HOSPITALS Magazine issue 52

Issue 52 / 164 MAY-JUNE 2020

THE ARAB HOSPITAL APPLICATION IS AVAILABLE

CONCERTED EFFORT IS REQUIRED TO DEFEAT CORONAVIRUS Field hospitals in ďŹ ght against covid-19

Chronic Diseases and Coronavirus

Thalassemia: A Chronic Non-Infectious Blood Disease

Hypothyroidism vs.

Hyperthyroidism

Cardiac ablation treating heart rhythm problems

Diabetes is number one cause of chronic kidney disease

Publisher Arab Health Media Communication

Medical Studies Scientific Value Vs. Common Misconceptions Medical and scientific studies are usually common and basically of great value and benefit. With the spread of the Covid-19 pandemic and the fact that the process of obtaining and approving a vaccine is necessarily time-consuming, several scientific studies have emerged in this field. However, scientific truth and misconceptions have been mixed as usual.

According to many researchers and medicals, these studies have a fundamental role in medicine advancement and community education. However, we have to guard against two things. First, the fake news published as “studies” – the term used quite liberally to create the illusion they offer genuine scientific merit - which misleads some. Second, the theoretical studies that cannot be applied in practice and lose their value even if they appear credible.

Therefore, the type of study that can best answer the research questions must be chosen. However, it should be noted that even if the medical study is correct and reliable, it remains a study. This means that no therapeutic decisions are made upon it. Dozens of studies usually must be conducted before a medical institution such as the WHO issues an official recommendation.

In this context, researchers say that a medical study is a scientific practice that has specific disciplines and aims at obtaining information about medical practice, diagnosis, treatment, and medical, pharmaceutical, and related sciences.

It contributes to understanding a specific disease or testing a behavioral therapy or a medical treatment.

Hence, we must differentiate between a study that required the effort and time of the researchers, provided humanity with an added value that contributes to its progress, and therefore deserves recognition, and inaccurate news that are published for commercial purposes and far from science and humanity. This is the responsibility of all of us and the goal of our permanent endeavor for the good of humanity, the value of medicine, and the rights of the researchers.

General Manager Simon Chammas schammas@tahmag.com Creative Department Roula Haddad - Georges Habka Creative Director: Jessy E. Hajj Photographer Hanna Nehme Copy Editor Jessica Achkar Editors Aline Debes, Mark Steven, Don Karn, Andrew Weichert, Colette Semaan, Abbas Moussa Advertising & Marketing advertising@tahmag.com Mirna Khayrallah mirna@tahmag.com Business Development Manager Ralph Rahal tahmag@tahmag.com Offices & Adresses AHMC, Lebanon Mansourieh High way, Jihad Wakim center, 3rd floor.

T/F: +961 4 53 40 58 M: +961 3 60 61 00 tahmag@tahmag.com Simon Chammas schammas@tahmag.com Dubai Schammas@tahmag.com +967 50 2971007 KSA Elias Aramouni Business Dot Sulaimaniah Offices building • 2nd flr M: +966 55 1595 000 T: +966 11 4568282 F: +966 11 2253666 P.O. Box: 085092 Riyadh 11691 Printing

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

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

3

MAY . JUNE 2020

32 Field Hospitals facing coronavirus

NEWS

8 Department of Health: Abu Dhabi further strengthens response to COVID-19 through Malaffi 12 UAE joins a joint ministerial statement to ensure continuity of global supply chains 14 SEHA Completes Over 28,000 Virtual Consultations 16 7th Emirates Physiotherapy Conference Goes Virtual 20 Abbott Announces CE Mark and Immediate Availability of its COVID-19 Laboratory-Based Antibody Test in UAE 24 Julphar appoints new CEO to drive operational transformation and fuel growth 26 First mobile center for people of determination and hearing impaired launched in UAE 28 COVID-19 Data Exchange to Curb the Virus’ Propagation and Limit its Economic Impact 30 WCM-Q students learning lessons of Covid-19 outbreak with MOPH 88 Omnicell introduces New Rapid Pandemic Response Scheme to support partners in the Middle East in fight against COVID19

MAY.JUNE 2020

4

89 IHF boosts knowledge-based defense against COVID-19 90 medis medical imaging systems acquires amid and secures further investment from van herk ventures 92 Everything You Need to Know About Diabetic Retinopathy 94 AbbVie Completes Transformative Acquisition of Allergan 96 5 percent of people over 60 and 15 percent of people over 75 years of age suffer from aortic stenosis 98 American hospital Cleveland Clinic and SAS share COVID-19 predictive models to help hospitals around the world plan

INTERVIEWS

32 Mr. Sami Rizk 36 Nurgul Vatansever 46 Alaa Adel 46 Dr Mohamed AlRayyes 58 Jeffrey R. Leonard 80 Sultana Afdhal

XN-31 Be confident fighting malaria

Results you can rely on – reliable and objective malaria information using the technology of fluorescence flow cytometry Results from 1 mL blood or less without sample pretreatment Enhance and standardise your malaria testing ✔ Fast with 24/7 availability ✔ Quality of result independent of the skills of the operator

www.sysmex-mea.com

MAY . JUNE 2020

64 Diabetic Kidney Disease

ARTICLES

68 Thyroid Disorders

84 Implantation of a device that changed the life

40 How does coronavirus affect patients with heart diseases?

42 How does Coronavirus affect cancer patients?

44 HDF Crisis Management in the Face of COVID-19 60 Coronavirus: What People with Cancer Should Know 62 Coming out of COVID-19: The Impact on Healthcare Tech 82 Healthcare Workers Beware of Coronavirus Encephalopathy 83 The Pulmonary and Chest Department at Al-Ahli Hospital succeeds in returning a woman to her normal life

72 Thalassemia MAY.JUNE 2020

6

of a patient with severe heart failure in Al-Ahli Hospital (April 2020) 86 COVID-19 and Diabetes-Obesity: What to do?

FEATURES

50 Field hospitals in fight against covid-19 54 Chronic Diseases and Coronavirus 64 Diabetic Kidney Disease 68 Thyroid Disorders 72 Thalassemia 76 Cardiac Ablation

76 Cardiac Ablation

MASTER EXÉCUTIF EN MANAGEMENT DE LA SANTÉ INSCRIPTIONS EN COURS

Un programme qui vous permet de faire face aux nouveaux défis de l’environnement de la santé au Liban et au Moyen-Orient.

Le Master Exécutif en Management de la Santé de l’ESA : le programme idéal pour aider les auditeurs à maîtriser le langage et les outils du management des milieux de la Santé.

Programme intégralement animé par les meilleurs experts internationaux du secteur de la santé.

Le MEMS a pour objectif de :

2 DIPLÔMES : • Le Master Exécutif en Management de la Santé de l’ESA • L’AMES “Analyse et Management des Établissements de Santé” de l’EHESP et Paris 7 Denis Diderot, diplôme d’État.

• Vous permettre de comprendre votre environnement • Vous donner les outils nécessaires pour un management des ressources humaines ciblé et efficace • Vous donner une connaissance en management de projets afin de conduire des projets de dimension stratégique

Formation en 16 mois

En partenariat avec

LEADERS DE DEMAIN

BBA

YOUTUBE LOGO SPECS

7460

576

568

5405

471

7581

289 rue Clemenceau, Beyrouth, Liban, T +961 1 373 373 ext.1126 E masters@esa.edu.lb

186

7654

325 PRINT main red

gradient bottom

C0 M96 Y90 K2

C13 M96 Y81 K54

white

black

C0 M0 Y0 K0

C100 M100 Y100 K100

PMS 1795C

WHITE

7657 on light backgrounds

7622

on dark backgrounds

standard

standard

no gradients

no gradients

watermark

watermark

www.esa.edu.lb

PMS 1815C

BLACK

NEWS

Department of Health: Abu Dhabi further strengthens response to COVID-19 through Malaffi

I

n an effort to further reinforce the response to COVID-19, and under the direction of the Department of Health – Abu Dhabi (DOH), Malaffi, the region’s first Health Information Exchange (HIE) platform, has announced the urgent release of two solutions, to provide urgent extended access to Malaffi and a centralised database of all COVID-19 testing results in real-time. These solutions empower the Abu Dhabi healthcare sector and the healthcare providers to make more accurate, efficient and safer decisions during the current pandemic.

Malaffi’s extended solution offers urgent access to the Abu Dhabi providers that are not yet connected to Malaffi and are part of Abu

MAY.JUNE 2020

8

Dhabi’s COVID-19 response. This allows front-line workers to consult their patients using real-time test results and relevant information from the medical history of the patient, helping with the assessment of the risk level for those patients and the making of further appropriate decisions for their care. As a result, doctors, nurses and healthcare professionals can take necessary first-response decisions, such as the need for patient isolation or hospitalisation, quicker and more effectively. Malaffi’s centralised database of COVID-19 test results from all Abu Dhabi testing sites, available in real-time as data is recorded, helps the DOH strengthen its COVID-19 response by identifying and tracing the newly diagnosed cases. The solution facilitates well-founded pan-

MALAFFI PROVIDES THE DOH WITH A CENTRALISED DATABASE OF REALTIME COVID-19 TEST RESULTS FROM ALL COVID-19 TESTING SITES IN ABU DHABI.

NEWS

spread of the virus and empower the front-line healthcare workers with clinical information to make safer and more efficient decisions.” “By centralising all COVID-19 testing results from all testing sites in Abu Dhabi, through Malaffi, the DOH now has access to accurate and real-time key pandemics indicators. Having access to this information is most important in such situations as it enables us to assess and better plan the testing and healthcare capacities and coordinate the distribution of the response resources in the Emirate.” Al Kaabi added.

Mr. Atif Al Braiki, Chief Executive Officer of Abu Dhabi Health Data Services, said: “During these unprecedented times, we recognise the need of having connected healthcare now, more than ever before. As many countries are working to consolidate pandemics-related data, owing to Abu Dhabi’s visionary leadership, by further integrating clinical sources and centralising information in Malaffi, we are well-founded to support a data-driven public health response.”

demic clinical decisions and allows policymakers to more efficiently allocate resources for better capacity utilisation and optimise planning and care coordination in the Emirate.

Commenting on the new developments, H.E Dr. Jamal Mohammed Al Kaabi, Acting Undersecretary of the Department of Health – Abu Dhabi, said: “Further to its efforts to ensuring ample testing capacities, as the first-line response to overcome the COVID-19 pandemic, the DOH is committed to enabling comprehensive digital solutions to ensure the health and safety of everyone in our society. Building on the existing advanced digital centralised information platform, Malaffi, we can have full visibility of the

Commenting on how Malaffi is helping UEMedical triage COVID-19 patients, Majd Abu Zant, Chief Operating Officer at UEMedical said: “Access to COVID-19 results and patients’ medical history through Malaffi is a great advantage for all connected providers. Checking the Malaffi file for testing results is now part of the routine triage and assessment process at UEMedical facilities. Having a record of testing results of the patient helps us understand the epidemiological circumstances and make further decisions.

Through Malaffi, we are able to report test results securely (in addition to reporting to various regulatory and governmental bodies) in order to ensure that the results are readily, and promptly available to other healthcare providers.”

UNDER ON THE DIRECTION OF THE DEPARTMENT OF HEALTH – ABU DHABI (DOH), PROVIDERS AT THE FRONT-LINE OF THE COVID 19 FIGHT ARE GRANTED URGENT EXTENDED ACCESS TO PATIENTS’ COVID-19 TEST RESULTS AND THEIR MEDICAL HISTORY.

Created in partnership between the Department of Health – Abu Dhabi (DOH) and Injazat Data Systems, and launched in 2019, Malaffi’s portal for medical providers now has 450+ connected facilities and is available to over 20,000 users in Abu Dhabi containing 53 million unique clinical records for more than 3 million patients.

Eventually, all 2,000 public and private healthcare providers in the Emirate will be connected.

9

NEWS

FAQs on the Latest COVID-19 Developments in Layman’s Terms

W

hile the world has accepted the harsh realities of COVID-19 and people have adjusted their lives accordingly, there are still have so many unanswered questions, such as why has COVID-19 taken such a detrimental toll and where are we in the process of finding a cure? To get a better idea of where science is headed, below are some easy-to-understand insights from Serpil Erzurum, MD, Chair of the Lerner Research Institute at Cleveland Clinic in the US.

Dr Serpi Erzurum

THERE ARE SO MANY NEW TECHNOLOGIES NOW THAT ARE USING THIS TYPE OF STRATEGY. MANY STUDIES ARE ALREADY IN PHASE ONE AND SOME ARE EVEN ENTERING PHASE TWO AND PHASE THREE. PHASE THREE MEANS LARGE STUDIES AND QUICKER PATHS TO HAVING SOMETHING AVAILABLE FOR OUR COMMUNITY.

Q: How is COVID-19 different from viruses like Ebola, H1N1 (swine flu) or SARS? These viruses are similar because they are encoded with Ribonucleic acid or RNA. They all infect the human host, but the difference between them and COVID-19 is this coronavirus is infectious before you become sick. It is infectious while you look very healthy and that is a very big difference.

Q: If you’ve been infected with the coronavirus, can you become infected again?

This virus is very similar to the first SARS virus where immunity was very effective.

Current data suggests that immunity occurs in people who have had the virus and that is effective for preventing them from getting infected again. The best evidence that we do have for effective immunity is the fact that we can take plasma from an individual who was infected, transfer that immunity passively to somebody who does have the infection, and it helps them recover. All those things strongly

MAY.JUNE 2020

10

support that immunity does develop and is effective at neutralizing the virus.

Q: Why is COVID-19 antibody testing not the norm?

The problem is that there are a lot of coronaviruses - for example, the common cold is a coronavirus. Immune testing to diagnose COVID-19 is difficult to do because if you have had a common cold a few weeks before and we tested your body, it would look like you have immunity to coronavirus, but not necessarily to COVID-19, and not necessarily that you are protected from catching it. It would be a false reassurance to do immunoglobulin testing as a diagnostic strategy.

Q: When do you think that we can expect to have a vaccine for COVID-19?

The usual strategy for making a vaccine is that you take the live virus, inject it into chicken eggs, allow the virus to grow, and then you deactivate it and inject that into people so immunity develops. When the real virus comes along, you are protected. That process can take 12 to 18 months. However, there are new strategies where we do not have to grow the virus.

Instead, we can take the nuclear material that encodes part of the virus (the surface proteins) and inject them into the body. The body will recognize it as being foreign, antibodies will develop and attack the surface proteins, so they go away. Now, if the virus enters your body, your body remembers those proteins and the antibodies come and destroy the virus.

NEWS

UAE joins a joint ministerial statement to ensure continuity of global supply chains 10 countries from across the world accede to the joint ministerial statement and sea freight operations, open in order to facilitate the flow of goods, including essential items.

T

he UAE has joined a joint ministerial statement issued by several countries around the world, expressing their commitment to keeping the supply chains open in the face of the COVID-19 pandemic. The initiative by New Zealand and Singapore stipulates that the signatory countries pledge their commitment to ensuring the continuity and interconnectivity of supply chains during the pandemic crisis and intensify joint efforts and coordination to identify and remove trade restrictive measures that negatively impact the movement of necessary goods.

AL MANSOORI: STATEMENT STRENGTHENS JOINT REGIONAL & GLOBAL EFFORTS TO FACILITATE MOVEMENT OF TRADE & OTHER NECESSARY GOODS ACROSS BORDERS.

The signatories further emphasized the importance of refraining from imposing controls that hinder exports or applying tariff or non-tariff barriers to trade and removing any existing measures that restrict the supply of basic commodities, especially medical supplies during the ongoing crisis. The signatory states further indicated that they will work with various other countries of the world that share their interests to ensure the continuity of trade without obstacles and to maintain the vital infrastructure of trade to support the continuity, safety and interconnectivity of supply chains at global level.

Commenting on the statement, H.E. Al Mansoori said that the UAE has strengthened dialogue with trade partners and has sent clear messages regarding its commitment to supporting international trade and ensure the continuity of the flow of goods and services between countries, as a lifeline to address the needs of people in various parts of the world and as an engine that drives economic recovery.

H.E. Eng. Sultan bin Saeed Al Mansoori, UAE Minister of Economy, in a letter to his counterpart David Parker, Minister for Trade and Export Growth, New Zealand, confirmed that the government of the UAE joins and endorses the ministerial statement, based on its belief in the need to strengthen joint efforts at regional and global levels to facilitate the movement of trade and the continuity of cross border trade will increase the ability of the UAE and its external partners to cope with the pandemic crisis, while also maintaining vital economic cooperation channels open.

H.E added: "The UAE has always proven its prominent and vital position in the global trade arena. We will continue our efforts to ensure the flow of necessary supplies and the integrity of supply chains by supporting the continuity of operational logistical networks, and by maintaining air, land and sea shipping routes. There is no doubt that the country’s accession to this joint statement, which includes countries from many continents of the world, is consistent with our vision and leading policies to support the movement of trade and its continued growth. "

The signatory countries affirmed through the joint ministerial statement that, out of their keenness to achieve their shared interests, they will work to keep the trade lines, including air

Apart from New Zealand and Singapore, the signatories of the statement, alongside the UAE, include Australia, Brunei, Canada, Chile, Laos, Myanmar and Uruguay to date.

MAY.JUNE 2020

12

An upstart on the global stage.

A consistent leader in the U.S. Here in Columbus, Ohio, we have it all: world-class cultural attractions, cuisine and pediatric specialty care that makes us a leading destination for patients from around the world. From advanced, minimally invasive neurosurgical procedures to the most complex, life-changing craniofacial reconstructions, our surgical and medical experts run internationally recognized programs. Add that to our novel therapies for pediatric cancers and our renowned gene therapy research — aimed at making neuromuscular disorders a thing of the past — and it’s clear that our commitment to innovative clinical research makes an unmistakable impact on care quality.

Reach out to our Global Patient Services team to learn more about our unique combination of a welcoming city and remarkable care.

Learn more, refer a patient or plan a trip: NationwideChildrens.org/Global-Patient-Services GlobalPatientServices@NationwideChildrens.org +1 614 362 9127 Nationwide Children’s Hospital, Columbus, Ohio - USA

W174546

AMERICA’S SECOND

LARGEST CHILDREN’S HOSPITAL

* Based on CHA survey of utilization and financial indicators

NEWS

SEHA Completes Over 28,000 Virtual Consultations The new Telemedicine Virtual Outpatient Clinic ensures continuity of treatment as the community observes social distancing a telemedicine consultation appointment, they will receive a call from the physician’s office to confirm patient details. The call will then be patched through to the physician or healthcare professional for the confidential consultation session. Once the call is complete, the patient will be able to access the consultation report through the SEHA app as per the normal process. If any medication is prescribed, it will be delivered via SEHA’s recently launched Medication Home Delivery service.

A

bu Dhabi Health Services Company (SEHA), the UAE’s largest healthcare network, has completed over 28,000 telemedicine virtual consultations within the first month of launch.

The Telemedicine Virtual Outpatient Clinic, which launched in March, was introduced in collaboration with the Department of Health – Abu Dhabi as a simple yet critical initiative to manage and minimize outpatient visitation to healthcare facilities, ensuring the community’s safety and seamless continuation of care as the nation combats the COVID-19 pandemic. It is a permanent service that will be available even after the end of the pandemic.

Outpatients who seek medical advice from facilities within the SEHA network are encouraged to consult their regular healthcare professional over the phone to ensure seamless continuation of treatment. New and existing patients can avail of this service by booking an appointment with the SEHA Call Center on 800 50. SEHA continues to work closely with long-term patients, including pregnant women, dialysis or oncology patients, to continue their treatment safely.

As the backbone of the healthcare system in Abu Dhabi with a legacy of advancing the Emirate’s medical sector, the government has empowered SEHA to deliver world-class healthcare facilities and services. As part of the initiative, once a patient is scheduled for and consents to

MAY.JUNE 2020

14

AS THE BACKBONE OF THE HEALTHCARE SYSTEM IN ABU DHABI WITH A LEGACY OF ADVANCING THE EMIRATE’S MEDICAL SECTOR, THE GOVERNMENT HAS EMPOWERED SEHA TO DELIVER WORLD-CLASS HEALTHCARE FACILITIES AND SERVICES.

Rashed Saif Al Qubaisi, Group Deputy Chief Executive Officer, SEHA, said: “As the COVID-19 situation continues to evolve, we are actively looking at new and innovative ways to continue catering to the community’s healthcare needs.

With the recent advancements in technology and medical innovation, the opportunities for technological solutions to efficiently care for our patients remotely during this time are endless. Staying indoors and practicing social distancing is paramount to the country’s response in fighting the pandemic and the Telemedicine Virtual Outpatient Clinic service has enabled our patients to continue caring for their health and regularly touch-base with their physicians, but from the safety of their homes.”

SEHA will continue to accept emergency and urgent care patients across its network of facilities. Additionally, SEHA has introduced other strategic initiatives to combat the COVID-19 outbreak, including designating Al Rahba Hospital and Al Ain Hospital as facilities exclusively treating coronavirus and quarantine patients, establishing 14 drive-through testing facilities nationwide that have seen over 32,000 visitors to-date, introducing a dedicated WhatsApp hotline to respond to the community’s coronavirus-related concerns and questions, and easy access to medication by launching a medication home delivery service that has delivered over 3,500 prescriptions to patient homes, with additional deliveries to patients’ cars at Sheikh Khalifa Medical City.

Nationally Ranked Cancer Care When it comes to overcoming cancer, it's more than offering new hope through discovery. It’s about providing the highest possible level of care as the clinical home for the Dan L Duncan Comprehensive Cancer Center at Baylor College of Medicine, one of only three NCI-designated Comprehensive Cancer Centers in Texas. It’s about giving patients access to the largest clinical genetics program in the United States. It’s about giving our patients, their families, and the community more.

StLukesInternational.org international@stlukeshealth.org Tel: +1 832-355-3350 Texas Medical Center, Houston, Texas – U.S.A.

NEWS

7th Emirates Physiotherapy Conference Goes Virtual

Amal Alshamlan

Abdullah bin Souqat

U

nder the patronage of H.H. Sheikh Hamdan Bin Rashid Al Maktoum, Deputy Ruler of Dubai, UAE Minister of Finance and President of Dubai Health Authority, the 7th Emirates Physiotherapy Conference will go Virtual from 12 – 13th June 2020.

Due to the growing concern around the coronavirus outbreak (COVID-19), and in alignment with best practices laid out by the Health Ministry of UAE, World Health Organization, and other relevant entities, the organising committee of Physio 2020 conference has decided to run the event as a virtual event.

Amal Alshamlan, the President of the Emirates Physiotherapy Society, and Chairman of the Conference, said “ As we stand united against the ongoing distress caused by coronavirus COVID-19, we have decided to reinvent the physiotherapy conference as a virtual event using the latest technology platform. The Physio UAE 2020 virtual conference & exhibition will continue to present the latest outcomes in the field of musculoskeletal physiotherapy delivered by world-class speakers, researchers and clinicians. She further added: “While many educational events got cancelled due to COVID19, we wanted to lead by example with a cutting-edge alternative to keep the action going. During these testing times, it is more important than

MAY.JUNE 2020

16

ever to learn from and network with like-minded peers. With a fantastic line up of international and regional speakers, we’re encouraging our colleagues to get signed up and join us for this unmissable virtual conference.”

His Excellency Abdullah bin Souqat, Executive Director of the Sheikh Hamdan Bin Rashid Al Maktoum Award for Medical Sciences, expressed his happiness to restart the activities of the 7th Emirates Physiotherapy Conference as a virtual event. He emphasized the Award continuing support for this special event in such critical times to continue to achieve the goals of the Award for the advancement of scientific research and developments of the health sector locally and globally. He also extended his sincere thanks and gratitude to His Highness Sheikh Hamdan Bin Rashid Al Maktoum for his permanent support to all scientific events that help contribute to finding the best solutions to current health issues.

Phyiso 2020 will run for two days for healthcare professionals to discuss the ever-evolving field of physiotherapy and rehabilitation.

Delegates and speakers will be assigned an online profile upon registration and available for contact, with meetings held via voice or video call through the event’s platform, harnessing the very latest in networking tools.

THE LIVE ONLINE CONFERENCE WILL HAVE THE SAME CONTENT AS THE IN-PERSON VERSION. SAME AGENDA WILL BE MAINTAINED, INVOLVING THE SAME COURSE TOPICS TAUGHT ON EACH DAY AS ORIGINALLY PLANNED, WITH MINOR ADJUSTMENTS TO THE SCHEDULE. PARTICIPANTS WILL ALSO HAVE THE LUXURY TO GET FULL ACCESS TO RECORDINGS OF EVERY SESSION EVEN AFTER THE CONFERENCE.

Artificial Intelligence Topics of the 11th Term for Sheikh Hamdan Bin Rashid Al Maktoum Award for Medical Sciences

Since its establishment in 1999, the Sheikh Hamdan Bin Rashid Al Maktoum Award for Medical Sciences has been a significant and creative initiative in establishing the principles of excellence and supporting communication between academic and health institutions in the public and private sectors.

His Highness Sheikh Hamdan bin Rashid Al Maktoum, Deputy Ruler of Dubai and Minister of Finance, the patron of the Award, has always envisioned upgrading medical services systems at the local, regional and international levels, adopting the excellent world-class standards.

This vision is reflected in the Award’s role in shedding light on innovative and breakthrough concepts, in line with the UAE strategic plans for continuously developing the health sector and fostering the latest technologies, such as Artificial intelligence in diagnosis and treatment. Hence, Artificial intelligence in Healthcare was chosen as the topic of the eleventh term, in collaboration with the UAE National Program for Artificial Intelligence.

Grand Hamdan International Award (AI in Healthcare) Artificial intelligence is making a quantum leap in the decision-making process in the health sector, and it is

expected that applications of artificial intelligence will reduce the financial burden of treating diseases.

Hamdan Award for Medical Research Excellence: (Artificial Intelligence in Genomics) The efficiency of AI applications relies on the increase in databases volume. However, such data is difficult to access due to privacy concerns. Scientists and regulatory bodies are working on addressing these challenges.

AI in Diagnostics Nowadays, the predictions of machine learning models can be used to support the diagnostic decision-making process of clinicians.

AI in Therapeutics AI supports the development of new drugs, assists in identifying the patients for clinical trials and increase clinical success by matching drugs to the right patient.

The aim of adopting artificial intelligence technology in healthcare is to enable doctors to make more accurate and prompt decisions to serve their patients.

The health authorities had recognized this reality early enough. They worked hard to introduce modern technologies to improve healthcare services.

Grand Hamdan International Award

Artificial Intelligence in Healthcare

AWARD TOPICS

Artificial Intelligence in Genomics

2019 - 2020

Artificial Intelligence in Diagnostics

Hamdan Award for Medical Research Excellence

Artificial Intelligence in Therapeutics

The United Arab Emirates, approach in stimulating innovation has succeeded in creating a fertile environment for excellence and prosperity for its citizens in all fields. This approach culminated in making the country a hub for innovative ideas and bright minds launching UAE world ranking in a record time exceeding all expectations.

Indeed, this is not peculiar to our government as throughout this challenging era that is replete of accomplishments, the medical sector has been a top priority in UAE

The Dubai International Conference for Medical Sciences

The conference will be organized in late 2020, and will discuss Artificial intelligence in Healthcare with a focus on Genomics, Therapeutics and Diagnostics. The chosen topic is aligned with the UAE strategy and will focus on the best practices in AI. Hopefully, the conference’s modules will participate in the efforts to regulate or a minimum to put the appropriate road map for the field in UAE.

HE Abdul Rahman Al Owais

Minister of Health & Prevention Chairman of the Board of Trustees

18

NEWS

Abbott Announces CE Mark and Immediate Availability of its COVID-19 Laboratory-Based Antibody Test in UAE New antibody blood test will run on Abbott's ARCHITECT® i1000SR and i2000SR laboratory instruments and will expand to its Alinity™ i system

A

bbott announced it received CE Mark to the IVD Directive (98/79/EC) for its laboratory-based serology blood test for the detection of the antibody, IgG, that identifies if a person has had the novel coronavirus (COVID-19). Antibody testing is an important next step to tell if someone has been previously infected. It will provide more understanding of the virus including how long antibodies stay in the body and if they provide immunity. This type of knowledge could help support the development of treatments and vaccines.

"Abbott has been singularly focused on bringing COVID-19 tests to market as quickly as possible to help address this pandemic," said Mohammad Aburub, Managing Director of Abbott’s diagnostics business in Gulf & Levant. "We are proud to be providing our antibody tests immediately as they will help understand who has had the virus, leading to greater confidence as we get back to living life."

Antibody tests to expand testing While molecular testing detects whether someone has the virus, antibody tests determine if someone was infected. Abbott's SARS-CoV-2 IgG test identifies the IgG antibody, which is a protein that the body produces in the late stages of infection and may remain up to months and possibly years after a person has recovered. The

MAY.JUNE 2020

20

ABBOTT IS ALREADY PROVIDING ITS COVID-19 MOLECULAR TEST FOR ITS M2000™ INSTRUMENT.

test demonstrated specificity and sensitivity to detect IgG antibodies of greater than 99 percent 14 days or more after symptoms started. Abbott's IgG antibody test will initially be available on its ARCHITECT® i1000SR and i2000SR laboratory instruments.* ARCHITECT is one of the most widely used laboratory systems in the world and it's been used for decades. Hundreds of these instruments are in use in laboratories throughout UAE. These instruments can run up to 100-200 tests per hour. Abbott is significantly scaling up its European manufacturing for antibody testing and will expand testing to its Alinity™ i system.

Abbott will also be expanding its laboratory antibody testing to the detection of the antibody, IgM, in the near future.

About Abbott's Diagnostics Leadership Abbott has long been a global leader in infectious disease testing, including the development of the first HIV test. The company created a Global Surveillance Program 25 years ago to monitor HIV and hepatitis viruses and identify mutations to ensure the company's tests remain up to date. Abbott also has a long-standing discovery program that identifies new or unknown pathogens and develops tests to address these new threats. Abbott has been an active healthcare player in the UAE for over 30 years, with 4 local offices and a regional distribution center in Jebel Ali Free Zone. 330 employees work at Abbott in the UAE to help people live their best possible life through the power of health.

NEWS

Julphar appoints new CEO to drive operational transformation and fuel growth His Highness Sheikh Saqer Humaid Al Qasimi, Chairman of the Board at Julphar said: “With his wealth of experience in the pharmaceutical industry across established and emerging markets, Dr. Essam brings a proven track record of leading business transformation, strategic planning and successful hands-on strategy execution. His ability to manage a diverse organization through challenging environments and achieving business and reputational success will ensure Julphar excels further and delivers a greater impact in the 50 markets we operate in around the world.”

G

ulf Pharmaceutical Industries PSC (Julphar), one of the largest pharmaceutical manufacturers in the Middle East and Africa, has announced the appointment of Dr. Essam Farouk as Chief Executive Officer (CEO), as the company drives its pioneering transformation programme across the Middle East region and beyond.

With over 27 years’ experience, Dr. Essam will be leading Julphar’s evolution through its ongoing commitment to elevating and enhancing its facilities, processes, practices and infrastructure, ensuring the company is in strong stead for a successful 2020 and beyond. Dr. Essam will help solidify the business position as a leading generics company in the region by fulfilling its mission to provide high-quality solutions and improve the health of people regionally and globally.

MAY.JUNE 2020

24

NEWLY APPOINTED JULPHAR CHIEF EXECUTIVE OFFICER SET TO DELIVER NEW STRATEGIC FOCUS FOR REGIONAL PHARMACEUTICAL GIANT TOP PRIORITY.

Prior to his appointment at Julphar, Dr. Essam was the CEO at Algerian pharmaceutical company, ELKENDI, managing the corporation since its inception in 2006. Under his leadership, the company experienced exceptional growth to become the second largest pharmaceutical company in Algeria and North Africa. He was then appointed CEO for MS PHARMA Group, a position he held for seven years, guiding the company to be known as one of the top five leading pharmaceutical companies in the Middle East and North Africa. In addition, Dr. Essam has also held senior roles at GlaxoSmithKline, Sanofi Aventis, T3A Pharma Group and Julphar Germany, accumulating a wealth of experience across both multinational and generic business environments.

Commenting on joining Julphar, Dr. Essam Farouk said: “It is an honour to join an organisation that is at the heart of the UAE and has contributed to the economic growth of Ras Al Khaimah and beyond. I am looking forward in the coming months to working with a highly-skilled team as we aim to continue ensuring that we produce high-quality medicines and innovative added-value generic products and healthcare solutions that will truly change lives for people who need them most. I am committed to restoring Julphar’s position as a leading regional pharmaceutical company within three years.”

Dr. Essam holds a Bachelor’s Degree in Pharmacy from the University of Zagazig and a Master’s Degree from AUC and American Society for Quality of USA in Total Quality Management and Operation Management.

NEWS

First mobile center for people of determination and hearing impaired launched in UAE

S

tar Key Hearing Centers, a leading UAEbased hearing care solutions provider has launched the first mobile hearing center in the region in line with the ‘National Home Screening Program for People of Determination”.

This home screening initiative was launched by HH Sheikh Mohammad Bin Zayed, Abu Dhabi Crown Prince and Deputy Supreme Commander of the UAE Armed Forces earlier this month. The core aim of this program is to provide healthcare services to people of determination who cannot physically visit health facilities during the current COVID-19 lockdown situation.

‘Star Key Mobile Center’ is a unique mobile hearing center dedicated to serving hearing impaired especially for people of determination.

This also enables Star Key Hearing Center to play its vital role in the society in realizing the plans and programs of the UAE government focusing on providing healthcare services for people.

Mr. Mohammad Kettaneh, Chief Executive Officer of Star Key Hearing Centers, said: “One of the core responsibilities at Star Key Hearing Centers is our commitment to enabling better hearing care solutions and increasing the accessibility of hearing health by bringing the hearing services closer to the community, especially for those who cannot easily access traditional medical care, yet are in urgent need. The vehicle is fitted with high-end advanced medical equipment by ASTEMED Medical Supplies and staffed by skilled hearing professionals who are passionate to assist in any circumstance and anywhere in the UAE”. “Consequently, Star Key

MAY.JUNE 2020

26

THE AI TECHNOLOGY HELPS ITS USERS TRACK THEIR BODY AND BRAIN ACTIVITIES AND PROVIDE ACCESS TO AMAZING FEATURES LIKE TRANSLATION TO 27 LANGUAGES AND FALL ALERT. IT ALSO HELPS VISUALLY IMPAIRED

BY IDENTIFYING PEOPLE AND THE SURROUNDINGS AROUND THEM. THE VEHICLE IS EQUIPPED WITH ALL MEANS OF SAFETY, PROTECTION AND STERILIZATION FOR EACH PATIENT’S SAFETY, TAKING INTO CONSIDERATION THEIR HEALTH AS THE COMPANY’S TOP PRIORITY.

Hearing is also committed to helping develop and boost the healthcare services and finding solutions to the challenges faced by the people who have hearing concerns. The launch of the mobile hearing care vehicle comes in line with supporting the national efforts and initiatives of the UAE government. In light of the exceptional circumstances that the whole world is going through, Star Key Hearing LLC is extending its way in seeking to provide all possible protection and safety for citizens while continuously providing better healthcare services and easy access right at their doorsteps with a reachable and realistic approach of hearing services,” added Mr Kettaneh.

Giscard Bechara, Managing Director, Starkey MEA FZCO, said “Starkey is the most innovative hearing aid company in the world, servicing hearing loss patients in more than 100 countries. Our core mission remains to service our patients better than anyone else. Our global partners understand this mission and reflect it in their own communities. Today we realize the need for our families and loved ones, our elderly and people of determination to be safe and to be able to hear and communicate clearly with their doctors, families and government health officials while being at home. We remain committed to our patients in the UAE and we won’t let them down despite the current situation”.

Additional to the above-mentioned services, Star Key Mobile Center also provides hearing aids repair and wireless adjustment, custom earmolds production for behind the ear (BTE), completely in canal (CIC) and invisible hearing aids (IIC) are all performed with the support of the latest equipment available in the vehicle such as 3D printer and 3D scanner for scanning, modelling and printing to enable prototyping and manufacturing. These wireless equipment for hearing tests and unique hearing aids are manufactured by the international hearing aids. leader - Starkey Technologies, worth to mention their leading product in the market which is the artificial intelligence technology.

NEWS

COVID-19 Data Exchange to Curb the Virus’ Propagation and Limit its Economic Impact A pro bono initiative accelerating & facilitating the access and the circulation of essential non-personal data between public and private organizations and other public services will be able to securely and easily access, publish, and exchange multiple sources of non-personal data worldwide, therefore acquiring more capabilities to answer crisis-related complex questions, faster.

“There is an unparalleled demonstration of solidarity from many organizations to contribute to the resolution of this crisis. It was an evidence for Dawex to immediately engage its resources and technology to bring the best environment to all these organizations to exchange data in the best conditions.” says Laurent Lafaye, co-founder and co-CEO of Dawex.

U

nder the impulse of the World Health Organization and the European Union stressing the importance of data sharing, Dawex, the leading data exchange technology company, announced launching a COVID-19 Data Exchange initiative.

The platform will be available pro bono to a large community of companies and organizations looking to contribute to the resolution of this crisis. The technology enables the exchange of vital non-personal data to hinder COVID-19’s dissemination and restrain its economic impact.

Scientific communities, hospitals and healthcare operations, pharmaceutical organizations, retailers, transport & logistics companies, specialized equipment manufacturers and distributors, consulting organizations, technology companies and health tech startups, banks, insurance, global and regional health organizations, governmental agencies, municipalities

MAY.JUNE 2020

28

THE TECHNOLOGY ENABLES THE EXCHANGE OF VITAL NONPERSONAL DATA TO HINDER COVID-19’S DISSEMINATION AND RESTRAIN ITS ECONOMIC IMPACT.

By using COVID-19 Data Exchange, participants remain in full control of the data they share, decide with whom they share it, and keep track of all data flows. Only vetted participants from public and private organizations will be granted access to the COVID-19 Data Exchange to ensure confidentiality and relevance of the data exchanges.

“COVID-19 crisis is challenging the way we will use data in the future. Thousands of data providers are willing to share their sources of data, right now, for free. Without trust, fairness and use cases, this effort will be pointless. Our dedicated team of experts from Deloitte, in data management, healthcare and artificial intelligence will make the most out of this coalition and Dawex technology.” says Mathieu Colas, Senior Partner at Deloitte.

“The COVID-19 Data Exchange will facilitate and accelerate data exchanges while we are in the midst of the storm. Moreover, it brings the community together, strengthening our ability to respond to future crises and prepare for a better and stronger future.” says Fabrice Tocco, co-founder and co-CEO of Dawex.

For the tireless, the selfless, the brave

You mean the world Whether you are working on the frontlines or are the last line of defense in the fight against COVID-19, you are making a world of difference for so many. Thank you.

bd.com/COVID-19 BD and the BD Logo are trademarks of Becton, Dickinson and Company.

All other trademarks are the property of their respective owners. Š 2020 BD. All rights reserved.

NEWS

WCM-Q students learning lessons of Covid-19 outbreak with MOPH tics of outbreaks, methods for investigating outbreaks, tools for managing outbreaks, and how to effectively communicate the outbreak risk to individual patients and the community at large.

W

eill Cornell Medicine-Qatar (WCM-Q) has devised a new elective course in collaboration with the Ministry of Public Health (MOPH) so students can learn about the management of public health emergencies like the coronavirus outbreak.

Seven third-year medical students are already enrolled on the course, which was developed as quickly as possible to enable them to gain experience of working with the MOPH during the current outbreak, while also contributing to efforts to contain the spread of the virus. While observing physical distancing protocols, the students will spend six hours a week at the Department of Public Health at the MOPH, spread over two days, as well as taking online lectures and seminars with WCM-Q faculty and participating in small-group discussion groups. While at the MOPH, the students will observe, interact and come to understand how a public health department manages the outbreak of an infectious disease, and will also have opportunities to contribute to the work of the department.

The elective, developed jointly by the MOPH and the Institute for Population Health (IPH) at WCM-Q will give the students a broad overview of public health aspects of infectious disease control, and explain the causes and characteris-

MAY.JUNE 2020

30

THE COURSE IS BEING DIRECTED AND DELIVERED

BY DR. MAMTANI, SHEIKH DR. MOHAMMED AL-THANI, DR. SOHAILA CHEEMA, AND DR. MOHAMUD VERJEE, ASSOCIATE PROFESSOR OF CLINICAL MEDICINE AND ASSISTANT DEAN, STUDENT AFFAIRS.

Dr. Ravinder Mamtani, WCM-Q’s Professor of Healthcare Policy and Research, Professor of Medicine and Vice Dean for Student Affairs, Population Health, and Lifestyle Medicine; Sheikh Dr. Mohammed Al-Thani, Director of Public Health at the Ministry of Public Health and Associate Professor of Healthcare Policy and Research at WCM-Q; and Dr. Sohaila Cheema, Director of the Institute for Population Health and Assistant Professor of Healthcare Policy and Research at WCM-Q, were instrumental in developing the elective.

Dr. Mamtani said: “Our students are highly motivated to help protect public health so we wanted to provide an opportunity for them to contribute to the measures to contain the virus, while also making the best of a difficult situation by providing them with valuable learning experience during the outbreak. An elective course seemed the most appropriate vehicle to achieve both aims.

“I am very grateful to everyone at the MOPH for collaborating with us on this project and helping to get the elective up and running as quickly as possible. We believe the students can be of assistance while also learning a great deal about how public health emergencies are managed, which will be of benefit to the community in the future.”

Sheikh Dr. Mohammed Al-Thani said: “This elective is an effective way for the Ministry of Public Health to help demonstrate to the next generation of doctors how we strategize to contain outbreaks of infectious diseases like Covid-19, which will be of great long-term benefit to the entire community in Qatar. We are also very pleased that the students are extremely keen to help and are making valuable contributions to our work.”

‫َر ْبط الصحة‬ ‫والتعليم‬ ‫والبحوث‬ Linking health, education and research

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

www.hamad.qa

INTERVIEW

The CEO of the LAU Medical Center-Rizk Hospital

Mr. Sami Rizk “We have become today a hospital specialized to receiving corona patients from A to Z”

U

pon arriving at the LAU Medical Center-Rizk Hospital’s entrance, you quickly become aware of the new strict procedures that the center applies in order to fight the novel coronavirus and limit its spread.

The guard at the door wears a mask and only allows in those who have imperative needs. He then asks some routine questions such as: “Do you have fever or a sore throat? Did you meet someone who came from an affected country?”

After verifying the answers, you should remove the gloves you’re wearing, sterilize your hands, and then enter, provided that the

MAY.JUNE 2020

32

guard leads you to your destination. We were heading to the office of the CEO, Mr. Sami Rizk, who informed us about the new policies pursued by the medical center with the objective of receiving confirmed or suspected cases of coronavirus. We discussed at great length the humanitarian initiative launched by the hospital since the beginning of the pandemic, the "mobile clinic".

We will start talking about “Healing with Compassion,” the initiative launched before the outbreak of the novel coronavirus. How has it been put into

INTERVIEW

effect today to reduce this pandemic?

The Healing with Compassion initiative started as a mutual idea between the LAU School of Medicine, represented by the Dean Dr. Michel Mouawad, and physicians at the hospital, after we have perceived the great need of many patients who are unable to provide the minimum level of hospitalization.

At that time, the idea was to collect in a “piggy bank” a share of the physicians’ remuneration, in addition to providing a considerable number of free medications for patients who were to be received on Saturdays.

However, as soon as this initiative was launched, the coronavirus appeared in Lebanon and the whole country was busy fighting it.

The whole medical body started working on confronting this virus at a time when we had finished setting up the mobile clinic that is roaming regions today and conducting free-ofcharge PCR tests in various Lebanese towns.

Thus, we were able to put into effect the principle of "Healing with Compassion" through a fully trained and equipped medical team that is roaming the regions and taking random samples for PCR testing.

We move on now to the procedures followed within the campus of the LAU Medical Center-Rizk Hospital.

Our first step was to create a task force with over 26 members including directors, administrators, the Dean of the School of Medicine, the Chief Medical Officer, heads of medical units, the nursing unit, the unit of infection control and bacterial diseases, and others. We used to meet daily via WebEx at 5 o'clock to keep up with the updates and gather opinions.

These meetings were the first building block of the steps followed today at the medical center where we were noting and discussing ideas to come up with new policies and procedures that were developed by specialists in infection control and bacterial diseases, primarily Dr. Jacques Mokhbat and Dr. Roula Hosni Samaha.

We came up with an integrated

preparedness plan and began implementing it at the medical center with daily followup to make observations, noting that the precautionary policies followed today are in accordance with the recommendations of the World Health Organization and the CDC. We did not stop here. We followed up on daily work by disseminating internal recommendations (Policies and Procedures & Internal Memos) to remind workers of their daily duties regarding the necessity of applying safety standards and procedures. We also intensively conducted training workshops via social media for all health care providers. Some of the workshops were conducted directly in our lecture hall but with less capacity in compliance with the rules of social distancing.

There are many standards and policies that we follow today at the medical center such as social distancing and reducing the number of daily employees. We also created a team of doctors and nurses whose job is only to contact workers and health care providers and ask them about the mechanism of work, whether they are feeling a symptom, or if they are facing any obstacles.

Doctors, nurses, guards, cleaning staff, and everyone working at the medical center are applying these standards today.

One of the most important things we came to at the beginning of this crisis is the impossibility of continuing to work at the hospital normally while receiving suspected or confirmed cases of coronavirus due to the seriousness of this issue and for fear of the possibility of contamination as a result of a mistake, even though it was accidentally made.

We decided to close most of the nonemergency units and postpone the nonurgent operations which we call cold cases. We also closed the outpatient clinics, the one-day surgery unit, the endoscopy unit, the prior medical consultations unit, and others. We kept working only in the units of emergency, dialysis, oncology, and the novel coronavirus.

All these procedures have enabled us to become a hospital specialized to receiving cases of coronavirus from A to Z.

WE HAVE WORKED IN THE PAST TWO MONTHS ON PROVIDING EVERYTHING NECESSARY TO BE FULLY PREPARED AND BOOST OUR READINESS IF THE NUMBER OF CASES INCREASES, IN ORDER TO BE

BY THEIR SIDE IN RECEIVING PATIENTS AND CONDUCTING TESTS.

33

INTERVIEW

OUR LABORATORY IS ONE OF THE LABORATORIES LICENSED BY THE MINISTRY OF HEALTH ON MARCH 16 TO PERFORM PCR TESTS. THE TESTING IS CARRIED OUT IN THE NEGATIVE PRESSURE ROOM WHICH IS A SPECIALIZED ROOM NEXT TO THE EMERGENCY UNIT, MEANING THAT IT IS OUTSIDE OF THE MEDICAL CENTER.

What other arrangements are directly related to the novel coronavirus?

The first thing we did was dedicating two rooms in the emergency unit to receive cases.

They are not inside of the unit but rather a subordinate branch of it. We preferred that the two rooms be in the open air so that the patient does not enter the emergency unit and infect other patients.

In the emergency unit, we also created another section in the open air to conduct PCR tests so that the patient does not enter the medical center or the laboratory unit.

We have also dedicated two operating rooms for confirmed or suspected coronavirus cases. For example, if a woman in labor comes and is suspected of being infected, we cannot get her into a regular operating room.

We have three floors with a capacity of 43 beds fully equipped for cases of coronavirus and with an internationally accredited ventilation system, one floor for intensive care, and two

MAY.JUNE 2020

34

floors for cases that need isolation. We also have around 22 ventilators for critical conditions.

Our laboratory is one of the laboratories licensed by the Ministry of Health on March 16 to perform PCR tests.

The testing is carried out in the negative pressure room which is a specialized room next to the emergency unit, meaning that it is outside of the medical center.

The tests are done based on a prior appointment made after that the patient has sent his identity via WhatsApp. Upon his arrival, he does not touch anything. He answers some routine questions and we ask him to bring the exact required financial value (i.e. 150,000 LBP - official tariff) which we take and put in a nylon bag. We take then the sample from the patient and he goes back home. We call him when the results are ready. We have also conducted many tests for our medical team at the center to check on them because they are the first line of defense. To date, we have conducted over

INTERVIEW

3,500 tests, whether in the mobile clinic or at the medical center. Only 3 to 4% of these tests were positive.

How would you evaluate your readiness today to support the Ministry of Health in fighting coronavirus?

In this context, it is necessary to salute the medical team working at Rafik Hariri University Hospital and their tremendous efforts in fighting the virus. They were in the first line of defense in this war.

Today, we support the Ministry in this battle. We have worked in the past two months on providing everything necessary to be fully prepared and boost our readiness if the number

of cases increases, in order to be by their side in receiving patients and conducting tests.

We also worked on providing the necessary PPEs for nurses to enter the room of coronavirus patients despite their high cost.

However, our medical and humanitarian duty makes it imperative that we work to the fullest, especially now that we have become a medical center equipped to receive corona cases from A to Z. In this context, we hope to receive any assistance from the Ministry of Health in the event that it receives external support, at least in relation to the PPEs so that it will serve as support for us, private university hospitals that have assumed this humanitarian duty.

WE DEVELOPED AN INTEGRATED PREPAREDNESS PLAN WITHIN THE MEDICAL CENTER.

35

INTERVIEW

Restorative Therapies Group Vice President at Medtronic CEMA

Nurgul Vatansever “We Are Passionate About Helping Healthcare Professionals By Providing Innovative Solutions”

M

edtronic is currently using Artificial Intelligent (AI) through various applications across its businesses, including Diabetes, Neurovascular, Gastroenterology and Minimally Invasive Therapies, as it opens up new and exciting possibilities for us to help alleviate pain, restore health, and extend life. “Hospitals” magazine met with Nurgul Vatansever, Vice President at Medtronic CEMA, and below is the full interview:

Can you tell us more about your background and when did you join Medtronic?

I have been working within the healthcare sector in Emerging Markets for over twenty-five years. My background is in Electrical and Electronic Engineering, in which I have two degrees from the Middle East Technical University, as well as an Executive MBA and B.S.

MAR.APR 2020

36

I joined Medtronic in October 2019 to lead the Restorative Therapies Group (RTG) business in the CEMA region (Central & Eastern Europe, Middle East & Africa).

Prior to joining Medtronic, I was with Johnson & Johnson for nine years. During my time, I served through three major leadership roles, most recently as Ethicon Middle East General Manager, as well as General Manager for Russia, CIS Countries and Turkey.

HELPING PEOPLE HAS ALWAYS BEEN IN MY DNA.

INTERVIEW

Prior to Johnson & Johnson, I was Managing Director of Hitachi Medical Corporation (HMC) Turkey & CIS Countries, and Zone Leader at GE-Healthcare Turkey.We have such a dedicated and united team here at Medtronic, which is key in our mission to create therapies that alleviate pain, restore health, and extend the life of as many patients as possible. Now more than ever, our togetherness will be crucial to achieving this.

The best part of my work is seeing the positive impact our solutions have on patients’ lives. Helping people has always been in my DNA.

Medtronic is a global leader in medical technology services and solutions, what is your mission statement as a company?

Our efforts are transforming the lives of millions of people each year, thanks to our unwavering commitment to our mission to help alleviate pain, restore health, and extend life.

We live our mission each and every day, whether in times of business as usual or during unprecedented times such as now, with COVID-19.

For example, we have extended our support through sharing open files of our ventilator designs to enable the global industry to evaluate options for rapid ventilator manufacturing to help doctors and patients in the fight against COVID-19.

Medtronic has been in the region for more than 30 years. How do you find the evolution and the development of the healthcare sector in this region?

With aging populations and the growing prevalence of diseases, healthcare remains a top priority as the demand and need for quality healthcare services rises in the region.

As a result, the healthcare landscape and market dynamics are always evolving and has

become very fast-paced.

This requires us to think differently and to fundamentally improve the way we do business, as well as the way we operate.

For example, hospitals are looking for ways to improve clinical outcomes and patient satisfaction, achieve efficiencies and reduce costs, and increase access so that they can maintain the quality of care.

Therefore, it is important that we partner with them in this challenge. We are already doing this through functions like our Integrated Health Solutions (IHS) and introducing new models to enable transformations to meet their evolving needs. As part of our mission to help alleviate pain, restore health, and extend life, we are passionate about our responsibility to continue helping healthcare professionals, healthcare providers, and patients by providing innovative solutions in order to meet the region's needs for advanced medical care and achieve life-changing results for our patients.

We are also committed to promoting better lifestyles for patients and making a positive impact in their lives and their family members.

AT MEDTRONIC, WE ARE CURRENTLY USING AI THROUGH VARIOUS APPLICATIONS ACROSS OUR BUSINESSES, INCLUDING DIABETES, NEUROVASCULAR, GASTROENTEROLOGY AND MINIMALLY INVASIVE THERAPIES, AS IT OPENS UP NEW AND EXCITING POSSIBILITIES FOR US TO HELP ALLEVIATE PAIN, RESTORE HEALTH, AND EXTEND LIFE.

What are the latest technologies that you have launched during 2019 and beyond?

Many of our new launches are focused on AI, and in 2019 we launched the first Artificial Intelligence System for colonoscopy during the United European Gastroenterology Week.

This system, which is a true testament to our mission to help alleviate pain, restore health, and extend life, aims to transform colorectal cancer detection and benefits both patients and gastroenterologists.

We also partnered with iSchemaView to distribute the RAPID software, another AI product, which is artificial intelligence-pow-

37

INTERVIEW

ered imaging software that allows doctors and first responders to quickly identify brain events, and all-importantly, speed up the treatment of patients suspected of having ischemic strokes. In addition, we notably launched Mazor X Stealth - a transformative robotics guidance system for spinal surgery which offers a fully integrated procedural solution for surgical planning, workflow, execution and confirmation.

Artificial Intelligence is becoming a huge part of healthcare, what is the role of AI in Medtronic?

At Medtronic, we are currently using AI through various applications across our businesses, including Diabetes, Neurovascular, Gastroenterology and Minimally Invasive Therapies, as it opens up new and exciting possibilities for us to help alleviate pain, restore health, and extend life. A key example is a technology co-developed between Medtronic and the recently acquired Mazor Robotics, specifically the Mazor X Stealth Edition.

This is a revolutionary new technology that uses cutting-edge software to plan the surgical procedure, then uses a robotic arm to guide implants and instruments through the steps of the surgical procedure with precision, while simultaneously using real-time imaging feedback to ensure the plan is being carried out as desired.

We are also aiming to leverage AI in stroke care through RAPID software by supporting hospitals to implement the software and optimize the referral pathways to ensure a more accurate diagnosis of patients who would benefit from endovascular stroke treatment.

Trying to improve the outcomes and lives of as many patients as we can, we are also providing consultancy services to enhance stroke patient pathways across pre/inter/ in-hospital phases.

MAY.JUNE 2020

38

Tell us about your future strategies in the region, and how are you coping with the ongoing changes on the healthcare level?

At Medtronic, we are always looking at how we can introduce and deliver increasingly meaningful therapies and procedures to address the challenges in healthcare access, whether locally, regionally, or globally.

At the same time, we are also striving to lead the creation of value-based healthcare solutions.We are always in tune with and innovating for the industry’s needs, both current and anticipated, which has allowed us to become a preferred partner of choice in the region. We are doing our utmost to accelerate partnerships with the public and private sector to help them address increasing lifestyle diseases, and concurrently control rising healthcare costs.

By using our technology and expertise we are able to help doctors provide more efficient care to patients, and help hospitals improve their operational efficiencies to achieve better clinical and economic outcomes.

For example, we have partnered with several diabetes clinics, where our technology is used to better manage the disease, to improve the lives of those patients.

This has also resulted in significant savings from reduced complications and hospitalizations, which can be redirected toward other needed resources and infrastructures. At Medtronic, we truly believe in harnessing the power of medical technology to change lives and make the future of the healthcare system better.

How is Medtronic implementing and supporting the UAE vision 2020?

Many of the priorities of UAE Vision 2020 are shared by us here at Medtronic too, and so implementing and supporting them is key

AT MEDTRONIC, WE ARE ALWAYS LOOKING AT HOW WE CAN INTRODUCE AND DELIVER INCREASINGLY MEANINGFUL THERAPIES AND PROCEDURES TO ADDRESS THE CHALLENGES IN HEALTHCARE ACCESS, WHETHER LOCALLY, REGIONALLY, OR GLOBALLY.

INTERVIEW

to both our continued success and ability to deliver on our mission to help alleviate pain, restore health, and extend life, as well as our ethical commitments to the communities we serve as a company.

For example, a competitive knowledge economy is one of the Vision’s core goals. As a company, we are heavily focused on innovation, research and development.

One of the ways we extend this is by working with local partners, such as congresses, and educational institutions. Local doctors also partner with us to learn, share and pass on best practices acquired at international congresses.

Through these partnerships, we believe we are playing a key role in facilitating and advancing knowledge exchange in the medical sector locally.

World-class healthcare is another priority set out within the Vision. Being a world leader in medical technology, developing solutions that support and enable world-class healthcare is central to our purpose. As such, we are at the forefront of research and development, always striving for new ways to overcome today’s healthcare challenges.

Our harnessing of AI, for instance, is just one example. Another example of how we are constantly adapting advanced technology to meet local needs is the introduction of the first MICRA, which is the world's smallest pacemaker for patients with Bradycardia, in KSA and the UAE. This was the first of its kind in the Middle East.The Vision also highlights the importance of an inclusive environment. Medtronic is passionately committed to ensuring an ethnically and culturally diverse workforce that respects local traditions. We are very active in our initiatives to drive this.

For example, we champion female empowerment and leadership in healthcare

and STEM industries. Our goal in 2022 is to have 40 percent of leadership roles held by women. We are proud to say we have already surpassed this.

How is Medtronic supporting in optimizing stroke pathway and saving more patients in the region?

Artificial Intelligence has been a great enabler when it comes to saving, improving and extending the lives of patients with stroke.

We do this in a multifaceted way, for example through the RAPID software, an artificial intelligence-powered imaging software that helps to quickly treat patients suspected of having ischemic strokes.

With such fine margins, time can make all the difference between a good or bad medical outcome for a stroke patient with a large-vessel occlusion (LVO). To help solve this, the AI can detect, locate, and notify doctors whether an LVO has occurred.

We are also working diligently with key stakeholders to optimize the processes and resources across the four different stages of patient pathways.

For instance, by supporting initiatives to expand the usage of specialized stroke screening scales to ensure more patients are getting the best care possible, as quickly as possible.

Other ways we are helping to elevate stroke pathways include partnering with healthcare professional societies and authorities to organize training programs, working with the industry and authorities to generate economic evidence for health technology assessments, as well as reimbursement submissions and resources allocation. Helping to reduce recurrence rates and lasting health problems is another vital area, which is why Medtronic also sponsors clinical registries to improve post-stroke treatment.

WORLD-CLASS HEALTHCARE IS ANOTHER PRIORITY SET OUT WITHIN THE VISION. BEING A WORLD LEADER IN MEDICAL TECHNOLOGY, DEVELOPING SOLUTIONS THAT SUPPORT AND ENABLE WORLDCLASS HEALTHCARE IS CENTRAL TO OUR PURPOSE. AS SUCH, WE ARE AT THE FOREFRONT OF RESEARCH AND DEVELOPMENT, ALWAYS STRIVING FOR NEW WAYS TO OVERCOME TODAY’S HEALTHCARE CHALLENGES.

39

ARTICLE

How does coronavirus affect patients with heart diseases?

A

mong chronic diseases, cardiovascular diseases are included in risk group regarding coronavirus. So, how does Covid-19 affect these patients and what are the symptoms? All details are in this interview made with Professor Sinan DaÄ&#x;delen, M.D, Cardiovascular Specialist in AcÄąbadem Healthcare Group Turkey.

Coronavirus caused Covid-19 disease leading to an outbreak which started from China and spread around the globe. Covid-19 is similar to other known influenza viruses. However, it can be differentiated from influenza based on its effects. Because, coronavirus involves more organs, the symptoms are severer especially in the elderly (with suppressed immune system) while they are milder in young individuals. Briefly, the older the organs are, the harder they protect themselves against the coronavirus.

Patients with which chronic diseases are most vulnerable to the virus?

Individuals older than 60-65 years of age create the highest risk group in coronavirus.

Although the disease can affect children and young adults, death and organ damage are most frequently seen in the elderly. Patients with cardiovascular disease, hypertension and diabetes are under high risk. In a report published in China, it is stated that 40 percent of Covid-19 patients have heart disease and 12 percent of patients are diabetic. According to another

MAY.JUNE 2020

40

published scientific research in China, infection patients are patients with chronic cardiovascular disease, hypertension and diabetes. Deaths are also most frequently seen in patients with cardiovascular diseases (10.5 percent). This is followed by hypertensive patients with a ratio of 6 percent. Covid-19 is more frequently seen and symptoms are severer also in patients with cardiovascular diseases.

Symptoms of Covid-19 in chronic patients Generally, symptoms of Covid-19 are similar to influenza infections, namely fatigue, tiredness, malaise. However, the disease is different from influenza with severe cough, high fever and less runny nose and watering in eyes, severer shortness of breath and extreme fatigue. Patients with chronic heart disease can show different symptoms as well. Abnormal hypertension can be seen in those patients. Because, the virus enters into cells by affecting enzyme receptors in body. Therefore, hypertension occurs. This condition can be severer in patients with heart failure. As the immune complexes and fever caused by coronavirus worsens the inflammatory condition of body, risk of heart attack is higher in patients with cardiovascular diseases.

The infection worsens heart disease Course of Covid-19 is much severer and longer in individuals with chronic heart disease.

INDIVIDUALS OLDER THAN 60-65 YEARS OF AGE CREATE THE HIGHEST RISK GROUP IN CORONAVIRUS. ALTHOUGH THE DISEASE CAN AFFECT CHILDREN AND YOUNG ADULTS, DEATH AND ORGAN DAMAGE ARE MOST FREQUENTLY SEEN IN THE ELDERLY. PATIENTS WITH CARDIOVASCULAR DISEASE, HYPERTENSION AND DIABETES ARE UNDER HIGH RISK.

ARTICLE

Heart diseases in those individuals become severer. For instance, class 2 heart failure can progress to class 3 and class 4. Blood pressure may not be controlled and rhythm disorders can develop.

Can antihypertensive drugs be used?

The relation between hypertension and coronavirus should be investigated. Because, coronavirus especially enters into lung cells through angiotensin receptor, this virus starts to maintain its vitality in the cell by this way.

This receptor is critical for hypertension. Related drugs are the antihypertensive agents that are most commonly used both in Turkey and around the world. There have been discussions about increase in effect of virus in body due to these drugs. However, according to notices of American Heart Association and European Heart Network, using this group of drugs called angiotensin converting receptor inhibitors and angiotensin receptor blockers has no negative effect on patients. Hypertensive patients can safely use these drugs.

When should heart patients see a doctor?

Patients with chronic diseases should necessarily present to hospital when there is an unexpected change in blood pressure and glucose levels before coronavirus infection is diagnosed. They should also consult a physician without wasting time when they notice abnor-

mal difficulty breathing and tiredness. Shortly, they should see their primary physicians if they say “I would not be this tired normally, I have been extremely tired for the last 3 days”. They should consult their cardiologists, internists or infection diseases physicians to ask “Do I have a viral infection?” in case of fever, cough, recent onset shortness of breath.

How is their treatment affected?

They should continue their medications especially drugs for heart diseases. Drugs for cholesterol, hypertension and heart diseases can be used. This virus can involve heart, lungs, brain, internal organs and cardiac muscle. When coronavirus affects the cardiac muscle, a heart inflammation called myocarditis is seen. Myocarditis causes complaints like palpitation, poor exercise capacity and fatigue. In other words, quicker and extreme shortness of breath and palpitation are experienced. At this point, whether the coronavirus involves the heart or not is investigated by a cardiologist. Briefly, patients with cardiovascular disease and hypertension should see their primary physicians or a cardiologist in case of abnormal conditions.

COURSE OF COVID-19 IS MUCH SEVERER AND LONGER IN INDIVIDUALS WITH CHRONIC HEART DISEASE. HEART DISEASES IN THOSE INDIVIDUALS BECOME SEVERER. FOR INSTANCE, CLASS 2 HEART FAILURE CAN PROGRESS TO CLASS 3 AND CLASS 4. BLOOD PRESSURE MAY NOT BE CONTROLLED AND RHYTHM DISORDERS CAN DEVELOP.

How can heart patients protect themselves from coronavirus?

• • • • • • • •

•

Especially people older than 60-65 years of age should avoid crowded places.

They should stay at least 5 meters away from people with influenza.

They should drink plenty of water.

They should eat healthily.

They should avoid physical and psychological tiredness and sleep well.

Immune system should be supported.

They should not be in crowded places unless strictly required.

When they have to be in crowded places, they should use gloves and mask. However, those gloves should immediately be thrown away after using. They should not touch their mobile phones and everyday items like comb and tissue. Gloves should immediately be peeled and thrown away after they are used in public spaces like subway.

In case of an unexpected problem, they should consult a physician.

41

ARTICLE

How does Coronavirus affect cancer patients?

C

ovid-19, which has spread to the entire globe and declared as a pandemic, poses more severe risk for those with chronic diseases. So, how are cancer patients affected from coronavirus? How can they be protected against coronavirus? All details in the interview made with Professor Aziz Yazar, M.D, Medical Oncology specialist in Acıbadem Healthcare Group Turkey.

Cancer patients should be particularly careful against Covid-19!

First coronavirus infection secondary to SARS-CoV-2 (Covid-19), which is a variation Coronavirus family, was seen in China in December 2019 and has spread around the entire globe leading to a pandemic (an infection which spreads to a wide area in more than one country or continent). Covid-19 rapidly became widespread around the globe and started causing risk for cancer patients in the area.

Who are under more risk due to Covid-19?

Effects of Coronavirus are more severe in individuals with a chronic disease (heart failure, kidney failure, COPD, hypertension, diabetes etc.). Cancer patients and those who receive cancer treatment should be added to this group.

MAY.JUNE 2020

42

Probability of hospitalization is higher for individuals with cancer when they are infected with coronavirus. Mortality risk secondary to infection increases.

What are the symptoms of coronavirus in cancer patients?

The most prominent signs of Covid-19 are fever, severe fatigue, cough and shortness of breath. Similar symptoms are also expected for cancer patients in the event of coronavirus infection.

What is the typical course of Covid-19 in cancer patients?

In normal circumstances, most individuals recover from Covid-19 without the need of hospitalization with experiencing mild or moderate symptoms. However, in the event of coronavirus, risk of shortness of breath and organ failure which should require hospitalization increases for individuals with cancer, which affects the immune system, and those who receive cancer treatment. Therefore, mortality risk also increases.

If the cancer treatment is completed…

It is highly possible that the immune system

EFFECTS OF CORONAVIRUS ARE MORE SEVERE FOR THE INDIVIDUALS WITH A CHRONIC DISEASE (HEART FAILURE, KIDNEY FAILURE, COPD, HYPERTENSION, DIABETES ETC.).

CANCER PATIENTS AND THOSE WHO RECEIVE CANCER TREATMENT SHOULD BE ADDED TO THIS GROUP. PROBABILITY OF HOSPITALIZATION IS HIGHER FOR INDIVIDUALS WITH CANCER WHEN THEY ARE INFECTED WITH CORONAVIRUS. MORTALITY RISK SECONDARY TO INFECTION INCREASES.

ARTICLE

of individuals, who completed cancer treatment one or more years ago, returned to normal levels. It is expected that the risk level of coronavirus infection for these individuals is similar with their peers.

Does coronavirus interferes with cancer treatment?

It is necessary to pause cancer treatment of the patients in the event of Covid-19 occurrence until the symptoms disappear. Pausing the treatment may lead to progression of the disease in types of cancer which show rapid progression rate.

How cancer patients should be protected against coronavirus?

The vaccine against the virus is yet to be developed. There is no known treatment method which is effective.

There are no additional measures for cancer patients other than those which are recommended for protection against the virus. These precautions include: • Avoiding crowded areas.

• Not touching mouth-eyes-nose in outdoor environments.

• Frequently washing hands with soap.

• Cleaning the hands with alcohol containing disinfectants in cases where washing

•

them with soap is not an option.

Cleaning the surfaces which are contacted frequently with disinfectants.

IT IS NECESSARY TO PAUSE CANCER TREATMENT OF THE PATIENTS IN THE EVENT OF COVID-19 OCCURRENCE UNTIL THE SYMPTOMS DISAPPEAR. PAUSING THE TREATMENT MAY LEAD TO PROGRESSION OF THE DISEASE IN TYPES OF CANCER WHICH SHOW RAPID PROGRESSION RATE.

If Covid-19 is suspected…

Individuals who are infected by Covid-19 should keep themselves in quarantine to avoid infecting others with coronavirus. Consuming plenty of fluids and resting are required. Using masks and cleaning the surfaces they touch with disinfectants are necessary. Hospitalization and supportive treatment might be necessary if complaints worsen.

While doctors and frontline medical staff have shown tremendous courage against global pandemic, treatment of our pediatric oncology patients continues.

To make the little patient accept wearing the treatment mask, doctors from Acıbadem Maslak Hospital in Istanbul, have decided to make him look like a hero.

Not all heroes wear capes, some wear masks.

43

ARTICLE

HDF Crisis Management in the Face of COVID-19

O

ne in ten patients in the world is a doctor or a healthcare worker. To ensure their protection and to welcome its patients, Hôtel-Dieu de France has implemented a crisis management plan in response to the situation on the ground in the face of the coronavirus pandemic.

Since March 1 and upon the request of the Lebanese authorities, HDF chose to rise to the challenge and take in patients with suspected COVID-19 in support of Rafik Hariri University Hospital, and thus became the first university hospital to join the battle.

During this period, HDF became safer, more attentive and firmer with protective barriers that can only be crossed by wearing a mask and gloves. The hospital also addressed the current situation with absolute transparency and professionalism.

MAY.JUNE 2020

44

What Was Hôtel-Dieu de France’s Role in This Time of Crisis?

The hospital confronted the epidemic very early on in late February. On March 1, the Lebanese authorities requested the mobilization of university hospitals in order to respond to the pandemic. Immediately, HDF, Saint Joseph University’s Medical Center and a non-profit institution, aware of its responsibilities and its social role, was the only one to respond.

A crisis unit was formed and held daily meetings at first, which then proceeded to become biweekly, with doctors, nurses, pharmacists and other professionals of the hospital.

A strong alliance was quickly formed with the Rodolphe Mérieux laboratory of the Faculty of Pharmacy at USJ, to detect through PCR tests COVID-19 cases.

HDF was split into two: a path for patients with suspected or confirmed COVID-19, and a

HDF, AS SAINT JOSEPH UNIVERSITY’S MEDICAL CENTER, HAS MAINTAINED A STRONG SCIENTIFIC APPROACH BY ADAPTING ITS HEALTHCARE SERVICES TO THE HIGHEST EUROPEAN AND NORTH AMERICAN STANDARDS.

ARTICLE separate one for patients with other pathologies. Such is the case with patients presenting flu-like symptoms and coming for a consultation: they are directed towards the Flu Center that receives 30 to 50 patients a day on weekdays.

Also, a protected path has been set up in the Emergency Department with a negative pressure room.

External consultation clinics remained open and are still disinfected regularly. Social distancing measures are also applied.

Such is the case with hospitalizations that were grouped on one floor within a Respiratory Isolation Unit; and such is the case with resuscitation patients all hospitalized in negative pressure rooms. Such is the case with the Medical Imaging Department which has separated its paths and will have in the coming days a scanner dedicated to chest scans. Such is the case with the Operating Room which has an operating room with negative pressure. Such is also the case for the reception of pregnant women, whereby a maternity area has been set up.

The HDF Pharmacy Department is now producing hand sanitizers for its patients, visitors and staff.

These measures are evolving and are being reassessed by the crisis unit depending on how the situation evolves.

What Has the COVID-19 Crisis Taught Us? It has shown us the weaknesses of a purchasing system based solely on importation. This is true for Lebanon and other countries affected by the pandemic to varying degrees.

The purchasing system has always been the most complicated issue. Already affected by the economic crisis that the country is going through, the prices of protection gears such as masks, over-gowns and overshoes have spiraled.

The demand for payment in USD is constant, despite the regulatory measures enacted by the Government and the central bank of Lebanon (Banque du Liban) which allow paying 85% of the amount in LBP and 15% in USD. These difficulties also threaten to affect the pharmaceutical sector and the recourse to essential laboratory tests for systematic screening which will become necessary.

The crisis has also shown us, both here and elsewhere, the irrational behavior of certain people who ignore medical care that does not seem urgent to them. This will certainly have repercussions on certain pathologies tardily treated. It has shown us the unequal social support for the population, which feels insecure as much from the health crisis as from the financial and economic crisis.

How Did the Hospital Deal With These Challenges?

First, the hospital has adopted a scientific and medical response. HDF, as Saint Joseph University’s medical center, has maintained a strong scientific approach by adapting its healthcare services to the highest European and North American standards. It is taking part in current international clinical trials and is developing more than a dozen studies around COVID-19. Its resuscitation techniques with respirators and an artificial lung (ECMO) are among the most sophisticated.

Second, a humanitarian response through an information hotline, where interns and residents volunteer to respond to the questions and concerns of sick or worried people confined to their homes.

HDF also took the initiative to seek social funding for patients through a fundraising campaign aimed at Lebanon and its diaspora.

The idea is to set up a social fund for COVID-19 patients with little to no medical insurance. It is to be feared that the lack of medical insurance will be substantial by the end of the health crisis as a result of the economic situation in Lebanon.

HDF plans to resume its normal activity by maintaining general and secure care services.

Only through this comeback, awaited by the entire hospital-university community, will the situation return to a sustainable and economically viable functioning.

In these times of confinement, the HDF community remains, now more than ever, attentive to others, aware of its social role and close to the people around it who trust in the quality of care it provides. Doctors, nurses and all caregivers involved in this crisis deserve our utmost gratitude for their dedication to patients and the sacrifices they made during the health crisis.

THE HOSPITAL CONFRONTED THE EPIDEMIC VERY EARLY ON IN LATE FEBRUARY. ON MARCH 1, THE LEBANESE AUTHORITIES REQUESTED THE MOBILIZATION OF UNIVERSITY HOSPITALS IN ORDER TO RESPOND TO THE PANDEMIC. IMMEDIATELY, HDF, SAINT JOSEPH UNIVERSITY’S MEDICAL CENTER AND A NON-PROFIT INSTITUTION, AWARE OF ITS RESPONSIBILITIES AND ITS SOCIAL ROLE, WAS THE ONLY ONE TO RESPOND.

45

INTERVIEW

USING INNOVATIVE TECHNOLOGIES TO HELP COMBAT COVID-19

Managing Director Cerner Middle East & Africa

Senior Physician Executive Cerner Middle East & Africa

Alaa Adel

Dr Mohamed AlRayyes

C

erner is offering expanded telehealth solutions to support clients with information about COVID-19 pandemic. Following the first reported cases of COVID-19, Cerner has updated its EHR platform by expanding its telehealth capabilities, implementing disease screening tools and updating its EHR dashboards.

Can you share additional details about this support to your clients?

In response to the COVID-19 pandemic, Cerner has expanded virtual care offerings for clinicians and patients by empowering health facilities to use telehealth within the acute care setting. This helps to lessen the impact and spread of the virus and allows patients to get access to care while at home.

In the Middle East, the pandemic accelerated the need for an immediate solution to limit physical visits to hospitals while still being able to provide the required care to the patients.

MAY.JUNE 2020

46

CERNER HAS ALSO CREATED DASHBOARDS AND DATA ANALYTICS TO INFORM QUICK DECISION-MAKING AND OPERATIONAL MANAGEMENT ASPECTS (E.G., VENTILATOR CAPACITY, BED MANAGEMENT, INFECTION RISK SCREENING, COVID 19 LAB RESULTS).

Cerner has been in discussion with our clients about telehealth and e-visit to find the best approach considering the patient experience, clinical workflow and related cost. However, the pandemic made this a priority. Cerner has been able, in a very short timeframe, to connect our clients with different partners to implement the right solution enabling clinicians to virtually communicate with their patients and help ensure continuity of care.

Cerner continues to support health organizations around the world as they combat the COVID-19 pandemic. Cerner has taken steps to introduce and improve new technology offerings, waive fees for expansion of hospital beds and collaborate with other companies to offer supporting solutions during this critical time.

In addition, Cerner has developed a dedicated COVID-19 taskforce to make health, safety and business continuity decisions for its associates and clients across the world.

INTERVIEW

How is Cerner using EHR optimization and what other measures are being considered to combat COVID-19?

Cerner has been working closely with clients in the region optimize our clients’ electronic health record (EHR) systems with the most recent and applicable developments and implementations from across the globe. This includes operational readiness, screening, testing, treating, monitoring, public health surveillance and other clinical activities. The optimized solutions cover each health organization’s requirements to respond to the pandemic.

• Operational readiness: Isolation bed tracking dashboards and providing the digital foundations to turn operating theaters and rooms into ICU and isolation rooms.

• Screening: Intelligent rules and documentation tools to alert clinicians to the risk of a patient testing positive to the virus. This is part of an end-to-end process that goes beyond a single facility to on-the-ground mass screening efforts, either through proactive community campaigns or drive-through testing facilities.

• Testing: Tracking dashboards for all tested patients with clear indications of results and recommendations for effective management plans.

• Treating: International guidelines and protocols are translated into easy-to-use and intelligent documentation, as well as patient management templates, to ensure a standard and up-to-date management of COVID-19 patients.

• Surveillance: Near-real-time dashboards that track the status of all tested, positive and recovered patients for strategic decision-making and action.

Over the past few weeks, Cerner completed numerous measures to make it easier for our clients to perform life-saving work. As a part of its EHR optimization, Cerner’s clients are now able to access updated population health management dashboards that help track trends and manage patients that have tested positive for coronavirus symptoms. From EHR to telehealth

CERNER HAS TAKEN STEPS TO INTRODUCE AND IMPROVE NEW TECHNOLOGY OFFERINGS, WAIVE FEES FOR EXPANSION OF HOSPITAL BEDS AND COLLABORATE WITH OTHER COMPANIES TO OFFER SUPPORTING SOLUTIONS DURING THIS CRITICAL TIME.

solutions, Cerner has expanded its technology to meet the needs of clients delivering care during this critical time. Recently, Cerner launched a dedicated resource site giving clients access to new and updated offerings. This site is a testament to the true global collaboration on practices, pathways and knowledge content between Cerner and our clients.

Healthcare facilities have various projects and initiatives to help protect their communities during this critical time. How is Cerner supporting its clients around the globe and in the ME region?

Many of Cerner’s associates are on the frontlines supporting our clients in combatting this pandemic worldwide. As clinicians and even volunteer paramedics, all of us play an important role in supporting our clients as they respond to COVID-19. A few global examples include: Our associates are helping to set up field hospitals, allowing a healthcare system to increase their bed capacity. In UAE, multiple healthcare, hospitality and residential facilities have been turned into isolation and quarantine centers using an extension of Cerner Millennium® domain from existing clients managing those centers. Linking these new facilities to an existing clinical information system has resulted in establishing a well-integrated pandemic response service.

In addition, Cerner has developed customized modules to support these facilities, suitable to their special functions. These include new user-friendly and intuitive documentation, ordering, patient management and tracking tools to cater for clinicians and other healthcare providers who are interacting with the system for the first time.

Moreover, we have implemented end-toend Cerner solutions to help clinicians monitor, track and discharge patients. Custom-built solutions are being used to quicken the nursing assessment and physician documentation at these field hospitals.

Cerner has also created dashboards and data analytics to inform quick decision-making and operational management aspects (e.g., ventilator capacity, bed management, infection risk screening, COVID-19 lab results).

47

INTERVIEW

Other similar initiatives across the globe include: • Standing up a 4,000-bed field hospital in a London convention center: Cerner is providing the EHR platform that will help healthcare professionals access and record relevant information for COVID-19 patients. This is an extension of the Cerner Millennium domain already in place at one of Cerner’s clients in London.

• Standing up a field hospital in Madrid over a weekend: Cerner’s solution, Selene, which is already being used at 18 hospitals in Europe, has been chosen as the EHR for this temporary facility.

• Working with our clients on creative offerings like laser-printing and the unique use of Ring cameras for patient-monitoring and desktop team rounding.

As one of the HIT market leaders worldwide, how will this pandemic impact how healthcare is delivered in the future?

The doctor-led approach of healthcare in most countries has been swept away in a stroke.

The only way of receiving healthcare for patients used to be by contacting their doctor, meeting them face-to-face, explaining their symptoms, being examined and ultimately diagnosed and treated. Within a few short weeks, patients have found other mechanisms to receive care. Patients have found themselves interacting via apps, online tools and video conferences, in many cases, with a more responsive approach. Telemedicine and virtual care have become a new vital tool in healthcare that clinicians and patients truly value during this pandemic. We believe this will become the new norm, rather than the exception.

Clinicians who have held out persistently for a more hands-on approach to care have found that the clinics that said could never go virtual have practically transformed overnight to remote working, with only minor numbers of patients being seen in person, and only after much of the investigation has been done.

The value of joined up data and interoperability across a population has been highlight-

MAY.JUNE 2020

48

WITH TRUE POPULATION HEALTH RECORDS, IT WILL BECOME EASIER TO IDENTIFY AND PROTECT THE VULNERABLE OR AT-RISK POPULATIONS, INCLUDING THE ELDERLY, THOSE WITH CHRONIC DISEASES AND UNDERLYING HEALTH CONDITIONS. IN ADDITION, A BETTER UNDERSTANDING OF THIS POPULATION’S MOBILITY AND LIVING ARRANGEMENTS WILL ALLOW THE BRAKES TO BE RELEASED IN AN INTELLIGENT WAY.

ed by this pandemic. It’s crucial for the care providers to be able to see full records, and have a greater sense of previous conditions, treatments and potential infection risk. The value of being able to open data up to both give to and receive from third parties that operate in an agile way to create smart, condition-specific apps and analytic algorithms will be seen as a vital way to deliver care.

Digital has been at the forefront of the battle against the coronavirus; it’s just not acceptable now to say that paper will do or that interoperability isn’t necessary. There will be increasing questions asked about scalability to add beds and users, reconfigure facilities and even stand up new hospitals. Systems will be expected to be more ‘elastic’ to handle those unforeseen loads.

In your opinion, how do you think this pandemic will change, in the future, an individual’s healthcare perspective.

How will organizations think about the importance of population health management and having a robust healthcare infrastructure among other factors?

The COVID-19 pandemic has exposed the ‘walls’ within global health and care systems, both between acute care providers, government and other stakeholders in public health.

It has also exposed the growing importance of population health management and mobility.

The pressing need to see patterns and infection rates has encouraged decision-makers to take a more realistic view about the use of personal data for the greater safety of all.

Healthcare is not a primarily hospital-based activity and the pandemic has highlighted this fact to a broader audience, who may request to take a greater personal ownership of their health and wellbeing in the future. With true population health records, it will become easier to identify and protect the vulnerable or at-risk populations, including the elderly, those with chronic diseases and underlying health conditions. In addition, a better understanding of this population’s mobility and living arrangements will allow the brakes to be released in an intelligent way.

Shaping the industry, keeping the patient first.

A unified voice for the region’s MedTech industry.

Add your voice by joining the Mecomed Medical Technology Association Middle East & Africa

For enquiries please contact: +971 4 513 6977 | info@mecomed.com

www.mecomed.com

ARTICLE FEATURES . Field Hospitals

FIELD HOSPITALS in fight against coronavirus

MAY.JUNE 2020

50

ARTICLE FEATURES . Field Hospitals

A

mid the severe shortage of hospital beds due to the rapid spread of the coronavirus around the world, the global demand for providing mobile field hospitals for the treatment of infectious diseases has increased.

Manufacturers are receiving an increasing number of demands to purchase such hospitals. In some cases, countries have resorted to converting conference halls, hotels, showrooms and garages into temporary hospitals to cope with the shortage of beds to treat patients with coronavirus. A number of countries have called in their armed forces, which have begun providing field hospitals to help tackle the novel coronavirus (Covid-19) crisis. Accordingly, the French, Serbian, American and Swedish armies as well as their medical staff, intervened and built hospitals in specific areas, in order to face the coronavirus crisis, amid the increasing cases with the imposition of the state of emergency to stop the spread of the virus.

The field hospital has always been an effective and alternative solution in times of crisis, wars and health disasters. It was first used in ancient times, then with time and with technical and medical progress, the world went for luxurious, highly equipped hospitals, responding to the requirements of modern hospitalization, clean environment and high-quality technology.

Currently, in order to face the spread of the coronavirus and the lack of hospital capacity, most countries resorted to the use of field hospitals. This type of hospitals has seen rapid development to meet the requirements of quarantine and artificial respiration. It is worth noting that field hospitals are often used to treat people affected by wars and natural disasters to provide first aid, before transferring them to fixed hospitals for further treatment.

IN ORDER TO FACE THE SPREAD OF THE CORONAVIRUS AND THE LACK OF HOSPITAL CAPACITY, MOST COUNTRIES RESORTED TO THE USE OF FIELD HOSPITALS. THIS TYPE OF HOSPITALS HAS SEEN RAPID DEVELOPMENT TO MEET THE REQUIREMENTS OF QUARANTINE AND ARTIFICIAL RESPIRATION.

more possibilities to fight the coronavirus, such as providing ICU beds in hospitals for those affected by the virus. In this regard, temporary hospitals have been established to relieve overcrowded city hospitals and provide treatment facilities for the injured, knowing that these include the latest and most luxurious hospitals in the world, and have set an example in emerging countries.

New York, for instance, has more coronavirus cases than any single country outside the US and death rates exceeded those in China. Therefore, they set up a field hospital in Central Park to help treat the tens of thousands of New Yorkers who have been infected with Covid-19. The field hospital, consisting of several white tents, has enough beds to take in 68 patients. It also has 10 respirators. The Jacob Javits Center prepared to open as a medical facility to increase hospital capacity in New York City amid the coronavirus COVID-19 pandemic. Almost three thousand beds are set up at Javits Center to receive patients who are not suffering from COVID-19.

A Navy hospital ship with 1,000 beds opens in New York City on Tuesday as the number of deaths and cases in the state from the coronavirus outbreak continues to sharply rise. The USNS Comfort docked at Pier 90 on the West Side of Manhattan.

Realistic examples The countries in the world, even the wealthy ones, have found themselves unable to meet the requirements of adequate treatment for people with coronavirus, which has spread in a way that exceeds the ability of governments to cope with it. Therefore, these countries sought to provide

51

ARTICLE FEATURES . Field Hospitals

The Comfort has 12 operating rooms that could be up and running within 24 hours. New York City’s emergency management office built a 350-bed facility at the Billie Jean King National Tennis Center in Flushing Meadows-Corona Park as efforts intensify to supplement hospital space as the U.S. battles the coronavirus pandemic.

Britain’s first coronavirus field hospital will treat up to 4,000 previously fit and healthy people struck down by Covid-19 once it opens, with sicker patients who are more likely to die being cared for in normal NHS hospitals. It is likely that the outbreak, weeks after its peak there, will put the UK in a critical situation especially as it has the lowest number of hospital beds per thousand in Europe.

Spain has already boosted its hospital beds by 20%. Dozens of hotels across Spain have been turned into recovery rooms, and authorities are building field hospitals in sports centers, libraries and exhibition halls.

Milan opened an intensive care field hospital at the city fairgrounds for 200 patients, complete with a pharmacy and radiology wards.

It expects to eventually employ some 900 staff.

The move came after the health situation turned extreme in Italy's Lombardy region, where bodies overflowed in morgues, caskets piled up in churches and doctors were forced to decide in some cases which desperately ill patient would get a breathing machine.

One reason Germany is in better shape than all other European countries is its high proportion of ICU beds, at 33.9 per 100,000 people, compared to 8.6 in Italy.

Back to basics In response to these developments, the demand for the production of tents intended to be field hospitals and other products has increased.

A report published by the Russian military export company, “Rosoboronexport”, stated that the company “received a large number of requests to supply mobile field hospitals to treat infectious diseases. These requests are treated with high priority due to the importance and necessity of these products.”

These products include mobile hospitals with units to diagnose and treat infectious disease,

MAY.JUNE 2020

52

THE IMPORTANT THING IN THESE HOSPITALS IS THAT THEY ARE SELFSUFFICIENT AND COMFORTABLE FOR THE MEDICAL STAFF AND PATIENTS ALIKE, AND THEY CAN BE INSTALLED IN A SHORT PERIOD OF TIME, RANGING FROM ONE TO 6 DAYS.

control and disinfection centers, and private halls to isolate and monitor the quarantined persons.

They are also equipped to receive up to 300 people. The important thing in these hospitals is that they are self-sufficient and comfortable for the medical staff and patients alike, and they can be installed in a short period of time, ranging from one to 6 days.

According to health monitors, this reality revealed at least two things: First, the high spending on luxury hospitals has turned out to be ineffective in times of crises. When the conflict raged between the pandemic and the world, it became clear that providing the place of treatment and the necessary equipment is the top priority even if it is inside a tent or garage. It is true that the luxury in providing a service and the patient welfare are important, and attract patients, but not in times of crises. Hospital rooms are no longer limited to the medical condition only, but have become well-equipped to suit different social groups, so hospitals today are more like hotel suites

NEWS

equipped with luxury amenities. Demand for premium rooms around the world is increasing, but these hospitals are very expensive, and not everyone can afford them.

Second, the important need for medical teams, and the insurance of thousands of medical personnel to operate the newly developed field hospitals. The developed world has discovered in this ordeal that its health system and medical capabilities are not that great and perhaps not better than third world countries.

Hospital workers are dealing with a huge influx of patients, while also facing a lack of equipment in many cases and the fear of becoming infected themselves. They said that they went to war without weapons. They underlined

A NUMBER OF COUNTRIES HAVE CALLED IN THEIR ARMED FORCES, WHICH HAVE BEGUN PROVIDING FIELD HOSPITALS TO HELP TACKLE THE NOVEL CORONAVIRUS (COVID-19) CRISIS.

the importance of being appropriately kitted out with masks, visors, gloves, scrubs and suits to avoid contagion. A “scary� number of staff would be needed to run the facility at full capacity and appealed for volunteers to come forward, according to Natalie Forrest, Chief Operating Officer of the Nightingale Hospital at the ExCel centre in London.

Italy, Britain and France are among countries that have called in medical students, retired doctors and even airplane attendants with first aid training to help, although all need re-training.

The medical staffing shortage has been exacerbated by the high number of infected medical personnel. In Italy alone, nearly 10,000 medical workers have been infected and more than 60 doctors have died.

53

ARTICLE FEATURES . Chronic Diseases and Coronavirus

I

n light of the rapid spread of the coronavirus, patients with chronic diseases are affected the most especially those suffering from diabetes and high blood pressure, which are most common in the elderly. People who suffer from chronic diseases should take extra precautions to stay safe, and should be aware of the slightest coronavirus symptoms.

Because of their weakened immune system, diabetic patients are more likely to develop infection and chronic risks than healthy individuals.

People who have underlying health conditions like high blood pressure, kidney disease, cancer, or diabetes are also more likely to get very sick or die from COVID-19. Also, people who are over the age of 60 are at a higher risk of developing a severe case of COVID-19.

But, how does the coronavirus affect the body in the presence of a chronic disease?

MAY.JUNE 2020

54

Diabetes Those living with either type 1 or type 2 diabetes could be at greater risk of more severe symptoms. The presence of diabetes affects primarily blood glucose levels as well as levels of insulin production in the body, which greatly affects immunity.

Diabetes is a result of your body’s inability to produce or use insulin. Insulin is a hormone that allows your body to turn glucose, or sugar, into energy. If your body has difficulty metabolizing glucose, it can lead to high blood sugar levels. This can affect your body’s ability to heal wounds. In people with diabetes, wounds tend to heal more slowly and progress more quickly, so it’s important to know what to look out for.

The diabetic patient should be very careful in following the protective measures to prevent the spread of coronavirus through hygiene, quarantine and social distancing. People with

THE DIABETIC PATIENT SHOULD BE VERY CAREFUL IN FOLLOWING THE PROTECTIVE MEASURES TO PREVENT THE SPREAD OF CORONAVIRUS THROUGH HYGIENE, QUARANTINE AND SOCIAL DISTANCING.

ARTICLE FEATURES . Chronic Diseases and Coronavirus

diabetes should make sure to check their blood sugar levels regularly, because any coronavirus symptom may lead to high blood glucose levels.

But early detection can always prevent serious complications, which requires diabetics to pay attention to any changes they may develop that could indicate the presence of infection.

The presence of a viral disease in a diabetic patient makes the body weak and unable to fight the infection naturally. If the diabetic patient does not obtain the necessary care immediately, Covid-19 may lead to pneumonia as the patient’s weak immune system makes it easier for viruses to spread in the body due to the instability of blood glucose levels.

Hypertension People with high blood pressure could be at greater risk of dying from COVID-19, the disease caused by the new coronavirus, according to a doctor in China working on the outbreak; Because there is an increased risk of death in patients who are likely to take angiotensin receptor blockers or angiotensin-converting enzyme inhibitors. However, patients who take these medications should not stop taking them, with the necessity of taking preventive measures such as practicing quarantine, social distancing, among others in order to avoid the risk of catching the virus.

PATIENTS WITH ASTHMA AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE ARE AMONG THE MOST VULNERABLE GROUPS GIVEN THE RISK OF SHORTNESS OF BREATH AS A RESULT OF PNEUMONIA THAT THEY DEVELOP, WHILE SUFFERING FROM COUGHING AND LACK OF OXYGEN.

that mimics heart attack injury even if their arteries lack the fatty, calcified flow-limiting blockages known to cause classic heart attacks. This scenario can occur when the heart muscle is starved for oxygen, which in the case of COVID-19 may be triggered by a mismatch between oxygen supply and oxygen demand. Fever and inflammation accelerate heart rate and increase metabolic demands on many organs, including the heart.

That stress is compounded if the lungs are infected and incapable of exchanging oxygen and carbon dioxide optimally. This impaired gas exchange can further diminish oxygen supply to the heart muscle.

Chronic Respiratory Disease COVID-19, the disease caused by the new coronavirus, can cause lung complications such as pneumonia and, in the most severe cases, acute respiratory distress syndrome, or ARDS. Sepsis, another possible complication of COVID-19, can also cause lasting harm to the lungs and other organs.

Patients with asthma and chronic obstructive pulmonary disease are among the most vulnerable groups given the risk of shortness of breath as a result of pneumonia that they develop, while suffering from coughing and lack of oxygen.

Heart Disease Heart disease puts people at higher risk of complications from COVID-19, but the virus can also trigger heart problems.

The virus's main target is the lungs. But that could affect the heart, especially a diseased heart, which has to work harder to get oxygenated blood throughout the body. That could exacerbate problems for someone with heart failure, where the heart is already having problems pumping efficiently.

Someone with an underlying heart issue also might have a less robust immune system.

People's immune systems weaken as they age and in those with chronic medical conditions, the body's immune response is not as strong a response when exposed to viruses.

Some people may experience heart damage

55

ARTICLE FEATURES . Chronic Diseases and Coronavirus

People with moderate to severe asthma may be at higher risk of getting very sick from COVID-19. COVID-19 can affect your respiratory tract (nose, throat, lungs), cause an asthma attack, and possibly lead to pneumonia and acute respiratory disease. There is currently no specific treatment for or vaccine to prevent COVID-19.

The best way to prevent illness is to avoid being exposed to this virus. Coronavirus targets people with other long-term chronic respiratory diseases such as chronic obstructive pulmonary disease, emphysema or bronchitis. According to the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO), COVID-19 symptoms can include fever, cough, shortness of breath or trouble breathing, chills, repeated shaking with chills, muscle pain, headache, sore throat among others.

How to boost the immune system?

Following general good-health guidelines is the single best step you can take toward naturally keeping your immune system strong and healthy. Every part of your body, including your immune system, functions better when protected from environmental assaults and bolstered by

MAY.JUNE 2020

56

healthy-living strategies such as these: • Don't smoke.

• Eat healthy: Eat a diet high in fruits and vegetables in addition to seeds and nuts. Foods recommended to boost immunity in the body are garlic, onions, ginger, and pickled foods, while avoiding antibiotics as much as possible because they decrease the beneficial bacteria in the human body.

• Exercise regularly.

• Maintain a healthy weight.

• If you drink alcohol, drink only in moderation.

• Get adequate sleep: Studies show that people who don't get quality sleep or enough sleep are more likely to get sick after being exposed to a virus, such as a common cold virus.

• Take steps to avoid infection, such as washing your hands frequently and cooking meats thoroughly • Try to minimize stress as much as possible because it harms the immune system and weakens its ability to fight diseases.

EVERY PART OF YOUR BODY, INCLUDING YOUR IMMUNE SYSTEM, FUNCTIONS BETTER WHEN PROTECTED FROM ENVIRONMENTAL ASSAULTS AND BOLSTERED BY HEALTHY-LIVING STRATEGIES.

INTERVIEW

MD, Chief of Neurosurgery, Nationwide Children’s Hospital

Jeffrey R. Leonard “Our main goal is to be able to educate people and train the next generation of surgeons, no matter where they are from”

N

ationwide Children’s Hospital is one of the largest pediatric hospitals and research institutes in the United States. In recent years, it has consistently been ranked among America’s top 10 children’s hospitals by U.S. News & World Report, the recognized authority on hospital rankings in the United States. Specific to neurology and neurosurgery, the hospital is ranked seventh in the country. "Hospitals" magazine had the chance to interview Jeffrey R. Leonard, MD, chief of Neurosurgery at Nationwide Children’s Hospital, about his program’s dedication to educating the next generation of pediatric neurosurgeons.

Can you give us a brief summary of your career?

I joined Nationwide Children’s Hospital in 2014 as chief of Neurosurgery, and also joined the faculty of The Ohio State University College of Medicine as a professor of Neurological Surgery. I am also a principal investigator in the Center for Childhood Cancer and Blood Diseases, which is part of the Abigail Wexner Research Institute at Nationwide Children's Hospital.

Before joining Nationwide Children’s Hospital, I was co-director of Pediatric Neurocritical Care and Neuro-Oncology at St. Louis Children’s Hospital, and an associate professor of Neurosurgery and Pediatrics at Washington University School of Medicine.

Can you tell us more about the Pediatric Neurosurgery Fellowship at Nationwide Children’s Hospital?

Nationwide Children’s Hospital offers a one-

MAR.APR 2020

58

year Neurosurgery Fellowship that is accredited by the Accreditation Council for Pediatric Neurosurgical Fellowships.

In order to become a board-certified pediatric neurosurgeon in the United States, it is necessary for physicians to do a pediatric fellowship program such as ours, after completing seven years of a neurosurgery training program.

Our fellows take part in at least 250 operations during their training.

What is unique about your fellowship program?

The program that we created is well-balanced in all aspects of neurosurgery. It provides fellows with advanced training in endovascular care, epilepsy, deep brain tumors, craniosynostosis, spasticity and more through collaboration with some of the field’s leading experts. Our fellows take part in research, lead a team of residents and nurse practitioners, see patients in both our outpatient clinic and Level-1 trau-

OUR CONSTANT MISSION IS TO PROVIDE GREAT OUTCOMES, BETTER DECISION-MAKING - FOR SURGEONS AND FOR FAMILIES - AND THE BEST TREATMENTS.

INTERVIEW

ma center, and learn innovative neurosurgical interventions. We also offer expanded academic and specialty experiences through our own multidisciplinary conferences and lectures as well as through Neurosurgery Grand Rounds at The Ohio State University Wexner Medical Center. At the end of their training, our fellows are able to handle any case that may come to them.

How do participants apply to the program? Do you accept international applicants?

I am the fellowship director, so candidates can reach out to me directly or go through our program website. Any applicant from outside the United States can certainly apply, provided they have neurosurgical training equivalent to what is required in the United States by the American Board of Pediatric Neurological Surgery.

What is the difference between standard neurosurgery and pediatric neurosurgery?

In addition to the required pediatric-specific fellowship training, the neurosurgical problems seen by pediatric neurosurgeons often differ from those commonly seen in adults. Adult neurological diseases usually occur over time, as with cervical degenerative disc disease, spine

fractures and other conditions. In children, the problems are more likely to be present from birth, as in kids with congenital birth defects.

Many of our patients are very young, so pediatric neurosurgeons must adapt to working on smaller body systems, often using different techniques and pediatric-specific equipment.

How would you define your department’s mission?

Our main goal is to be able to educate people and train the next generation of neurosurgeons, no matter where they are from. We want to help them learn and succeed so that children, now and in the future, here and everywhere, have the benefit of well-trained, experienced neurosurgeons. We also strive to be very transparent in all of our outcomes; we have the lowest infection rates in the United States, and the highest level of success in epilepsy surgery. We work relentlessly to improve our quality of care.

Our constant mission is to provide great outcomes, better decision-making — for surgeons and for families — and the best treatments.

OUR MAIN GOAL IS TO BE ABLE TO EDUCATE PEOPLE AND TRAIN THE NEXT GENERATION OF NEUROSURGEONS, NO MATTER WHERE THEY ARE FROM. WE WANT TO HELP THEM LEARN AND SUCCEED SO THAT CHILDREN, NOW AND IN THE FUTURE, HERE AND EVERYWHERE, HAVE THE BENEFIT OF WELL-TRAINED, EXPERIENCED NEUROSURGEONS.

To learn more about Nationwide Children’s Hospital and the Pediatric Neurosurgery Fellowship, please visit NationwideChildrens.org/Fellowship-Programs.

59

ARTICLE

Coronavirus: What People with Cancer Should Know

C

OVID-19 is a new virus that first arose in animals and was then transmitted to humans, first in China. These new viruses emerge occasionally and because the world is so connected by travel, they can spread rapidly from one place to another. Now that COVID-19 is here, what should you and your health care workers be doing?

Are Cancer Patients at Higher Risk?

All humans are at risk of infection with this virus, even children, and over 50% of patients infected in the U.S. so far are between 18 and 49 years old.

Older people above 65 or 70 are at somewhat higher risk of infection and have a higher risk of more severe infection and death especially if they have underlying chronic illness such as lung or heart disease, diabetes or other significant illnesses. Some cancer patients, but not all, are at higher risk.

Cancer patients on active treatments with chemotherapy or other treatments that lower the immune system are at higher risk. Some other cancer patients are at higher risk because of the type of cancer that they have because the cancer itself impacts their immune system. Your doctor can let you know if you have one of those types of cancer like leukemia or lymphoma.

Cancer survivors who are well past their active treatment and don’t have active cancer are probably not at increased risk unless their age places them in a higher risk group. Breast or prostate cancer patients on therapy to block estrogen or androgens are not at higher risk other than that related to age.

Most patients with the infection have mild or moderate symptoms like a bad cold or flu but others get very sick and can die. The goal is to reduce the number of infected people in order to reduce the chance of infection in those destined to have a severe case.

It is becoming evident that some infected individuals who don’t have symptoms can still infect others inadvertently and thus the need for everyone to minimize contact with others.

MAY.JUNE 2020

60

What Can I Do To Reduce My Chance of Getting the COVID-19 Infection?

Social distancing, meaning avoid contact with others as much as possible. Stay home except when you need to go to the grocery store or pharmacy. Minimize or don’t allow visitors to your home. If you must encounter another person, stay six feet away and avoid those completely who claim to just have a “cold.”

Work remotely at home unless your work is deemed essential and you can’t do it at home.

Wash your hands frequently with soap and water for at least 20 seconds, which is very effective especially when you come back into your home from the store or work or after handling packages, grocery bags or other items. If you can find hand sanitizer, carry it with you when out and use frequently. Don’t forget to clean areas in your car like the steering wheel, etc.

Avoid touching eyes, nose, and mouth without first washing hands.

Cover your mouth/nose with a tissue when you sneeze or cough, or cough into the inside of your bent elbow to prevent spreading germs.

What Should You Do If You Feel Sick?

Stay at home and contact your doctor if you have a fever, cough or other symptoms of a cold or flu.

Do not go to your doctors office or the emergency room.

If you are very sick with fever, cough and shortness of breath, call your doctor immediately and if you have to go to the emergency room, let them know ahead of time so they can prepare.

Should You Cancel Your Clinic Visit?

•

• •

Keep your appointments if you are on treatment. You should arrive 10-15 minutes early to do the necessary screening on entry to the building.

Call for an appointment if you are not on treatment but have a problem.

Clinic personnel will be contacting those with routine scheduled appointments to determine if it can be resched-

CANCER PATIENTS ON ACTIVE TREATMENTS WITH CHEMOTHERAPY OR OTHER TREATMENTS THAT LOWER THE IMMUNE SYSTEM ARE AT HIGHER RISK. SOME OTHER CANCER PATIENTS ARE AT HIGHER RISK BECAUSE OF THE TYPE OF CANCER THAT THEY HAVE BECAUSE THE CANCER ITSELF IMPACTS THEIR IMMUNE SYSTEM. YOUR DOCTOR CAN LET YOU KNOW IF YOU HAVE ONE OF THOSE TYPES OF CANCER LIKE LEUKEMIA OR LYMPHOMA.

ARTICLE

•

•

•

•

uled or handled by telemedicine, which Baylor has developed as an alternative.

New patients will continue to be scheduled as before. Please notify the staff if you have symptoms, have recently traveled to a high-risk location or have had contact with a sick person.

Non-urgent surgeries in the hospital will be rescheduled if the delay will not impact the patient’s health.

Cancer surgery or other surgery that is necessary to maintain health will continue to be scheduled as usual if deemed safe at that time.

Food service is limited to grab and go at all facilities and sitting in the snack areas or cafeteria are not permitted.

What Are Baylor St. Luke’s Medical Center And Other Hospitals Doing to Protect Staff and Patients?

• •

We are taking extra precautions to protect our patients and staff.

We are screening all patients and em-

•

ployees at the front door of the hospital for symptoms, exposures, etc.

We are restricting the number of people allowed to accompany a patient to clinic visits or hospital.

What Else Can You Do To Stay Healthy?

• • •

• •

•

Keep busy at home, move around and exercise.

Take walks outside avoiding crowded areas.

Reduce stress if you can with meditation, reading, watching a movie and exercise.

Use social media to keep in contact with others.

Eat healthy meals and drink plenty of fluids. You can’t get infected from water you drink.

Act as if you have the virus even if you don’t think you do to avoid transmitting it to others inadvertently and to avoid others from transmitting it to you.

MOST PATIENTS WITH THE INFECTION HAVE MILD OR MODERATE SYMPTOMS LIKE A BAD COLD OR FLU BUT OTHERS GET VERY SICK AND CAN DIE. THE GOAL IS TO REDUCE THE NUMBER OF INFECTED PEOPLE IN ORDER TO REDUCE THE CHANCE OF INFECTION IN THOSE DESTINED TO HAVE A SEVERE CASE.

61

ARTICLE

Coming out of COVID-19: The Impact on Healthcare Tech

T

he COVID-19 pandemic has shone a light on the heroism, fortitude and cruciality of frontline healthcare workers. It has also highlighted the importance of having the right technology and resources in place to reduce the strain on those frontline workers and support them in their day-to-day work, with or without a pandemic unfolding.

As hospitals and healthcare workers are placed under increased strain, technology has risen to the forefront in the fightback against the pandemic in a number of innovative and exciting ways.

A collective leap forward in technological innovation One remarkable initiative is from the Pan-European Privacy-Preserving Proximity Tracing (PEPP-PT) organisation. The initiative brings together scientists and researchers from eight countries to develop smartphone technology that will be able to track people who have come into contact with others who have contracted COVID-19.

MAY.JUNE 2020

62

OKI EUROPE IS OFFERING FREE* FLOOR STICKER MEDIA AND DOWNLOADABLE ARTWORK COMMUNICATING SOCIAL DISTANCING GUIDELINES.

Similarly, countries including Austria, Germany, Norway, and the UK are developing their own public contact tracing mobile apps to help track and control the spread of the virus. Chatbots are also being put to use with one German start-up launching a ‘Corona-Bot’ that asks users a series of automated questions to conclude whether they have contracted COVID-19 if they begin to display the symptoms.

Germany has also seen a significant rise in doctors using telemedicine services that allow patient consultations to take place remotely online, enabling them to perform their duties while adhering to social distancing measures.

When it comes to hospital capacity, centralised dashboards are helping to ensure efficient bed utilisation across different hospital settings.

Countries outside Europe has launched technology innovations to help fight COVID-19, UAE who developed a smartphone application, that aims to slow the spread of coronavirus

by Bluetooth & contact tracing technology to notify you when exposed to an individual who tested positive or are displaying symptoms of Covid-19.

ARTICLE

With researchers and scientists around the world performing their own tests and studies to understand the virus and develop a vaccine, the European Commission has also announced the launch of a data portal providing access to tools and data sets. This will prove to be a welcome resource for those working tirelessly towards combating the impact of the virus.

Each of these innovations reduces strain on the healthcare sector in one way or another, but the effectiveness of technology inside hospitals and healthcare facilities also needs to be considered. This is where healthcare specific printer technology comes into play.

The role of printer technology in the healthcare revolution While the pandemic is encouraging all kinds of innovation and development, there is plenty of existing technology making a difference within healthcare organisations.

For example, accessing patient records quickly and securely is critical to patient care.

Having a printer that provides 24/7 support is therefore an essential requirement that can be met by smart MFPs that can be easily maintained by the user, like OKI’s MC800 Series, ensuring the availability and confidentiality of information at all times.

A new requirement all organisations are having to face as a result of the COVID-19 pandemic, is the implementation of social distancing guidelines. Floor stickers are the ideal solution for encouraging social distancing highlighting where patients need to stand or wait to maintain the recommended distance from each other. The ability to print floor stickers as and when needed can help healthcare organisations protect the wellbeing of staff and patients.

To support businesses and organisations with their floor sticker requirements through the pandemic, OKI Europe is offering free* floor sticker media and downloadable artwork communicating social distancing guidelines. This will enable healthcare organisations to minimise the time it takes to print essential floor stickers and put them in place, whether in hospitals, surgeries or pharmacies, communal spaces, wherever

HEALTHCARE ORGANISATIONS NEED TO THINK BEYOND THE WORST OF THE PANDEMIC AND CONSIDER HOW THEY WILL COPE WITH THE PRESSURE WHEN PEOPLE WHO HAVE NONCOVID-19 ILLNESS AND AILMENTS CAN GET THE TREATMENT THAT THEY HAVE BEEN WAITING FOR.

they may be required. Printers specifically for the healthcare sector, for example, are driving efficiency and reducing administrative strain.

Healthcare organisations need to think beyond the worst of the pandemic and consider how they will cope with the pressure when people who have non-COVID-19 illness and ailments can get the treatment that they have been waiting for. When it comes to making healthcare workers’ lives easier printers that are designed specifically for the sector can make all the difference. For example, OKI’s DICOM embedded printers enable healthcare staff to print directly from medical imaging equipment without conversion software or external hardware. These devices for non-diagnostic imaging as well as general office printing.

Compact printers that provide DICOM and general printing capabilities have a smaller footprint meaning devices can be moved to the front of house, freeing up administrative time and delivering productivity gains. What’s more, OKI’s healthcare printers use secure printing software, meaning sensitive documents can be accessed on the device, printed securely and then deleted automatically.

Looking ahead through a positive lens When the worst of the pandemic has passed and life begins to return to a form of normality, national healthcare providers will likely begin to address areas where technology can help support and improve staff efficiency and operations. While the pandemic has brought significant challenges and disruption to peoples’ lives, we should all find solace in the fact that the crisis has also accelerated and shone the light on those innovative technologies that are helping to drive improvements.

Like many other industries, the healthcare sector will likely go through significant change as we come out of this crisis, but change is not always a bad thing. With the right technology in place, healthcare organisations can improve efficiencies and provide the best possible service when pressure is at an ultimate high. *Terms & Conditions Apply

63

ARTICLE FEATURES . Diabetic Kidney Disease

DIABETIC KIDNEY DISEASE High blood glucose damages blood vessels in the kidneys

D

iabetic nephropathy (diabetic kidney disease) is one of the complications of type 1 and type 2 diabetes. Although there is no way to prevent diabetes complications, modern treatments take into consideration keeping kidneys healthy and maintaining and controlling diabetes levels at the same time to reduce complications or at least delay their onset.

The main function of the kidneys is to filter waste products and excess water from the bloodstream so that they can be excreted in the form of urine. Kidneys are also involved in controlling blood pressure and secreting hormones.

Kidney damage means that blood cannot be filtered properly which may lead to waste accumulation in the body.

High blood glucose damages blood vessels in the kidneys. This damage lets protein into the urine leading to high blood pressure that damages the kidneys. Although both types of diabetes lead to kidney damage and other health problems, type 1 is more likely to cause the damage.

Diabetes is the number one cause of chronic kidney disease (CKD). According to the latest international medical studies, more than 50% of the cases of CKD are caused by diabetes.

High blood glucose and urine glucose levels in diabetics, especially those who are not following a diet and treatment plan, affect the filtration units of the kidney. Over the years, this leads to kidney damage where the patient does not feel any symptoms.

The disease does not appear until the later stages, i.e. after years of having diabetes, which leads to difficulty in maintaining kidney function and consequently having CKD. Regular follow-ups with the doctor appear to be very important for diabetics. Normally, kidney damage

MAY.JUNE 2020

64

DOCTORS PRESCRIBE SOME ORAL MEDICATIONS TO TREAT HIGH BLOOD PRESSURE. WHEN BLOOD PRESSURE IN THESE VESSELS DECREASES, KIDNEY DAMAGE ALSO DECREASES AND THUS THE AMOUNT OF PROTEINS THAT LEAK FROM BLOOD INTO URINE IS GREATLY REDUCED.

caused by diabetes progresses slowly and may take several years before showing symptoms.

Symptoms of diabetic nephropathy may appear 15-20 years after a diagnosis of type 1 diabetes.

Hence, it is fundamental for diabetics to start following the necessary protection measures to reduce the damage.

Diabetes starts affecting kidneys by limiting their function and reducing their ability to remove urea from the blood.

At later stages, it leads to a complete failure in the filtering systems of the kidneys. There is no treatment for diabetic nephropathy or for glomerulosclerosis associated with the disease.

However, there are procedures that contribute to reducing the aggravation of the disease and delaying kidney failure such as regular treatment for diabetics, high blood pressure reducers, maintaining a healthy diet, and abstaining from smoking.

It is difficult to predict which diabetic patients will develop diabetic nephropathy, but there are some dangerous factors that lead to its development which are the lack of control of blood glucose levels, type 1 diabetes that started before the age of 20, high blood pressure, and a family history of diabetes and CKD.

Diabetic nephropathy patients usually have the following symptoms: • • • • • • • • • •

Worsening blood pressure control Increased need to urinate Protein in the urine Swollen feet, ankles, or hands Reduced need for insulin Difficulty concentrating and confusion Loss of appetite Nausea and vomiting Persistent itching Fatigue

ARTICLE FEATURES . Diabetic Kidney Disease

Diabetic nephropathy has 5 stages: STAGE 1 More blood passes through the kidneys leading to increased filtering and kidney enlargement without the patient feeling any symptom.

This stage may last for years.

STAGE 2 Glucose begins affecting the filtration units of the kidneys. Small quantities of albumin (protein) are found in the urine without any symptoms. At this stage, diabetics are able to preserve their kidneys and not reach stage 3, especially if they maintain their blood pressure and blood sugar levels.

STAGE 3 The patient loses large amounts of albumin in the urine as a result of the damage of the filtration units that lose their ability to prevent blood proteins from leaking into the urine and thus losing them. Kidneys also lose their filtering ability leading to high levels of waste in the blood. This stage can be easily detected upon a urine routine test in addition to high blood pressure. It lasts for many years leading to gradual kidney function deterioration if the patient is not treated.

STAGE 4 Stage 4 is overt diabetic nephropathy, whereas the filtration units lose about 75% of their ability to filter blood. Most patients at this stage suffer from high blood pressure and deterioration of other kidney functions.

STAGE 5 A person with stage 5 CKD has end-stage renal disease (ESRD) in which the kidneys have lost their filtering ability leading to the complete appearance of symptoms. At this stage, patients often suffer from general weakness, loss of appetite, insomnia, anemia, lack of urination, and fluid accumulation in the legs and abdomen and sometimes in the lungs and heart leading to breathing difficulties. Patients who do not undergo dialysis (hemodialysis) or kidney transplant may enter coma and ultimately die.

65

ARTICLE FEATURES . Diabetic Kidney Disease

Microalbuminuria Test The first sign of diabetic nephropathy is albuminuria. Urine samples provide the doctor with the necessary information on kidney function or the presence of a large amount of albumin in the urine. Albuminuria results from damage within the kidneys. People with type 2 diabetes should be tested for microalbuminuria at diagnosis. On the other hand, patients with type 1 diabetes should be tested for microalbuminuria annually five years after diagnosis. Collecting the first urine voided in the morning for examination is preferred to avoid the error caused by the difference in the amount of albumin. Urine should be collected and checked again within 3-6 months for the final diagnosis. If it contains albumin, kidney function and cholesterol tests must be performed. The test is repeated once every year if the result is normal. It is a simple and inexpensive test. The analysis can be done by taking one urine sample and measuring the percentage of albumin in it or by collecting urine specimens for a period of 24 hours and measuring the percentage of protein in them in general.

Microalbuminuria is an early sign of diabetic nephropathy. Studies have shown that microalbuminuria in diabetics is also associated with possible cardiovascular effects.

So, the early sign of diabetic nephropathy is a tiny but abnormal amount of albumin in the urine (<30 mg/24 h). In this case, if there is no rapid medical intervention, 80% of diabetics will have an increased level of urinary albumin and reach the stage of diabetic nephropathy. The amount of urinary albumin increases then to more than 300 mg/24 h leading to ESRD. Medical research has shown that patients with type 2 diabetes are two to three times more likely to develop cardiovascular disease if they have a tiny amount of urinary albumin. If that amount increases, the chance of developing cardiovascular disease increases to tenfold. This is the same chance patients with type 1 diabetes have.

Methods of Treatment Albuminuria requires rapid intervention in order to prevent the condition from developing and reaching ESRD. Albuminuria in diabetic patients indicates that there are changes in blood

MAY.JUNE 2020

66

DIABETES STARTS AFFECTING KIDNEYS BY LIMITING THEIR FUNCTION AND REDUCING THEIR ABILITY TO REMOVE UREA FROM THE BLOOD.

vessels and correlates with high blood pressure.

Doctors prescribe some oral medications to treat high blood pressure. When blood pressure in these vessels decreases, kidney damage also decreases and thus the amount of proteins that leak from blood into urine is greatly reduced.

The important step of the treatment is to reduce the intake of salt and animal proteins such as meat and other to 0.6 g/kg per day. This requires the patient to adopt a healthy diet specific to his condition and follow-up with a nutritionist.

Prevention is the best way to protect kidneys from diabetes. The most important step is to maintain a normal blood glucose level by adopting a diet, exercising, and taking medications regularly according to the recommendations of the treating physician.

Prevention is also accomplished by controlling blood glucose level and blood pressure.

A fasting blood glucose level should range between 80-120 mg/dL and be less than 140 mg/dL after eating. A diabetic patient should not have a blood pressure of more than 130/85, or else it will accelerate the damage of the kidneys.

Recent studies have proven that controlling the level of blood glucose for long periods reduces the risk of serious diabetes complications, the most important of which are nephropathy and retinopathy. Periodic follow-ups with the treating physician and routine tests are key to diagnosing the disease at an early stage and thus starting the treatment.

67

ARTICLE FEATURES . Thyroid Disorders

THYROID DISORDERS

Hypothyroidism vs. Hyperthyroidism: How Do They Differ?

T

hyroid disorders lead to several health problems and diseases that vary in terms of symptoms and risks. Most of these disorders consist of hypothyroidism or hyperthyroidism which each has its symptoms and different treatment methods.

What is the thyroid gland? What is its importance? What is its function?

It is a small gland in the front of the neck that secretes hormones that affect all body tissues. Although it is small, it has a fundamental role in keeping the person healthy.

The thyroid gland is the bodyâ&#x20AC;&#x2122;s master metabolic control center. Brain, heart and kidney

MAY.JUNE 2020

68

THYROID HORMONE (TH) HAS DIRECT EFFECTS ON THE HEART AND BLOOD VESSELS.

function, as well as body temperature, growth, muscle strength, and nerve function are at the mercy of thyroid function.

The thyroid gland controls every cell in the human body. It secretes two hormones thyroxine (T4) and triiodothyronine (T3) in the bloodstream which are necessary for all cells in the human body to function normally.

These hormones in turn control the rate at which cells and tissues turn nutrients into energy and the amount of oxygen cells use.

The thyroid also works in conjunction with the pituitary gland which regulates how much hormones the thyroid releases. The thyroid gland produces a large amount of T4, but this

ARTICLE FEATURES . Thyroid Disorders

hormone is not very active. T4 is converted to T3 via an enzyme that removes one of its iodine atoms. T3 is considered the effective form of thyroxine produced by the thyroid gland.

Thyroid hormone (TH) has direct effects on the heart and blood vessels. T3 increases the heart rate and force of contraction and decreases vascular resistance, including coronary vascular tone. TH also has benefits on muscle strength. It regenerates the skeletal muscles and affects the transport of substances through them as it increases the flux of calcium ions inside them. It also increases the leak of protons through the mitochondrial inner membrane, stimulating more oxidation in addition to producing energy in these muscles.

TH stimulates the pancreas to produce some of the substances that lead to the formation of a number of cells that produce insulin inside the pancreas. TH also increases the production of the primary source of energy in most of the cellular processes in the body which is adenosine triphosphate (ATP) and maintains ion gradients (which are the Na+/K+ gradient and others). It also stimulates metabolic cycles involving fat, glucose, and protein catabolism and anabolism.

It also greatly affects the production of cholesterol in the body, creating or disposing of steroids through the bile. Any change in the percentage of the hormone that stimulates the thyroid gland affects the weight. People with high hormone levels have a higher body mass and vice versa. The thyroid gland also secretes calcitonin, a hormone that controls the levels of potassium and calcium in the body and helps the kidneys reabsorb calcium.

During pregnancy, the hormones produced by the thyroid gland are very necessary for the natural and proper development of the brain and nervous system of the fetus. The fetus relies on the mother for thyroid hormones during the first trimester of pregnancy.

DURING PREGNANCY, THE HORMONES PRODUCED BY THE THYROID GLAND ARE VERY NECESSARY FOR THE NATURAL AND PROPER DEVELOPMENT OF THE BRAIN AND NERVOUS SYSTEM OF THE FETUS. THE FETUS RELIES ON THE MOTHER FOR THYROID HORMONES DURING THE FIRST TRIMESTER OF PREGNANCY.

thyroid hormones are secreted, the body cells work slower than normal, and you have hypothyroidism. This leads to a lowered heart rate and decreased bowel activity.

Hyperthyroidism Hyperthyroidism is a condition in which the thyroid gland makes more thyroid hormones than the body needs. This leads to the acceleration of all functions and processes in the human body. This disorder has several causes. They include Graves' disease (autoimmune disorder that is most prevalent among women under the age of 40 in particular), hyper functioning thyroid nodules, infections, problems in the immune system, cancerous tumors in the thyroid, or problems in the pituitary gland.

Hyperthyroidism is the most common condition for increased thyroid activity and is classified as autoimmune disorder, meaning that the immune system errs and becomes unable to attack foreign cells. Thyroid clusters that contain abnormal tissues also affect the natural production of TH causing an increased thyroid activity.

These clusters can be toxic or benign and each is treated differently.

In some cases, a viral infection can lead to excess production of TH affecting thus the activity of the thyroid gland and leading to its inflammation. In some other cases, excessive iodine supplementation may be the reason for an increased activity of the thyroid gland. Iodine that is present in various foods is used by the thyroid gland to produce hormones.

Thyroid disorders If too much of the thyroid hormones are secreted, the body cells work faster than normal, and you have hyperthyroidism. This leads to an accelerated heart rate or increased bowel activity. On the other hand, if too little of the

69

ARTICLE FEATURES . Thyroid Disorders

Symptoms of hyperthyroidism are: • • • • • • • •

Excessive nervousness and anxiety Weight loss Fast heartbeat Increased sweating Trouble sleeping Hair loss Muscle weakness Hand tremor

Patients with hyperthyroidism suffer from several complications unless the correct diagnosis is made to get the appropriate treatment.

The most prominent problems are heart problems, rapid heartbeat, and osteoporosis that depends on an increased amount of calcium and other minerals that exist in the body. When the thyroid gland produces a lot of TH, it interferes with the body’s ability to incorporate calcium into the bones.

Some patients may also suffer from eye problems such as swelling, redness, light sensitivity, blurred vision, or double vision. In certain cases, complications also include redness of the skin and swelling often in the legs and feet.

MAY.JUNE 2020

70

To diagnose thyroid disorders, several tests can be done such as TSH test (TSH is a hormone responsible for the functioning of the thyroid gland), thyroid antibody test, and an ultrasound of the thyroid gland to check for inflammation or any other problem. These tests contribute to determining the cause that led to hyperthyroidism. On this basis, the doctor determines the appropriate treatment according to the patient's condition in general. Some cases may require medications while others may require treatment with radioactive iodine. Surgical intervention is the last treatment option.

Hypothyroidism Hypothyroidism occurs when the body doesn’t produce enough thyroid hormones. At first, the patient may not show any symptoms and the condition tends to develop slowly. Once the hormones deficiency increases, some of the symptoms begin to appear such as weight gain, joint pain, heart problems, and others.

The symptoms differ according to the hormones deficiency level and to the patient's condition, age, and weight.

PATIENTS WITH HYPERTHYROIDISM SUFFER FROM SEVERAL COMPLICATIONS UNLESS THE CORRECT DIAGNOSIS IS MADE TO GET THE APPROPRIATE TREATMENT.

ARTICLE FEATURES . Thyroid Disorders

However, the common symptoms of hypothyroidism are: • • • • • • • • •

Constant fatigue Cold sensitivity Hair loss Chronic constipation Weight gain Slow heartbeat Swelling in the neck Poor concentration Muscle weakness

The doctor requests some blood tests necessary to check the levels of TSH and T4. Low levels of T4 usually mean hypothyroidism, although some people have an increased TSH level and a normal T4 level. This is thought to be at an early stage of hypothyroidism. Sometimes the doctor requests an ultrasound of the thyroid gland to check for swelling or inflammation.

Hypothyroidism is divided into several groups according to the hormone deficiency level. There is primary hypothyroidism which occurs when the gland is unable to produce TH as a result of many factors including Hashimoto's thyroiditis (an autoimmune disease that produces antibodies and leads to an underactive thyroid gland). Hypothyroidism can also occur after treatment with radioactive iodine.

Secondary hypothyroidism is attributed to an insufficient TSH production from the pituitary gland. This hormone, also known as thyrotropin, is the master regulator of the thyroid gland.

It is secreted by the pituitary for this purpose.

Secondary hypothyroidism can happen if the pituitary gland is damaged due to exposure to radiation or surgery or having a tumor. Some patients have hypothyroidism due to surgical removal of the thyroid gland or injury to the gland as a result of chemotherapy for hyperthyroidism.

In tertiary hypothyroidism, inadequate secretion of thyrotropin-releasing hormone (TRH) from the hypothalamus leads to insufficient release of TSH, which in turn causes inadequate thyroid stimulation.

Iodine is considered very important for the balance of work and functions of the thyroid gland. Iodine deficiency is the main cause of hypothyroidism worldwide.

Hypothyroidism is associated with an increased risk of infertility whereas low levels of TH can interfere with ovulation, impeding fertility. Babies born to women with untreated thyroid disease may have a higher risk of birth defects compared to babies born to healthy mothers.

These children are also more prone to serious intellectual and developmental problems. Untreated hypothyroidism can cause a number of health problems such as an enlargement of the thyroid gland and an increased risk of developing some heart diseases. This is due to the fact that people with hypothyroidism can have higher than normal LDL (bad) cholesterol levels.

These patients also suffer from psychological issues that may intensify with the development of the condition. Long-term, untreated hypothyroid may cause peripheral neuropathy (damage to the peripheral nerves that carry information to and from the brain and spinal cord to the rest of the body).

Treatment involves daily use of the synthetic thyroid hormone levothyroxine (Levo-T, Synthroid, others). This oral medication restores adequate hormone levels, reversing the signs and symptoms of hypothyroidism. The patient slowly begins to improve so the doctor gradually reduces the dose of the drug. Some cases may need life-long treatment provided that TSH levels are monitored annually. Determining the right dosage of levothyroxine takes time, so the doctor checks the level of TSH several times during the period of treatment.

HYPOTHYROIDISM IS ASSOCIATED WITH AN INCREASED RISK OF INFERTILITY WHEREAS LOW LEVELS OF TH CAN INTERFERE WITH OVULATION, IMPEDING FERTILITY.

ARTICLE FEATURES . Thalassemia

THALASSEMIA

A Chronic Non-Infectious Blood Disease MAY.JUNE 2020

72

ARTICLE FEATURES . Thalassemia

T

halassemia is an inherited blood disorder characterized by decreased hemoglobin production that leads to the destruction of red blood cells, which in turn causes severe anemia. This chronic non-infectious blood disease requires continuous health care in order to prevent complications. Treatment consists of regular and permanent blood transfusion.

Children get thalassemia early in life, within the first year of age, because they receive genetically infected genes either from the father or the mother, which means that the disease is transmitted from one of the parents.

In severe cases of thalassemia, patients depend on blood supply permanently since their early childhood and cannot live a comfortable life without regular blood transfusions for the rest of their lives.

A thalassemia patient has a very small number of red blood cells and hemoglobin which makes the impact of the disease range from mild to severe and to life-threatening. Mild thalassemia does not require medical treatment but more severe types require continuous treatment. Patients with beta-thalassemia need regular blood transfusions.

The seriousness of the disease lies in the fact that low hemoglobin levels cause anemia which symptoms are severe fatigue and weakness, and in severe cases cause damage to other organs of the body which may lead to death. This absence or lack of the production of hemoglobin, which is found in red blood cells and carries oxygen to all parts of the body, leads to a decrease in the level of oxygen in every cell of the body.

There are two primary types of thalassemia.

The first is alpha thalassemia caused by a defect in one or more genes in the alpha-globin or by a genetic mutation in this gene. The second type is beta thalassemia caused by a defect in one or more genes in the beta-globin or by a genetic mutation in this gene or related genes.

The alpha and beta thalassemia are further divided into two types. The first type is thalassemia major resulting from inheriting faulty genes from both parents and may lead to the death of the child during birth or in late pregnancy. The second type is thalassemia minor

IN SEVERE CASES OF THALASSEMIA, PATIENTS DEPEND ON BLOOD SUPPLY PERMANENTLY SINCE THEIR EARLY CHILDHOOD AND CANNOT LIVE A COMFORTABLE LIFE WITHOUT REGULAR BLOOD TRANSFUSIONS FOR THE REST OF THEIR LIVES.

resulting from inheriting a faulty gene from one of the parents only, knowing that people with this type of thalassemia do not have any symptoms but their red blood cells are smaller in size than in normal individuals and there is a greater possibility for them to develop mild anemia.

This hereditary disease leads to chronic anemia which makes the patient need permanent blood transfusions according to the severity of the condition, the age of the patient, and the degree of hemoglobin deficiency in the blood.

The patient may die of the disease if the blood transfusion is not done on a regular basis.

Appropriate Nutrition Since thalassemia is a special health condition, appropriate nutrition is necessary. Regular and permanent blood transfusion causes iron overload. Therefore, the amount of iron that the digestive system absorbs from food must be reduced. The amount of iron that the human body absorbs from food is small and this absorption process increases with the decrease in the level of hemoglobin in the blood. Therefore, patients with thalassemia have to adjust their diet in the periods between blood transfusions where their hemoglobin level decreases, limiting thereby the absorption of iron in food.

There are two forms of dietary iron: heme (in meat) and nonheme (in plants). Heme iron is found in red meat such as veal, beef, lamb, red

73

ARTICLE FEATURES . Thalassemia

parts of bird meat, sardines, and other seafood such as shrimp.

As for nonheme iron, it is found in many foods. The most important of which are leafy greens such as spinach, parsley, mint, coriander, thyme, grape leaves, and nuts such as almonds, hazelnuts, pistachios, pine nuts, and peanuts.

Iron is also found in grains such as chickpeas, lentils, dry fava beans, dry beans, and dried foods such as prunes, plums, raisins, figs, apricots, and spices such as turmeric, black pepper, saffron, and cumin.

However, total abstinence from eating food containing iron is not practically possible, so it is advised to follow methods that reduce iron absorption and avoid foods that increase it.

Dairy products are among the most important foods that reduce the absorption of iron because they are rich in calcium. Therefore, patients with thalassemia are advised to drink a cup of milk when they eat red meat and use dairy products in preparing foods that contain meat. The fact that these foods contain calcium reduces the risk of osteoporosis.

Tea and coffee also limit the absorption of iron. Drinking a large amount of them daily, especially with meals, reduces the amounts of iron absorbed.

Regular Blood Transfusion Thalassemia treatment relies on regular blood transfusions to provide the body with hemoglobin. Blood transfusions are very safe given the careful examination methods used to check the donor's blood. However, the only drawback of regular blood transfusions is iron overload. This overload is added to the extra iron absorbed from food, which means that people with beta thalassemia major who undergo blood transfusion must be treated to get rid of excess iron from the body.

Bone Marrow Transplant Bone marrow transplant is the only curative treatment for thalassemia patients but it is done for specific patients only. The bone marrow can be taken from a relative donor, who is usually a sibling, and the stem cells are taken from the cord blood. The bone marrow is the tissue inside the bone that makes blood stem cells. These

MAY.JUNE 2020

74

BONE MARROW TRANSPLANT IS THE ONLY CURATIVE TREATMENT FOR THALASSEMIA PATIENTS BUT IT IS DONE FOR SPECIFIC PATIENTS ONLY. THE BONE MARROW CAN BE TAKEN FROM A RELATIVE DONOR, WHO IS USUALLY A SIBLING, AND THE STEM CELLS ARE TAKEN FROM THE CORD BLOOD.

cells turn into blood cells including white and red blood cells and platelets. Each of them has a role in maintaining the health of the body. White cells are important for immunity and fighting infections, red cells supply the body with oxygen, and platelets help in controlling bleeding.

So, to eliminate the need for regular blood transfusions, a bone marrow transplant can be performed to replace the damaged bone marrow with a new one from a donor without thalassemia. The new bone marrow begins then to produce healthy blood cells.

This process benefits many patients who suffer from blood diseases, especially patients with beta thalassemia. There are two types of this process: the first is autologous where the bone marrow is taken from the patient himself but after the disease has been in a period of stagnation where it dwindles or disappears. Healthy cells are then collected from the patient himself and given back to him later.

The second type is allogeneic transplant from a first-degree relative (brother or sister) to have identical tissues. However, the patient can receive healthy cells from an unrelated donor searched for via the World Bone Marrow Donor Registry (BMDW) to choose the appropriate type of bone marrow transplant.

So, this process depends primarily on the presence of a donor, preferably from the first degree. Tests must be performed to confirm the histological and cellular congruence (100%) between the donor and the patient. The chances of the success of the transplant increase for those who do not suffer from iron overload or enlarged liver and spleen. However, the percentage of tissue rejection is usually lower for children than for adults. The rejection does not happen immediately after the operation. It may take 3-5 years. The patient thus needs a very careful follow-up.

Before transplant, the patient is given drugs that destroy the marrow cells for a period of 6 days where he feels weak and under complete sterilization. The marrow cells are collected through a special needle and under general anesthesia. This process takes about half an hour and is completed by injecting the healthy bone marrow into the patient in a kind of blood transfusion process.

ARTICLE FEATURES . Thalassemia

THE BONE MARROW IS THE TISSUE INSIDE THE BONE THAT MAKES BLOOD STEM CELLS. THESE CELLS TURN INTO BLOOD CELLS INCLUDING WHITE AND RED BLOOD CELLS AND PLATELETS. EACH OF THEM HAS A ROLE IN MAINTAINING THE HEALTH OF THE BODY. WHITE CELLS ARE IMPORTANT FOR IMMUNITY AND FIGHTING INFECTIONS, RED CELLS SUPPLY THE BODY WITH OXYGEN, AND PLATELETS HELP IN CONTROLLING BLEEDING.

75

ARTICLE FEATURES . Cardiac Ablation

Cardiac Ablation High-precision techniques to diagnose and treat heart rhythm problems

C

ardiac ablation is a procedure that can correct heart rhythm problems (arrhythmias). Cardiac ablation works by scarring or destroying tissue in your heart that triggers or sustains an abnormal heart rhythm. In some cases, cardiac ablation prevents abnormal electrical signals from entering your heart and, thus, stops the arrhythmia. Ablation is a procedure to treat atrial fibrillation, thus helping maintain a normal heart rhythm.

MAY.JUNE 2020

76

Cardiac ablation usually uses long, flexible tubes (catheters) inserted through a vein or artery in your groin and threaded to your heart to deliver energy in the form of heat or extreme cold to modify the tissues in your heart that cause an arrhythmia. Cardiac ablation is sometimes done through open-heart surgery, but it's often done using catheters, making the procedure less invasive and shortening recovery times.

Cardiac ablation is a procedure that's used

ARTICLE FEATURES . Cardiac Ablation

THE ELECTRICAL IMPULSES THEN ARRIVE AT A CLUSTER OF CELLS CALLED THE ATRIOVENTRICULAR (AV) NODE. THE AV NODE SLOWS DOWN THE ELECTRICAL SIGNAL BEFORE SENDING IT TO THE VENTRICLES. THIS SLIGHT DELAY ALLOWS THE VENTRICLES TO FILL WITH BLOOD. WHEN ELECTRICAL IMPULSES REACH THE MUSCLES OF THE VENTRICLES, THEY CONTRACT, CAUSING THEM TO PUMP BLOOD EITHER TO THE LUNGS OR TO THE REST OF THE BODY.

fast, too slow or irregularly. Heart arrhythmias may feel like a fluttering or racing heart and may be harmless. However, some heart arrhythmias may cause bothersome — sometimes even life-threatening — signs and symptoms.

Your heart is made up of four chambers — two upper chambers (atria) and two lower chambers (ventricles). Your heart rhythm is normally controlled by a natural pacemaker (sinus node) located in the right atrium. The sinus node produces electrical impulses that normally start each heartbeat. These impulses cause the atria muscles to contract and pump blood into the ventricles.

The electrical impulses then arrive at a cluster of cells called the atrioventricular (AV) node.

The AV node slows down the electrical signal before sending it to the ventricles. This slight delay allows the ventricles to fill with blood.

When electrical impulses reach the muscles of the ventricles, they contract, causing them to pump blood either to the lungs or to the rest of the body. In a healthy heart, this process usually goes smoothly, resulting in a normal resting heart rate of 60 to 100 beats a minute. Certain conditions may increase your risk of developing an arrhythmia. These include coronary artery disease or other heart problems and previous heart surgery, hypertension, congenital heart disease, thyroid problems, diabetes, obstructive sleep apnea and electrolyte imbalance.

Cardiac ablation

to correct heart rhythm problems. When your heart beats, the electrical impulses that cause it to contract must follow a precise pathway through your heart. Any interruption in these impulses can cause an abnormal heartbeat (arrhythmia), which can sometimes be treated with cardiac ablation.

What is arrhythmia?

Heart arrhythmias occur when the electrical impulses that coordinate your heartbeats don't work properly, causing your heart to beat too

Catheter ablation is performed in the hospital. After your sedative takes effect, your doctor or another specialist will numb a small area near a vein on your groin, neck or forearm. Your doctor will insert a needle into the vein and place a tube (sheath) through the needle.

Your doctor will thread catheters through the sheath and guide them to several places within your heart. Your doctor may inject dye into the catheter, which helps your care team see your blood vessels and heart using X-ray imaging.

The catheters have electrodes at the tips that can be used to send electrical impulses to your heart and record your heart's electrical activity.

This process of using imaging and other tests to determine what's causing your arrhythmia is called an electrophysiology (EP) study that is usually done before cardiac ablation in order to determine the most effective way to treat

77

ARTICLE FEATURES . Cardiac Ablation

your arrhythmia. Once the abnormal heart tissue that's causing the arrhythmia is identified, your doctor will aim the catheter tips at the area of abnormal heart tissue. Energy will travel through the catheter tips to create a scar or destroy the tissue that triggers your arrhythmia. In some cases, ablation blocks the electrical signals traveling through your heart to stop the abnormal rhythm and allow signals to travel over a normal pathway instead. The energy used in your procedure can come from extreme cold (cryoablation), heat (radiofrequency) or lasers.

Patients with atrial fibrillation patients benefit the most Ablation is a procedure to treat atrial fibrillation. It uses small burns or freezes to cause some scarring on the inside of the heart to help break up the electrical signals that cause irregular heartbeats. This can help the heart maintain a normal heart rhythm.

For ablation, a doctor puts catheters (thin hollow tubes) into a blood vessel in the groin and threads it up to the heart giving access to the inside of the heart. The doctor then uses the catheters to scar a small area of the heart by making small burns or small freezes. In the burning process, a type of energy called radiofrequency energy uses heat to scar the tissue. The freezing process involves a technique called cryoablation.

Scarring helps prevent the heart from conducting the abnormal electrical signals that cause atrial fibrillation. Some people have unpleasant symptoms from atrial fibrillation, like shortness of breath and palpitations. Atrial fibrillation also greatly increases the risk of stroke. Anticoagulant

MAY.JUNE 2020

78

medicines used for preventing stroke pose their own risks, and people on certain anticoagulation medicines require extra blood draws and monitoring. The main reason for ablation is to control symptoms. It is not intended to eliminate the need for blood thinners for stroke prevention.

Many people with atrial fibrillation take medicines to help control their heart rate or their heart rhythm. Some people respond poorly to these medicines. In such cases, the doctor may suggest ablation to correct the problem.

In atrial fibrillation, blood can pool in the heart's upper chambers and form blood clots. If a blood clot forms in the left-sided upper chamber (left atrium), it could break free from your heart and travel to your brain. A blood clot can block blood flow to your brain and cause a stroke. Blood clots can also block blood flow to other organs.

The risk of stroke from atrial fibrillation rises as you grow older. The following health conditions also increase your risk: high blood pressure, diabetes, heart failure, some valvular heart disease and stroke. To reduce your risk of stroke or damage to other organs caused by blood clots, your doctor may prescribe a blood-thinning medication.

Living a healthy lifestyle can improve your heart health and reduce your risk of developing atrial fibrillation. Aim to include healthy habits in your life such as exercising regularly, eating heart-healthy foods, keeping a healthy weight, avoiding smoking, limiting or avoiding alcohol and keeping blood pressure and cholesterol levels under control. Managing your atrial fibrillation and any other conditions you have that increase your risk of stroke also can help you reduce your risk of stroke.

HEART ARRHYTHMIAS OCCUR WHEN THE ELECTRICAL IMPULSES THAT COORDINATE YOUR HEARTBEATS DON'T WORK PROPERLY, CAUSING YOUR HEART TO BEAT TOO FAST, TOO SLOW OR IRREGULARLY. HEART ARRHYTHMIAS MAY FEEL LIKE A FLUTTERING OR RACING HEART AND MAY BE HARMLESS. HOWEVER, SOME HEART ARRHYTHMIAS MAY CAUSE BOTHERSOME â&#x20AC;&#x201D; SOMETIMES EVEN LIFE-THREATENING â&#x20AC;&#x201D; SIGNS AND SYMPTOMS.

ARTICLE FEATURES . Cardiac Ablation

79

INTERVIEW

Op-Ed: At WISH, We Recognize that Nurses are our Healthcare Heroes

By Sultana Afdhal, CEO, World Innovation Summit for Health, an initiative of Qatar Foundation

T

he year 2020 has been named as the Year of the Nurse and the Midwife by the World Health Organization (WHO). With the world presently engulfed by an unprecedented healthcare challenge, this designation could not be more timely.

COVID-19 has brought into sharp focus the selfless contributions of nurses on the frontline of the global pandemic. They account for almost 60 percent of health professionals worldwide, and are in the highest risk category for contracting the virus. In Italy, healthcare workers

MAY.JUNE 2020

80

make up 9 percent of all COVID-19 cases, while in Spain this figure is as high as 14 percent. To date, over 100 National Health Service workers in the UK have died after contracting the coronavirus. Meanwhile, official data from the Centers for Disease Control and Prevention suggests these frontline workers account for 11 percent of all infections in the United States.

Even as we struggle to comprehend the enormous toll that the virus has taken across all sectors of society, these figures are particularly sobering. The fortitude and selflessness of nurses the world over must be recognized and

THE FORTITUDE AND SELFLESSNESS OF NURSES THE WORLD OVER MUST BE RECOGNIZED AND APPLAUDED.

INTERVIEW applauded. There is currently a global shortfall of nurses and midwives, and recent events demonstrate the urgent need to raise their numbers and place them at the heart of resilient healthcare systems all around the world.

My own journey to understanding the critical role that nurses play began with the commissioning of the 2018 WISH report on Nursing and Universal Healthcare Coverage, led by our research group chair, Lord Nigel Crisp, co-chair of Nursing Now, a global initiative launched by the International Council for Nurses and the WHO in 2018.

The report showed strong public backing for nurses to play a greater role in health services, and demonstrated that they are well-positioned to manage the defining health challenges of modern times.

Through nursing leadership courses, symposiums, and workshops, we are empowering nurses to expand their horizons in meaningful ways, learn new skills, and make their voices heard in healthcare policymaking.

In Qatar, our work is a collaborative effort, supported by the Nursing Now committee which is co-chaired by the Chief Nursing Officer at Hamad Medical Corporation and myself, and brings together senior representatives of WISH, Primary Health Care Corporation, Al-Ahli Hospital, and the University of Calgary in Qatar.

We are already witnessing some remarkable changes. Qatar’s nurses are growing in confidence as they realize their true potential and look to become researchers, leaders, and educators. The aim is to inspire more Qataris to take up the profession, build on the skills that nurses of today already possess, leverage technology, and applaud the work they are doing.

Recently, I was honored to be part of the Steering Committee of the State of the World’s Nursing Report 2020, launched by the WHO on April 7. Based on data from 191 countries, the first-of-its-kind report details the latest evidence and policy options for the global nursing workforce. It maps out key recommendations for the nursing sector, to help deliver the 2030 global Sustainable Development Goals and universal healthcare coverage (UHC). These include the

need for governments to invest in a massive acceleration of nursing education, the need for six million new nursing jobs to be created by 2030 (primarily in low and middle-income countries), and investments to be made in nurse leadership new models of care, advanced practice roles, and policy decision-making - to maximize the efficiency and effectiveness of health and social care systems. It is an agenda we must commit to.

At WISH, we recognize that nurses are the backbone of our healthcare systems, yet millions of people are unable to access the crucial primary care services that they provide. For instance, across Africa, there are only 8.7 nurses per 10,000 population, while in the US, 27.9 million people have no health insurance – particularly dire statistics in light of the current situation.

To coincide with the Year of the Nurse and the Midwife, WISH is leading the development of special reports, one of which will focus on men in nursing, in partnership with the British Medical Journal. The reports are expected to be published in time for the WISH 2020 summit, set to take place from November 16–18.

Additionally, WISH is working on a policy recommendations paper, Nursing and Midwifery Workforce Development, offering a global perspective as well as a specific focus on Qatar. This policy paper will also be ready for WISH 2020, and we look forward to sharing the findings with global healthcare leaders.

Alongside our other efforts, WISH has partnered with the Nursing Now campaign to give young nurses a voice at the World Health Assembly meeting in Geneva, an annual gathering of health ministers organized by the WHO. In May last year, nurses from 18 countries participated in five days of meetings, talks, workshops and networking opportunities, offering a chance to positively influence global healthcare policy.

As the world fights the COVID-19 pandemic, it is time to applaud the amazing contributions of our nurses, and that of all healthcare professionals working tirelessly to keep us safe from harm. But applause is not enough - nurses are our healthcare heroes, and investment in nursing represents an investment in our future.

THROUGH NURSING LEADERSHIP COURSES, SYMPOSIUMS, AND WORKSHOPS, WE ARE EMPOWERING NURSES TO EXPAND THEIR HORIZONS IN MEANINGFUL WAYS, LEARN NEW SKILLS, AND MAKE THEIR VOICES HEARD IN HEALTHCARE POLICYMAKING.

81

ARTICLE

Healthcare Workers Beware of Coronavirus Encephalopathy

F

eatures of Coronavirus infection include fever, cough and breathing difficulty. It’s well known by now that the lung and the heart are the main target organs affected.

Dr. El Fatih M Bashir Elmalik Consultant Neurosurgeon at Al Ahli Hospital

However, the brain has now appeared as another target organ for the disease. Such cases have been reported in many places including China, Europe and the United States of America.

These patients presented in a way not dissimilar to cases of viral encephalitis. Besides impaired senses of smell and taste which were noted previously in Coronavirus patients, symptoms of delirium, seizures and speech difficulties have been reported in patients who otherwise had not shown other features of typical Coronavirus disease. Besides testing positive for Coronavirus, the Bain MRI scans in these cases showed features known to neuroscientists as typical of viral encephalitis.

However, it’s not clear yet if the involvement of the brain is due to direct attack by the virus

MAR.APR 2020

82

or the result of viral antibody effect. What is important here is to warn the healthcare workers of this new development of the disease. As such, it is essential to keep a low threshold for considering patients presenting with similar neurological symptoms as due to Coronavirus until proven otherwise. Particularly that it is not difficult to confirm the diagnosis with Coronavirus Lab test and Brain MRI.

References:

• https://www.thailandmedical.news (Coronavirus News; Mar 05, 2020) • http://www.xinhuanet.com/english/2020-03/05/c_138846529.htm • https://www.encephalitis.info/blog/coronavirus • https://www.nytimes.com/2020/04/01/health/coronavirus-stroke-seizures-confusion.html • https://www.cureus.com/articles/29414-neurological-complications-of-coronavirus-disease-covid-19-encephalopathy • https://www.the-scientist.com/news-opinion/lostsmell-and-taste-hint-covid-19-can-target-the-nervous-system-67312 • https://onlinelibrary.wiley.com/doi/10.1111/ ene.14227

ARTICLE

For 5 years, she has been suffering from rare and strange stenosis of the main bronchus

The Pulmonary and Chest Department at Al-Ahli Hospital succeeds in returning a woman to her normal life

T

he patient complains of severe stenosis of the upper respiratory tract and was suffering to take a breath accompanied by a type of strider.

Dr. Hassan Sawaf Consultant Neurosurgeon at Al Ahli Hospital

The Pulmonary and Chest Department at Al-Ahli Hospital received a rare case of a 38-yearold Canadian woman, who visited the Pulmonary and Chest Department at Al-Ahli Hospital, after her health condition deteriorated, fatigue got her, and she was complaining of dyspnoea that is constantly associated with her, as a result of "asthma" disease of which she was diagnosed five years ago.

She has followed treatments since that time because of this disease until she decided to come to the Pulmonary and Chest Department at Al-Ahli Hospital, which was able to diagnose the disease with accurate ways, and discovered what the patient complained of, and succeeded in determining the feasible treatment that relieved her of dyspnoea, which was getting worse every so often. Dr. Hassan Sawaf, Consultant and Head of the Pulmonary and Chest Department at Al-Ahli Hospital, spoke about this patient, her condition and how she was treated.

Dr. Sawaf confirmed that the medications and treatments that the patient had been using for five years had no effect or good results and benefit on her condition and health. On the contrary, her condition was getting worse every so often. As a result, she went to see a doctor, consulted a number of her friends, and she was advised to go to the Pulmonary and Chest Department at Al-Ahli Hospital.

tory tract, especially the upper ones. As a result, a CT scan of the neck and chest was immediately performed, where it was suspected that something, which might be organic, was blocking the respiratory tract. Although her general condition upon arrival was acceptable, she was suffering to take the breath, and her breathing was accompanied by a kind of syrigmophonia.

Rare stenosis On the stages of her treatment, he said: "After a rapid and bronchoscopy was performed within two days, it became clear that there was almost entirely obstruction in the main trachea through which the human being is breathing, which is known also as "windpipe", and she had only a small hole of 2 mm length that allowed her to breathe.

As a result, we encountered difficulty during the bronchoscopy process, because this hole might be obstructed at any moment, which might lead to serious complications to the patient. Based on what we discovered through various diagnostic processes, we coordinated directly for Tracheal Surgery.

Immediately after surgery, she became normal, breathing much better than before and didn't need her previous treatment anymore.

Quick diagnosis Dr. Hassan Sawaf added: â&#x20AC;&#x153;As soon as I had checked out the patient, a set of rapid and systematic plan and examinations were performed, including breath testing, images and radiology tests that showed severe stenosis of the respira-

83

ARTICLE

Implantation of a device that changed the life of a patient with severe heart failure in Al-Ahli Hospital (April 2020)

T

here has been a tremendous amount of research and improvement in the treatment of heart failure, over the last 20 years.

Some important drugs have been introduced and tested which made a big difference to the life of patients of heart failure.

Dr. Gehani Consultant Cardiologist and Chairman of Ahli Heart Center

However, there are many patients who continue to suffer from symptoms of heart failure, despite maximum medications. These patients often need repeated admissions, from time to time, to control their heart failure by giving medications via injections. In some, heart failure is so severe that they may need to be intubated and put on Ventilator (artificial respiration via a tube introduced through the mouth into the air-pipe). For such patients, there has been an extremely important discovery of implantable devices called CRTD-ICD, and which made a huge difference to their life.

We hereby report one such patient who had severe heart failure who saw his life turn around after the implantation of a special heart device.

Mr. DD is a here a middle-aged British gentleman who works as an engineer. He had suffered from increasing fatigue and breathlessness which he thought because of activity at work, but his symptoms got much worse that he could not climb stairs at all, and sometimes finds walking or even going to the toilet a difficult task. He attended the Cardiology Clinic of Dr.

Gehani (Consultant Cardiologist and Chairman of Ahli Heart Center) in March 2018. He complained of severe breathlessness both on walking and at rest. Some nights he had to sit up because lying down made him feel choked.

He said that sometimes he felt he was going to die. Dr. Gehani, said that the patient also had evidence of fluid in the lungs and swelling of both legs, which are highly suggestive of heart failure. He was immediately admitted and investigations confirmed severe weakness of heart muscle. The Echocardiogram revealed the pumping efficiency of the heart muscle was only 27% (Normally 55-65%). During admission, he was given medications by Intra-venous drip to reduce the fluid overload on the lungs and the body. Coronary angiogram was carried out to exclude blockage of the coronary arteries that supply the heart muscle, which is one of the most important causes of heart failure.

This done by passing a fine catheter from the arm or the goring and injecting small amount of dye directly in the coronary arteries, which can uncover any narrowing or blockage of the coronary arteries. There was no blockage and therefore Cardiac MRI (Magnetic Resonance Imaging) was carried out to study the structure of the heart muscle in details. This confirmed that there was extensive scarring of the heart muscle leading to its weakness. This is called Cardio-myopathy.

The patient had a good response to the medications when given in the hospital by Intra-venous drip, but he was given tablets to take at home, he became worse again and needed another admission to give the medications by drip. It has become clear that he needs more assistance than just medications. One such modern option which has shown a great promise in such cases is a device called Cardiac Re-Synchronization Therapy Device (CRTD).

This is implanted under the skin and has wires which are passed through the veins under the Collarbone to the heart (Figure â&#x20AC;Ś..). These

MAR.APR 2020

84

ARTICLE This is the important function of the CRTD part of the device. The other part of the device is called ICD (Implantable Cardioverter Defibrillator) which has another very important function, which is the prevention of Sudden Cardiac Death which is common in patients of heart failure. The ICD Technology continuously monitors the heart rate of the patient and if this becomes abnormal and threatens sudden arrest of the heart, the ICD deals with this by giving an electric shock that can bring the heart rhythm back to normal and prevent cardiac arrest.

devices look like pacemakers, but are much more complicated. Traditional pacemakers only deal with slow heart rate (Bradycardia) which can cause dizziness of loss of consciousness. Under these circumstances, the pacemaker gives extra beats to prevent loss of consciousness, but they cannot treat abnormally fast heart rate which can also cause sudden cardiac death.

In each admission, Mr. DD showed good response when medications were given by drip, but whenever this was replaced by tablets to allow him to go home, he had some recurrence of symptoms and therefore oral medications were not able to completely control his symptoms.

It was clear that he needs more than just oral medications and therefore, we had a long discussion with Mr. DD about the option of implanting one of the modern devices that has been shown to add to the improvement achieved by medications. Such devices also can prevent Sudden Cardiac Death which is known to be a real threat in patients with heart failure.

After studying the ECG (Electrocardiogram) and Echocardiogram (Ultrasound scan) of the heart, it became obvious that CRTD-ICD is the device of choice in this case. CRTD-ICD devices have, in addition to treating slow heart rate, they can also improve the function of the Heart muscle by improving the coordination between the left and right Ventricles of the heart. This coordination is lost in many patients with heart failure which makes heart failure much worse.

The implantation procedure for CRTD-ICD devices is done in the Cardiac Catheterization rooms and takes between 1-2 hours on average.

They can be done under sedation and local anesthesia, but in patients who could not tolerate lying flat still (which is often the case in patients with heart failure), general anesthesia is often necessary and advisable. The implantation procedure was done by Prof. Gehani, and the anesthesia was administered by Dr. Iman Daoud, Consultant Cardiac Anesthetist. The procedure was straightforward without complications and three wires were passed from the CRTD-ICD device to the following chambers of the heart: One to the Right Atrium, one to the Right Ventricle and the third was passed to a special venous channel in the back of the heart, called Coronary sinus, because it is close to the third chamber that we wanted to pace, the Left Ventricle said Prof. Gehani.

THE PUMPING EFFICIENCY OF HIS HEART MUSCLE WAS ONLY 27% (LESS THAN HALF OF NORMAL HEART).

SOME NIGHTS HE HAD TO SLEEP SAT UP FROM BREATLESSNESS AND SOMETIMES HE FELT HE WAS GOING TO DIE. AFTER THE DEVICE IMPLANTATION WENT BACK TO NORMAL LIFE WITH LITTLE SYMPTOMS.

The patient was discharged on the third day. He was seen for follow-up for nearly 2 years before he traveled back to his country. He experienced a huge improvement in daily life after the implantation of the CRTD-ICD device. He is now able to climb up to 3 flights of stairs without stopping and can sleep almost flat without waking up with cough and breathlessness. The device was programmed from time to time to optimize its function and the patient's response was excellent every time, such that we were able to reduce the number and quantity of medications, said Prof. Gehani.

85

ARTICLE

COVID-19 and Diabetes-Obesity: What to do?

F

rom January, 2020, we have been facing an unprecedented outbreak of coronavirus disease 2019 (COVID-19) caused by a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which has now become a global catastrophe. Data from the early months of 2020 suggest that most people with COVID-19 have comorbidities, the most prevalent of which are diabetes, cardiovascular disease, and hypertension.

Mohamed Elrishi Consultant Endocrinologist at Al Ahli Hospital

People with diabetes, in particular with poor control had much higher rates of serious complications and death than people without diabetesz. Studies have also shown that COVID-19 is associated with hyperglycemia particularly in the elderly with type 2 diabetes3. Diabetes in older age is associated with cardiovascular disease, which in itself could help to explain the associa-

MAR.APR 2020

86

tion with fatal outcomes of COVID-19.

Currently, there is no evidence regarding the increased risk of COVID-19 infection in people with obesity. Evidence suggests that for common seasonal flu, people with obesity with BMI â&#x2030;Ľ 40 kg/m2 have an increased risk of serious complications1.

Noted potential β cell damage caused by the virus leading to insulin deficiency is supported by the observation of Italian colleagues who have reported frequent cases of severe diabetic ketoacidosis (DKA) at the time of hospital admission6. Another important observation from various centers in different countries affected

by COVID-19 is the tremendous insulin requirement in patients with a severe course of the infection. To what extent COVID-19 plays a direct role in this high insulin resistance is unclear.6 The risks are similar for people with type 1

ARTICLE

and type 2 diabetes. People with type 1 diabetes have an increased risk of DKA. COVID-19 can cause a typical presentation of a mix of DKA ad hyperosmolar state , so it is recommended to stop metformin and SGLT2 inhibitors (Flozins) in type 2 diabetes patients and reassess the safety once patient becomes more stable7.

What should people with diabetes do if they get infected with COVID-19?

People with diabetes infected with the virus may see a deterioration in their glycaemic control during the illness. Patients should follow “sick day guidelines” to improve their diabetes decompensation5. This includes continuation and strict abidance with adequate control of blood pressure and lipids.

Therefore, continuation with an appropriate antihypertensive and lipid-lowering regimen in all these patients is of crucial importance6.

Following measures are suggested by American Diabetes Association (ADA) in these patients2: Follow advice of the physician (or diabetes team) regarding diabetes medication and monitoring of blood glucose.

Be aware of the signs of a hyperglycaemia (such as passing more urine than normal; especially at night), being very thirsty, headaches, tiredness and lethargy). Monitor blood glucose frequently throughout the day and night (generally, every 2-3 hours).

Stay hydrated. If blood glucose is below 70 mg/dL (3.9 mmol/L) or below the target range, drink 120- 150 ml (ex. juice or regular soda). Blood glucose should be checked in 15-20 minutes to ensure sugar levels are increasing.

Ketones should be checked if blood glucose levels are more than 240mg/dL (13.3 mmol/L) twice in row.

Physician should be consulted immediately if the patient has medium or high ketones (and if instructed to with trace or small ketones.

Hands should be washed, and injection and finger-stick sites should be cleaned with soap and water or rubbing alcohol.

Subgroup of people with diabetes who work as healthcare professionals. Given that COVID-19 might be more prevalent among the

sick than is currently being diagnosed, healthcare professionals with diabetes should be deployed away from front line clinical duties where possible. For cases in which this is not possible or desirable, high-grade protection or increased protection should be used.6

What measures should be taken by people with obesity if they get infected with COVID-19?

Patients with obesity and diabetes could be at specific risk of ventilatory failure and complications during mechanical Ventilation. Clinical experience with young patients with obesity and COVID-19 supports this notion.6 People with obesity are advised to follow the recommendations provided by WHO and their local authority if suspected of COVID-19 symptoms8. People should not discontinue any medical treatment they are receiving (including anti-obesity medications) without first discussing with their healthcare provider.

Individuals with obesity should continue physical activity in accordance to guidance from local health authorities and ensure social distancing.

CURRENTLY, THERE IS NO EVIDENCE REGARDING THE INCREASED RISK OF COVID-19 INFECTION IN PEOPLE WITH OBESITY. EVIDENCE SUGGESTS THAT FOR COMMON SEASONAL FLU, PEOPLE WITH OBESITY WITH BMI ≥ 40 KG/M2 HAVE AN INCREASED RISK OF SERIOUS COMPLICATIONS

References

1. Chen Y, Gong X, Wang L, Guo J. Effects of hypertension, diabetes and coronary heart disease on COVID-19 diseases severity: a systematic review and meta-analysis. medRxiv 2020; published online March 30; DOI:10.1101/2020.03.25.20043133 (preprint).

2. ADA: https://www.diabetes.org/diabetes/treatment-care/planning-sick-days/coronavirus 3. Xue T, Li Q, Zhang Q, et al. Blood glucose levels in elderly subjects with type 2 diabetes during COVID-19 outbreak: a retrospective study in a single center. medRxiv 2020; published online April 2; DOI:10.1101/2020.03.31.20048579 (preprint).

4. IDF: https://www.idf.org/our-network/regions-members/europe/europe-news/196-informationon-corona-virus-disease-2019-covid-19-outbreak-and-guidance-for-people-with-diabetes.html 5. Diabetes UK: https://www.diabetes.org.uk/about_ us/news/coronavirus 6. Practical recommendations for the management of diabetes in patients with COVID-19. Stefan R Bornstein, Francesco Rubino, Kamlesh Khunti, et al. Lancet Diabetes Endocrinol 2020 Published Online April 23, 2020 https:// doi.org/10.1016/ S2213-8587(20)30152-2 7. The Royal College of Emergency Medicine. Safety Alert. //Ww.rcem.ac.uk/safety 8. WOF: https://www.worldobesity.org/news/coronavirus-disease-covid-19-outbreak-for-people-living-with-ob

87

NEWS

Omnicell introduces New Rapid Pandemic Response Scheme to support partners in the Middle East in fight against COVID19

O

mnicell, Inc. (NASDAQ:OMCL) - a leading provider of medication management solutions and adherence tools for healthcare systems and pharmacies - announced that the company is working alongside its distributor partners in the Middle East to fast-track its healthcare automation solutions to the front line, to help meet the increasing demand for services during the current COVID-19 pandemic.

Ivor Matthews SQ

Omnicell technology has been supporting healthcare providers in the Middle East for 17 years, including King Faisal Specialist Hospital (KSA), National Guard Health Affairs (KSA) and Dubai Health Authority (UAE). Barriers to the ordering, shipping and installation of its XT Automated Dispensing Cabinets have been removed to help hospitals quickly ‘scale-up’ additional medication management and supply needs as soon as required.

Ivor Matthews, Omnicell’s Director of International Sales in the Middle East, says: “Rapidly expanding bed capacity and unprecedented pressure on ICU units at this time means support for healthcare infrastructure has never been greater. By providing a range of ‘fast-track’ products and services, we hope to help enable healthcare professionals to spend more time on face-to-face patient care.”

Omnicell has been driving innovation in medication and supply automated technology for 25 years across all healthcare settings.

Its range of products and services aim to reduce medication dispensing errors, improve patient safety, drive efficiency and allow healthcare professionals to spend more time on face-toface patient care.

With healthcare providers in the Middle East and globally under unprecedented pressure, Omnicell has fast-tracked production and deployment of their XT Automated Dispensing Cabinets for wherever technology and support services are needed the most – whether that’s ICU/ED or new/repurposed care areas.

Quick to Order, Quick to Ship, Quick to Care This includes simplifying the procurement process and manufacturing cabinets based on a signed pricing supplement. With standardised preconfigured XT cabinet options for medication (based on best practices for ICU/ ED areas),

MAY.JUNE 2020

88

Omnicell is now able to deliver cabinets to healthcare providers within 14 days of an order being placed. There are two installation options depending on needs - either self-install with remote support or on-site install with training.

Rapid Onboarding The organisation has developed a new ‘howto’ 25-minute user training module; ‘Omnicell’s solutions for end-users’, as well as providing guidance on how to make sure the Omnicell hardware is clean.

Responding quickly to meet customers’ needs Omnicell is increasing its support for clients globally. Earlier this month, for instance, Omnicell installation teams were on site at Guys and St Thomas’s NHS Trust in the UK to support them in reconfiguring their ICU as it grows from 100 beds to 300 beds to meet increased demand for services. In addition to providing the above services, Omnicell’s Pandemic Response Team has established procedures and protocols designed to mitigate the risk of exposure to the virus and potential impact on business operations. As such, they have prioritised travel that is essential to implementations and support while prohibiting non-essential travel and adopting a global protocol for employees whose roles can be carried out remotely. This will help to maintain a safe working environment for customers and employees who are carrying out business-critical activities, including service, implementation and supply chain.

“Our installation teams are already supporting healthcare providers in the region as they rapidly respond to the COVID-19 outbreak and will continue to do so for as long as needed,” Matthews adds. “It’s vital that those on the ‘front-line’ are able to focus solely on providing critical patient care, safe in the knowledge that the very best in key technology solutions is supporting them. We understand the need to support healthcare providers to quickly ‘scaleup’ to meet increasing demand.”

NEWS

IHF boosts knowledge-based defense against COVID-19

T

he International Hospital Federation (IHF) has been actively supporting the efforts of healthcare associations and organizations in dealing with the pandemic crisis through COVID Information and Resources, a knowledge-based resource made openly available on IHF website.

With historic decades of service to members around the world, IHF continues to expand its knowledge-based resources that are timely and beneficial to stakeholders. By providing a public access to COVID database, it provides a one-stop exchange for information-sharing of expertise, experiences, and endeavors tackling coronavirus disease. During this challenging time of self-isolation, home quarantine, and lockdown, being connected to the net in search for latest updates becomes a necessity among communities. This is where web resources become instrumental to elevating public awareness and health education.

TO HELP THE NETIZENS FIND THE RIGHT INFORMATION, THE IHF COLLABORATES WITH ITS MEMBERS AND PARTNERS IN THE DISSEMINATION OF COVID UPDATES ON BOTH NATIONAL AND REGIONAL LEVELS.

IHF President Risto Miettunen,M.D. said

“the COVID-19 outbreak is affecting an increasing number of populations across the world, placing great strain on health services delivery organizations. The International Hospital Federation does not seek to overlap with the key role of the World Health Organization at the global level, and of the countries' national agencies and health service organizations giving the most appropriate recommendations in a fast-evolving situation”.

With the influx of information on digital platforms, netizens tend to react in an overwhelming manner leading to confusion and panic. To help the netizens find the right information, the IHF collaborates with its members and partners in the dissemination of COVID updates on both national and regional levels. IHF remains proactive to its mission of improving the standards of healthcare sector worldwide. It is not only to bring solutions to present crisis but also, to be ready for the future of healthcare organizations on national and regional levels.

IHF vows to fight #TogetherAgainstCOVID

T

he International Hospital Federation (IHF) is committed to fighting against the COVID-19 as the entire world acts vigilant towards a global cause in saving lives of patients and medical workforce. COVID-19 has clearly challenged the capabilities, resources, and economy of almost all nations. However, the resilience of the global healthcare community becomes evident given so much dedication to surviving the pandemic crisis.

IHF CEO Eric de Roodenbeke,Ph.D. said “We do wish to underscore the essential role played by the health service providers that are on the front line to support all those affected by the virus and provide responses for the most critical cases.

We must all recognize the work carried out by all health professionals: this is not only because it is their job to do so that we shouldn't praise them for what they are doing while taking serious risks with their own health to care for others”.

While most of the civilians stay home for well-being, there are front liners like doctors,

WITH DECADES OF GLOBAL HEALTHCARE LEADERSHIP, THE IHF KEEPS OPTIMISM ALIVE IN ITS PROACTIVE ROLE IN HELPING REBUILD THE HEALTHCARE INDUSTRY WORLDWIDE.

nurses, researchers who are facing the risks of exposure to the viral infection of COVID-19. Also, there are service providers like hospitals, test centers, clinics that are suffering from shortage of medical supply and equipment. Such problems have been addressed on a national level while others are still waiting for immediate solutions in some regions. As the leader of the global healthcare community, IHF responds to crisis by continuously supporting its members worldwide through strategic and innovative interventions.

To recognize the response efforts of healthcare organizations, IHF has activated a social media campaign #TogetherAgainstCovid where stories, voices, and thoughts can be shared aiming to chronicle the learnings in their journey.

With decades of global healthcare leadership, the IHF keeps optimism alive in its proactive role in helping rebuild the healthcare industry worldwide. It envisions a revitalized comeback of the global healthcare community that will be ready for recurring crisis in the future.

89

NEWS

Medis Medical Imaging Systems acquires Amid and Secures further investment from Van Herk Ventures

M

EDIS, a leading developer and supplier of software applications for image-based diagnosis and quantitative assessment of cardiovascular disease, announced that it acquired Advanced Medical Imaging Development S.r.l. (AMID), a developer and supplier specialized in cardiovascular mechanics and innovative image processing in ultrasound and other modalities.

The strategic acquisition will expedite MEDIS’ expansion in new areas of cardiovascular disease, and secure MEDIS’ access to key technologies to further enhance its innovative portfolio of post-processing solutions for X-ray, MR, CT, IVUS, OCT and US devices.

The acquisition of AMID, based in Sulmona (Italy), will further increase MEDIS’ share in the cardiovascular market. “This acquisition expands our product portfolio and brings in new sales channels. The combination of AMID’s products with our product and services portfolio will enable us to provide our customers a unique and more complete multi-modal offering for cardiovascular imaging analysis”, said Hans Brons, CEO of MEDIS. “As part of MEDIS we will have significantly more leverage to position our portfolio of innovative technologies in the global market for cardiovascular imaging software,” commented Giovanni Tonti, CEO of AMID. “Our technology offerings will allow MEDIS to complement and further enhance its already impressive suite of clinical offerings and spur innovation.”

“MEDIS and AMID have already had an excellent cooperation for over five years, both commercially and in product development. I am very excited about our access to the unique know-how and innovative power of AMID’s founders and their technology, and to intensify the cooperation leading to new solutions that ultimately will benefit the patients“ says Hans Reiber, founder and CSO of MEDIS. MEDIS will leverage AMID’s proprietary

MAY.JUNE 2020

90

state-of-the-art software and know-how to provide even more sophisticated cardiac and cardiovascular imaging software solutions to its customers. “The integration of both companies will take place over the next months. We expect to significantly strengthen our power to innovate and are very excited about our new relationships with AMID’s existing OEMs and sales channels” added Hans Brons. “Our new customers will continue to receive the same high quality of service which they have come to expect.”

AMID, which will continue to operate under that name is now a wholly owned subsidiary of MEDIS. Over the last 6 months, Van Herk Ventures has made significant further equity investments in MEDIS with the aim to help accelerate the growth of the company and to enable the acquisition of AMID. “With this investment, Van Herk Ventures enables us to further expand on our position as an independent vendor of high specialty software and a leader in this industry,” stated Hans Brons, CEO of MEDIS. “We have been intrigued by the broad spectrum of innovations in the cardiovascular imaging domain that MEDIS has created and commercialized over the years, and in particular the more recent exciting and disruptive opportunities in the field of interventional cardiology.

MEDIS has been recognized worldwide as a company that develops high-quality software, listening to the needs of the clinicians and researchers and supporting them with new and expanded applications. We believe that there is a great upwards potential in MEDIS and we like to stimulate these developments and see the company grow to the next level. We are therefore very excited about the MEDIS acquisition of AMID,” said Dharminder Chahal, Managing Director of Van Herk Ventures.

OVER THE LAST 6 MONTHS, VAN HERK VENTURES HAS MADE SIGNIFICANT FURTHER EQUITY INVESTMENTS IN MEDIS WITH THE AIM TO HELP ACCELERATE THE GROWTH OF THE COMPANY AND TO ENABLE THE ACQUISITION OF AMID.

NEWS

91

NEWS

Everything You Need to Know About Diabetic Retinopathy By: Dr. Luisa M. Sastre, Specialist Ophthalmologist in Medical Retina and Cataract Surgery

S

udden fluctuations in eyesight including blurred vision, double vision, and the appearance of floaters in the eye could go unnoticed as people maneuver complicated and unpredictable lifestyles. However, these minor ailments could be a sign of a more serious underlying disease. These symptoms are some of the key indicators of diabetic retinopathy, one of the leading causes of preventable blindness in the world.

As the name implies, diabetic retinopathy is directly linked to diabetes, a condition where the body’s inability to produce adequate insulin, the hormone that regulates glucose, triggers longterm instability in blood glucose levels. Diabetes is a disease that can develop in two forms, Type 1 which is a congenital disease and Type 2 which is more common and is linked to obesity and lack of physical activity.

Diabetes is a significant public health issue in the region with several GCC countries including, UAE, Saudi Arabia, Bahrain, and Kuwait leading in numbers as part of the top 15 countries in terms of the prevalence of diabetes worldwide.

In fact, according to the International Diabetes Federation, an estimated 32 percent of the adult population (age 20-79) in the UAE, including both UAE nationals and expatriates, may have or could develop diabetes or prediabetes over the next decade.

As these numbers trend upwards health experts grow progressively concerned for the future of the nation. Studies show that as many as 50 percent of diabetes sufferers in the country do not know they have the disease and 74 percent of diabetics in the UAE may not be aware that they have diabetic retinopathy.

Caused by changes to the blood vessels of the retina, diabetic retinopathy is onset by poor glucose control which can cause damage to nerves and blood vessels. As one of the most complex and vascular organs in the body, the eye is especially vulnerable to damage caused by diabetes. This impairment of the eye vessels

MAY.JUNE 2020

92

CAUSED BY CHANGES TO THE BLOOD VESSELS OF THE RETINA, DIABETIC RETINOPATHY IS ONSET BY POOR GLUCOSE CONTROL WHICH CAN CAUSE DAMAGE TO NERVES AND BLOOD VESSELS. AS ONE OF THE MOST COMPLEX AND VASCULAR ORGANS IN THE BODY, THE EYE IS ESPECIALLY VULNERABLE TO DAMAGE CAUSED

BY DIABETES.

causes new weak blood vessels to grow and leak fluid into the retina progressing the disease. For these reasons, almost all Type 1 and two-thirds of Type 2 diabetes patients will develop diabetic retinopathy within 20 years of diagnosis.

Diabetic retinopathy can be reversible only in the early stages of the disease if excellent diabetic control is achieved. In the advanced stages of the disease, diabetic retinopathy is not reversible. However, early detection and treatment plays an important role in the progression of the disease.

Treatment options are available, and sometimes a combination of procedures can manage and reduce the effects of the disease. These include intravitreal injection of medications (anti-VEGF and or steroids), panretinal photocoagulation (conventional peripheral laser therapy) and in more advanced cases, with proliferative retinopathy or with intravitreal hemorrhages, surgery is inevitable.

Anti-VEGF drugs reduce the new vessel formation and the leakage from these weak new vessels, helping to keep the macula and the peripheral retina dry. Intravitreal steroids aid in reducing the swelling in the macula. Panretinal photocoagulation improves the oxygenation of the retina and by doing so, decreases the stimulus to the growth of retinal and iris new vessels. When the above treatments are not enough, surgery helps restore the anatomy of the eye. During the procedure the surgeon removes non-clearing hemorrhages and fibrotic tissue that proliferates between the retina and the vitreous causing vitreous hemorrhages and traction retinal detachments.

There are key visual complications associated with the presence of diabetic retinopathy.

However, it is common for the disease to start asymptomatic. Diabetic retinopathy can only be diagnosed by an ophthalmologist with a Fundus examination. Therefore, regular screenings are imperative in people with diabetes because early detection generally leads to better management and better outcomes.

NEWS

Phase III DAPA-CKD trial will be stopped early after overwhelming efficacy in patients with chronic kidney disease Dapagliflozin is the first sodium-dependent glucose transporter-2 inhibitor (SGLT2i) to show meaningful benefit in patients with chronic kidney disease in a trial including both type-2 diabetics and non-diabetics

T

he Dapagliflozin And Prevention of Adverse outcomes in Chronic Kidney Disease (DAPA-CKD) Phase III trial for dapagliflozin in patients with chronic kidney disease (CKD) will be stopped early following a recommendation from an independent Data Monitoring Committee (DMC) based on its determination of overwhelming efficacy.

The decision to stop the trial early was made following a routine assessment of efficacy and safety which showed dapagliflozin’s benefits earlier than originally anticipated and AstraZeneca will now initiate closure of the trial.

Ahmed Soliman, AstraZeneca Medical Director GCC said: “Chronic kidney disease patients have limited treatment options, particularly those without type-2 diabetes. We are very pleased the Data Monitoring Committee concluded that patients experienced overwhelming benefit. This might potentially lead to a change in the management of chronic kidney disease for patients around the world.”

rate (eGFR), onset of end-stage kidney disease (ESKD) or cardiovascular (CV) or renal death) in patients with CKD irrespective of the presence of type-2 diabetes (T2D).

The full results will be submitted for presentation at a forthcoming medical meeting and AstraZeneca will now initiate discussions with global health authorities regarding early regulatory submissions.

In August 2019, the US Food and Drug Administration (FDA) granted Fast Track designation for the development of dapagliflozin to delay the progression of renal failure and prevent CV and renal death in patients with CKD. Dapagliflozin is under Priority Review with the FDA and under regulatory review at the European Medicines Agency (EMA), as well as in other regions, for the treatment of patients with heart failure (HF).

THE FULL RESULTS WILL BE SUBMITTED FOR PRESENTATION AT A FORTHCOMING MEDICAL MEETING AND ASTRAZENECA WILL NOW INITIATE DISCUSSIONS WITH GLOBAL HEALTH AUTHORITIES REGARDING EARLY REGULATORY SUBMISSIONS.

Dr Bassam Bernieh, Consultant Nephrologist and the Chairperson of the Emirates Medical Association of Nephrology (EMAN) Scientific Committee said: “As a nephrologist taking care of CKD patients, including both diabetic and non-diabetic, I consider these overwhelming benefits of dapagliflozin, demonstrated in DAPA-CKD Trial, will open new avenues in the management of CKD patients, particularly for non diabetic CKD patients, who have so far limited therapeutic tools to slow down their CKD progression to end stage renal disease.

The primary endpoint of DAPA-CKD is a composite of worsening of renal function or death (defined as a composite endpoint of ≥50% sustained decline in estimated glomerular filtration

93

NEWS

AbbVie Completes Transformative Acquisition of Allergan

A

bbVie (NYSE: ABBV), a research-based global biopharmaceutical company, announced that it has completed its acquisition of Allergan plc following receipt of regulatory approval from all government authorities required by the transaction agreement and approval by the Irish High Court.

“We are pleased to reach this important milestone for the Company, its employees, shareholders and the patients we serve” said Richard A. Gonzalez, chairman and chief executive officer, AbbVie. “Our new Allergan colleagues should be commended for all their efforts, along with those of our own employees, to achieve this turning point for our Company.

The new AbbVie will be a well-diversified leader in many important therapeutic categories, with both on-market and pipeline assets, and our financial strength will allow us to continue to invest in innovative science and continue to serve unmet medical needs of patients that rely upon us. I am proud of both organizations and look forward to the opportunities ahead.”

Well-Positioned for Long-Term Growth in Key Therapeutic Areas The transaction significantly expands and diversifies AbbVie’s revenue base and complements existing leadership positions in Immunology, with Humira®, and recently launched Skyrizi TM and RinvoqTM, and Hematologic Oncology, with Imbruvica® and Venclexta®.

Allergan provides new growth opportunities

in Neuroscience, with Botox® Therapeutics, Vraylar® and UbrelvyTM and a global aesthetics business, with leading brands including Botox® and Juvederm®.

This diversified on-market portfolio will drive the existing AbbVie growth platform to approximately $30 billion in revenues in full year 2020, with combined revenues of approximately $50 billion. It also positions the Company for enhanced long-term growth potential, a growing dividend and investment in innovation in each of its therapeutic categories. The Company anticipates rapidly paying down the incremental debt with its increased operating cash flows.

ROBUST PORTFOLIO OF ON-MARKET AND PIPELINE ASSETS WELL-POSITIONED FOR SUSTAINABLE LONG-TERM GROWTH.

Additionally, in connection with the closing of the transaction, the AbbVie Board of Directors has elected Thomas C. Freyman, retired Executive Vice President and Chief Financial Officer, Abbott to join the AbbVie board. Mr. Freyman recently served on the Allergan Board of Directors.

Financial Terms Under the terms of the transaction agreement, Allergan shareholders will receive 0.8660 AbbVie shares and $120.30 in cash for each Allergan share, for a total consideration of $193.23 per Allergan share (based on the closing price of AbbVie’s common stock of $84.22 on May 7, 2020). Allergan common stock ceased trading on the New York Stock Exchange as of the close of trading (May 8th, 2020).

Abu Dhabi issues guidelines for people returning to work

A

bu Dhabi has issued a set of guidelines to ensure the safe return of employees heading back to offices, retail outlets and others places of work in the city.

The Abu Dhabi Department of Economic Development outlined six steps that employers must adhere to during the transitional return to work phase. The instructions aim to “promote

MAY.JUNE 2020

94

business continuity” for private companies while ensuring the “health and safety of employees”, as more people start heading back to work over the coming weeks and months. As per the guidance, which falls under the precautionary measures issued by the National Emergency Crisis and Disaster Management Authority, those who can continue to work effectively from home have been encouraged to do so

THE INSTRUCTIONS AIM TO “PROMOTE BUSINESS CONTINUITY” FOR PRIVATE COMPANIES.

NEWS

Mayo Clinic develops test to detect COVID-19 infection

M

ayo Clinic has developed a test that can detect the SARS-CoV-2 virus in clinical samples. The SARS-CoV-2 virus causes COVID-19. The test, "Severe Acute Respiratory Syndrome Coronavirus-2 (SARS CoV-2), Molecular Detection" has been fully validated. Data from this test will be submitted to the Food and Drug Administration for review and emergency use authorization.

"This test should help ease some of the burden that is currently being felt at the Centers for Disease Control and Prevention and state public health laboratories," says William Morice II, M.D., Ph.D., President of Mayo Clinic Laboratories. "We are doing everything we can to help relieve the burden during this time to provide answers for patients here in Rochester and around the world."

THROUGH COLLABORATIONS WITH CLINICIANS AT MAYO CLINIC AND HEALTHCARE PROVIDERS AROUND THE WORLD, MAYO CLINIC'S SUBSPECIALIZED LABORATORIES ARE A CRITICAL COMPONENT TO PATIENT CARE.

The real-time polymerase chain reaction (PCR) test can identify SARS-CoV-2 from a variety of clinical samples. The PCR assay has been validated to test respiratory samples collected from suspected COVID-19 patients, including nasopha-

ryngeal swabs, sputum, throat swabs, bronchoalveolar lavages, and bronchial washings. Mayo Clinic will follow CDC's recommended guidelines for SARS-CoV-2 testing, enabling U.S. healthcare providers to send testing directly to Mayo Clinic.

For existing Mayo Clinic Laboratories clients, the SARS-CoV-2 assay will be offered in the U.S. and abroad.

Faster turnaround time for SARS-CoV-2 result "An individual can now receive his or her result for SARS-CoV-2 within 24 hours," says Matthew Binnicker, Ph.D., a clinical microbiologist and director of the Clinical Virology Laboratory at Mayo Clinic in Rochester. Through collaborations with clinicians at Mayo Clinic and healthcare providers around the world, Mayo Clinic's subspecialized laboratories are a critical component to patient care. "We have the expertise to create tests such as this one, and we felt it was our obligation to help ease the burden that the CDC and public health laboratories are feeling at this time," says Dr. Binnicker.

MSD contributes more than $ 500.000 for COVID-19 Emergency Response to HealthCare sector in Lebanon

M

SD in Lebanon, (known as Merck & Co in the US and Canada) announced a cash and medicines donation valued at more than $500,000 to the healthcare sector in Lebanon. This donation is in response to calls for support by the Prime Minister during the COVID-19 outbreak in Lebanon.

The donation will support various institutions, hospitals and medical associations in their ongoing efforts against the COVID-19 outbreak. Furthermore, the cash and medicines donation will be used to deliver healthcare to patients who are suffering from many conditions such as cancer and whose access to routine

MSD HAS ALSO LAUNCHED A PROGRAM TO ENABLE OUR MEDICALLY TRAINED EMPLOYEES TO VOLUNTEER THEIR TIME TO AID THEIR COMMUNITIES WHILE MAINTAINING THEIR BASE PAY.

healthcare may have been interrupted during the containment stage.

“We are grateful to the Government and to all healthcare providers for everything that they are doing to protect the Lebanese people and to ensure their wellbeing and safety during this global public health crisis,” said Okan Isikci, General Manager of MSD Levant. “We recognize that the officials are experiencing challenges never-before anticipated. We also want to thank all the healthcare workers and those on the front lines of this health crisis who are treating and saving as many lives as they can. We say Thank You and we salute you.”

95

NEWS

5 percent of people over 60 and 15 percent of people over 75 years of age suffer from aortic stenosis

A

pollo Hospitals announced that one of its patients is the longest-living person to have received pioneering heart surgery.

The old man underwent an operation a few years ago to replace an aortic valve.

Dr. Rahul Gupta, Senior Consultant Cardiologist of Apollo Hospitals in Navi Mumbai

Aortic stenosis is a condition where the aortic valve does not open and close properly, which can result in breathlessness, chest pain, dizziness and heart failure. Aortic valve stenosis disease is associated with age. It affects 5 percent of the population at 60 years and the percentage reaches 10 to 15 percent in those up to 75 years of age. So, this is the disease of the elderly population. Without an aortic valve replacement (AVR), as many as 50 percent of patients with severe AS will not survive more than an average of two years after the onset of symptoms. It is therefore, imperative that this illness is diagnosed and treated very fast.

According to Apollo Hospitals, its cardiac surgery team performed Transcatheter Aortic Valve Implantation (TAVI) surgery on the patient named xxx when he was xxx. TAVI stands for trans catheter aortic valve implantation. It is the most advanced and minimally invasive procedure that treats severe aortic valve disease. It can be performed without general anaesthesia.

“Compared to the existing procedures which in most case is an open-heart surgery and requires longer hospitalization and recovery time, TAVI is preferred. While an open-heart surgery offers 97 percent success, TAVI offers 99 percent success. Also, individuals who are too old or who have other medical problems, open heart surgery may be considered too risky. TAVI is therefore the most preferred medical procedure for such groups of patients,” said Dr. Rahul Gupta, Senior Consultant Cardiologist of Apollo Hospitals in Navi Mumbai.

Globally, over 50000 TAVI procedures have been performed. TAVI allows an aortic valve to be implanted using a long narrow tube called a catheter.

The doctor uses advanced imaging techniques to guide the catheter through the blood vessels, to the heart and into the aortic valve. Once it's precisely positioned, a balloon is expanded to press the replacement valve into place in the native aortic valve.

Some valves can expand without the use of a balloon. When the doctor is certain the valve is securely in place, the catheter is withdrawn from the blood vessel. TAVI in general is a safe procedure and is the future for the elderly.

Japan supports UNICEF in Jordan to help children stay healthy during COVID-19 UNICEF HAS DISTRIBUTED SOAP TO 120,000 REFUGEES AND CARRIED OUT MASS HYGIENE AWARENESS CAMPAIGNS.

T

he Government of Japan has announced a new contribution of US$2.2 million to support UNICEF’s work to keep children healthy, learning and protected during the COVID-19 pandemic, and to reduce the impact on the most vulnerable families. The funding will support UNICEF’s health and nutrition, child protection, water and sanitation, and social protection interventions for children and women in Jordan, including Syrian refugees.

"UNICEF, working closely with partners

MAY.JUNE 2020

96

including the Government of Japan, is rapidly scaling up and striving to maintain continuity of programmes at this time, while also responding and adapting to the pandemic and its impact on the most vulnerable," said Tanya Chapuisat, Representative, UNICEF Jordan. "We are very grateful for the continued support from the people of Japan, which is helping children in Jordan to survive and thrive."

Ambassador of Japan to Jordan, Hidenao YANAGI, said "Japan always stands by Jordan as

NEWS a friend even during difficult times. We attach also great importance to the role of UNICEF in providing humanitarian assistance to vulnerable Jordanians and refugees in various sectors such as health, WASH as well as protection. Given the increasing threat of the COVID-19, it is critically important to enhance humanitarian responses, particularly, in health and WASH sectors. I sincerely hope our assistance will be of help to address the unprecedented crisis as well as to mitigate risks of transmission in the refugee camps and host communities."

The contribution from the Government of

Japan will enable UNICEF to scale up water, sanitation and hygiene facilities in schools across Jordan, as well as supporting the provision of safe water and sanitation to vulnerable Syrian refugees living in remote areas and refugee camps. Since the outbreak of COVID-19, UNICEF has distributed soap to 120,000 refugees and carried out mass hygiene awareness campaigns.

UNICEFâ&#x20AC;&#x2122;s partnership with the Government of Japan is also supporting lifesaving efforts with the Ministry of Health to deliver health and nutrition services to children in refugee camps and provide routine and catch-up immunization services to children and mothers across the country.

DGW reinforces implementation of precautionary measures to curb spread of COVID-19

D

ubai Government Workshop (DGW) has revealed its move to bolster its implementation of precautionary and preventive measures to prevent the spread of the coronavirus (COVID-19) and reduce its impact through the issuance of a series of circulars and directives aimed at protecting the health and safety of its employees and customers.

H.E. Fahad Ahmed Al-Raeesi CEO of DGW

H.E. Fahad Ahmed Al-Raeesi CEO of DGW, said, "DGW continues to keep itself up to date with the latest local and international updates related to the COVID-19 pandemic. We are keen to adhere to the directives, circulars and mandates issued by relevant government entities with regards to this matter. In fact, we are working 24/7 to ensure that all necessary requirements are implemented to protect the health and safety of both our employees and clients during this extraordinary situation that we are all facing--working closely with all competent authorities to ensure adequacy."

H.E Al-Raeesi expressed his appreciation and valued all the preventive measures being followed by DGW employees on all levels to help ensure business continuity--providing the best service to its clients while also adhering to all set measures in conformity with the workshop mindset and all-times goal to protect the safety of its employees, clients, outsourcing companies

and all community members. He added that these efforts fall in line with the recommendations made by the wise leadership, which are centered on all unified efforts to ensure the health and safety of UAE citizens and residents.

DGW has taken a number of precautionary tactics to prevent the spread of COVID-19, including the implementation of a remote working from home system, wherein the DGW is considered as one of the forerunners in applying a 100 per cent remote work system for administrative jobs. The workshop also suspended and replaced direct meetings with virtual meetings via remote communication technologies and platforms. It has reinforced its communication with all of its clients to ensure continuity of services without compromising on the preventive measures. DGW continues to coordinate with its clients and partners to ensure that the utmost care and caution are adhered to. DGW is one of the most proactive entities that took a series of strict steps and measures to protect the health and safety of employees and customers and ensure the continuity of its services without interruption.

The workshop continues to follow closely the latest developments and review its procedures and preventive measures to meet the current challenges and mitigate its impact as well as contribute to getting life back to normal as early as possible depending on the current conditions.

97

NEWS

American hospital Cleveland Clinic and SAS share COVID-19 predictive models to help hospitals around the world plan globally can use them in their own communities.

Our hope is that others contribute their ideas and improvements to the models as well.”

T

o fight the novel coronavirus pandemic, U.S. hospital Cleveland Clinic and analytics company SAS have created innovative models that help hospitals forecast patient volume, bed capacity, ventilator availability and more.

The models, which are freely available via GitHub, provide timely, reliable information for hospitals and health departments to optimize healthcare delivery for COVID-19 and other patients and to predict impacts on supply chain, finance and other critical areas. Unlike some forecasts that focus on a projection based on a single set of assumptions, these analytic models were used to create worst-case, best-case and most-likely scenarios, and can adjust in real time as the situation and data change. For example, the models can factor in social distancing’s dampening effect on disease spread.

“These predictive models were developed jointly by two organizations that understand patient populations, data and modeling,” said Chris Donovan, executive director of Enterprise Information Management & Analytics at Cleveland Clinic. “We are sharing the models publicly so health systems and government agencies

MAY.JUNE 2020

98

MODELS HELP FORECAST BED AND VENTILATOR NEEDS AND PREDICT IMPACTS ON CRITICAL SUPPLY CHAINS, FINANCE AND STAFFING TO OPTIMIZE HOSPITAL PREPAREDNESS BEFORE, DURING AND AFTER REGIONAL PEAKS.

Cleveland Clinic is using the models to support its decision-making. With this information, Cleveland Clinic can predict and plan for future demands on the health system, such as ICU beds, personal protective equipment and ventilators. After reviewing possible COVID-19 surge scenarios in the U.S. generated by the models, Cleveland Clinic elected to activate a plan that prepared it for the worst-case scenario and has built a 1,000-bed surge hospital on its education campus for COVID-19 patients who don’t need ICU care. The hospital system also used the models to inform decisions about organizing and activating new labor pools.

The GitHub link where the models are available has been visited more than 1,700 times in the past two weeks, resulting in more than 50 downloads.

At the heart of the work is an epidemiological SEIR model in which people move through the stages of Susceptible, Exposed, Infected and Recovered over time. The SEIR model developed

by SAS and Cleveland Clinic is based on a University of Pennsylvania open source model that has been recoded and expanded on the SAS® analytics platform and continuously improved with real-time feedback from Cleveland Clinic epidemiologists and data scientists. The resulting models include flexible control of model parameters and different model approaches that consider regional health and demographic variations and state-level assumptions.

“These models can help hospitals, healthcare facilities, state departments of health and government agencies forecast the impact of COVID-19 and prepare for the future,” said Steve Bennett, Ph.D., Director of SAS’ Global Government Practice. “The models can also assist more vulnerable, less developed health systems in the fight against COVID-19.”

NEWS

NEWS

WELCOME TO MALAFFI CONNECTING HEALTHCARE

Malaffi, the Abu Dhabi Health Information Exchange, will connect all public and private healthcare providers in the Emirate of Abu Dhabi, to create a unified patient file and to improve healthcare quality and patient outcomes.

www.malaffi.ae MAY.JUNE 2020

100

/Malaffi