and tools available for empowering the Arab nations.

We would like to shed light on leading professional terminals?

Founder and Chairperson of UAE Genetic Diseases Association

Dr. Mariam Matar “We see a large number of women decision-makers, owners and partners in leading healthcare organizations” SEPT.OCT 2019

102

Multi-award winning International Leader, and Mentor, I’m recently recognised as ‘Pioneering Arab Woman in Healthcare Innovation 2019’ by 21st Pioneer Leadership Award in Healthcare, Kuwait. I’m also leading the scientific and healthcare community of the Arab region through a fundamental progressive shift in thinking about genetics and preparing the stakeholders to embrace the science of genetics, technology and tools available for empowering the Arab nations. • First Woman Director General in Dubai Government - Community Development Authority. • First Emirati woman Undersecretary in Dubai Government - Ministry of Health. • Recognised as ‘Pioneering Arab Woman in Healthcare Innovation 2019’ by 21st Pioneer Leadership Award. • Among two chosen Arab women members of Selection Committee of Zayed Sustainability Award. • Represented UAE women as recipient of prestigious Shaikha Fatima Leadership

INTERVIEW

•

• •

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Award USA. Represent Arab scientific community as Co-chair and committee member of the Global Commission to End the Diagnostic Odyssey for Children with a Rare Disease. Recognised among top 20 Arab scientists with the biggest contribution to humanity by British Scientific Community. Mentored over 12,000 young professionals. Founded over 14 non-profit organization and charities in the last 17 years. The most powerful scientist in the UAE from 2014.

The most recent awards for the ``Arab Women in Health Innovation Award 2019 ‘’. What is the added value of such unfairness in your career? H E Sheikh Nahyan bin Mubarak Al Nahyan, Minister of Tolerance and president UAE Genetic Diseases Association congratulated me and said that this is a win for UAE, a country which encourages leaders and celebrate innovators. I receive awards such as this one on behalf of my country and my fellow women scientists. As a representative of Emirati and Arab women, especially women scientists, and a mother of a young daughter, my recognition is an opportunity for me to show the level of qualifications, performance, standards and capabilities of women in Arab world. The best recognition that one can get is the one that comes from one’s own people. Still, being in the service of people and giving generously are for me better than any award.

The UAE was the first in supporting women to reach the highest ranks, where she held many leadership positions. How do you evaluate the reality of Emirati women in the health sector? On Emirati Women’s Day, UAE celebrates the role and contribution of women as a partner and supporter of the country’s development. The mother of the nation, Her Highness Shaikha Fatima bint Mubarak, Chairwoman of the General Women’s Union, President of the Supreme Council for Motherhood and Childhood, and Supreme Chairwoman of the Family Development Foundation is the visionary and force behind creating strategic and long term support, empowerment and encouragement to women to take up senior positions in business and government roles. In healthcare, traditionally we have seen more women in support services however today the women are placed very well as specialists, doctors, and senior management roles. Also, we see a large number of women decision-makers, owners and partners in leading healthcare organizations and providers as well as investors in the healthcare sector. So women are not only working in the operational side but also driving the decisions, the strategies and at the same time living as role models for younger women.

To what extent have women in leadership positions contributed to improving and strengthening the outcomes of the health system? I’m very honoured by the trust put in me by our government in promoting women. Our founding

fathers were visionaries who created strategy to include women in the nation building programs from day one. Our biggest role model is Sheikha Fatima bint Mubarak, Chairwoman of the General Women’s Union, Supreme Chairwoman of the Family Development Foundation and President of the Supreme Council for Motherhood and Childhood. She is a leading light to women of this country and her beliefs, the wise leadership and trust in our capabilities had made it possible for Emirati women to make a strong mark in all businesses and communities in the world.

Could you tell us about innovative initiatives in empowering the community and individuals more vulnerable to genetic disorders? Since founding UAE GDA in 2004, we have achieved: • Legislation on Mandatory Premarital screening. • Legislation on Mandatory Newborn screening. • A national screening program for the common genetic blood disorders in 2006 aimed at identifying Thalassemia, Sickle cell anemia and G6PDH carriers in the UAE population. The largest population screening program till date in the UAE. • Manal – Folic Acid prevention program & WHO fortified wheat campaign. • A recent cabinet decision that rules that unmarried women and couples can now freeze their eggs in the UAE. • Legislation on ban of smoking in public places in UAE.

What are the tasks assigned

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to the Emirates Genetic Diseases Association? What are the achievements of the association? UAEGDA and Sheikh Zayed Research Centre were founded in 2004 as a dedication to the memory of His Highness Sheikh Zayed bin Sultan Al Nahyan, founding father of the U.A.E. In 2019, the “Year of Tolerance” UAE GDA is committed to bring diverse experts and tools in genetic research to UAE and the Arab world for a Healthier and happier community in the UAE. Since 2004, UAE GDA is the only nonprofit organization in the region working towards the awareness and prevention of most common genetic disorders. • The first and the only non-profit organisation in the region which is focused on genetic disorders awareness, education and research. • Volunteers lead the work. • Arab region’s longest running awareness and screening campaign on common genetic disorders. • Pioneered the concept of “community empowerment” and “prevention centric genetic disorders management” • Support high risk community from step one till they receive appropriate medical care. • Offer free genetic screening and subsequent free counselling. • Representing UAE in leading global health awareness campaigns and alliances. • Established as a knowledge centre and hub between global and regional research and academic institutions.

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What about the latest developments in genetic science? To what extent will it contribute to the treatment of many genetically transmitted diseases? Gene mutation had Far reaching impact on human population in the history. Today, Science is capable of reversing DNA mutation in days. Scientists are Putting the Human Genome to Work & Using Genes to Treat Disease and three key ways the technology and science in leading the prevention and management of genetic disorders is : • Gene-transfer approach in which a wild-type copy of the mutated gene is delivered. • RNA modification therapy, in which the mRNA encoded by a mutant gene is targeted. • Stem cell therapy, in which human stem cells are used to repair disease-damaged tissue.

phenotype. CRISPR can be readily scaled up for genome-wide screening due to the broad range of potential target sequences and ease of generating gRNA-containing plasmids

Where is the importance of early diagnosis of hereditary diseases and pushing patients towards the adoption of the best means of care dedicated under the prevailing beliefs that this will not change anything in the course of the disease? Genetic disorders can be prevented through education, as education is the supreme key in order to manage genetic disorders. We strongly believe that prevention is the key to reduce the impact of genetic disorders, socially and economically, and it’s a long term sustainable solution, especially in a country like ours where close to 60 percent of population is under 30 years of age.

What is the new scientific research in the field of genetic diseases? And how this reflected on the course of treatments?

What do you say about the future of genetic diseases?

Scientists worldwide are discovering new use and potential of gene therapies. Two key examples are: 1. STEM Cell which is considered as frontiers of regenerative medicine as they have indefinite self-renewal and potential to differentiate into other types of cells. 2. Second is the potential of gene editing. The goal of a genome-wide screening experiment is to generate and screen a population of mutant cells to identify genes involved in a particular

The new and emerging sciences and research reflect the increasing scientific evidence supporting the health benefits of using genetic tests and family health history to guide clinical and public health interventions. The future of genetic disorders is centered around the prevention and preventive screening. Tens of thousands of genetic tests are currently in trial and also available, which have the potential to improve health in a variety of ways by informing health care through: Risk prediction, Prevention, Diagnosis, Treatment, including choice of medication and dosage and Prognosis.

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Hospitals should embrace cross-cultural understanding

major outcome of the dynamic medical tourism is seen with hospitals all over the world receiving many international patients from diverse cultural backgrounds. The trend is growing. This gives rise to an obvious question – Are the hospitals prepared well enough in understanding the cultural issues? To what extent are they successful in addressing varied issues of patients arising from cultural differences?

Deep-rooted cultural perceptions of patients influence their decision-making in medical treatment and adherence to it, which has a direct impact on the treatment outcome. Hospitals need to build cultural competence by broadening the capacity to provide effective medical care with appropriate knowledge, skills, attitude and behavior.

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Better cultural understanding – improved treatment outcomes: Patients seeking healthcare services abroad consider the ‘culture’ factor quite seriously. Will I be able to communicate my problems? Will the foreign hospital respect my cultural beliefs and values? These questions always work in their hindsight. It is,

therefore, an obvious outcome we see Brits preferring English speaking countries, Americans preferring Thailand or Mexico, Japanese traveling to Taiwan, Muslims preferring GCC region and Malaysia, the list is endless.

Research and studies showed better cultural understanding leads to:

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Improved patient-provider relationship. • Better diagnosis and treatment plans. • Lesser medical errors. • Enhanced patient experience. • Improved treatment outcomes. This is what matters most for globally reputed hospitals offering any kind of healthcare assistance.

Build cultural empathy: It implies seeing the world with the patient’s eyes. Empathy is not a mere act of kindness but is the central piece of healing. While cultural diversities will continue to shape the beliefs and practices of human beings, hospitals need to ingrain cultural empathy in its DNA. A study published by JAMA in 2011 reveals kindness, respect, empathy and privacy were in the highest priority list of international patients where real cost appeared at the bottom. Patients are eager to build a relationship with the provider on whom they have confidence and would prefer the same provider in future episodes of illness.

Identifying and addressing the barriers: Communication: Effective communication is the cornerstone of developing cultural empathy. Strong evidence-based studies conclude good communication skill is essential to deliver value-based patient-centric care. Multiple studies link good communication with better patient outcome. It reduces adverse events and shortens hospital stay.

For international patients, the inability to communicate properly is the first stumbling block. Certified medical interpreters do a praiseworthy job by not only translating the words of the patient but also his/her feelings. But there are more to be considered based on the patient’s perspective and his/her cultural background. How would you greet the international patient? Proper greeting sets the tune of communication. Hi, Hello may be the usual norm in western countries but not in Asia. A majority of international patients are comfortable with handshake but not all. Japanese are used to bowing although they accept shaking hands. Ethnic Chinese prefer a light handshake. All Asian women may not prefer handshake but prefer nodding, bowing or folding hands. Prolonged eye contact during communication is appreciated by the Americans, Australians and some Europeans, but the Chinese may take it as confrontational. Even using the left hand while giving or accepting something goes against the cultural etiquette of many countries. Next comes addressing the patient. Should you address the patient by his/her name? This might work fine with most of the US citizens but not with Europeans who prefer to be more formal. It is always safe to add prefix Mr./Mrs. while addressing the patient. Patients from the US, Australia, Europe and some Asian countries prefer free communication about the disease with the doctor but those from Russia and Islamic countries may not be comfortable with it. Russians are used to the parental approach in healthcare and expect the same in a

Dr Prem Jagyasi Dr Prem Jagyasi is an award-winning global speaker, renowned author and publisher. Dr Prem is also leading authority and influencer in Global Healthcare, Medical Tourism and Wellness Tourism. Thus far, Dr Prem has travelled to more than 65 countries to conduct workshops and addressed numerous international conferences. foreign hospital. They feel more comfortable if guided what is required to do. Japanese have high regard for doctors and seldom question their diagnosis and treatment plans but Americans prefer to go for the details. Female patients from the Islamic background may not be comfortable in discussing physical issues with the doctor. Male members, especially from African, Islamic and other Asian countries, may be more participative in discussing ailments on behalf of the female patient and take the lead in decision-making. Physicians need to be careful with word choice as names

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of specific body parts or disease may be considered offensive to patients of conservative background. It may be somewhat easier to build an effective communication channel with patients hailing from countries practicing cultural pluralism. Often, it is highly energy demanding for the doctors and patients to understand the requirements and remedies. Poor health literacy of international patients compounds the problem. Hospitals should be prepared enough to handle this sensitive area with care and kindness. Touch: Many instances support the fact physical touch by the doctor takes off the patient’s emotional load. A pat on the patient’s back during consultation accompanied by an amicable smile from the doctor signals everything will be fine. The historian and author of “In the Hands of Doctors: Touch and Trust in Medical Care” states that many patients feel the doctor’s physical touch helps in getting better. Considering the cultural diversities of international patients, this touch should be applied with great care without hurting anybody’s sentiments or modesty. For example, Islamic women especially those unmarried may not be comfortable with the touch during physical examination. Hospitals should take utmost care to this factor. Medical beliefs: Many ethnic groups rely on traditional medicine in most cases. Even though they seek advanced healthcare services, their traditional beliefs often create serious problems for physicians in delivering the

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right treatment and care. Japanese, Chinese and few African nationals are still inclined towards time-tested traditional form of treatments. It may be a trying time for the hospital to convince patients regarding the usefulness and dangerous aspect of certain therapies. Food habits: Food habits vary widely with culture. Certain food items may not be liked by people hailing from a specific cultural background. Hospitals and clinics need to make special culinary arrangements based on the cultural background of visiting patients. Hospitals of GCC region and South Asia catering to a large number of Muslim patients have special arrangements during the fasting months and other religious occasions. Serving halal meat is the norm. Pork and alcoholic beverages are strictly prohibited. Nursing and attendance: Patients from the Middle East, Turkey, African nations especially women from a conservative background are likely to prefer same-sex medical care and attendance. Hospitals need to make special arrangements for this. Privacy is a prime concern. So women may prefer covering themselves with a gown to prevent exposure of body parts during physical examination. Patients may ask for a religious ritual before a critical surgery which could be permitted under special consideration. Medication: Cultural difference can even influence the choice of medication. During the months of fasting, Muslim

patients from Middle East, Turkey and some South Asian countries may refuse oral medication. They might prefer IV drip. Since alcohol consumption is strictly prohibited in Islam, hospitals should take care not to prescribe medications with alcohol. In case of unavailability of any alternative, the patient should be explained properly. Maternity and female care: Female patients are naturally more sensitive about privacy and touch. It becomes mandatory the hospital to show sympathy and maintain comforting touch (even by same-sex physicians and attendants) during the physical examination especially in child delivery, mammogram tests and surgery in private parts of the body. In Islamic custom, the placenta after delivery should be handed over to the parents for proper disposal. Some cultures may require performing certain birth rituals before and after delivery. If these rituals pose health threats to the mother and the baby, it should be explained politely. Displaying cultural competence may not be confined within medical services. Many complaints and grievances of international patients are non-medical like those related to basic necessities. They expect proper arrangement for religious services, transportation, cell-phone connection, banking services, special accommodation for the accompanying members, shopping, dining and other entertainment activities. Hospitals offering medical assistance to this unique group of international patients must take this into account and carefully assess their ability to deliver empathetic care.

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Breastfeeding How to do it, when and how frequently?

he first step in breastfeeding is to look for the baby’s hunger cues. Babies usually turn their heads toward anything that brushes against their mouth or cheek (rooting) and they put their hands to their mouth and make sucking sounds; these are some of the examples of baby’s hunger cues according to March of Dimes. Don’t wait until the baby is crying. Once you see signs of hunger put them in a breastfeeding position where you find most comfortable and

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suitable for both of you. Next is to encourage and establish a good breastfeeding latch to ensure that the babies are getting enough milk and throughout the breastfeeding, it will not cause pain for you. Form your fingers in a V shape and hold your breast around (but not touching) the areola. To get a large mouthful of breast let the baby’s lower lip to be well below the nipple. A deep latch will help to make sure that the nipple is at baby’s soft palate at the back of the mouth instead of the baby’s hard palate toward the front, which can cause discomfort. If the baby’s hungry, feed him or as often as they want to eat. Frequent breastfeeding is important in establishing a good milk supply, usually 8-12 times per day. As for how long to breastfeed on each breast, every baby, and every feeding can be different.

Advantages of breastfeeding to the mother and baby Immediately right after giving birth, mothers are being encouraged to do breastfeeding because it releases the hormone oxytocin, which helps the uterus to return to its pre-pregnancy size and reduces uterine bleeding after birth; one of the major advantages of breastfeeding for the mothers. It helps to lose pregnancy weight faster as breastfeeding also burns calories. It lowers the risk of breast and ovarian cancer and also the risk of osteoporosis. It saves time and money. It also gives regular time to relax and bond with the newborn. As for the infants, breast milk provides them ideal nutrition which is composed of vitamins, proteins and fats needed for their growth that

is more easily digested than infant formula. They’ll gain the right amount of weight rather than becoming overweight. Antibodies are also produced in breast milk which helps fight off viruses and bacteria. It lowers the baby’s risk of having asthma or allergies. Exclusive breastfeeding for the first 6 months, without any infant formula, have fewer ear infections, respiratory illnesses, and bouts of diarrhea. They also have fewer hospitalizations and trips to the doctor. It also has been linked to higher IQ scores and plays a role in the prevention of SIDS (sudden infant death syndrome).

Role of Medical Staff to encourage breastfeeding The main role of medical staff is to provide information and health teachings to parents regarding the importance of breastfeeding. Medical staff will support exclusive breastfeeding by encouraging them to remain with their infant throughout the hospital stay unless medically contraindicated. They will educate mothers and assist them with techniques and different strategies in breastfeeding to establish proper feeding to infants. Through adequate learning, mothers will be encouraged and will be more confident to do breastfeeding.

Commonly faced problems of breastfeeding and how to treat Low supply of breast milk is one of the most common problems of breastfeeding. By frequent breastfeeding on both sides of the breast and pumping during the day helps boost milk supply. Also, find time to take rest when the baby is sleeping, drink enough fluids and eat a well-balanced diet.

Faten Jabnouni Midwife at Al Ahli Hospital Second is painful latching. For the first attempt at breastfeeding, others may feel pain, but it doesn’t mean that what you are doing is wrong. Some needs adjustment period to toughen up the nipple before the pain-free feeding comes in but if it lasts for more than a minute or two try to reposition and latch the baby in a more comfortable position for the both of you. And if you still feel discomfort even with a good position, you may have other problems such cracked nipples, plugged or clogged ducts and painful engorgement. Wear a loose bra and do not use soap or alcohol in cleaning the breast to prevent cracked nipples. Apply warm compress before nursing which can help open the ducts and relieve pain and swelling. Do not stop breastfeeding (even on the affected side).

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Tinnitus TINNITUS IS DEFINED AS SENSATIONS OR PERCEPTION OF SOUND OR NOISE IN THE ABSENCE OF REAL ACOUSTIC STIMULATION.

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It affects 10%- 15% of the general population worldwide (This is an estimated 280 million subjects). Tinnitus limits daily living in 1%-2% of people. The tinnitus risk factors are hearing impairment, increasing age, gender (male more affected than females), exposure to noise.80% of people don’t seek help. 6-8% of those affected are severe. 40% of patients experience depression.

Characteristics Tinnitus may be sudden, intermittent, or persistent as ringing, whistling, roaring, buzzing affecting one ear or both ears, sometimes patient Said that all over the head, it can have presented as pure-tone, noise either low, mid or high frequency.

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Treatment Basic Counselling: • •

Evaluation of Tinnitus •

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History: Duration, nature, effects, Noise exposure, Other ear symptoms Ear examination: Rule out outer/middle ear disease. Audiological tests. Audiogram, tympanogram, Specialized hearing tests: Tinnitus

Reassurance: The first step is to understand the problem. Explain about the mechanism of tinnitus, avoiding silence.

Tinnitus Masking Device •

Combination of hearing aid and tinnitus masker devices.

Tinnitus Retraining Therapy •

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Causes of tinnitus: a- Causes affecting ear: Wax, otitis externa and chronic otitis media, otosclerosis, Meniere’s disease and ototoxic drugs. b- Central causes: Multiple sclerosis, tumors. c- Systemic: Hypertension and Diabetes, Vitamin deficiency, Anemia. • The pathophysiology of tinnitus is not well understood. • Range of theories from loss of outer hair cell functions. • Increased spontaneous activity of central auditory nerves due to loss of neurons.

pitch and loudness matching, OAE’s, ECochG, ABR MRI

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That a person can habituate to acoustic noise in the environment. Involves wearing ear noise generator, table top generator May take several months to take effect (Minimum 12 months)

Psychological therapy Teaching the patient to ignore the tinnitus noise: this is combined with deep relaxation exercises and stress management. The objective is the elimination of the patient’s anxiety, so that the tinnitus is no longer perceived as a danger, thus diverting the concentration away from the tinnitus noise. The end goal is complete habituation of the noise.

Dr. Hanaa Hussein El- Sanadiki Consultant Audio Vestibular Medicine at Al Ahli Hospital lation and improves metabolism. Have shown results of improvement in some patients with tinnitus.

Transcranial Magnetic Stimulation •

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Conclusion • •

Alternative Therapies • • •

Vitamins: B1, B3, B6, B12, zinc, calcium, Mg Laser Therapy Tinnitool - uses laser beam, which penetrates in to the deeper subcutaneous layers and works as a bio-stimulation directly on the blood circu-

Identify active areas with PET (Positron Emission Tomography) Apply magnetic stimulation, Evidence in small trials showed that there is some reduction in the effect of tinnitus. More detailed research still ongoing.

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Tinnitus is a common condition Main role is to exclude major illness and co-ordinate further treatment Basic advice and counseling plays a major part in improvement of condition. More severe cases may require psychological support, masking devices or Tinnitus Retraining Therapy.

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Kuwait’s participation in China forum strengthen ties

Kuwait’s Health Minister

Sheikh Dr Basel Al-Humoud Al-Sabah

uwait’s Health Minister Sheikh Dr Basel Al-Humoud Al-Sabah, representing State of Kuwait at second meeting of the Chinese-Arab health forum, said the Kuwaiti participation crowned the 2018 State visit to China by His Highness the Amir Sheikh Sabah Al-Ahmad Al-Jaber Al-Sabah. Addressing the meeting, the minister affirmed that the Kuwaiti involvement in the event emanated from the solid ties between the two countries, noting that His Highness Sheikh Sabah Al-Ahmad Al-Jaber Al-Sabah’s visit to Beijing last year resulted in elevating level of the relations between the two friendly countries, turning them into a comprehensive, strategic relationship. He expressed gratitude to all

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personnel who played a role in organizing this major forum for the second time, noting that it constituted a good result of the constructive cooperation between the Council of Arab Health Ministers and China.

THE MINISTER AFFIRMED THAT THE KUWAITI INVOLVEMENT IN THE EVENT EMANATED FROM THE SOLID TIES BETWEEN THE TWO COUNTRIES, NOTING THAT HIS HIGHNESS SHEIKH SABAH AL-AHMAD AL-JABER ALSABAH’S VISIT TO BEIJING LAST YEAR RESULTED IN ELEVATING LEVEL OF THE RELATIONS BETWEEN THE TWO FRIENDLY COUNTRIES, TURNING THEM INTO A COMPREHENSIVE, STRATEGIC RELATIONSHIP

Such a relationship is a framework for exchanging views, expertise, policies and programs between the two sides’ health leaders for facing challenges and attaining the international goal for sustainable development, 2030, with respect of the sector in particular, Sheikh Dr Basel added. The “Beijing Declaration,” expected to be publicized at end of the meetings, will open a new chapter in the relations between the two sides for bolstering health cooperation, he added further. The State of Kuwait is participating in the meeting with a delegation from the Ministry of Health headed by Sheikh Dr Basel. It includes the State of Kuwait Ambassador to China Sameeh Hayat. Also addressing the gathering, Ambassador Haifa Abu Ghazala, the Arab League assistant general secretary for social affairs, indicated that the conferees would address a host of issues, namely health policies, pharmaceutical industries, conventional medicine, public health, training cadres, producing vaccines and serums. Meanwhile, Chinese Minister of Health Ma Xiaowei urged for pressing ahead with building “the silk road” in the health sector, noting that Beijing had inked 12 memoranda of understanding in the health field with Arab states, also indicating that the cooperation had resulted in executing a number of cooperation ventures in sectors of prevention from epidemics, building public health facilities, mother and child health care and conventional medicine. He called for enhancing the Arab-Chinese cooperation at this level.

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