HOSPITALS Magazine issue 53

Issue 53 / 166 JULY-AUG 2020

THE ARAB HOSPITAL APPLICATION IS AVAILABLE

Stroke Reducing mortality, disability and other complications

Diabetic Foot Symptoms, treatment and foot care

HEART ATTACK What health conditions increase your risks?

How robotic surgery is transforming orthopedic?

Chilhood Cancer Coping with the challenges

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Publisher Arab Health Media Communication

Telemedicine

General Manager Simon Chammas schammas@tahmag.com

Coronavirus Crisis and Safety of Doctors and Patients The coronavirus crisis has given new impetus to telemedicine around the world, as self-isolation of half of the population and the fear of transmission of the virus have contributed to the promotion of medical consultations through video calling applications and smartphones.

With the progress of the pandemic, measures were modified or mitigated in some countries to allow teleconsultations on a large scale. This type of medical consultations has become accepted and covered by the insurance institutions, and this was not fully applied before. According to social security in France, these consultations have contributed to reducing waiting periods in medical clinics, and their pace did not slow down after the end of the closing period.

In some countries, the number of teleconsultations increased from 10,000 a week in early March to nearly one million in mid-May. Doctors and specialists believe that such a leap, although it is more applicable to general medicine, needed years to happen in normal times.

However, this positivity in helping patients and protecting doctors, which allowed broader access to healthcare for the largest number of people living away from cities, was not without difficulties, such as protecting patient profile data.

Doctors emphasize that people must be mindful of the misinterpretations that can easily result from video consultations.

Despite the harsh conditions of the pandemic, this development led to a positive step that was necessary to make it easier for the doctor and the patient on one hand, and to expand the scope of safe medical care to include the largest possible number of people on the other hand.

Publisher

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.

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JULY . AUGUST 2020

30 Heart Attack

NEWS

8 Information exchange during COVID-19: Lifesaving Data By Dr. Bakr Sadoon Ismael, Ambulatory Healthcare Services Co, a SEHA System Facility Member of the Clinical Advisory Committee of Malaffi 10 The LAU Medical Center-Rizk Hospital makes a contribution to the Obstetrics and Gynecology department at the Rafic Hariri University Hospital 12 American Hospital Dubai Selects Oracle and Cerner to Deliver Exceptional Healthcare 14 Saudi German Hospital in Jeddah successfully performs a first of its kind surgery on infant's rare congenital condition 16 Fight against Covid-19: Rostock-based company supplies mobile and portable X-ray equipment all over the world 20 EKF introduces novel molecular transport media for dual COVID-19 and influenza sampling

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24 Ajman Specialty Hospital Enters into Collaborative Partnership with Thumbay University Hospital and Thumbay Labs to Deliver Advanced Healthcare Services 26 WCM-Q faculty published lessons for humanity after COVID-19 90 Humania Closes a $360million Debt & Equity Platform for New Hospitals in North Africa 92 GE Healthcare Launches New AI Suite to Detect Chest X-ray Abnormalities, Including Pneumonia Caused by COVID-19 & Tuberculosis 96 Cleveland Clinic Children’s Ranked Among the Best Children’s Hospitals by U.S. News & World Report

INTERVIEWS

50 Timothy P. Cripe, MD, PhD, FAAP 76 Liz Youngblood 76 Sal Ababneh 80 Dr. Umayya Musharrafieh

JULY . AUGUST 2020

42 Robotic Orthopedic Surgery ARTICLES

28 The Ethics Committee of Hôtel-Dieu de France During the COVID-19 Pandemic 36 Heart Attack... Number One of Death Worldwide 52 Pandemic Response: Maintaining Effective and Safe IV Infusion Therapy for Critically Ill and Isolated Patients 82 Exercise in the time of Covid-19 83 Al-Ahli Hospital is a successful destination in the treatment of “Endometriosis" 84 We possess modern competencies and equipment and we are distinguished in vocal cords surgery 85 The Orthopedic & Traumatology Department makes a quantum leap in the area of excellence 86 Essential Role of Fortified Powdered Milk in the Daily Diet of Children 88 ‘Networks, AI, Analytics & Security will Accelerate

62 Stroke JULY.AUG 2020

56 Childhood Cancer Digital Transformation Roadmaps in Middle East Healthcare Industry’: Aruba Expert

FEATURES

30 Heart Attack 42 How robotic surgery is transforming orthopedic?

56 Childhood Cancer 62 Stroke 68 Summer Skin Allergies 72 Diabetic Foot

MEDICAL INSTITUTIONS

38 Cutting-edge Technology and Innovative Approach in Orthopedic Joint Replacement Surgery 46 Acıbadem Healthcare Group starts to admit patients to Turkey again

72 Diabetic Foot 6

+90 552 363 6 999

info@roboticortopedi.com

www.roboticortopedi.com/sa/

NEWS

Information exchange during COVID-19: Lifesaving Data

By Dr. Bakr Sadoon Ismael, Ambulatory Healthcare Services Co, a SEHA System Facility Member of the Clinical Advisory Committee of Malaffi

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he key theme for the 2020 World Allergy Week of ‘COVID-19 and allergy’ has generated a lot of debate within the global healthcare community. According to the World Allergy Organization (WAO), discussions for the week will focus on the critical issues currently affecting allergy and asthma patients, such as the importance of maintaining regular care during the COVID-19 pandemic, as well as the challenges that come with the similarity between certain allergy and asthma symptoms to those associated with COVID-19. For many healthcare providers and patients alike, the similarities can sometimes be misleading and may cause critical delays in necessary treatment.

Dr Bakr Sadoon Ismael

THE ALLERGY INFORMATION IN MALAFFI IS ALSO CRITICAL TO ENSURE PATIENT SAFETY AND ADEQUATE MEDICATION PRESCRIPTION AND ADMINISTRATION TO AVOID ALLERGIC REACTIONS THAT CAN BE DETRIMENTAL.

Using data to mitigate critical delays Malaffi, which is the region’s first Health Information Exchange (HIE) platform, and one of the key initiatives of the Department of Health – Abu Dhabi, connects all public and private healthcare providers in Abu Dhabi, allowing them to exchange important patient health information in real-time, and therefore establish a database of unified medical records. By accessing patients’ Electronic Medical Records (EMRs) through Malaffi, doctors can make better informed and more efficient clinical decisions, based on the patient’s allergy or asthma history (or lack thereof). They are also able to access other important information such as demographics, medication, laboratory and radiology results, previous procedures and past medical interactions, from consultation to emergency treatment.

Having access to this readily available information, allows the attending doctor to make the most informed, rapid diagnosis and treatment decisions, which can sometimes be critical, in determining whether a patient is presenting with symptoms of allergy or asthma, or have they potentially contracted COVID-19. The allergy information in Malaffi is also critical to ensure patient safety and adequate medication

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prescription and administration to avoid allergic reactions that can be detrimental.

It is very important to be able to determine the often-subtle difference of overlapping symptoms between allergies and asthma from those of COVID-19, in order to be able to diagnose and treat patients quickly and accordingly.

While we are on high alert for COVID-19 symptoms, according to the Harvard Medical School, many people may just be experiencing their annual springtime tree pollen allergies. People may also just be experiencing a common cold.

Mayo Clinic, highlights that COVID-19 causes fever, shortness of breath, difficulty breathing and potentially stomach upset. Seasonal allergies do not cause those symptoms, and typically present with itching, watery eyes, runny nose and sneezing.

A more concerted effort to manage the incidence of allergic emergencies In the UAE, where over 14 per cent of residents have asthma, and up to one-fifth of the population is thought to suffer from some form of allergy, there is a collective call for a more concerted effort to manage incidences of allergic emergencies during the COVID-19 pandemic.

This is where data exchange really comes into play, through a coordinated and emirate-wide real-time exchange of allergy information to empower healthcare practitioners with the right information at the right time. Access to this data is also instrumental for doctors when conducting consultations via telemedicine, particularly during the pandemic, where testing cannot be carried out on the spot.

Data standardisation within EMRs is the way forward In times of a pandemic such as COVID-19, having access to a large amount of EMR data is extremely important, but even more so when the data is standardised, allowing doctors to

NEWS

speak the same clinical language. When it comes to recording allergies in EMRs, the standardisation of how EMR systems capture allergies, brings immeasurable value. It can make all the difference between prescribing a medication that will cause an allergic reaction and one that won’t. This can be lifesaving, especially in an emergency.

There is a pressing need to have standardised allergy terminology in EMR systems, which could be in the form of a drop-down menu which doctors can choose from to simplify the data inputting process and facilitate the exchange of critical patient information. This will allow doctors to provide specific and detailed information about the reaction the patient has experienced and record the allergens or trigger that caused the reaction in a structured format, rather than using a free text field that is currently standard in some EMR systems This type of coding and information recording will significantly improve data quality

and support patient diagnoses, medical decision-making, and as a result, the management of the condition through the choice of more appropriate medication that will avoid severe preventable side effects. Lastly, this will allow for the information to be interoperable across EMRs and easily accessible.

With the establishment of Malaffi within Abu Dhabi, the journey of embracing digital transformation by healthcare providers through the recording, access and exchange of important patient information from multiple EMRs, is a potential lifesaver in the management of allergic emergencies during the COVID-19 pandemic.

Fortunately, the pandemic has only accelerated all these efforts. We are now in an even better position to reap the benefits of technology to improve healthcare in every respect, especially when it comes to empowering healthcare providers to utilise data to make more informed choices, in times when speed and accuracy are critical and can truly help save lives.

BY ACCESSING PATIENTS’ ELECTRONIC MEDICAL RECORDS THROUGH MALAFFI, DOCTORS CAN MAKE BETTER INFORMED AND MORE EFFICIENT CLINICAL DECISIONS.

1. https://www.health.harvard.edu/blog/allergies-common-cold-flu-or-covid-19-2020040919492 2. https://newsnetwork.mayoclinic.org/discussion/what-you-need-to-know-about-spring-allergies-and-covid-19/

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NEWS

The LAU Medical Center-Rizk Hospital makes a contribution to the Obstetrics and Gynecology department at the Rafic Hariri University Hospital

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n Tuesday, July 7th, the LAU Medical Center-Rizk Hospital made a contribution to the Obstetrical Simulation Center at the Rafic Hariri University Hospital as a sign of gratitude and appreciation to a fellow medical institution.

The LAU Medical Center-Rizk Hospital and the LAU Gilbert and Rose-Marie Chagoury School of Medicine offered 4 obstetric beds and 2 incubators to the “Obstetrical Simulation Cen-

ter” at the Rafic Hariri University Hospital.

The donation ceremony took place in the presence of the Chairman of Obstetrics & Gynecology Department at Rafic Hariri University Hospital, Dr. Rabih Chahine and Dr. Georges Yared, a faculty member at the LAU Medical Center-Rizk Hospital and site coordinator at Rafic Hariri University Hospital. The Chief Executive Officer, Mr. Sami Rizk and the Chief Medical Officer, Dr. Georges Ghanem of the LAU Medical Center-Rizk Hospital were also present, along with the Chairman of the Obstetrics & Gynecology Department at LAU Medical Center-Rizk Hospital Dr. Tony Zreik and Mr. Saad el Zein, assistant to the LAU President for Special Projects.

The donation was highly regarded from the Rafic Hariri University Hospital who expressed their thankfulness and gratitude to members of the LAU Medical Center-Rizk Hospital. Through this contribution, the LAU Medical Center-Rizk Hospital reinforces its mission of “healing with compassion”, as it sends a strong message of solidarity and support to the medical community as well as to the Lebanese society.

THE DONATION WAS HIGHLY REGARDED FROM THE RAFIC HARIRI UNIVERSITY HOSPITAL WHO EXPRESSED THEIR THANKFULNESS AND GRATITUDE TO MEMBERS OF THE LAU MEDICAL CENTER-RIZK HOSPITAL.

... And Receives a generous grant of $1.328 million SUCH GRANTS by the American Schools and Hospitals Abroad program ARE OF MAJOR

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hile tremendous work and effort were being put in place to fight the outbreak of COVID-19, the LAU Medical Center-Rizk Hospital’s usual activities were in parallel, still being carried on by teams of dedicated people.

Recently, the LAU Health Foundation received a generous grant of $1.328 million from ASHA, the American Schools and Hospitals Abroad program, to support commodities critically needed for the first Stroke Center that was previously established in Lebanon in March 2018 at the LAU Medical Center-Rizk Hospital. This support is made possible by the generous support of the American people through the United States Agency for International Development (USAID). USAID administers the U.S. foreign assistance program providing economic and humanitarian assistance in more than 80 countries worldwide. This grant allows the existing Stroke Center to establish a Hybrid Operating Theatre, which is central to a Stroke Center’s Medical Imaging and Intervention aspect, where both open surgery and laparoscopic procedures may be accomplished. Despite the inevitable and heavy focus placed on the outbreak of COVID-19, the hospital’s Stroke Center is still expanding under the leadership of Dean of the Gilbert and Rose- Marie Chagoury School of Medicine Doctor Michel Mawad.

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IMPORTANCE AS THEY MAKE POSSIBLE THE ADVANCEMENT OF THE LAU MEDICAL CENTERRIZK HOSPITAL’S SERVICES AND ENABLE IT TO BETTER SERVE ITS COMMUNITY.

NEWS

American Hospital Dubai Selects Oracle and Cerner to Deliver Exceptional Healthcare Oracle Cloud Applications and Cerner Chosen to Enhance Efficiency and Prepare a Digital-Ready Healthcare Workforce collected will be used to report and improve patient outcomes, which ultimately will help optimise clinical and business performance across the entire organization.

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merican Hospital Dubai, part of Mohamed & Obaid Al Mulla Group, has selected Oracle Cloud Applications and Cerner, a Gold Level member of Oracle Partner Network (OPN), for a major digital transformation. The initiative is aimed at reducing cost, optimising physician performance, driving better inventory management, avoiding losses to over or understocking, and hiring and retaining the best talent.

As per the agreement, Cerner will deliver a new health IT platform – an electronic health record (EHR) to improve the safety, quality, and healthcare experience for patients and caregivers.

In addition, Oracle will provide the digital business platform and Oracle Enterprise Resource Planning (ERP) Cloud to enhance productivity, reduce costs, and improve controls. Both solutions will integrate hospital business and clinical operations to improve efficiency and business decision-making based on real-time data.

The new EHR and ERP platforms will provide American Hospital Dubai with the ability to truly automate its end-to-end clinical and business processes. The implementation of these industry-leading solutions will enable the hospital to deliver a seamless patient journey, drive efficiency, and provide high-quality, affordable care. In addition, the wealth of data

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Sherif Beshara, Chief Executive Officer of Mohamed & Obaid Al Mulla Group, said: “Medical well-being is integral for the progress of our nation and its people, and we are consistently seeking intelligent methods to improve quality of care and to enhance the patients’ experience.

Our partnership with Cerner and Oracle significantly improves our clinical and non-clinical services and further positions American Hospital as a beacon of medical service excellence and expertise in the region and beyond.”

AMERICAN HOSPITAL DUBAI WILL ALSO IMPLEMENT ORACLE HUMAN CAPITAL MANAGEMENT (HCM) CLOUD TO FURTHER EQUIP ITS 1,200 EMPLOYEES WITH THE TOOLS THEY NEED FOR THE DIGITAL HEALTHCARE ERA. THIS INITIATIVE WILL HELP AMERICAN HOSPITAL RETAIN AND HIRE THE BEST TALENT, INITIATE TRAINING PROGRAMS, AND ENSURE ENHANCED EMPLOYEE SATISFACTION.

“The Oracle Cloud Applications implementation is aimed at automating American Hospital’s core processes to provide a single source of truth with better budgeting and planning tools for the hospital’s leadership – as well as increasing employee satisfaction and reducing turnover,” said Rahul Misra, Vice President – business applications, Lower Gulf, Oracle. “American Hospital is a true pioneer and with this transformation, the healthcare provider is preparing for its next growth phase and continued delivery of excellent patient care.”

Alaa Adel, managing director, Cerner Middle East & Africa, said, “We are excited to work collaboratively with American Hospital to roll out a network wide EHR that will create a patient-centric healthcare delivery system and engage individuals in a culture of proactive health management. “During the time of COVID-19 pandemic, the role of technology becomes even more prominent. With Cerner’s innovative solutions, American Hospital will not only further enhance its response to the global crisis, but more importantly be well-equipped with cutting-edge technologies to thrive in the new era of post-pandemic healthcare.”

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

W205735

AMERICA’S SECOND

LARGEST CHILDREN’S HOSPITAL

* Based on CHA survey of utilization and financial indicators

NEWS

Saudi German Hospital in Jeddah successfully performs a first of its kind surgery on infant's rare congenital condition Congenital Thoracoschisis is a rare condition with only 15 cases reported in medical literature

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audi German Hospital in Jeddah has successfully performed a surgical procedure on a newborn suffering from a rare congenital condition called 'Congenital Thoracoschisis.' The successful operation is the Arab world's first ever surgery dealing with this critical condition, which is a congenital malformation characterized by herniation of the abdominal content through a defect detected in the thorax that developed during the fetal stage.

According to the hospital's senior officials, the infant was born with a portion of the colon, stomach and liver outside of its body.

Upon being admitted to the hospital, a team of surgeons assessed the situation and condition of the infant and immediately prepared for surgery. The objective was to place the internal

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THE HOSPITAL IS EQUIPPED WITH ADVANCED TECHNOLOGIES AND MANNED

BY A HIGHLY EXPERIENCED AND QUALIFIED WORLD-CLASS TEAM OF MEDICAL EXPERTS AND PROFESSIONALS.

parts to its normal location while also repairing the chest and the diaphragm. After performing the operation successfully, the infant's condition has greatly improved. He is thankfully now off the ventilator machine and can be orally fed.

Given the excellent recovery, the baby was soon discharged to go home to be with his family.

Congenital Thoracoschisis is seen as a very rare condition wherein there are only 15 known cases around the world. The pediatric surgery department at Saudi German Hospital in Jeddah is one of the pioneering medical institutions in the Kingdom of Saudi Arabia that is able to treat and address rare medical cases such as Congenital Thoracoschisis. The hospital is equipped with advanced technologies and manned by a highly experienced and qualified world-class team of medical experts and professionals.

YOUR HEALTH

IS A LOT OF THINGS. THE ONE THING IT ISN’T,

IS ON HOLD.

No virus can weaken our mission.

At Baylor St. Luke’s , we’re resuming the scheduling of appointments and procedures.

And we’re doing it safely. Our thorough approach determines which procedures can safely be performed, where, and when.

These are the steps we’re taking to make it happen:

• • • • • •

Cleaning all our facilities to an enhanced extent Limiting the number of visitors Requiring masks for all patients and staff Screening everyone entering our care sites Enforcing social distancing inside Requiring COVID-19 testing prior to procedures

Staying on top of your health has never been more important, whether it’s an ongoing health concern, a routine checkup, or a procedure. Don’t let social distancing stop you and don’t wait until it becomes an emergency.

Talk with your doctor about scheduling an appointment. For more information, visit us online at stlukesinternational.org

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

NEWS

Fight against Covid-19: Rostock-based company supplies mobile and portable X-ray equipment all over the world The Rostock company OR Technology has recorded a significant increase in sales of mobile X-ray equipment in recent months

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ighting the coronavirus: Mobile and portable X-ray systems made in Germany by OR Technology help to provide fast and best possible diagnostics around the globe. Orders for mobile X-ray solutions have multiplied several times over.

Deliveries were made, for example, to Vietnam, Luxembourg, Portugal, South Africa, Ghana and Trinidad & Tobago, in order to expand the diagnostic capacity in the corona crisis there.

"With this X-ray systems, the challenges of the pandemic can be mastered better," says Managing Director Bernd Oehm. "In a few seconds, excellent pulmonary images of a suspected Covid-19 patient can be obtained.

Our lightweight complete solution Amadeo M-DR mini, for example, is suitable for outdoor use as well as for bed imaging in hospitals or nursing homes".

The X-ray solution is brought directly to the patient preventing long waiting times in crowded hospitals. In less than two minutes, the unit is set up and ready for use. Transport and operation can be carried out by one person.

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The integrated diagnostic software ensures a worldwide and fast exchange of information via cloud or e-mail. This saves a lot of time and transport costs.

In the case of a temporary power interruption, the device can still be used to take X-ray images. The compact X-ray unit is simple and easy to move. Stowed together, it is easy to transport and even fits into a station wagon.

Steps and uneven terrain are no obstacle. The wheels allow easy 360-degree rotation when folded, which makes it much easier to handle in confined spaces such as elevators.

OR Technology has been producing digital X-ray technology and developed image management systems since 1991. Our in-house solutions are being used successfully in hospitals, radiology and private practices in over 100 countries. Our portfolio ranges from DR retrofits for existing X-ray systems (X-ray imaging without cassettes), and CR systems (X-ray imaging with cassettes) to the mobile DR detector suitcase solution for outdoor use (e.g. on ships and oil rigs, in remote locations or disaster management).

THE SYSTEM IS OF ADVANCED DESIGN. ALL NECESSARY COMPONENTS SUCH AS X-RAY DETECTOR, X-RAY GENERATOR AND IMAGE PROCESSING STATION ARE COMBINED IN ONE SYSTEM. THE USER IS SUPPORTED BY A PRACTICAL X-RAY ASSISTANT. THE AMADEO M-DR MINI ENABLES WIRELESS DIGITAL X-RAYS OF THE ENTIRE BODY TRUNK.

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

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NEWS

EKF introduces novel molecular transport media for dual COVID-19 and influenza sampling Patented PrimeStore® MTM technology enables safe sample handling and testing for multiple pathogens from one sample swab

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As multiple tests can be processed from one sample swab, this makes it ideal for the approaching flu season since samples stored in PrimeStore MTM can be tested for both COVID-19 and influenza from a single sample that has been inactivated and stabilised. This can assist with disease differentiation at reduced costs.

KF Diagnostics, the global in vitro diagnostics company, announces that it has added a novel viral transport media for the safe sample handling and testing of multiple infectious diseases from a single swab to its product range. PrimeStore® MTM (Molecular Transport Medium) is an FDA cleared and CE IVD marked sample collection device which deactivates viruses, including COVID-19, flu A, flu B, HIV and TB. Already proven in the U.S. market, this fully patented device ensures transportation and workplace safety for disease testing programmes, greatly reducing risk of infection to health workers, couriers, and lab technicians.

Traditional viral transport media (VTM) were designed for transporting live samples to be cultured and also contain ingredients that inhibit optimal molecular testing. However, modern molecular tests do not require viable virus, but just intact microbial nucleic acids. Molecular testing is now widespread due to its improved performance and turnaround times compared to traditional microbiology testing. In fact, most currently approved tests for COVID-19 and other infectious diseases are nucleic acid-based molecular assays, so removing the need for and risk of live pathogen transportation for routine testing.

Designed and optimised for molecular testing, PrimeStore MTM is a unique FDA class 2 cleared sample collection and transportation device that effectively kills viral and bacterial pathogens whilst preserving and stabilising the released DNA and RNA. The molecular transport media supports many downstream molecular applications, including qPCR and next generation sequencing. The sample can be safely stored at ambient temperature for up to 7 days and reused several times. As well as reducing the risks of handling live pathogenic samples, this also cuts costs by eliminating cold chain requirement and need for Category 3 facilities, as testing can take place outside of containment.

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PrimeStore MTM is proven technology with millions of tubes already sold globally during and prior to the COVID-19 pandemic to hospitals and laboratories who trust that it provides safer and more reliable testing than traditional VTM or universal transport media, saline, or RUO devices. Multiple peer-reviewed scientific papers have been published from 2011 onwards, validating the use of PrimeStore MTM for reliable pathogen detection from a wide variety of clinical matrices and biofluid types, and with a range of analytical platforms. A selection of these references are available on the EKF website.

“PrimeStore MTM is a real game changer for the sampling and transport of pathogenic samples from a safety, reliability and cost perspective,” said Julian Baines, CEO, EKF Diagnostics. “It’s clear that we need a strong testing programme ready for flu season and a potential second wave of COVID-19 – as thousands of people are going to start presenting with symptoms that could be flu or coronavirus. We have a sample collection kit that was designed in 2006 specifically for pandemics, it’s FDA cleared and CE IVD marked, and can be used to collect both flu and COVID-19 samples in one kit. The kit immediately neutralises infectious samples and doesn’t require refrigerated transport so it’s safer, cheaper and easier to use than standard collection kits.”

Recently, a consortium of researchers put forward the case for biosafety in pathogen transportation and testing through the adoption of virus-inactivating VTM which kill biological pathogens whilst ensuring DNA and RNA stabilisation and preservation for molecular applications. They noted that PrimeStore MTM has been extensively analysed to effectively inactivate/ kill viral, bacterial and fungal pathogens while preserving stability of the released DNA and RNA for diagnosis, and is FDA cleared. They also observed that, “Moving to virus-inactivating VTM at collection allows risk mitigation from transportation and handling of bio-specimens for diagnosis and can potentially reduce the need for special packaging and transportation measures for SARS-CoV-2/COVID-19 test samples.”

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NEWS

Ajman Specialty Hospital Enters into Collaborative Partnership with Thumbay University Hospital and Thumbay Labs to Deliver Advanced Healthcare Services

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healthcare facilities and 350 beds. Patients thus referred can also avail Thumbay University Hospital’s radiology services, lab tests, the 100bed long-term Care facility, etc. Furthermore, the agreement also provides for the exchange of specialists, exchange of knowledge and joint scientific research between the two hospitals.

he collaboration extends to providing advanced treatments including tertiary and quaternary care, long-term care, lab & radiology services and sample testing to patients referred to Thumbay University Hospital, Al Jurf, Ajman.

Ajman Specialty Hospital has signed two separate agreements with Thumbay University Hospital and Thumbay Labs, according to which the residents of Ajman can easily access state-ofthe-art healthcare facilities including specialist treatments and diagnostic tests. The agreement was signed at Thumbay University Hospital, Al Jurf, Ajman on 9th July 2020.

His Excellency Hamad Obaid Taryam Al Shamsi, Director of Ajman Medical District signed the agreement representing Ajman Specialty Hospital, while Mr. Akbar Moideen Thumbay, Vice President of the Healthcare Division of Thumbay Group signed on behalf of Thumbay University Hospital and Dr. Nasir Parwaiz, Director of Thumbay Labs signed the agreement for Thumbay Labs. Dr. Thumbay Moideen, the Founder President of Thumbay Group was present at the ceremony.

According to the agreement, patients of Ajman Specialty Hospital requiring advanced treatments will be referred to Thumbay University Hospital, the largest private academic hospital in the region with state-of-the-art

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ACCORDING TO THE AGREEMENT SIGNED WITH THUMBAY LABS, PCR TESTING OF SAMPLES COLLECTED AT AJMAN SPECIALTY HOSPITAL WILL BE TESTED BY THUMBAY LABS.

Speaking at the signing ceremony, His Excellency Hamad Obaid Taryam Al Shamsi said, “It is my pleasure to sign these agreements with Thumbay Group. Thumbay University Hospital is a beautiful healthcare facility, and I am sure that it has all the advanced treatments and services for our patients of Ajman Specialty Hospital, including specialist consultations, radiology and complex surgeries. I am confident that this collaboration will be beneficial for the people of Ajman.”

Mr. Akbar Moideen Thumbay said he hoped that the benefits of the collaboration would positively impact the health and well-being of Ajman residents. “Thumbay University Hospital’s cutting-edge facilities, our centers of excellence and our team of expert doctors and healthcare professionals make us a unique healthcare facility, serving the Emirate and the country and beyond, as an outstanding referral hospital. We thank Ajman Specialty Hospital for this partnership, and look forward to working together,” he said.

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 faculty published lessons for humanity after COVID-19

F

aculty at Weill Cornell Medicine – Qatar (WCM-Q) have collated information about the novel coronavirus – and suggested lessons that humanity could learn from the current crisis. Led by Dr. Ali Sultan professor of microbiology and immunology at WCM-Q, the team worked with colleagues at Qatar’s Ministry of Public Health to gather known facts about the virus’ epidemiology, individual countries’ responses to the outbreak and their success, as well as treatments and potential vaccines. From this the researchers compiled a list of actions that could help prevent or mitigate future pandemics.

Dr. Ali Sultan said: “If we are to combat the novel coronavirus we have to understand it in its totality. This means understanding its transmission rates, whether they can be reduced with measures like face masks, the benefits, if any, of the currently available drugs, and the effectiveness of the social distancing measures that we have seen implemented across the world. “In conjunction, of course, we must understand the pathology of the virus and how this can be treated and, if possible, prevented using a vaccine. Often this kind of information is fragmented but in this research paper we have tried to collate the pertinent facts so that they are all in one place.

Our publication came about as a result of ongoing scientific collaborations with our colleagues at Qatar’s Ministry of Public Health.”

Another member of the team at WCM-Q, Dr. Triggle, professor of pharmacology, said: “Challenges in writing our paper included the speed in which the news of the pandemic was changing daily combined with the need to separate the science-based data from potentially misleading information that was appearing in the media as a result of the rush to publish and report.”

The research team has documented the virus’s incubation period, its symptoms, its transmission rates and how the very strict social distancing measures imposed by countries like China, Vietnam and South Korea have been effective in curbing the virus’ spread, unlike the slower and more relaxed measures introduced

by Western nations, particularly the UK and the

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“THE MOST IMPORTANT THING THOUGH, IS THAT WE UNDERSTAND WHAT MEASURES HAVE WORKED, WHAT HAVE FAILED AND WHY, AND THAT WE HAVE A UNITED, GLOBAL RESPONSE TO POTENTIAL EPIDEMICS AND PANDEMICS IN THE FUTURE.”

United States. But perhaps the most important section of the research paper deals with the lessons that must be learned across the world if we are to manage potential future pandemics.

These are: 1. Establishing a rapid reporting system for any unusual infectious outbreak, and notification of the WHO should be a high priority.

2. Immediately isolating the infected person(s) and identifying and quarantining individuals who have been in contact with them.

3. When a viral spread has occurred, testing should be introduced and immediate lockdown considered.

4. If the spread of the infection is wide, social distancing and travel restrictions imposed along with restrictions on public gatherings. This needs public support alongside enforcement.

5. The early genomic identification of the pathogen is important and can help to determine and develop the best treatment options.

6. Vaccine development could be enhanced by pursuing any progress and clinical trials made with previously developed vaccines.

7. Drug development programs should be enhanced and serve to identify and test compounds effective against coronaviruses and other zoonotic viruses.

8. A global network should be established to ensure there is sufficient personal protective equipment and hospital equipment available to countries to deal with a pandemic.

Dr. Triggle said: “The response to COVID-19 has been varied across the world and this has resulted in wildly different infection and mortality rates. Asian countries have dealt with the virus much more effectively than the West, but only with the implementation of strict social measures, which could be interpreted as a curtailment of basic freedoms. However, far fewer people have died so this may be something that the public must accept.

The work has now been published on open access as a mini-review in the journal of the American Society for Microbiology, mSphere and can be read in full at https://msphere.asm.org/ content/5/3/e00317-20.abstract

‫َ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

ARTICLE

The Ethics Committee of Hôtel-Dieu de France During the COVID-19 Pandemic

H

ôtel-Dieu de France’s Ethics Committee is composed of health professionals and people of moral authority (academics, religious, lawyers, social workers, civil society members, etc.).

The Committee meets once a month or more, in case of emergencies, to discuss with doctors and health professionals and advise them in order to make the best decision and offer their patients the best possible attitude to face pathologies that can often confuse them, their families and healthcare providers.

The Committee intervenes in clinical matters, but also gives a decisive opinion concerning the research work taking place at Hôtel-Dieu

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de France by professors and researchers of the Saint Joseph University or by the doctors of HDF. During the COVID-19 pandemic, the Committee issued some ethical recommendations specific to this period, as ethical issues related to medical care and research were recalled all over the world: 1. Never before has medical privacy been so severely undermined. It should be emphasized that it is not allowed to publicly disclose the name of the person infected. Names must never circulate, especially in the press. Respecting anonymity is a core principle. If a positive person refuses to reveal its infection

IT IS IMPORTANT TO AVOID THE STIGMATIZATION OF INFECTED PATIENTS AND HEALTHCARE WORKERS WHO TAKE CARE OF THEM.

ARTICLE

2.

3.

4.

5.

6.

7.

and to remain in quarantine, breaching medical confidentiality is authorized by law.

Triage of patients. An ethics committee or "ethics experts" should not replace doctors who are responsible for setting priorities in this matter. Local ethics committees should solely be available to help with the decision.

The freedom to choose your own doctor.

Every person has the right to choose his or her own doctor. Treating patients is more than just having a good knowledge of the disease and its treatments, the chemistry between the patient and the doctor is also essential for the treatment to be successful.

Healthcare workers cannot shirk their responsibilities and therefore not be present during this pandemic. Not only is their physical presence required, but also a presence filled with compassion that eases fears of the sick and potentially sick. All healthcare workers must take care of their own mental health.

A counselling and support unit must always remain open to welcome them and patients.

The right for everyone to have access to healthcare must be preserved, if not reinforced in times of pandemic. All financial considerations that can limit equal access to healthcare must be disregarded in favor of providing optimal care for anyone in need.

The duty to show solidarity. Great emphasis should be placed on the necessary solidarity among all members of HDF. We must be able to count on the availability of the religious or spiritual guidance services, be it Muslim, Christian or non-religious. These people will guide the sick and their families, listen to them and comfort them by their mere presence.

It is important to avoid the stigmatization of infected patients and healthcare workers who take care of them.

Those who freely agreed to treat these patients deserve esteem and consid-

eration. We must never neglect them, nor reject them, nor stigmatize their disease.

Moreover, the COVID-19 pandemic had a major impact on the conduct of ongoing clinical trials at the hospital. Visits to healthcare sites, the participants' self-isolation, the high risk of infection and the population’s confinement led to the implementation of appropriate measures.

In order to ensure the safety of participants in clinical trials and of healthcare professionals, the Ethics Committee has published recommendations recalling the need to weigh the benefits and risks when taking any action and to respect the same research criteria as outside of these times of pandemic.

For interventional studies, laboratory tests were encouraged outside the hospital if participants could not reach it, and that at the expense of the sponsor of the study.

In addition, researchers had to ensure that patients would still receive their medical treatment. The Committee had suggested a safe distribution of the experimental material directly to participants when feasible.

These various recommendations were issued in harmony with the European Guidance on how to manage clinical trials and the Food and Drug Administration Guidance on Conduct of Clinical Trials of Medical Products during the COVID-19 pandemic. However, since the start of this pandemic, the Ethics Committee of HDF has approved no less than 40 new research projects related to various aspects of this new virus and its treatment, as part of the work of teachers-researchers of the Saint Joseph University in the medical, paramedical and engineering fields.

These various initiatives and services provided by the Ethics Committee during this pandemic were put in place in parallel with the exceptional measures taken by Hôtel-Dieu de France’s administration to manage the COVID-19 sanitary crisis. To an unprecedented emergency like this one, it was necessary to respond very quickly with emergency measures in order to guide healthcare workers and researchers in essential care and research procedures to preserve the dignity of the human being facing this unparalleled crisis.

THE COMMITTEE INTERVENES IN CLINICAL MATTERS, BUT ALSO GIVES A DECISIVE OPINION CONCERNING THE RESEARCH WORK TAKING PLACE AT HÔTEL-DIEU DE FRANCE BY PROFESSORS AND RESEARCHERS OF THE SAINT JOSEPH UNIVERSITY OR BY THE DOCTORS OF HDF.

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ARTICLE FEATURES . Heart Attack

Heart Attack What health conditions increase your risks?

I

t is a medical emergency that requires rapid medical intervention to save a patient's life.

The danger of a heart attack is that it occurs suddenly and has serious consequences if the patient doesn’t arrive at the hospital quickly to get the necessary medical assistance at the appropriate time. Severe chest tightness (which some describe as "having a rock on the chest") that usually goes hand in hand with pain in the left arm and neck is one of the possible symptoms of an impending heart attack.

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LONELINESS INCREASES THE RISK OF HEART DISEASE.

According to the World Health Organization, cardiovascular disease is the leading cause of death worldwide, accounting for 30% of all deaths yearly.Studies show the impact of lifestyle on the heart, whether in terms of food quality, physical activity or even in social communication and living a fun life away from problems and worries. These factors can be controlled in order to reduce the risk of heart disease. It is enough to make a lifestyle change to avoid that risk.Heart attacks and strokes are mainly caused

ARTICLE FEATURES . Heart Attack

by a blockage that prevents blood from flowing to the heart or brain. The most common reason for this is a build-up of fatty deposits on the inner walls of the blood vessels that supply the heart and brain. This makes them narrower and less flexible, decreasing thus the blood flow and increasing the risk of blocked vessels.The main reasons for the build-up of fatty deposits are controllable such as smoking, unhealthy diet, and lack of physical activity.

The Impact of Social Isolation on the Heart With the isolation of millions of people around the world due to the coronavirus pandemic, recent studies on the impact of social isolation on heart patients have emerged. It turned out that socially isolated people are over 40% more likely to develop cardiovascular diseases, such as a heart attack or stroke, than those who were socially integrated.

Feeling lonely and anxious about this novel virus increases depression and stress, which negatively affects the heart. Hence, these studies show that social relations and communication with friends, even via social media or on phone, contribute greatly to bringing joy to the person's heart, as well as alleviating the burden of problems by discussing them with others. Strong social relationships are as important to the heart as classic factors such as maintaining healthy cholesterol levels and controlling normal blood pressure, weight, and other things related to a healthy lifestyle.

People with no social ties are at risk of developing heart disease, especially a heart attack.

Feeling lonely is one of the reasons and it may be stressful for them since they have no one to help them organize their feelings.

Other studies have shown that a person who feels lonely has a 29% increased risk of a heart attack or angina, and 32% increased risk of stroke, high blood pressure, high cholesterol, and diabetes.

Researchers note that loneliness affects lifestyle, whereas a person tends to spend less money and smoke more, in addition to eating irregularly. More importantly, loneliness weakens the immune system and makes it unstable.

How Does Sleep Affect the Heart?

PEOPLE WITH NO SOCIAL TIES ARE AT RISK OF DEVELOPING HEART DISEASE, ESPECIALLY A HEART ATTACK.

On a related level, some studies on heart diseases linked the relationship between anxiety, lack of sleep, and cardiovascular diseases and found that people who slept less than 6 hours a night were twice as likely to have a heart attack as those who slept 6 to 8 hours a night.

It turned out that the risk may increase when a person gets too little or too much sleep. People who sleep less than 7 hours or more than 9 hours a day may be at greater risk than others.

Doctors attribute this to the fact that sleep disorders may increase the risk of cardiovascular diseases such as atherosclerosis, high blood pressure, arrhythmia, and strokes.

So, lack of sleep causes serious cardiovascular problems such as heart attacks and strokes.

Doctors and researchers believe this is because the lack of sleep may disrupt the parts of the brain which control the circulatory system or cause inflammation that makes the development of a blood clot more likely to happen. Ongoing studies have revealed a relationship between sleep disorders and chronic diseases. Bad sleep, which is the inability to sleep at night and waking up very early, leads to difficulty concentrating during the day and may increase the risk of obesity, which in turn increases sleep disorders.

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ARTICLE FEATURES . Heart Attack

How Does Smoking Affect the Heart?

Smoking is a major risk factor of heart disease, especially if it is combined with other risk factors such as unhealthy cholesterol levels, high blood pressure, weight gain, or obesity.

The carbon monoxide in cigarettes reduces the amount of oxygen in the blood, which makes it more likely to clot, and thus increases the chance of a heart attack or stroke.

The chemicals in cigarettes damage the function and structure of the heart and blood vessels, which increases over time the risk of developing atherosclerosis, whereas a waxy substance called plaque accumulates in the arteries narrowing them and thus decreasing the amount of oxygen-rich blood flowing to the organs and other parts of the body. Over time, heart disease can lead to chest pain, heart attack, heart failure, arrhythmia, or even death.

In addition, the narrowing of the arteries causes high blood pressure and increases the heart rate. The chemicals in cigarettes contribute to many cardiovascular diseases including coronary heart disease, in which the arteries that

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THE CARBON MONOXIDE IN CIGARETTES REDUCES THE AMOUNT OF OXYGEN IN THE BLOOD, WHICH MAKES IT MORE LIKELY TO CLOT, AND THUS INCREASES THE CHANCE OF A HEART ATTACK OR STROKE.

supply blood to the heart become narrow, heart attack, which is twice more likely to happen for smokers than for non-smokers, and chest pain.

Also, some of the substances in cigarettes such as nicotine or carbon monoxide may make the heart work harder and faster, causing difficulty in exercising. Smoking may affect the heart even if you smoke 5 cigarettes or less per day.

Atherosclerosis occurs when tobacco reaches the blood vessels. The chemicals inside this substance cause the buildup of a layer of fatty deposits (known as cholesterol) inside artery walls. This results in narrowing and hardening of the artery, decreasing the amount of blood flowing through it to one of the organs in the body, and thus decreasing the nutrition of this organ which weakens its vitality or stops it from performing its function.

Smoking also affects the surrounding blood vessels whereas plaque accumulates on the walls of blood vessels that carry blood to the head and organs. Over time, the risk of developing other heart diseases, angina, and stroke generally increases.

On the other hand, passive smoking greatly

ARTICLE FEATURES . Heart Attack

affects non-smokers who inhale the smell of cigarettes, thus increasing their risk of heart disease. Passive smoking may lead to blood viscosity, which over time leads to clogged arteries.

Harmful chemicals in smoke increase the risk of heart attacks and strokes. Various studies have indicated that a non-smoker who is exposed to passive smoking is at a high risk of coronary diseases such as coronary artery disease, congenital heart disease, and others.

How Does Obesity Affect the Heart?

Obesity causes high levels of bad cholesterol and triglycerides and the resulting heart diseases. These risks are caused by the damage done to the arteries, as obesity contributes to increasing the levels of fatty deposits built up on the arterial walls, leading to the development of the most dangerous heart diseases, in addition to the increased risk of sudden and devastating heart strokes.

Obesity is one of the serious risk factors of coronary heart disease resulting from building blocks of fat (cholesterol) inside the arteries. It

OBESITY IS ONE OF THE SERIOUS RISK FACTORS OF CORONARY HEART DISEASE RESULTING FROM BUILDING BLOCKS OF FAT (CHOLESTEROL) INSIDE THE ARTERIES.

also contributes to cardiac insufficiency, whereas the obese person has a large amount of blood which the heart cannot pump easily. Obesity is often accompanied by sleep apnea, which causes health problems such as high blood pressure, which in turn causes cardiac insufficiency.

This overweight also puts a lot of pressure on the heart, which over time leads to muscle strain and cardiomegaly. Some studies indicate that the persistence of severe obesity also increases the pressure on the right ventricle, which weakens the heart and prevents it from performing its vital functions in a natural way.

The dangers of obesity and its impact on the heart are not limited to this. It can also lead to sudden death caused by left ventricular hypertrophy, due to the fact that it leads to an increase in blood volume and in the number of capillaries.

Obesity is also a major risk of irregular blood pressure, which leads to enlarged heart muscle, coronary artery disease, and the enlargement of the aorta that carries blood from the heart to the body (aortic aneurysm).

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ARTICLE FEATURES . Heart Attack

High Cholesterol Levels Globally, a third of ischemic heart disease is related to high cholesterol levels. The reason is the accumulation of this substance on the walls of the arteries, which narrows them and thus decreases the amount of blood flowing through them, resulting in a heart attack. This can also lead to the formation of blood clots in the arteries, which in turn can cause heart attacks and strokes and narrow blood vessels in the limbs.

Excessive intake of fat-rich foods increases the risk of having high LDL cholesterol levels, which can cause fatty deposits to build up on the walls of the arteries and develop cardiovascular diseases. This buildup is called plaque, a thick and hard deposit. Over time, this can narrow the arteries and make them less flexible. This condition is known as atherosclerosis. The arteries become unable to supply enough oxygen-rich blood to the heart muscle. This lack of oxygen leads to severe chest pain called angina. Also, a blood clot may

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THIS LACK OF OXYGEN LEADS TO SEVERE CHEST PAIN CALLED ANGINA.

form in one of the coronary arteries and lead to complete blockage in the artery, and consequently cause a heart attack (myocardial infarction) or the death of the heart muscle or part of it.

Atherosclerosis is related to high levels of cholesterol, which may negatively affect the arteries that carry blood from the heart to the rest of the body. Once the disease begins, LDL cholesterol builds up on the arterial walls blocking the flow of the blood. This may lead to a heart attack if it is not detected early.

ARTICLE FEATURES . Heart Attack

High cholesterol levels can increase the risk of: •

•

•

•

•

Blockage of blood vessels as a result of the increase of cholesterol levels and the accumulation of fatty deposits.

Coronary artery disease, which occurs as a result of the progressive narrowing of the arteries that supply blood to the legs. When any physical activity is made, the legs do not get enough blood, and thus the person feels excruciating pain in the legs.

Heart diseases and angina, which are diseases related to the blood vessels of the heart such as the narrowing of the arteries of the heart.

Heart attack, which occurs due to narrowed arteries and low blood flow to the heart, preventing the heart from getting enough blood.

Stroke, which occurs when the blood supply to the brain is reduced due to the narrowing of the arteries.

How Does Diabetes Affect the Heart?

Diabetes is one of the factors that contribute to a heart attack unless it is controlled and checked regularly. Over time, high blood glucose can damage the blood vessels and nerves, which eventually leads to heart attacks.

Diabetes increases the risk of heart disease due to the resulting complications such as high cholesterol, high blood pressure, atherosclerosis, and vascular damage. Diabetics are more likely to develop atherosclerosis than others as a result of insulin resistance. In a diabetic patient, insulin isn’t necessarily absent, but it can be non-functional and unable to make cells benefit from glucose in the blood and absorb it, which leads to high levels of fat in the body. Diabetics also suffer from an increased rate of blood clotting, vascular calcification, difficulty in breaking down fats, and high fat levels in the bloodstream, in addition to vasculitis and weak internal layer of blood vessels.

Diabetics are more likely to have the following cardiovascular diseases: •

Atherosclerosis

• • •

Coronary artery disease Weak heart muscle Peripheral vascular diseases such as venous thrombosis in the feet Heart attacks causing ischemic heart disease and the death of parts of the heart muscle

DIABETES INCREASES THE RISK OF HEART • DISEASE DUE TO THE RESULTING COMPLICATIONS SUCH AS HIGH High Blood Pressure CHOLESTEROL, The higher the blood pressure, the greatHIGH BLOOD er the risk of heart attacks. The reason is the PRESSURE, reduced blood flow to the heart. Heart attacks ATHEROSCLEROSIS, occur when a coronary artery narrows due to the AND VASCULAR gradual accumulation of fatty deposits. When DAMAGE. the plaque breaks apart, a blood clot forms to DIABETICS ARE repair the damage done to the artery’s wall and MORE LIKELY blocks the flow of oxygen-rich blood to a part of TO DEVELOP the heart muscle, leading to a heart attack. If you ATHEROSCLEROSIS have high blood pressure, the increased pressure THAN OTHERS AS A of blood flowing through your arteries gradually RESULT OF INSULIN can cause a variety of problems, including artery RESISTANCE. damage and narrowing. High blood pressure can damage the cells of the arteries inner lining. This launches a cascade of events that make artery walls thick and stiff, a disease called atherosclerosis. Arterial damage can cause many problems, including angina, heart attack, heart failure, kidney failure, stroke, blocked arteries in the legs or arms, eye damage, and aneurysms.

Over time, the constant pressure of blood moving through a weakened artery can cause a section of its wall to enlarge and form an aneurysm, which is more common in the aorta, the body’s largest artery. When the blood doesn’t flow freely to the heart, the patient may experience a chest pain or arrhythmias. In addition, high blood pressure forces the heart to work harder than necessary in order to pump blood to the rest of the body.

This causes the left ventricle to thicken or stiffen (left ventricular hypertrophy), which limits its ability to pump blood to the body. This condition increases the risk of heart attack, heart failure, and sudden cardiac death. Over time, the strain on the heart caused by high blood pressure can cause the heart muscle to weaken and work less efficiently. Eventually, the overwhelmed heart begins to wear out and fail.

Damage from heart attacks adds to this problem.

35

Article

Heart Attack... Number One of Death Worldwide

By Dr. Mazen Shaheen, Consultant Interventional Cardiology Clemenceau Medical Center - Dubai

T

he heart is the muscular pumping organ of the body that normally weighs about 200 grams. The heart is composed of four main constituents: heart muscle, heart valves, Coronary arteries and electrical conduction system.

Coronary arteries for many reasons can get narrowed and calcified and this can cause a heart attack. Typical signs of heart attack are chest pain typically left-sided, left arm pain, profuse sweating and feeling doomed sensation.

Silent heart attack can present with various ways such as shortness of breath, nausea, vomiting, and pain between the back of shoulders area, dizziness and feeling fatigue. Patients who are elderly, diabetics and female gender are more prone to have silent heart attacks.

Coronary arteries are conduits that deliver oxygen and nutrients to the heart muscle. Normally the coronary arteries are smooth and free of disease. There are five major risk factors that predispose us to develop plaque and narrowing of these coronary arteries.

The five major risk factors are smoking, high blood pressure, high cholesterol lipid levels, high blood sugar and positive family history of coronary heart disease.

The above-mentioned risk factors initiate the formation of plaque in the inner walls of the coronary arteries that can cause significant blockage and cause chronic chest pain or even worse can form plaque that can rupture and induce total or subtotal blockage of the coronary artery that cause heart attack.

In taking care of patient with heart disease or at high risk of developing heart disease the most important factor is modifying these major risk factors, it cannot be stressed enough the need to quit smoking.

Smoking not only develops blockage in the coronary arteries but also in all other arteries and causes cancer, chronic lung disease and

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36

increase tremendously our mortality rate. Also, it is so important for patients at high risk to live a healthy lifestyle including diet, exercise and stress relief habits.

Heart attack occurs usually because of plaque in the coronary artery ruptured which will lead either to total blockage of the heart artery or subtotal occlusion of the artery.

There are many important medications that need to be given if no contraindication to the patient after heart attack and their role is to protect the muscle of the heart as well as prevent further heart attacks.

These medication are aspirin, nitroglycerin as needed for chest pain, beta blocker (such as metoprolol, carvedilol, bisoprolol), statin medications (like rosuvastatin, atorvastatin) and Angiotensin converting enzyme inhibitor such as Ramipril lisinopril.

If patient ended up receiving stent, he needs to be on other medication along aspirin such as brilinta, Plavix to prevent clot in the stent received nd the duration of that combination to be decided by his/her cardiologist.

When a major heart attack occurs, time is the essence. Any time lost equates to heart muscle becoming dead. It is crucial when a major heart attack occurs for a patient to undergo lifesaving coronary angiogram as soon as possible. Based on what the coronary angiogram shows, he will undergo types of intervention either coronary balloon /stent or open-heart surgery.

In summary, a heart attack is a life-threatening condition, it is the number one cause of death in the United States and worldwide. The major risk factors to develop heart attack are smoking, high blood pressure, high lipids, high blood sugar and positive family history.

When someone develops chest pain, they need to seek medical attention directly and call an ambulance.

Article

37

MEDICAL INSTITUTIONS

Cutting-edge Technology and Innovative Approach in Orthopedic Joint Replacement Surgery

W

e are thrilled to introduce you to Robotic Orthopedic Surgery Center in Bursa, Turkey, which performs your kinematically aligned knee and hip replacement. We are proud of delivering personalized experience to meet your needs and exceed expectations. At Robotic Orthopedic Surgery Center, we are committed to providing the best care and experience for you.

Our team is dedicated to making your surgery, stay, and the transition home as smooth as possible.

Introduction to Kinematically Aligned Knee and Hip Replacement Surgery

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Hip and knee joints are the most weight-bearing joints of the human body. Due to this function of the knee and hip joints, they are most commonly injured, which often results in osteoarthritis(OA). Pain, stiffness, loss of motion, deformity, and difficulty during walking are the main complaints of patients with hip and knee OA. If you can not walk or do your daily activities as you desire and all the other treatment options such as medications or physiotherapy do not help you any more than your orthopedic physician might recommend you knee or hip replacement surgery.

AT ROBOTIC ORTHOPEDIC SURGERY CENTER, WE ARE COMMITTED TO PROVIDING THE BEST CARE AND EXPERIENCE FOR YOU.

MEDICAL INSTITUTIONS

and high modularity resulted in a more anatomical fit overall.

Precision and accuracy of implantation has significantly improved through the use of assistive technological tools (e.g., computed or robotic-assisted surgery, patient-specific cutting guides) and pre- or intra-operative tri-dimensional dynamic planning, respectively. These changes in practice over the last few decades could only partially reduce the unsatisfactory rate; nevertheless, complications have remained!

This maybe because of gold-standard techniques for implanting hip and knee components aim to implant all patients similarly, thus neglecting each individual's unique joint anatomy and kinematics. Systematic techniques for joint replacement was originally devised for simplifying implantation, making it more reliable in the surgeon's hands.

However, there are some intrinsical limitations in this systematic mechanical alignment (MA) technique: • • •

With all the improvements that have been made to techniques and instrumentation, hip and knee replacement surgeries are one of the safest and most successful types of operations, despite the fact they are affected by non-negligible rates of residual symptoms and complications. The criteria that are measured as a source of patient's satisfaction are generally: recovery in a short time, easy return to a daily routine, a joint feeling natural, improving the implants' longevity.

Unsatisfactory clinical outcomes are primarily mechanical and related to prosthetic impingement, dislocation, edge loading, wear, liner fracture, etc.

Recent advances in material and design of prosthetic components, which are sophisticated, hard-wearing material, and various shapes, sizes,

No respect of constitutional anatomy, No respect for physiological soft-tissue tension, No consideration of dynamic acetabular orientation.

Nevertheless, the fact is much like people themselves; no two knees are precisely alike. So, when a knee replacement is needed, the position and fit of implants should be as precise and individual as it can be.

In recent years, more personalized and

THE CRITERIA THAT ARE MEASURED AS A SOURCE OF PATIENT'S SATISFACTION ARE GENERALLY: RECOVERY IN A SHORT TIME, EASY RETURN TO A DAILY ROUTINE, A JOINT FEELING NATURAL, IMPROVING THE IMPLANTS' LONGEVITY.

39

MEDICAL INSTITUTIONS

anatomical/soft-tissue friendly techniques have been developed. Kinematic alignment techniques for implanting hip and knee components are gaining popularity. The kinematic alignment approach naturally aligns the patient's joint by custom positioning the implants to the native joint line, just like it was before OA developed.

Considering all the satisfactory cradles and clinical outcomes, in our Robotic Orthopedic Surgery Center we have combined the most appropriate alignment technique, kinematic, with the most advanced implants material and design, and precise Robotic-assisted technological tools together.

We aim to reproduce patients' native anatomy by customized methods and tools, therefore improving the prosthetic hip-knee kinematics and functional outcomes.

Combination of three pillars in our Robotic Orthopedic Surgery Center: As an innovative approach with the technique and technology we use with this perspective, we would like to talk about their combination:

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1. Kinematic Alignment: Briefly, there are two techniques used in replacement surgeries.

One is the Mechanical Alignment(MA) technique.

In this technique, implant placement is performed similarly in almost every patient. However, we all know that every patient has unique anatomy and therefore, implant positioning should be patient-specific.

In the other method, the Kinematic Alignment (KA) technique, the implant is positioned

MEDICAL INSTITUTIONS

regarding each patient's individual and unique knee or hip anatomy. KA technique aims to reconstruct a joint which has the patient spesific kinematics, just like before OA has developed.

Since KA technique helps to maintain the natural structure of the knee and hip after surgery patients feel less pain, walk easily with a prosthetic joint but feeling like a natural one.

2. Robotic Surgery: While performing joint replacement surgeries, we successfully use a robotic surgery system that provides us the latest and advanced technology. Robotic surgery is the surgical system that ensures that the implants are placed in the most accurate and precise position by the patient's joint structure. With robotic surgery, each patient's knee or hip anatomy is determined with the computer-assisted system, and the 3-D model of the joint is established. The robotic surgery system provides more accurate planning and allows surgeons to place an implant precisely.

3. Kinematic Alignment with Robotic Surgery: One of the significant advantages of robotic surgery is that it enables us to perform kinematic alignment with high precision and accuracy. The positioning of the implant with the kinematic sensors, knee/ hip alignment, and balancing of the soft tissue is performed in a patient-specific way. Thus, a natural range of motion is achieved in the joint; patients experience a more natural knee feel, functions, and movements are improved.

JOURNEY◊ II Total Knee Arthroplasty:

evolving total knee arthroplasty. This journey began with the commercial production of the first unicondylar knee on the market in the 1970s. In the 1980s, total knee systems with modern knee designs introduced. And then JOURNEY's story has begun in the 2000s. It was the first total knee arthroplasty to accurately replicate the normal kinematic patterns of the healthy knee joint.

Over 60,000 JOURNEY knees have been implanted around the world.

Now, as the latest generation and advanced technology, JOURNEY◊ II offers unique and new features: more knee function, durability, motion, and higher flexion. There is much clinical evidence that JOURNEY◊ II has improved functions.

In a study analyzing the kinematics of 50 knees, it has been showed that JOURNEY◊ II exhibits a normal-like knee features (Grieco TF. et al., J Arthroplasty, 2017). Results of another study done with 200 patients indicate that, JOURNEY◊ II led to significant improvements in patient satisfaction, knee functions and flexion (Nodzo SR. et al., Tech Orthop. 2018).

As the first team that applied these new techniques successfully in Turkey, we are proud to offer advanced technology in joint replacement including; Robotic Surgery, Kinematic Alignment Technique, JOURNEY◊ II prosthesis, in a patient-centered care at a suitable cost.

The combined use of kinematic technique, robotic surgery and JOURNEY II technology allows physicians to find solutions for surgical treatment problems and break barriers. At the same time, it enables patients to have a more active lifestyle, short recovery time, and more native knee feel.

JOURNEY◊ II, IS A PROSTHESIS DESIGNED TO CREATE NORMAL POSITION, SHAPE, AND MOVEMENT IN THE KNEE. UNLIKE CONVENTIONAL KNEE PROSTHESES, JOURNEY◊ II IS A TECHNOLOGY THAT OFFERS STRONG FUNCTION, MOTION, AND ENDURANCE FOR A MORE ACTIVE LIFESTYLE.

Another factor determining the outcome of the surgery and patient satisfaction is the prosthesis used. In total knee arthroplasty, the prosthesis should meet the needs of the patient.

JOURNEY◊ II, is a prosthesis designed to create normal position, shape, and movement in the knee. Unlike conventional knee prostheses, JOURNEY◊ II is a technology that offers strong function, motion, and endurance for a more active lifestyle. Thus, it provides patient satisfaction by increasing the ability to perform daily movements and activities. This system is specifically designed for total knee replacement surgery.

"JOURNEY" actually means a journey of

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ARTICLE FEATURES . Robotic Orthopedic Surgery

How robotic surgery is transforming orthopedic?

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obotic surgery is today the latest trend in modern medicine, after it has proven to be very worthy in operating rooms, especially in delicate surgeries. It represents the latest surgical techniques by means of high-precision robotic technology.

The skilled surgeon controls the robot from the control console by using 3D cameras that give him high-resolution images. He moves the four robot arms to reach the area on which the surgery is performed. These arms have the highest level of flexibility and move in a better way than the human hand.

The introduction of robots into the operating rooms provided the opportunity for the surgeons to perform the greatest surgeries with the help of technical and computer assistance based on technological developments by using advanced robotic systems.

Today, robotic assistance is essential for the surgeon during dangerous surgeries, as he guides the robot from the control console and gives orders to move the robot arms that are programmed to follow the surgery steps with

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SURGICAL ROBOTS HELP DOCTORS DIAGNOSE DIFFERENT CONDITIONS WITH PRECISION AND PERFORM SURGERIES WITH UTMOST PRECISION AND SAFETY.

high precision. In addition to the possibility of performing surgeries remotely, using robots in surgeries decreases the patient's pain, reduces complications of surgical incisions and bleeding during the surgery, and thus allows for avoiding the transfer of large amounts of blood to the patient, which leads to a speedy recovery and returning to normal life.

Robotic surgery is performed with the help of an automated and computerized technique. The surgeon can perform all surgeries laparoscopically if possible in various surgical specialties.

These robots call for high expertise and skills from doctors and surgeons who have studied this field and performed many robotic surgeries because the technology alone, despite its importance today in a lot of delicate surgeries, is of no use unless there is a doctor who mastered the art of dealing with the robot in the operations room. It is him who moves the robot arms in the direction he wants after having seen 3D images of the location of the surgery on the computer screen.

ARTICLE FEATURES . Robotic Orthopedic Surgery

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NEWS

Robotic Orthopedic Surgery Today, orthopedic surgeries are witnessing unprecedented achievements after the widest introduction of robots into this field. Many companies specializing in the medical field have developed surgical robots that assist in orthopedic surgeries such as knee, femur, shoulder, or spine surgeries, and help obtain satisfactory results for both the patient and the doctor.

Robotic joint replacement surgeries have become typical surgeries across the world, provided there is a skilled surgeon with long experience in his field.

Robotic orthopedic surgeries are also proving to be very effective and have a significant role in improving the efficiency of spine surgeries (which are considered among the most delicate surgeries) and many others.

The robot enables surgeons to perform delicate surgeries easily, especially spine, joint,

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and other bone surgeries, which contributes to alleviating patient suffering, shortening the post-surgery recovery period, reducing bleeding, etc. Robotic joint replacement surgeries have contributed to many positive results for the patients of knee replacement.

Knee Replacement Using robots in knee replacement surgeries contributes greatly to the rapid recovery of the patient. First, the size of wounds and scars is very small and does not exceed the small holes in the tissues surrounding the knee. Second, the process of drilling the bone connected to the tissues is infinitely precise, in addition to reducing the time of the surgery and post-surgery pain.

These characteristics encouraged many patients to look for skilled orthopedic surgeons around the world, which led to developing the

NEWS

will be removed from the surface of the bones to implant the joint. During the robotic surgery, the surgeon moves the robot arm that has a bone drilling tool, and shapes the surface of the bone in a way that fits the form and size of the artificial joint. The robot arm does not move by itself, the surgeon is the one who moves it and controls it. The robot only drills in the places that are determined by the computer, and the arm is not allowed to move or drill in other places.

Spine The robot helps doctors perform the complex and delicate spine surgeries with utmost precision and safety. This robot can be used to plan the procedure in detail in advance, and 3D images are obtained during surgery by easily moving the robot arm.

This type of surgical robots helps doctors to accurately diagnose the condition, to perform the required surgeries with utmost precision and safety, and to employ the three-dimensional CT machine, which is the latest of its kind internationally and most accurate in spine surgeries.

technology related to this modern surgical method while adhering to the highest international standards in the field of robotic surgery.

Hip Replacement Hip replacement is one of the surgeries that have benefited from technological development of robots. It is possible now to perform this surgery more smoothly and with fewer complications by using the robot, especially since the majority of patients who need such surgeries are elderly persons. This means that most of them suffer from chronic diseases, and undergoing major surgeries may pose a threat to their overall health.

A few days before the surgery, a three-dimensional CT scan of the joint is taken. The scan is uploaded into the computer in order to determine the size of the artificial joint, the optimal position to implant it, and the parts that

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MEDICAL INSTITUTIONS

Acıbadem Healthcare Group starts to admit patients to Turkey again

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he world is going through a crisis for months due to the spread of Covid-19.

Several countries, including Turkey, have introduced total or partial lockdown to slow the spread of the pandemic. In these circumstances Acıbadem Healthcare Group took necessary precautions and continue to support all patients.

Since March 11th, 2020, the date of the official declaration of the first case of Coronavirus infection in Turkey, Acıbadem Healthcare Group has engaged its crisis management procedure.

We have reorganized our hospitals and medical centers. Since we have met the criteria set by the Ministry of Health, our hospitals have been declared pandemic hospitals which enables us to be able to diagnose and treat Covid-19 patients along with other examination, diagnostic and therapeutic services.

Beside our physical and medical competence, this is a matter of spiritual pride in terms of serving out people in such a period.

Infection control and safety practices at our hospitals are always pretty superior considering the global averages.

For Covid-19 pandemic, we have rechecked these measures and evaluate continuously within our Infection Council. Suspected or confirmed Covid-19 patients are isolated from other patients and admitted to pre-determined

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SUSPECTED OR CONFIRMED COVID-19 PATIENTS ARE ISOLATED FROM OTHER PATIENTS AND ADMITTED TO PRE-DETERMINED AREAS.

THE FIRST PATIENT ARRIVES FROM ALGERIA AFTER THE AIR EMBARGO WAS LIFTED Assil, accompanied by her parents, left her country Algeria on June 11th for Turkey seeking a medical treatment for her case. The family was welcomed at Istanbul International Airport by the staff of Acıbadem Healthcare Group who accompanied Assil and her parents to Acıbadem Altunizade Hospital immediately after completing the arrival procedure. As a first stage, the diagnosis will be confirmed, then she will start a treatment based on bone marrow transplantation.

MEDICAL INSTITUTIONS

areas. The healthcare professionals dealing with suspected or confirmed cases are not involved in care of non-suspected patients due to the risk of cross-contamination.

Public areas in the hospitals are disinfected frequently, magazines at the waiting rooms, seats and chairs from the cafeterias are removed, only packed foods are allowed to be sold and a specific elevator is allocated for suspected and confirmed Covid-19 patients.

We have allocated rooms at the hospitals for physicians, nurses and other staff who deal with Covid-19 patients where they can prefer not go back home for preventing contamination.

All patients with complaint of fever and cough are welcomed at isolated area of emergency room. All medical staff equipped with personal protective materials and all patients have been provided masks against the risk of cross-contamination.

The examination and inpatient areas for non covid-19 patients are strictly reserved and isolated from emergency areas. Moreover, these patients in examination areas are served by staff specifically assigned to this unit.

For control patients of cancer and chronic diseases, we have allocated separate entrance points to hospitals.

Only one companion is allowed and we have measured body temperature of the patients and the companion in every visit. All patients

who will undergo a surgery are first examined considering Covid-19. Medical staff is equipped with personal protective materials.

All equipment are sterilized at Central Sterilization Unit and the operating theater is disinfected before each procedure. After the surgery, patients are transferred to single rooms for postoperative recovery.

As Acıbadem Healthcare Group, we will continue to follow the recommended protocols of World Health Organization and the Turkish Ministry of Health and continue to prioritize the needs of our patients. We are pleased to assure you that we will continue to support the medical needs of our patients during and after this extreme global situation.

Procedure for medical travel to Turkey Dear Guests; Thank you for trusting Acıbadem Healthcare Group for your treatment. As Acıbadem Healthcare Group we know that it can be very complicated to travel with many restrictions so we try to make the journey as smooth as possible.

Please read the following instructions before your travel and get back to us if you have any questions.

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AS ACIBADEM HEALTHCARE GROUP, WE WILL CONTINUE TO FOLLOW THE RECOMMENDED PROTOCOLS OF WORLD HEALTH ORGANIZATION & THE TURKISH MINISTRY OF HEALTH AND CONTINUE TO PRIORITIZE THE NEEDS OF OUR PATIENTS. WE ARE PLEASED TO ASSURE YOU THAT WE WILL CONTINUE TO SUPPORT THE MEDICAL NEEDS OF OUR PATIENTS DURING AND AFTER THIS EXTREME GLOBAL SITUATION.

You and your companions should obtain

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MEDICAL INSTITUTIONS

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negative COVID-19 PCR test result performed in the last 48 hours, if it is accessible at your country.

You should be submitting us the necessary forms and documents.

Signed consent forms for yourself and for your companions.

COVID-19 PCR test result Medical reports for your current diagnosis Copies of your and your companion’s passport You should purchase the flight or bus ticket and inform us about the details.

For now you will not able to pass the border with your own car.

At the border, negative COVID-19 PCR test should be presented, if it is accessible at your country.

If you or your companions have clinical findings of COVID-19 (e.g. cough, fever) during boarding, you will be turned away so please be careful with your current symptoms.

You should be wearing masks starting at boarding. It should be replaced every three hours and hand sanitizers should be used while replacing the masks.

When you arrive to the airport, you and your companions will be examined for COVID-19 symptoms and COVID-19 PCR test will be performed. You will not make any additional payment for

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the test at the zone.

At the customs in Turkey, negative COVID-19 PCR test should be submitted if it is accessible at your country.

You should also be ready to submit documents showing invitation to Turkey within scope of International Medical Tourism.

You should be wearing masks at all times during custom inspection.

When you completed the customs inspection and ready to be transferred to hospital. Please come to our Acıbadem Health Point Lounge at exit.

You will be transferred to our hospital with designated and disinfected transport vehicles or ambulances due to your medical condition. You will not able to be transferred to another location than predesignated hospital.

You and the driver should put on mask before getting on the vehicle.

After every transport, vehicles and ambulances are disinfected and the personal protective equipment of drivers will be disposed as a medical waste.

When you arrive to our hospitals, you will be welcomed by Acıbadem Health Point Team. They will support you in your own language through your journey.

If your treatment is completed in seven days you can be discharged with a negative PCR test but we will transfer you to the airport.

If your treatment is completed in between seventh and fourteenth day, you can be discharged with a negative PCR test. We will transfer you to the airport but you can also prefer to stay in Istanbul considering your visa.

If your treatment is completed after fourteenth day, you will be discharged without requirement of a PCR test.

We will transfer you to the airport but you can also prefer to stay in Istanbul considering your visa.

PUBLIC AREAS IN THE HOSPITALS ARE DISINFECTED FREQUENTLY, MAGAZINES AT THE WAITING ROOMS, SEATS AND CHAIRS FROM THE CAFETERIAS ARE REMOVED, ONLY PACKED FOODS ARE ALLOWED TO BE SOLD AND A SPECIFIC ELEVATOR IS ALLOCATED FOR SUSPECTED AND CONFIRMED COVID-19 PATIENTS.

MEDICAL INSTITUTIONS

LITTLE HEARTS FROM BOSNIA TREATED IN TURKEY Baby Hana Seper was born with a complex congenital heart disease called Transposition of Great Arteries (TGA) where the two main arteries coming off from the heart are reversed in position. Baby Adin Bjelak was born with a very complex congenital heart disease called Hypoplastic Left Heart Syndrome (HLHS) where the left-sided structures of the heart are underdeveloped. TGA and HLHS are among the most important and critical heart diseases that are seen in newborns. These conditions must be treated immediately after the birth.

When all national and international flights were terminated during Covid-19 Pandemic, Hana and Adin came to our hospital by air ambulance from their country Bosnia Herzegovina with special permissions obtained for air transport and flight. They were successfully operated by Professor Yusuf Kenan Yalçınbaş and Asc. Professor Ahmet Arnaz. Both babies regained their health and waiting for international scheduled flights to start for returning Bosnia Herzegovina.

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INTERVIEW

Chief of Hematology and Oncology at Nationwide Children’s Hospital

Timothy P. Cripe, MD, PhD, FAAP “I think immunotherapies like CAR T-cell therapy will be a new pipeline for research”

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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. Specific to pediatric cancer, the hospital is ranked eighth in the country. "Hospitals" magazine recently interviewed Timothy P. Cripe, MD, PhD, FAAP, Chief of Hematology and Oncology.

What is CAR T-cell therapy and how can it be used in the treatment of pediatric cancers?

We are getting much more experienced with CAR T cells and it is becoming a life-saving treatment for many patients. CAR T-cell therapy is a type of immune cell therapy in which a patient’s T cells are meant to attack cancerous cells. This technology can be used not only against cancer but against other challenging virus infections.

We had a premature infant whose mother got a viral infection during pregnancy and passed it to her baby. Infants are very immunocompromised, so the baby got very sick. The mother recovered but the baby was admitted to the ICU and less than 10 percent chance of survival. So, our team isolated the T cells that were active against the virus from the mother and gave them her newborn, and within 24 hours the baby was off the ventilator and soon recovered and went home.

Can CAR T-cell therapy be used in all types of cancers?

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Not yet. Immunotherapies have limitations when fighting solid tumors. We recently received a substantial grant to investigate using this technology for patients with solid tumors.

We are now using animal models of disease for the study.

I think immunotherapies like CAR T-cell therapy will be a new pipeline for research. We are looking forward to exciting results and new breakthrough treatments.

How is cancer different in children than adults?

Unlike many cancers in adults, childhood or pediatric cancers are not linked to lifestyle and environmental risk factors, like smoking, obesity and lack of activity. Most adult cancers are caused by mutated genes where a change occurs in their DNA. Only a limited number of pediatric cancers are caused by DNA changes that are passed from their parents. We used to think that inherited predisposition to cancer was around 10 percent, but recent research shows it might be higher.

OUR TEAM ISOLATED THE T CELLS THAT WERE ACTIVE AGAINST THE VIRUS FROM THE MOTHER AND GAVE THEM HER NEWBORN, AND WITHIN 24 HOURS THE BABY WAS OFF THE VENTILATOR AND SOON RECOVERED AND WENT HOME.

INTERVIEW

Is cancer treated the same way in children as adults?

We use a lot of common treatments but in pediatric oncology we are now using more and more targeted therapies that are unique to each patient and are seeing more promising results.

Usually, childhood cancers tend to respond better to certain treatments especially chemotherapy. Another reason why we get better results with children is that they do not have additional health problems that adults may have acquired during their lives which can often get worse with cancer treatment.

Should children and adults be treated in the same oncology facilities? And why?

I think children and teens with cancer must be treated in centers that cater only to them.

Patients have the benefit of being treated by specialists and medical teams that are more experienced and know the differences between adult and childhood cancers.

In these centers, you will find a group of psychologists, social workers, dietitian and physical therapists who are willing to educate the patient and family on all the aspects of treatment.

The parents are always informed and educated about what we are doing, the treatments we are using. Also, we give them the chance to get into new clinical trials, and they must be educated about the risks and benefits of any medical trial before agreeing for their child to participate.

What are the risks for secondary cancer at a later stage of life for children who survived cancer at an early age?

We do know that we are all at an increased risk of cancer as we age, and a person who had childhood cancer is at a higher risk especially if he or she had radiation and chemotherapies during treatment.

So once treatment is finished, we have a survivorship program for many years afterwards where we monitor the patient at least once a year not only to talk about side effects of their treatments and health risks, but also to monitor for recurring cancer. Monitoring and early treatment are key to long-term survival.

WE USE A LOT OF COMMON TREATMENTS BUT IN PEDIATRIC ONCOLOGY WE ARE NOW USING MORE AND MORE TARGETED THERAPIES THAT ARE UNIQUE TO EACH PATIENT AND ARE SEEING MORE PROMISING RESULTS.

To learn more about Nationwide Children’s Hospital and Dr. Cripe, visit NationwideChildrens.org/Cancer

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ARTICLE

Pandemic Response: Maintaining Effective and Safe IV Infusion Therapy for Critically Ill and Isolated Patients

Lisa Gangol. RN, BSN. Beckton Dickinson. Senior Clinical Resource Consultant. Medication Management Solutions. Eastern Europe, Middle East & Africa.

Natalie Samuda. RM, BSc. Becton Dickinson. Senior Clinical Resource Consultant. Medication Management Solutions.

Eastern Europe, Middle East & Africa.

James Waterson. RN, M.Med.Ed. Becton Dickinson. Medication Safety Manager, Eastern Europe, Middle East & Africa.

James.Waterson@bd.com

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he magnitude of IV medication error even under ‘normal’ conditions is large (*). Smart Pumps with Dose Error Reduction Systems (DERS) reduce this risk with the application of hard limits for dose/rate, concentration, and duration of continuous and intermittent medications (#). The Covid-disease pandemic’s requirement for strict isolation of large numbers of patients has made maintaining the Rights of IV medication administration: patient, medication, dose, route, timing, and documentation, increasingly difficult.

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There is also the Right Maintenance of continuous critical short half-life infusions (CSHLI) such as noradrenaline or glyceryl trinitrate. Of course, with critically ill Covid-disease patients in the ICU any prolonged interruption of CSHLI infusion delivery could be fatal. Monitoring of these infusions is vital for isolated ICU patients, as nursing staff must respond promptly to any infusion alarm, and certainly within the plasma half-life of these medications if serious cardiovascular events are to be avoided. Some typical half-lives of CSHLI are given in Table 1.

IN STANDARD FLUID-KINETICS NOTATION THIS IS EXPRESSED AS: Q =πΔPr4 / (8μL)

ARTICLE

A three-year retrospective study in The University Hospital of Antwerp, Belgium identified that centralised monitoring of isolated neonates in an NICU with 60 single-rooms reduced nurse reaction times to CSHLI alarms by 31% and reduced the total number of alarms that nurses are exposed to by 56.25%. (**) We therefore recommend central monitoring of all infusions delivered to isolated patients. This has an extension beyond the pandemic to immunocompromised critical patients who require protective isolation. The use of wireless pumps in single rooms that can transmit their infusion data and any alarms to a centrally based monitor is extremely valuable in this respect.

To reduce nursing time for IV bag changes and intermittent IV medication administration spent inside rooms of SARS-CoV-2 virus infected patients some facilities have adopted the use of long extension lines that allow the patient’s pumps to remain outside of the isolation room.

This practice does have some issues that must be considered to maintain safety, infusion continuity and accuracy. This includes considerations on how to run the IV line to the patient.

Running the IV line under the door and across the room’s floor, and taping and padding it to prevent tripping or dislodgment, is not ideal but does provide protection of the line and a visual warning of its presence. (##) However, the technique may cause issues of pressure gradient changes affecting occlusion alarms, accumulation of air in the line due to the low level of the line in relation to the pump and the patient, and of rate accuracy. This is related to a

question of physics. In nonideal fluid dynamics the Hagen-Poiseuille law gives the pressure of an incompressible fluid flowing through a long cylindrical pipe or tube of constant cross section. The law states that the steady-flow velocity (Q) of a fluid through a narrow tube (such as an IV set or a catheter) will vary in relation to the pressure drop (Δp), to the radius (R) of the tube, to the length (L) of the tube, and to the viscosity (μ) of the fluid in the line. In standard fluid-kinetics notation this is expressed as:

Q =πΔPr4 / (8μL) Where: Q is the volumetric flow rate. Δp is the pressure difference between the two ends of the infusion line.

L is the length of pipe or tube. μ is the fluid dynamic viscosity. r is the line or catheter radius.

APPROPRIATE CLEANING AND DECONTAMINATION OF PUMPS BETWEEN PATIENTS, AND ON A REGULAR BASIS, IS A BOTH VITAL COMPONENT OF PANDEMIC PLANNING.

Smart pumps are accurate, but long lines can then, in theory, increase siphonage in the case of large bore lines and increase down-

Table 1:

Half-lives of common Critical Short Half-life Infusions (CSHLI) Drug

Half-life

Epinephrine

3-10 minutes

Norepinephrine

2-3 minutes

Dopamine

1-2 minutes

Dobutamine

2 minutes

GTN

30-60 seconds

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stream pressure when microbore lines are used.

It is important to maintain the recommended height of the infusion bag above a large volume pump (this is usually 50 centimetres) and any unnecessary resistance in the downstream line should be reduced by keeping the extension set additions as limited as possible to achieve a safe working distance, and infusing through as large an IV catheter as possible. Priming of long extension lines can be undertaken by gravity, but it is often easier to control the prime by using the pump.

Another consideration with long lines is that downstream occlusion pressure limits may need to be increased to avoid nuisance alarms, particularly at higher rates, due to higher volumes being forced through long narrow tubing. This can be done by the user at the bedside, but when we have wireless-connected smart pumps in a facility changes to default pressure alarms configurations can be made centrally and distributed rapidly via the network to all pumps. Smart pumps should also have an option of occlusion pressure limits that are dynamic, meaning that the flow rate automatically determines and alters the downstream occlusion pressure alarm.

In this case, with long extension lines, this mode can be considered at rates above 30 ml/hr. Of course, critically ill Covid-disease patients are likely to be receiving multiple infusions through one IV access line, and if the disease causes

Systemic Inflammatory Response Syndrome or there is a secondary systemic sepsis, there may be an emergent need for rapid delivery of IV fluids. In this situation a dynamic occlusion alarm is of real value, as it will reduce the number of nuisance occlusion alarms and assist with infusion continuity. Pumps with auto-pressure features which, on activation, set a margin of 30 mmHg above the patient-line pressure also allow for a rapid user response to occlusions alarms.

Independent studies on the cleaning of long-lines and their materials suggest that wiping a PVC extension set 2-3 times daily with 70% isopropyl alcohol solution has minimal impact on the line’s function and performance (i.e. there will be no weakening leading to excess kinking or excessive compliance on the line). The risk of isopropyl alcohol entering the fluid pathway is negligible. It is therefore expected that the PVC IV extension sets would still deliver their critical function with minimal risk to clinician or patient.

With repeated disinfection of PVC extension sets clinicians may note visual defects on the line’s surface and that it feels ‘tacky’. This has no impact on the line’s performance and is limited to the exterior of the line. (^) Administration of intermittent infusions with long lines requires that we know the priming volume for the entire length of the tubing when programming infusion rates and flush volumes. Nurses should consider priming the set with the medication rather than with normal saline or dextrose, to facilitate prompt delivery. Post-medication flushes should be given at the same rate as the medication. This is best achieved with well-constructed DERS libraries with pre-set durations of delivery for each medication and smart pumps with a ‘restore’ function

**Bastanie et Al. Alarm Visibility and Infusion Continuity: Environmental Change and Technology Assistance. 2nd Congress of Joint European Neonatal Societies. 7th International Congress of UENPS. Journal of Pediatric and Neonatal Individualized Medicine 2017;6(2) Oct 2017. http://www.jpnim.com/ index.php/jpnim/article/ download/060248/485

^ BD, 2020. https://www. bd.com/a/77514

##ISMP, 2020. https:// ismp.org/resources/ clinical-experiences-keeping-infusion-pumps-outside-room-covid-19-patients

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for ensuring accurate rate/volume delivery of the flush.

A large capacity DERS library with multiple profiles can allow for a specific library for critically ill Covid-disease patients, giving rapid and easy access to specific medications used to care for these patients along with specialist concentrations and higher dilution medications to be used with long-lines. The Covid-disease pandemic has also caused supply shortages in key medications, such as Fentanyl, the ability to rapidly update alternate medications in the DERS library, such as substituting Propofol 2% for 1%, and to deploy the new library remotely via wireless allows facilities to respond and adjust rapidly to supply challenges, and to emergent changes in treatment protocols such as the new protocol for Dexamethasone use in Covid-disease.

IV medication administration commonly requires a two-nurse check. With highly infectious isolation patients this can potentially expose two nurses to the risk of infection during patient identification. In highly developed IV infusion medication safety systems the second nurse can be replaced by barcode medication administration (BCMA) during which the smart pump, via a bidirectional wireless communication with the patient’s electronic mediation administration record (EMAR), undertakes the bedside checks of right patient, right medication, and right timing, and automatically documents administration in the patient’s EMAR. Appropriate cleaning and decontamination of pumps between patients, and on a regular basis, is a both vital component of pandemic plan-

ning, as well as being central to any ‘standard’ infection control plan. Selection of infusion pumps is a factor here. There should be no difficult to access areas that can harbour contaminant and that cannot be exposed to disinfectant material.

This includes plunger grips on syringe pumps and line or cartridge loading spaces on large volume pumps. Furthermore, the pump’s body must be not be degraded by cleaning products that can fight the SARS-CoV-2 virus.

New polymers released in the last few years for pump manufacture have considerably broadened the cleaning products that can be used without fear of damage to the device. If there is any doubt over the use of a cleaning product, the manufacturer’s local agent should be contacted. We have found that a review of the Material Safety Data Sheet of combination cleaning products has allowed us to reassure customers over the continued use of their chosen cleaning product.

The care of patients in isolation stretches a facility’s physical resources but demands on resources do not stop at devices and equipment, there is also a high demand for Critical Care clinicians as ‘pop-up’ pandemic critical units are opened. Facilities have had to quickly crosstrain existing staff and recruit new staff to ease the burden. Clinical facilitators are tasked with upskilling nurses who usually work non-critical care areas to care for critically ill patients. The training and education of staff is essential to maintaining patient safety. Facilities benefit from partnerships with device vendors, providing educational resources and clinical trainings to ensure best practices. Infusion therapy during a pandemic is multi-faceted and challenging, but patient safety does not have to be compromised even under the strictest of isolation procedures.

Engaging with your infusion device vendor to seek expert advice, the application of technology, and creative strategies that build on, or adapt, existing safeguarding processes and strategies are the keys to keeping both critically ill patients, and the staff caring for them, safe.

https://www.researchgate.net/publication/263746156_National_Burden_of_Preventable_Adverse_ Drug_Events_Associated_with_Inpatient_Injectable_Medications_Healthcare_and_Medical_Professional_Liability_Costs

#Waterson. J. Making Smart Pumps Smarter, Making IV Therapy Safer.

British Journal of Nursing.

July 2013. Vol 22. Sup13. https://www.magonlinelibrary.com/ doi/abs/10.12968/ bjon.2013.22.Sup13.22

References. *Lahue et Al. National Burden Of Preventable Adverse Drug Events Associated with Inpatient Injectable Medications Healthcare and Medical Professional Liability Costs. American Health Drug Benefits 2012: (5)7. 1-10.

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ARTICLE FEATURES . Childhood Cancer

Childhood Cancer How do we deal with the child psychologically and therapeutically? What is the cure rate?

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he cure rate of cancer has increased especially among children and adolescents thanks to the outstanding medical developments regarding diagnosis and treatment. The future seems promising as scientific research continues in full swing.

In contrast, there is no clear scientific answer that justifies why a child has cancer. Children, as well as adults, get this malignant disease.

Parents, doctors, and the staff find it difficult to deal with this age group and to tell the child the truth about his condition, the treatments he will undergo, and the complications he may experience during his journey with the disease.

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RARE GENETIC DISORDERS OR THE EXPOSURE OF THE CHILD OR MOTHER TO IONIZING RADIATION DURING PREGNANCY ARE AMONG THE CAUSES OF CHILDHOOD CANCER.

Hence, special hospitals or departments within hospitals have been established solely for children with cancer and they were equipped in conformity with the requirements of this age group, in addition to providing a team of medical care providers who are able to deal with children with cancer.

Although cancer affects adults and children equally, it differs somewhat in childhood as the cure rate increases if the child gets the necessary medical care. Unlike adults, there is no strong relationship of childhood cancer to environmental factors, smoking, and pollution. It’s usually the result of DNA changes in cells that take place during fetal stages. Rare genetic disorders or the

ARTICLE FEATURES . Childhood Cancer

exposure of the child or mother to ionizing radiation during pregnancy are among the causes of childhood cancer.

How does it happen?

Childhood cancer arises from cells that are partly fetal and therefore are more vulnerable, while adult cancer arises from different and very mature tissues and therefore has more mechanisms to resist drugs and medicines.

Cancer in children and adolescents is related to growth and development, meaning more cell division. When the cells divide, some errors that cause cancer can occur, especially within the cells where the tissues develop rapidly.

It should be noted that the immune system is the rapidly developing system in the body and is highly active during childhood and adolescence. On the other hand, the immune system consists mostly of lymph nodes. About half of all cases of childhood cancer are lymphoma or leukemia, in addition to bone cancer in adolescents because bones grow very quickly during puberty.

It may be difficult to identify or discover childhood cancers early because common illnesses and bruises can mask the early symptoms.

That’s where parents should look out for unusual symptoms and go immediately to the doctor for examination. Periodic follow-ups with a pediatric specialist should not be neglected.

The most common symptoms of concern especially if they persist for a long time are: •

Mass or swelling in certain areas of the body.

• Persistent and unexplained fever • Frequently getting sick for no obvious reason.

• Unexplained paleness and loss of energy.

• Lasting pain in a specific part of the body.

• Tendency to bruise easily.

• Unexplained weight loss.

• Sudden vision changes.

• Frequent headache, often with vomiting.

The most common types of cancer diagnosed in children from the age of one day to 19 years are leukemia, brain cancer, lymphoma, and solid tumors such as neuroblastoma and nephroblastoma (Wilms Tumor). Early and accurate

ABOUT HALF OF ALL CASES OF CHILDHOOD CANCER ARE LYMPHOMA OR LEUKEMIA, IN ADDITION TO BONE CANCER IN ADOLESCENTS BECAUSE BONES GROW VERY QUICKLY DURING PUBERTY.

diagnosis and the necessary treatment have contributed to the survival of many children.

Dealing with the child The problem that parents face is how to deal with the child and alleviate his pain and suffering. This requires intervention by the medical team in cooperation with the patient’s relatives because cancer affects not only the child’s body but also his state of mind.

The first advice that parents should follow is not to show their grief in front of the child but to be happy and not anxious at all. They should also motivate the child to do activities he likes and not isolate him as much as possible, especially that hospitals designated for children carry out many recreational activities and involve all children as this would have a positive impact on the child’s state of mind and consequently on the success of the medical treatment.

Those hospitals also provide patients with psychological support and assistance and give parents advice on how to deal with the child and how to answer his questions. Also, the presence of people around the patient is of great importance during the treatment journey so that the child does not feel lonely and starts having dark thoughts. It is useful to communicate with moral support groups at this critical time.

All family members, not just the mother and father, should stand together to provide psychological support and assistance to the child so that he does not feel that his disease is affecting his lifestyle or theirs. The family of a child with cancer must stay strong, faithful, and patient

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in order to continue the journey of fighting the disease. The real suffering is when the child's hair falls out after undergoing chemotherapy.

That’s where the medical team and the parents must inform the child before reaching this stage in order not to be shocked. They must also convince him that it is a temporary stage and it is one of the complications of the treatment that will soon disappear when the disease goes away.

The main reasons why cancer is terrifying are the physical changes that occur during treatment such as hair loss, weight loss, possible scars, and change in a part of the body after surgery. The possibilities are many depending on the type of cancer and its stage. Family members should reduce the child's fear and

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THE MOST COMMON CANCERS IN CHILDREN ARE LEUKEMIA AND BRAIN CANCER.

ensure that he is living in a family atmosphere while staying in the hospital. Psychologically and morally supporting the patient to overcome his ordeal and accept his new situation is an essential part of the success of the treatment.

It is also necessary for the child to know what advanced treatments available today make it possible to recover and return to normal life and that he only has to bear the treatment period.

The most important thing is not to deal with the child with compassion or show sadness and concern. Optimism and playing and laughing with the child contribute greatly to improving his state of mind and accepting his new condition.

Any opportunity to bring joy and pleasure to the child's life should be seized.

ARTICLE FEATURES . Childhood Cancer

Leukemia

the most common type of cancer among children Leukemia is the most common type of cancer among children under fifteen years of age. It is a type of cancer that affects the bone marrow and spreads through the blood to other parts of the body. Early detection contributes greatly to increasing the rates of recovery. Some types of childhood leukemia show some signs and symptoms, but not in all cases.

Leukemia begins in the bone marrow through the formation of cancerous white blood cells (WBCs). Although most leukemia cases affect WBCs, there are some other types that occur as a result of the change of other types of blood cells into cancerous ones. The growth of leukemia cells randomly and the fact that they don’t die naturally like the rest of the normal cells make them accumulate in the bone marrow and crowd out the normal blood cells.

Symptoms of leukemia are caused by problems in the bone marrow. Leukemia causes an imbalance in the formation of WBCs and a shortage of platelets, causing many symptoms and signs which the family may overlook. The most common signs and symptoms include:

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CHILDREN HOSPITALS FOR CANCER PROVIDE PATIENTS WITH PSYCHOLOGICAL SUPPORT AND ASSISTANCE AND GIVE PARENTS ADVICE ON HOW TO DEAL WITH THE CHILD AND HOW TO ANSWER HIS QUESTIONS.

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Bruises which parents do not notice because children spend a lot of time playing and are subject to falling and having them. However, having bruises easily and perhaps without falling is cause for concern because it is a sign of leukemia.

Anemia that develops when the body does not have enough red blood cells, causing weakness, fatigue, dizziness, and loss of appetite. It is one of the serious indicators of leukemia.

Recurrent nosebleeds for no obvious reason, such as sunstroke or nasal injury, are a symptom that calls for concern because it is an indicator of leukemia.

The capillaries in the nose are weaker and tend to burst easily in children with leukemia.

Long-term loss of appetite is evidence that the destroyed cells have accumulated in the stomach and spleen which limits the bowel secretion of digestive juices, leaving the child not feeling hungry.

Frequent infections and diseases because cancer weakens the immunity and slowly destroys WBCs that are very important to detect diseases and factors that cause infections.

Swelling in parts of the child's body such as the armpits, joints, neck, and collarbone. This is considered an indicator of leukemia because cancerous cells affect the lymph nodes in these areas of the body causing swelling.

Acute stomach pain without having indigestion or digestive problems. This is evidence of leukemia that affects stomach tissues.

Breathing problems because cancerous cells affect the lung cells and destroy them, causing respiratory problems such as difficulty breathing and wheezing in children.

Joint pain due to the accumulation of cancerous cells in the blood around the joints causing inflammation and continuous pain in the knees, elbows, back, etc.

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ARTICLE FEATURES . Childhood Cancer

Childhood lymphoma It is characterized by an abnormal growth of cells that begins in the lymphoid tissues. The lymphatic system is part of the body's immune system in children and adults. There are two types of lymphoma: Hodgkin’s and non-Hodgkin’s.

Cancerous cells may be found in the bone marrow, lymph nodes, spleen, tonsils, thymus, or any other lymphoid tissues, in addition to the lymph vessels that connect them. After a biopsy, the tissue sample is examined in a lab to determine the type of cancer.

Hodgkin's lymphoma is most common in early and late adulthood. The most common symptom is painless enlargement of the lymph

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WHEN HODGKIN'S LYMPHOMA STARTS IN THE LYMPH NODES IN THE CENTER OF THE CHEST, IT CAN PRESS ON THE TRACHEA.

nodes (a condition known as swollen glands) in the neck, above the collarbone, in the underarm area, or in the groin. When Hodgkin's lymphoma starts in the lymph nodes in the center of the chest, it can press on the trachea. This causes coughing, shortness of breath, or problems with blood flowing to and from the heart.

Some children have other symptoms including weakness, poor appetite, itching, unexplained fever, night sweats, and weight loss.

Non-Hodgkin's lymphoma (NHL) is more likely to occur in children under the age of 15 than Hodgkin’s lymphoma, but it is still rare in children younger than 3 years old.

When diagnosing this type of cancer, doctors

ARTICLE FEATURES . Childhood Cancer

discover a malignant growth of specific types of lymphocytes. After classifying the disease according to its location and how advanced it is, the treatment is determined.

Chemotherapy is the primary treatment for all types of lymphoma. In some cases, radiation can also be used by directing high-energy rays at the person to kill cancerous cells and prevent them from growing and multiplying.

Brain tumors in children Brain tumors in children typically are primary tumors – tumors that start in the brain when normal cells have errors (mutations) in their DNA. These mutations allow cells to grow and divide at increased rates and to continue living when healthy cells would die. This results in a mass of abnormal cells, which forms a tumor.

Certain types of brain tumors, such as medulloblastoma or ependymoma, are more common in children. The cause of the tumor is unknown, but a family history of brain tumors or a family history of genetic syndromes may increase the risk of brain tumors in some children, though uncommon. The most prominent types of brain tumors in children are: • Embryonal tumors • Medulloblastoma • Ependymoma • Glioma • Pineoblastoma • Craniopharyngioma • Choroid plexus carcinoma Signs and symptoms of a brain tumor in chil-

PRIVATE HOSPITALS OR DEPARTMENTS WITHIN HOSPITALS ARE EQUIPPED IN CONFORMITY WITH THE REQUIREMENTS OF THIS AGE GROUP, IN ADDITION TO PROVIDING A TEAM OF MEDICAL CARE PROVIDERS WHO ARE ABLE TO DEAL WITH CHILDREN WHO HAVE CANCER.

dren vary greatly and depend on the brain tumor type and the age of the child. Some of them may not be easy to detect because they're similar to symptoms of other conditions. Therefore, the necessary tests must be done and modern methods must be adopted to detect the type and risk ratio of brain cancer.

In general, symptoms of a brain tumor in children include: • • • • • • • • •

Severe headache Double vision Feeling of increased pressure in the head Swollen lymph nodes Swelling of any part of the body without cause Difficulty concentrating Trouble walking Inability to write Frequent vomiting and fever for no reason

Treatment depends on a number of factors including the type, size, and location of the brain tumor and whether it is widespread or not, as well as the child's age and general health.

Treatment methods are constantly evolving which means that there may be many treatment options at each stage. Treatment for brain tumors in children is different from treatment for adult brain tumors, so it is important to follow up with a pediatric specialist in cancer and neurology.

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ARTICLE FEATURES . Stroke

Stroke Reducing mortality, disability and other complications

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lthough medical developments have not reached the stage where stroke is prevented, however, what we are witnessing today is the development of prevention and treatment programs that have led to a reduction in mortality, disability and complications resulting from stroke. We are also witnessing the promotion of health awareness, understanding the potential risks if stroke occurs and how to prevent it.

These developments helped in the implementation of the best programs and treatment protocols as well as the development of clinical

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ADEQUATE AWARENESS OF THE PATIENT OR THOSE AROUND HIM MAKES EARLY MEDICAL INTERVENTION MORE EFFECTIVE.

practices, in addition to rehabilitation, physical therapy and occupational therapy programs that have played a positive role in improving the patient's movement, speed of recovery, and movement restoration.

The problem is that stroke occurs suddenly without any prior warning, as it is possible that the patient is completely healthy and does not feel any sign or symptom and yet he suffers from stroke; this increases the difficulty of rapid intervention, and damage is irreversible. Adequate awareness of the patient or those around him makes early medical intervention more effective.

A stroke is a medical emergency that happen

ARTICLE FEATURES . Stroke

STROKE REHABILITATION PROGRAMS ARE DESIGNED TO MEET ALL INDIVIDUAL NEEDS, INCLUDING BASIC TREATMENT, PREVENTION OF COMPLICATIONS, TREATMENT OF DISABILITY AND IMPROVEMENT OF PATIENT FUNCTIONS.

often affects just one side of your body. Try to raise both your arms over your head at the same time. If one arm begins to fall, you may be having a stroke. Also, one side of your mouth may droop when you try to smile.

Problems seeing in one or both eyes: You may suddenly have blurred or blackened vision in one or both eyes, or you may see double.

Headache: A sudden, severe headache, which may be accompanied by vomiting, dizziness or altered consciousness, may indicate that you're having a stroke.

Trouble walking: You may stumble or lose your balance. You may also have sudden dizziness or a loss of coordination. Seek immediate medical attention if you notice any signs or symptoms of a stroke, even if they seem to come and go or they disappear completely.

THINK “FAST� AND DO THE FOLLOWING: Face: Ask the person to smile. Does one side of the face droop?

Arms: Ask the person to raise both arms.

Does one arm drift downward? Or is one arm unable to rise?

Speech: Ask the person to repeat a simple phrase. Is his or her speech slurred or strange?

Time: If you observe any of these signs, seek emergency medical help immediately.

when blood flow to the brain stops. Within minutes, brain cells begin to die. There are two kinds of stroke.

Symptoms If you or someone you're with may be having a stroke, pay particular attention to the time the symptoms began. Some treatment options are most effective when given soon after a stroke begins. Signs and symptoms of stroke include: Trouble speaking and understanding what others are saying: You may experience confusion, slur your words or have difficulty understanding speech.

Paralysis or numbness of the face, arm or leg: You may develop sudden numbness, weakness or paralysis in your face, arm or leg. This

The more common kind, called ischemic stroke, is caused by a blood clot that blocks or plugs a blood vessel in the brain.

The other kind, called hemorrhagic stroke, is caused by a blood vessel that breaks and bleeds into the brain.

If a stroke occurs, prompt treatment is crucial. Early action can reduce brain damage and other complications.

Atrial Fibrillation and Stroke Atrial fibrillation, a common heart rhythm disorder, can increase your risk of stroke. 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

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can also block blood flow to other organs.

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

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.

Types of stroke and how to treat them There are two main causes of stroke: a blocked artery (ischemic stroke) or leaking or bursting of a blood vessel (hemorrhagic stroke).

Some people may have only a temporary disruption of blood flow to the brain, known as a transient ischemic attack (TIA), that doesn't cause lasting symptoms.

Ischemic stroke is the most common type of stroke. It happens when the brain's blood vessels become narrowed or blocked, causing severely reduced blood flow (ischemia). Blocked or narrowed blood vessels are caused by fatty deposits that build up in blood vessels or by blood clots or other debris that travel through your bloodstream and lodge in the blood vessels in your brain.

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To treat an ischemic stroke, doctors must quickly restore blood flow to your brain. This may be done with emergency IV medication. Therapy with drugs that can break up a clot has to be given within 4.5 hours from when symptoms first started if given intravenously. The sooner these drugs are given, the better. Quick treatment not only improves your chances of survival but also may reduce complications.

Doctors sometimes treat ischemic strokes directly inside the blocked blood vessel. Endovascular therapy has been shown to significantly improve outcomes and reduce long-term disability after ischemic stroke. Doctors insert a long, thin tube (catheter) through an artery in your groin and thread it to your brain to deliver tPA directly where the stroke is happening. The time window for this treatment is somewhat longer than for injected tPA, but is still limited.

Hemorrhagic stroke occurs when a blood vessel in your brain leaks or ruptures. Brain hemorrhages can result from many conditions that affect your blood vessels. Emergency treatment of hemorrhagic stroke focuses on controlling the bleeding and reducing pressure in your brain caused by the excess fluid. If you take blood-thinning medications to prevent blood clots, you may be given drugs or transfusions of blood products to counteract the blood thinners' effects. You may also be given drugs to lower the pressure in your brain (intracranial pressure),

THE GOAL OF STROKE REHABILITATION IS TO HELP YOU RELEARN SKILLS YOU LOST WHEN A STROKE AFFECTED PART OF YOUR BRAIN. STROKE REHABILITATION CAN HELP YOU REGAIN INDEPENDENCE AND IMPROVE YOUR QUALITY OF LIFE.

ARTICLE FEATURES . Stroke

lower your blood pressure, prevent spasms of your blood vessels and prevent seizures.

If the area of bleeding is large, your doctor may perform surgery to remove the blood and relieve pressure on your brain. Surgery may also be used to repair blood vessel problems associated with hemorrhagic strokes.

Rehabilitation and Physical Therapy The goal of stroke rehabilitation is to help you relearn skills you lost when a stroke affected part of your brain. Stroke rehabilitation can help you regain independence and improve your quality of life. The severity of stroke complications and each person's ability to recover vary widely. Researchers have found that people who participate in a focused stroke rehabilitation program perform better than most people who don't have stroke rehabilitation.

There are many approaches to stroke rehabilitation. Your rehabilitation plan will depend on the part of the body or type of ability affected by your stroke.

PHYSICAL ACTIVITIES MIGHT INCLUDE: Motor-skill exercises: These exercises can help improve your muscle strength and coordination. You might have therapy to strengthen your swallowing.

Mobility training: You might learn to use mobility aids, such as a walker, canes, wheelchair or ankle brace. The ankle brace can stabilize and strengthen your ankle to help support your body's weight while you relearn to walk.

Constraint-induced therapy: An unaffected limb is restrained while you practice moving the affected limb to help improve its function. This therapy is sometimes called forced-use therapy.

Range-of-motion therapy: Certain exercises and treatments can ease muscle tension (spasticity) and help you regain range of motion.

ISCHEMIC STROKE IS THE MOST COMMON TYPE OF STROKE. IT HAPPENS WHEN THE BRAIN'S BLOOD VESSELS BECOME NARROWED OR BLOCKED, CAUSING SEVERELY REDUCED BLOOD FLOW (ISCHEMIA).

Speech Therapy A stroke is one of the most catastrophic experiences an individual can undergo. Strokes often cause temporary or permanent paralysis on one side of the body. Balance, memory, speech,

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ARTICLE FEATURES . Stroke

cognition, and vision may also be affected. In addition, muscle spasms and pain are common complications of a stroke. Because of these issues, stroke survivors may have difficulty managing basic tasks such as bathing and dressing.

Consequently, it may be challenging for them to continue to manage their roles as spouses, parents, or employees.

One of the most serious complications of stroke is difficulty communicating, with many stroke patients experiencing a decrease in speaking ability. While it does not affect intelligence, aphasia can make it challenging for the patient to speak and understand others, while also impeding their abilities to read and write.

Speech and language pathologists help improve your language skills and ability to swallow.

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Speech and language pathologists can also work with you to develop tools to address memory, thinking and communication problems.

Treatment of swallowing Your stroke may cause a swallowing disorder called dysphagia. Aspiration is a common problem for people with dysphagia. It occurs when something you’ve swallowed enters the airway and lungs. Normally, aspiration causes a violent cough, but a stroke can reduce sensation.

In this case, you may not know you’re aspirating (silent aspiration). While in the hospital after a stroke, you are screened to determine your ability to swallow safely. If you have a problem with swallowing safely, you may not be allowed to eat until a speech-language pathologist evaluates

ONE OF THE MOST SERIOUS COMPLICATIONS OF STROKE IS DIFFICULTY COMMUNICATING, WITH MANY STROKE PATIENTS EXPERIENCING A DECREASE IN SPEAKING ABILITY.

ARTICLE FEATURES . Stroke

how well muscles in your mouth move, you can swallow and your voice box works.

The speech-language pathologist may recommend you change what you eat and drink.

That’s because some foods are hard to chew and thin liquids are often hard to swallow. The speech-language pathologist will determine when it’s safe to eat more normal foods.

Adequate nutrition is essential. So if it’s not safe for you to swallow, a feeding tube may be suggested to help meet your nutritional needs.

Improving patient skills The focus of occupational therapy is to help individuals achieve health, well-being, and participation in life through engagement in occupations (i.e., activities). Occupational therapy practitioners collaborate with clients and their families or caregivers to determine what activities are necessary, meaningful, and/or relevant to them.

Occupational therapy practitioners under-

stand the importance of emotional well-being, social connections, and healthy life habits for individuals post-stroke. In addition to ongoing physical rehabilitation as needed, they engage stroke survivors and family members to take charge of their lives, create human connections, and lead healthy lifestyles. This may include developing coping strategies to deal with loss, individualized ways to promote psychosocial health, education to minimize potential for a second stroke, promotion of increased exercise and healthy eating, and strategies to overcome barriers to sexual intimacy.

Stroke can cause serious long-term disability, and many stroke survivors face barriers to engaging in productive activity. Occupational therapy practitioners use their expertise in activity analysis and adaptive methods to facilitate the client’s performance of needed or meaningful occupations within realistic contexts to promote independence.

THE SPEECHLANGUAGE PATHOLOGIST MAY RECOMMEND YOU CHANGE WHAT YOU EAT AND DRINK. THAT’S BECAUSE SOME FOODS ARE HARD TO CHEW AND THIN LIQUIDS ARE OFTEN HARD TO SWALLOW. THE SPEECH-LANGUAGE PATHOLOGIST WILL DETERMINE WHEN IT’S SAFE TO EAT MORE NORMAL FOODS.

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ARTICLE FEATURES . Summer Skin Allergies

Summer Skin Allergies How to protect ourselves?

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pring and summer are times when there are many substances that can cause allergic skin reactions in the environment — moulds, pollens, plant and animal substances.

For instance, hives can be triggered by heat or sweat, eczema can worsen in the summer, especially with excess sweating while certain plants and grasses can cause skin rashes. Together, these factors can cause allergic skin conditions, as the summer is also a suitable environment for these types of diseases. What are the most common types of skin allergies that we can suffer from during the summer? How can we prevent them?

Sun allergy Sun allergy is a term often used to describe a number of conditions in which an itchy red rash occurs on skin that has been exposed to sunlight. The most common form of sun allergy is polymorphic light eruption, also known as sun poisoning. Some people have a hereditary type of sun allergy. Some people have a hereditary type of sun allergy. Others develop signs and

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MILD CASES OF SUN ALLERGY MAY CLEAR UP WITHOUT TREATMENT. MORE SEVERE CASES MAY BE TREATED WITH STEROID CREAMS OR PILLS.

ARTICLE FEATURES . Summer Skin Allergies

symptoms only when triggered by another factor — such as a medication or skin exposure to plants such as wild parsnip or limes.

Mild cases of sun allergy may clear up without treatment. More severe cases may be treated with steroid creams or pills. People who have a severe sun allergy may need to take preventive measures and wear sun-protective clothing.

Symptoms: The appearance of skin affected by sun allergy can vary widely, depending on what's causing the problem. Signs and symptoms may include: • Redness • Itching or pain • Tiny bumps that may merge into raised patches • Scaling, crusting or bleeding • Blisters or hives Signs and symptoms usually occur only on skin that has been exposed to the sun and typically develop within minutes to hours after sun exposure.

Heat rash Heat rash develops when blocked pores (sweat ducts) trap perspiration under your skin.

Symptoms range from superficial blisters to deep, red lumps. Some forms of heat rash feel prickly or intensely itchy.

Heat rash usually clears on its own. Severe

forms of the condition may need medical care, but the best way to relieve symptoms is to cool your skin and prevent sweating. Adults usually develop heat rash in skin folds and where clothing causes friction. In infants, the rash is mainly found on the neck, shoulders and chest.

It can also show up in the armpits, elbow creases and groin. To help protect yourself from heat rash, avoid overdressing and wearing tightfitting clothes that can irritate the skin. When it's hot, stay in the shade or in an air-conditioned building or use a fan to circulate the air and keep your sleeping area cool and well-ventilated.

Insect sting allergy The severity of an insect sting reaction varies from person to person. There are three types of reactions - normal, localized, and allergic.

A normal reaction will result in pain, swelling, and redness around the sting site. A large local reaction will result in redness and swelling that extends beyond the sting site. The swelling may extend about 4 inches from the sting site over a period of a couple of days. It should get better within five to 10 days. While the most serious reaction to an insect sting is a systemic allergic reaction known as anaphylaxis. This condition requires immediate medical attention.

First aid is necessary to treat the condition quickly. Use a cloth dampened with cold water or filled with ice. This helps reduce pain and

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swelling. If the injury is on an arm or leg, elevate it. Apply 0.5 or 1 percent hydrocortisone cream, calamine lotion or a baking soda paste to the bite or sting several times daily until your symptoms go away.

Chronic skin conditions Fungi, eczema and other chronic skin problems and conditions increase during the summer and patients should take the necessary precautions to avoid the condition from worsening.

Hot temperatures can also aggravate eczema. The heat can stimulate that itchy, prickly feeling those with eczema know all too well. It can also cause sweating, which may lure bacteria and unwanted chemicals to the skin. Patients can

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take antihistamines, which are a type of medicine that block the effects of a substance in the blood called histamine. They can help relieve the itching associated with atopic eczema.

Sunburns Sunburn is damage to the skin caused by exposure to UV radiation. Too much UV radiation causes the skin to become hot, red and painful.

Most people who have been sunburnt also peel, which is the body’s way of shedding dead and damaged skin cells and making way for the new skin underneath. You are most at risk of sunburn if you have fair skin. But all people can get sunburn, including people with dark skin.

In advanced cases, sunburn may become a

HEAT RASH DEVELOPS WHEN BLOCKED PORES (SWEAT DUCTS) TRAP PERSPIRATION UNDER YOUR SKIN.

ARTICLE FEATURES . Summer Skin Allergies

chronic condition especially for those with sensitive skin. But the most important thing is not to be exposed to the sun for long hours, especially during peak times and to use protective creams.

Freckles and skin pigmentation It occurs due to direct exposure to UV radiation to get a bronzed skin that leads to skin pigmentation; freckles are small brown spots on the skin that usually appear on areas exposed to the sun such as the face, shoulders and chest.

Common freckles themselves are quite harmless and rarely develop into skin cancer. These are particularly common in people with red hair and a fair complexion. Hereditary freckles cannot be prevented because they are genetically determined.

Sunscreen won't get rid of existing freckles, but it helps prevent new ones. You should wear sunscreen year-round, even when it's cloudy.

Intertrigo It is a rash that usually affects the folds of the skin, where the skin rubs together or where it is often moist. This rubbing can cause a breakdown in the top layers of the skin, causing inflammation and a rash. The breakdown of skin makes it easier for bacteria or fungus to develop

in this area. The most common areas affected include larger skin-fold areas such as armpits, beneath the breasts, genital area and abdomen.

Prevention and treatment of intertrigo should maximize the intrinsic moisture barrier function of the skin by focusing on minimizing skin-on-skin contact and friction, removing irritants from the skin and protecting the skin from additional exposure to irritants.

Sweat rash The mildest form of heat rash (miliaria crystallina) affects the sweat ducts in the top layer of skin. This form is marked by clear, fluid-filled blisters and bumps (papules) that break easily.

A type that occurs deeper in the skin (miliaria rubra) is sometimes called prickly heat.

It appears in various parts of the body such as the neck, chest, back and arms, and its symptoms include a burning sensation, severe itching and pain in the affected parts, and it may lead to blood coming out as a result of severe itching.

Avoid high temperatures, especially indoors, in addition to wearing loose, light cotton clothes, while avoiding direct sun exposure, and having frequent showers in cold water are the most important prevention tips.

FUNGI, ECZEMA AND OTHER CHRONIC SKIN PROBLEMS AND CONDITIONS INCREASE DURING THE SUMMER AND PATIENTS SHOULD TAKE THE NECESSARY PRECAUTIONS TO AVOID THE CONDITION FROM WORSENING.

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ARTICLE FEATURES . y

Symptoms, treatment and foot care

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f you have diabetes, having too much glucose in your blood for a long time can cause some serious complications, including foot problems. Diabetes can cause diabetic neuropathy; uncontrolled diabetes can damage your nerves.

If you have damaged nerves in your legs and feet, you might not feel heat, cold, or pain there.

This lack of feeling is called “sensory diabetic neuropathy�.

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DIABETES CAN DECREASE THE BODY'S ABILITY TO FIGHT INFECTION.

If you do not feel a cut or sore on your foot because of neuropathy, the cut could get worse and become infected. The muscles of your foot may not work properly because nerves to the muscles are damaged. This could cause your foot to not align properly and create too much pressure on one part of your foot. In addition, diabetes can also cause peripheral vascular disease. Diabetes also affects the flow of blood.

Without good blood flow, it takes longer for a sore or cut to heal.

Poor blood flow in the arms and legs is called "peripheral vascular disease." If you have an infection that will not heal because of poor blood flow, you are at risk for developing ulcers or gangrene (the death of tissue due to a lack of blood).

Diabetes mellitus represents several diseases in which high blood glucose levels over time can damage the nerves, kidneys, eyes, and blood vessels. Diabetes can also decrease the body's ability to fight infection. When diabetes is not well controlled, damage to the organs and impairment of the immune system is likely. Foot problems commonly develop in people with diabetes and can quickly become serious.

People with diabetes must be fully aware of how to prevent foot problems before they occur, to recognize problems early, and to seek the right treatment when problems do occur.

Although treatment for diabetic foot problems has improved, prevention - including good control of blood sugar level - remains the best way to prevent diabetic complications. People with diabetes should learn how to examine their own feet and how to recognize the early signs and symptoms of diabetic foot problems. They should also learn what is reasonable to manage routine at home foot care, how to recognize when to call the doctor, and how to recognize when a problem has become serious enough to seek emergency treatment.

Angioplasty Angioplasty is used to restore blood supply to the extremities when arterial occlusion occurs, as in diabetic foot. This condition is caused by long-term high blood sugar levels, which leads over time to foot damage through two mecha-

ARTICLE FEATURES . Diabetic Foot

nisms. The first is the result of diabetic neuropathy that leads to numbness, loss of sensation, and sometimes pain in your feet, legs, or hands.

It is the most common complication of diabetes.

The second is early arteriosclerosis and blocked blood vessels that lead to what is known as gangrene, and angioplasty helps the blood carry oxygen, proteins and white blood cells which is necessary for wound healing.

Symptoms Foot symptoms of diabetes vary from person to person and may depend on the specific issues a person is experiencing at the time. However, symptoms might include:

Slower wound healing Your blood sugar level is the main factor in how quickly your wound will heal. When your blood sugar level is higher than normal, it prevents nutrients and oxygen from energizing cells, prevents your immune system from functioning efficiently and increases inflammation in the body’s cells. These effects slow down wound healing.

Foot pain The nerve damage that affects patients with diabetes over time leads to foot pain, the skin becomes very sensitive and wearing shoes or socks becomes intolerable. One of the causes of pain is that the blood flow in the foot is not normal, as small vessels become blocked and oxygen barely reaches the tissues in the foot.

Cold feet Frequent high blood sugar levels can lead to

narrowing of the arteries and a reduced blood supply to the tissues, which may cause cold feet.

In some people, diabetes can lead to diabetic peripheral neuropathy, a form of nerve damage.

DIABETES MELLITUS REPRESENTS SEVERAL DISEASES IN WHICH HIGH Foot swelling and redness BLOOD GLUCOSE The diabetic patient’s feet can become red LEVELS OVER TIME and swollen, and they may feel numb, possibly CAN DAMAGE THE due to an infection or inflammation.

NERVES, KIDNEYS, EYES, AND BLOOD Lost feeling in feet VESSELS. Over time, diabetes may cause nerve dam-

age, also called diabetic neuropathy, that can cause tingling and pain, and can make you lose feeling in your feet. When you lose feeling in your feet, you may not feel a pebble inside your sock or a blister on your foot, which can lead to cuts and sores.

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ARTICLE FEATURES . Diabetic Foot

Diagnosis and treatment The first step is that if you have a foot ulcer, your doctor asks when you first noticed it. He also wants to know if you have any other medical conditions, such as peripheral neuropathy or lower extremity arterial disease, which increase the risk of foot ulcers. Your doctor inspects the foot, toes, and toenails for blisters, cuts, scratches, or ingrown toenails that may lead to additional ulcers. He or she also evaluates the rate of blood flow in the foot by feeling the pulse.

Your doctor may recommend X-ray imaging to assess changes in the alignment of the bones in the foot, which can contribute to an ulcer.

X-rays can also reveal a loss of bone mass, which may occur as a result of hormonal imbalances related to diabetes.

MRI scans use a magnetic field and radio waves to create computerized, three-dimen-

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sional images of soft tissues inside the body.

Your doctor may recommend this test if he or she needs more information about the extent of damage caused by an ulcer. MRI images can also reveal inflammation, which may be a sign of infection.

If there are signs of infection, such as redness, swelling, and warmth in the affected foot, your doctor may recommend a blood test to screen for it.

There are several key factors in the appropriate treatment of a diabetic foot ulcer: 1. Prevention of infection.

2. Taking the pressure off the area, called “off-loading”.

3. Removing dead skin and tissue, called “debridement”.

YOUR DOCTOR MAY RECOMMEND X-RAY IMAGING TO ASSESS CHANGES IN THE ALIGNMENT OF THE BONES IN THE FOOT, WHICH CAN CONTRIBUTE TO AN ULCER.

ARTICLE FEATURES . Diabetic Foot

4. Applying medication or dressings to the ulcer.

5. Managing blood glucose and other health problems.

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Tips and Advice Protecting the feet starts with controlling blood sugar levels the whole time as well as visiting the physician regularly whose role is to educate the patient on how to protect his feet in order to avoid getting diabetic foot and thus avoid bacterial inflammation.

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Tips and guidelines that must be followed by diabetic patients:

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Controlling blood sugar levels Educating the patient about how to take care of their feet to prevent diabetic foot complications Treating foot ulcers by a specialist Choosing the right footwear and avoid walking barefoot

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Ensuring that there are no objects inside the shoe before wearing them Wearing the appropriate socks Checking the feet daily to make sure there are no wounds or ulcers or even a change in color or even swelling Washing the feet with water and soap and drying them especially between the toes Cutting the toenails straight across the top Using oil or moisturizer to keep the feet soft and hydrated Avoiding tight shoes and high heels Making sure that the water is not hot before washing the feet so you do not suffer from burns Avoiding the use of warm compresses to warm the feet Consulting the doctor immediately once you see something strange no matter what it is

PROTECTING THE FEET STARTS WITH CONTROLLING BLOOD SUGAR LEVELS THE WHOLE TIME AS WELL AS VISITING THE PHYSICIAN REGULARLY WHOSE ROLE IS TO EDUCATE THE PATIENT ON HOW TO PROTECT HIS FEET IN ORDER TO AVOID GETTING DIABETIC.

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INTERVIEW

Baylor St. Luke’s

Strong and Supportive Mission and Integration Team

President Baylor St. Luke’s Medical Center & SVP / COO Texas Division, CHI St. Luke’s Health

Vice President of Operations, Baylor St.Luke’s Medical Center

Liz Youngblood

Sal Ababneh

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aylor St. Luke’s have worked to expand access to virtual care services, by offering patients the option to schedule virtual visits as a convenient and safe care option. ‘Hospitals’ met Liz Youngblood, President Baylor St. Luke’s Medical Center & SVP / COO Texas Division, CHI St. Luke’s Health, and Sal Ababneh, Vice President of Operations, Baylor St.Luke’s Medical Center.

How are you responding to the COVID19 crisis? And what are the steps you are taking to limit its spread?

Our care sites have closely monitored all developments with COVID-19 since the very beginning and continue to identify, immediately isolate, and treat any potentially infected patient while also following the latest guidance from the Centers for Disease Control and Prevention (CDC) and these public health agencies.

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To prepare for a surge of COVID-19 patients and ensure we could provide these patients with the safest care, our facilities have not performed most scheduled procedures since mid-March.

Our first priority in doing this was to ensure we were focused on the safety of our employees and providing quality care for our patients.

Now that we have gradually starting to perform some of these elective procedures, many precautions will stay in place, including en-

ALL OF OUR FACILITIES HAVE PANDEMIC AND SURGE CAPACITY POLICIES AND TRAINING THAT WE HAVE REFINED OVER THE YEARS WITH LEARNINGS FROM OTHER PANDEMIC OUTBREAKS.

INTERVIEW

hanced cleaning of our facilities, limitations on visitors, requirements that all patients and staff wear masks, screenings for anyone entering our care sites, and social distancing once inside.

We also require that patients coming in for certain procedures are tested for COVID-19 testing prior to the procedure to provide appropriate care and reduce the risk of infection for caregivers.

The coronavirus crisis is placing a huge strain on the healthcare system worldwide, how are you coping with this? And what lessons can we learn for the future?

The pandemic has without a doubt put a strain on our resources and our employees, who are our greatest assets. During this time, we have had to quickly adjust and pivot how and what type of care we provide and had to come up with creative ways to expand our ability to care for infected patients while enhancing protocols to protect patients and staff.

To protect employees and in response to the need for more negative pressure rooms, Baylor St. Luke’s has worked with startup companies to make 3D-printed face shields available to employees, as well as work with colleagues to develop reusable gowns and establishing reprocessing and sterilization protocols for N95 masks so employees would have a clean mask each day.

Additionally, staff at Baylor St. Luke’s worked together to convert a 50-year old patient floor into a COVID-19 unit and build an ACU or aerosol containment unit to protect hospital healthcare workers and patients during the intubation process for critically-ill patients.

It’s a plexiglass type of box that allows doctors to safely access patient airways during intubation. Each box is designed with two arm holes for unrestricted arm movement during the tracheal intubation process of COVID-19 patients.

A third hole attaches to an HVAC unit which in essence is pulling air inside the box and pulling

air through a Hepa filter, which is designed to filter out the virus. These plexiglass acrylic intubation boxes protect doctors and nurses from exposure to airborne droplets and aerosols. We have also adopted new technology, such as the Butterfly IQ, a portable point-of-care ultrasound device that can be used in critically-ill patients while decreasing the risk for contamination.

Overall, this experience has reinforced the importance of making clinical decisions based on evidence and scientific research, as well as following guidance from our clinical leaders.

We are starting to hear about healthcare lessons for the post corona World, what is your vision and the policies you will be adopting for the coming period?

We have worked to significantly expand access to virtual care services for the communities we serve. We have been offering patients the option to schedule virtual visits as a convenient and safe care option for our patients.

We see this trend continuing and hope becoming the norm for patients with chronic conditions who need medicine management and follow up visits. The use of technology to communicate with patients’ family members and physicians and experts across the world is something we will continue to embrace post-pandemic, as well as improved communication with physicians and staff.

TO PROTECT EMPLOYEES AND IN RESPONSE TO THE NEED FOR MORE NEGATIVE PRESSURE ROOMS, BAYLOR ST. LUKE’S HAS WORKED WITH STARTUP COMPANIES TO MAKE 3D-PRINTED FACE SHIELDS AVAILABLE TO EMPLOYEES, AS WELL AS WORK WITH COLLEAGUES TO DEVELOP REUSABLE GOWNS AND ESTABLISHING REPROCESSING AND STERILIZATION PROTOCOLS FOR N95 MASKS SO EMPLOYEES WOULD HAVE A CLEAN MASK EACH DAY.

How do you rate your preparedness during the pandemic? And what are the difficulties you faced during this time?

What about the shortage in medical supplies?

All of our facilities have pandemic and surge capacity policies and training that we have refined over the years with learnings from other pandemic outbreaks. Our facilities have always invested in infection control and prevention, so while preparation for COVID-19 has kept our infection control teams and numerous other staff working hard, we understand that investing in

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preparation is the best course of action.

Our emergency preparation coordinators at our facilities and our infection prevention leaders are continuously updating our policies and procedures in real-time to best respond to the latest developments with COVID-19 in order to meet the needs of our patients and communities.

Unlike influenza, testing was not immediately available, and that has created a challenge. It meant that we had to take precautions in the intervening time while we tested and awaited the results of a potentially-infected person, known as “persons under investigation” (PUIs). This is also a disease the world still knows very little about and there isn’t a real treatment, vaccine or therapy to treat the disease.

We addressed the potential shortage of PPE by helping our workers understand when, whether and how to use PPE and by working with suppliers around the world to obtain additional supplies. Baylor St. Luke’s Medical Center has been working non-stop to ensure that all team members who need personal protective equipment (PPE) have the right equipment, at the right time and are using it correctly.

Restrictive visitor policies have also posed challenges for hospitals across the country; it has made us realize how much more important the role of a caregiver and family member is when it relates to the well-being of a patient.

Our frontline workers have had to take on a much greater role than ever before when dealing with end of life situations and helping families stay connected to their loved ones utilizing technology. We are fortunate that we have a strong and supportive mission and integration team, so our chaplains have played an integral role in the spiritual healing of patients and staff.

Do you see the necessity in changing and transforming global health development and expenditure?

This pandemic has created a renewed sense of urgency surrounding our need to address

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health inequities and working collaboratively to address global health needs. We need to work together to not just develop ways to treat diseases but always ways to prevent them. By aligning our efforts and promoting transparency we can make a difference.

COVID-19 brought together many different people and organizations and demonstrated how everyone plays a key role in addressing significant healthcare issues.

We do see this experience as an opportunity for countries and organizations to reexamine their supply chain processes for critical health and livelihood related products. For instance, before the pandemic, half the surgical masks made globally came from China. Industries such as the pharmaceutical and medical supplies industries are going to have to look for partnerships to produce domestically as well as using the global supply chain to be better prepared for the next pandemic.

OUR FRONTLINE WORKERS HAVE HAD TO TAKE ON A MUCH GREATER ROLE THAN EVER BEFORE WHEN DEALING WITH END OF LIFE SITUATIONS AND HELPING FAMILIES STAY CONNECTED TO THEIR LOVED ONES UTILIZING TECHNOLOGY.

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

INTERVIEW

Family Medicine and Infectious Diseases Specialist / Professor, American University of Beirut Medical Centerl

Dr. Umayya Musharrafieh “E-visits Have Already Started at AUBMC”

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ealthcare systems need to become more resilient to adapt to any emerging pandemic similar to the one that we just experienced, said Dr. Umayya Musharrafieh Family Medicine and Infectious Diseases Specialist, Professor, American University of Beirut Medical Center. Below is the full interview:

How are you responding to the COVID19 crisis? And what are the steps you are taking to limit its spread?How do you rate your preparedness during the pandemic? And what are the difficulties you faced during this time? What about shortage in the medical supplies?

At the beginning of the COVID-19 pandemic, several multidisciplinary task forces were formed to share information and align projected activities. The aim was to identify effective approaches and implement recommended measures that enhance the prevention, preparedness, and readiness of AUBMC for the COVID-19 pandemic: • Patients, suspected to have COVID-19 infection, were isolated in a different freestanding building within the medical complex so that all patients are safe and well protected. The Flu Clinic handled all ambulatory patients with respiratory symptoms and those suspected of having COVID -19. In-patient wards and intensive care units were established.

Well-trained and skilled staff served at all these units, and they followed strict measures for their safety and the safety of patients, such as wearing full personal protective equipment (PPE).

• “Train the trainer” strategy was followed to ensure that all staff are well-trained to protect themselves, use PPEs properly, and monitor staff performance.

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•

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Coordination amongst many programs and departments at AUBMC were reinforced. These included infection control programs, nursing body, occupational health unit, safety department, emergency department, each in its capacity to issue timely guidance for management of COVID-19 patients and tracing exposed healthcare workers (HCW). More efforts targeted ensuring safe places, available and safe attires, and providing guidance statements issued as implied and needed.

A major component of the plan was conducting careful contact tracing of every exposed staff including the isolation of many healthcare workers for the safety of all. We were updating our recommendations continuously as per CDC and WHO guidelines.

Mental health assessment and support for COVID-19 patients and for HCWs dealing with COVID-19 patients was introduced.

Installation of COVID screening and public health precautions at entrance of every AUBMC building where patients arrived to seek care.

Educational campaigns were conducted through many initiatives and reminders (COVID studio, live sessions on social media, a dedicated webpage, etc.)

WE HAVE LEARNED THAT DISEASES DO NOT HAVE BORDERS AND PANDEMICS ARE UNPREDICTABLE AND MAY NOT BE ONCE IN A LIFETIME. WE HAVE WITNESSED MANY SOCIETIES WERE ILL PREPARED AND INCAPABLE OF COPING AND MANAGING SUCH HEALTH EPIDEMICS EFFECTIVELY.

INTERVIEW The main challenges we faced were to ensure availability of sufficient supply of PPEs and adequate training of HCW to deal with COVID patients. A tradeoff had to be made between isolating exposed HCWs and avoiding depleting other inpatients’ wards during contact tracings of exposed HCWs.

The coronavirus crisis is placing a huge strain on the healthcare system worldwide. How are you coping with this? And what lessons can we learn for the future?

This is very important as the crisis affects not only people’s health but it affects and has already affected the social, economic and political aspects of each country with long term consequences; a fact that will take good time to recover. We have learned that diseases do not have borders and pandemics are unpredictable and may not be once in a lifetime. We have witnessed many societies were ill prepared and incapable of coping and managing such health epidemics effectively.

The pandemic had huge consequences and it was imperative that we work in unity within our hospitals and with the healthcare system in our country to make an impact and a difference.

This pandemic opened our eyes to appreciate our most essential needs and our values. It stopped our non-stop rush in life and made us realize the value of each job and every career in society. Before the outbreak of the pandemic, some roles were taken for granted or sometimes undervalued. As time passed, these people proved to be the front liners in combating the COVID-19 pandemic; examples in point include the hospital orderlies, the housekeepers, the people sitting at the entrance counters in clinics and hospitals, and many others who have been offering much help to those who are in need during this pandemic.

I could see a tremendous degree of kindness among our staff physicians and nurses in the hospital and I could see so many initiatives held by many who tried to do their best to help: Simply, everybody turned his/ her face and mind to one side which is serving humanity.

There is a need to cooperate to face challenges wherever we work; at the local level,

national level, and even more at the global level like when we face global challenges.

We are starting to hear about healthcare lessons for the post-corona world, what is your vision and the policies you will be adopting for the coming period? Do you see the necessity in changing and transforming global health development and expenditure?

There will be reshaping of health and development institutions, occupations, and priorities.

Healthcare systems need to become more resilient to adapt to any emerging pandemic similar to the one that we just experienced.

This requires an upgrade of any shortcomings we noted in the healthcare system at any level during this pandemic. We need to fill the gaps and update our healthcare systems because inefficient system will not be able to handle the next outbreak when it happens.

COVID-19 pandemic opened the door for healthcare facilities to explore alternatives to face-to-face triage to reduce unnecessary visits and prevent transmission of COVID-19. Later, this might become the norm in healthcare. There will be more implementation of artificial intelligence in healthcare which may help us in any future crisis. I can see clearly a shift in the point of care where digital health may provide solutions that are ready made to bring healthcare to patients at the convenience of their homes. E-visits have already started at AUBMC; medical encounters and results are shared remotely.

Our education and continuous medical education will change. Medical schools will be resorting more and more to on-line learning, more dependence on remote learning through artificial intelligence and so will our attendance to conferences. As we lose our trust in globalization, our travel to attend conferences and communicate with experts will change due to worries in safety and more stringent safety measures. For example, we may be asked to submit immunity passports prior to travel; taking more vaccines before entering a country may be mandatory for any future travel. In other words, we are heading towards new trends and habits in medical education and healthcare.

COVID-19 PANDEMIC OPENED THE DOOR FOR HEALTHCARE FACILITIES TO EXPLORE ALTERNATIVES TO FACE-TO-FACE TRIAGE TO REDUCE UNNECESSARY VISITS AND PREVENT TRANSMISSION OF COVID-19.

LATER, THIS MIGHT BECOME THE NORM IN HEALTHCARE. THERE WILL BE MORE IMPLEMENTATION OF ARTIFICIAL INTELLIGENCE IN HEALTHCARE WHICH MAY HELP US IN ANY FUTURE CRISIS.

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ARTICLE

Exercise in the time of Covid-19

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eminding everyone that exercise remains as important as ever to help keep our population healthy especially during this extra-ordinary time.

Dr. Reham Elgafy Head of Physical Medicine and Rehabilitation Department, Physical and Rehabilitative Medicine at Al Ahli Hospital

Most people are currently nervous about the potential impact of COVID-19, and we in the Physical & Rehabilitation Medicine dept.

AAH, wanted to take the opportunity to remind everyone that we should still consider physical activity a top priority -besides diet & maintaining proper hygiene - for two main reasons.

Firstly, research does show that exercise can support our immune system and secondly, exercise is proven to support our mental health.

We all understand that exercise supports our physical health, however, during times of crisis such as this, it is the first activity we tend to ignore. Being active can not only keep us healthy, it can also help us fight off infection.

As a result of the inability to move around and spending more time indoors, there may be some weakness in muscle groups and weight gain. Thus being active as much as possible at home and exercising regularly is crucial for all age groups.

Exercise is also unique as it can boost our mental health, and during this anxious time it’s more important than ever to keep our minds clear and focused. It can also be a means of gathering family members in the same house to do something useful and fun if done together.

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Instead of reaching for a snack or the remote control during the long hours of home stay, how about lacing up your trainers and heading for exercise whether outside around your home in the form of walking, jogging or biking if applicable or inside your house, with your spouse/father/mother or children. All you need is trainers, loose cotton outfit, colorful yoga mats and most important setting a routine (a fixed time for daily exercise). Many fitness companies are offering free virtual classes and resources to access from anywhere, at any time.

There are also loads of exercises for different abilities all what you need is a strong will to start.

For individuals working at a home desk for long hours, try some simple stretches to open up your chest cage and back: Stand straight and lean down to touch your toes, or link your hands above your head and pull up to elongate your spine.

Another stretch for improving posture is the shoulder roll: Sit or stand comfortably. As you inhale, raise your shoulders to your ears.

As you exhale, pull your shoulder blades down and together. Do this five times in a row, a few times a day. One should take a deep breath in front of an open window for fresh air, hold it for a few seconds, and then breathe out completely. This should be repeated without straining oneself. Wishing everyone to stay healthy and active until this hard time passes safely.

ARTICLE

Even in its advanced and intractable stages

Al-Ahli Hospital is a successful destination in the treatment of "Endometriosis"

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Dr. Mazen Bishtawi Specialist and Head of the Obstetrics and Gynecology Department at Al Ahli Hospital

r. Mazen Bishtawi, Specialist and Head of the Obstetrics and Gynecology Department at Al-Ahli Hospital, confirmed that the department succeeded in treating a 37-year-old American woman who was suffering from severe and persistent pain in the lower abdomen caused by "Endometriosis", where she was suffering initially from these pain with the menstrual period and her condition developed into continuous and extended pain throughout the days, in all the positions she takes, whether sitting, sleeping or others, which affected her daily life and her work that she had been absent from as a result of this pain occurred signifintally and frequently.

Then he said: "Once she performed initial tests, including exploratory laparoscopy, it turns out that she was complaining of a very advanced condition represented in the adhesions inside the pelvis and adhesions between the intestine and the uterus on one hand and between the intestine and ovaries on the other hand, to the extent that the possibility of seeing and good detection of the uterus and ovaries during the endoscopy process is obscured, due to the large and many adhesions. The medical team who initially examined her was unable to intervene or find viable solutions to her condition, and she was advised to go to a hospital in America for treatment.

In the meantime, she was advised to go to the Obstetrics and Gynecology Department of Al-Ahli Hospital, and she did. Once the necessary checks and diagnostics were performed, it was found that she complained about a case we dealt with a lot before, and we achieved several successes therein, given what we have of experience and efficiency and what Al-Ahli Hospital provides us of modern and sophisticated devices and high-endoscopes, all comparable to what is found in the best hospitals in the world.�

Then he said: "We were able to perform this procedure laparoscopic and the results were good and surprising for the patient. She examined the first results after she awakened from

the operation and discovered that she did not complain of any pain and got rid of that pain after she had suffered for a long time which affected her life and forced her to visit emergency clinics continuously to take strong analgesics to get rid of the intense pain even for a short time". He added: "Thanks to Allah, during the operation, we were able to perform adhesiolysis, we removed the endometriosis, and the patient returned to her normal life. This disease is considered a common disease that affects about 15% of women, and unfortunately, the diagnosis of this disease delays from 5 to 7 years because it begins with pain during the menstrual period. Most women do not pay attention to these pains, thinking that it is the normal pains that accompany the monthly period which happens to every woman until their condition develops later and the disease is discovered late and in advanced cases, until this chronic disease requires an integrated medical team with expertise and competence that enables them to deal meaningfully therewith, in addition to advanced and modern equipment that help in this issue, and this is exactly what Al-Ahli Hospital has, which enables us to be a successful destination in the treatment of "endometriosis, early detection of tumors, the care of pregnant women, and women who complain from the polycystic ovary and other cases."

IN ADDITION TO ADVANCED AND MODERN EQUIPMENT THAT HELP IN THIS ISSUE, AND THIS IS EXACTLY WHAT AL-AHLI HOSPITAL HAS, WHICH ENABLES US TO BE A SUCCESSFUL DESTINATION IN THE TREATMENT OF "ENDOMETRIOSIS, EARLY DETECTION OF TUMORS, THE CARE OF PREGNANT WOMEN, AND WOMEN WHO COMPLAIN FROM THE POLYCYSTIC OVARY AND OTHER CASES.

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ARTICLE

We possess modern competencies and equipment and we are distinguished in vocal cords surgery

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he ENT clinics in Al-Ahli Hospital are very distinguished clinics, and the reason for their excellence is due to the number of distinguished doctors, high competencies and highly experienced staff, in addition to the equipment and state-of-the-art science that helps in the stages of accurate and rapid diagnosis and the provision of effective and feasible treatment for patients.

Dr. Aref Awa Consultant ENT Surgeon at Al Ahli Hospital

The ENT Department at Al-Ahli Hospital contains 3 clinics that operate around the clock, supervised by a group of consultants and specialists who provide all necessary care, diagnostic and treatment services for different patients. These clinics are concerned with all diseases affecting the ear, nose, and throat, and are distinguished in dealing with the most difficult and complex ones, including vocal cords problems, and rare problems such as that of an American patient who recently visited the clinic. Dr. Aref Awa, Consultant ENT Surgeon at Al-Ahli Hospital, talked about the clinics and their distinction in dealing with some incurable diseases, and about this rare case.

Dr. Aref Awa confirmed that the subject of the vocal cords is very sensitive and accurate, as the doctor does not know how sharp the patient’s voice is, for that reason, he first asks the patient some questions in the first meeting, such as asking him about the presence of any hoarseness in his voice, or the presence of changes in the sound level, in addition to, of course, the awareness of the patient's behavior and life habits, such as asking him if he is smoking, and about his social function and so on.

Rare Case Then he said: "We, in our clinics at Al-Ahli Hospital, treat all ear, nose and throat diseases in the elderly, adults and children as well, starting with tonsillectomy surgeries, through ear surgeries, acoustic hypoesthesia, and nasal septum deviation, down to rhinoplasty surgery and advanced surgeries in the treatment of

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larynx diseases."

We excel especially in diseases of vocal cords and hoarseness or disappearance of the voice.

Our distinction, as I mentioned earlier, is due to the presence of distinguished expertise and high efficiencies and the use of very advanced equipment, and state-of-the-art technology.

Thanks to that, we managed to deal with some cases that are accurate and complicated, among them the case of an American patient, who came to the clinic two weeks ago, and was complaining of hoarseness at the voice level, which even affected the strength and shape of his voice, and he was speaking with a kind of rattle accompanied with some kind of difficulty in the level of breathing and swallowing. By diagnosing the patient’s condition through direct laryngoscopy, we discovered that he had a "polyp" on the vocal cord, which is something that rarely happens, because the "polyps" of the vocal cord are usually located on the anterior to the middle third of the vocal cords, and in his case, the "polyp" was located on the anterior junction of the vocal cords, which makes its diagnosis and ablation more difficult.

After completing the testing procedures, including blood test, an appointment was made for the surgery we had done under general anesthesia and by microscopic ablation materials under the microscope, and with a very high amplification system, so that the muscle of the vocal cords would not be harmed. The lesion was removed by lifting the mucous membrane and excising it from the muscle of the vocal cords, and then returning the mucous membrane to its normal position.

This was a success in dealing with this rare case. A set of advice was provided to the patient after the success of the operation, including resting the voice, not smoking, and avoiding eating spicy foods. After one week, the patient's voice improved, and he gradually returned to his normal state, and he is very pleased today with the success of the operation, after which he returned to his normal state in a time not exceeding two weeks.

ARTICLE

Through removing a tumor from a patient's shinbone

The Orthopedic & Traumatology Department makes a quantum leap in the area of excellence

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he Orthopedic & Traumatology Department at Al-Ahli Hospital - which deals with knee and pelvic joints, and the problems and damage which occurs thereto - has recently performed a complex and delicate operation on a patient suffering from a tumor inside the shinbone, below the knee exactly, which caused him many pains that affected his daily life negatively.

Dr. Maher Yousef Consultant Orthopedic Surgery Al Ahli Hospital

Dr. Maher Yousef, Consultant Orthopedic Surgery at Al-Ahli Hospital, talked about this case and the success of the operation saying: “The patient’s condition represents in the presence of a tumor in the shinbone, and we were able to remove it and plant replacement bone for him and retained it with a retaining plate and screws. It did not take one year for the patient until his condition became normal and excellent. He does not complain of any complications and does not have any prodromata of the tumor appearing again."

He indicated: "This type of operation is not usually performed in private hospitals, and even if that happens, they are very rare cases."Then he added: "We subjected the patient to specific checks through which we were able to confirm the type of the tumor that was not a malignant

tumor, which is difficult to deal with, and its complications differ that it can sometimes lead to leg amputation, and in the best cases remove a large amount of bone, including the knee joint, and replace both with artificial substitutes.

When he was asked about the stages of the operation, he replied: "During the operation, we started to open the bone in a window-like manner, and through that opening, we worked to remove the tumor completely, then we replaced that bone with artificial bone and retained it with a retaining plate and screws, which help to make the bone natural and strong, especially after the operation of removing the tumor that made the bone weaker than usual and more prone to fracture."

He concluded saying: "The Orthopedic & Traumatology Department at Al-Ahli Hospital is distinguished in the field of joint replacement operations for both the knee and pelvis, which is the core of our specialty in which we are highly distinguished and through which we have achieved many successes. In addition, all the competencies and expertise owned by the staff of our department make us able to take other challenges and treat most of the orthopedic diseases, even if they are complex and delicate."

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Article

Essential Role of Fortified Powdered Milk in the Daily Diet of Children

By Dr. Dana Al-Hamwi - Clinical Dietitian, holding a Doctorate in Medicine from the University of Damascus and a master’s degree in Clinical Nutrition and Dietetics from the University of Sheffield in the United Kingdom ing positions that signal their personal independence. This tends to come with changes in their dietary habits, which often entail the exclusion of milk from their diet as a way for children to express that they’ve grown up, or because they’re bored with the taste of milk, or simply because they’re aiming to emulate older people in their environment by drinking sweetened beverages, soft drinks, and fruit juices.

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hether children are going to school or learning remotely at home as is currently the case, school-age remains one of life’s most important periods for parents to experience with their children. This is when a child develops the most physically, mentally, and cognitively, thus requiring the most attention to their diet so it’s balanced and provides all the nutrients their body needs. Fortified Powdered milk in particular should be an essential part of their diet during this period, because it helps to provide all the crucial nutrients required for their growing years.

It’s very common at that age for children to rebel against their parents in general by assert-

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Many parents falsely believe that the only reason children should drink milk is for the calcium they need for growth, and that there are no nutritional differences between liquid and powdered milk varieties. Parents are generally unaware that fortified powdered milk in particular is not only natural, and free of added sugar, preservatives and colorings, but also contains all the nutrients their child needs for healthy development.

This includes proteins for building strong muscle mass and maintaining a healthy body weight, calcium for healthy and strong bones development, vitamin D for better calcium absorption, vitamin A to boost a child’s growth and immunity, zinc for the normal functioning of the immune system, and B vitamins essential for combatting fatigue and tiredness. And, of course, vitamin C which boosts immunity and is included in just the right concentrations to ensure complete absorption of Iron, which is essential for a child's physical and mental development, and for strengthening immunity.

It is worth noting that Iron cannot be added to liquid milk, many varieties of which also do not contain vitamins A, C or D. Moreover, Liquid milk doesn’t contain the right concentrations of vitamins and minerals to meet a child’s developmental needs, leaving children who

RECENT STUDIES HAVE SHOWN THAT 80% OF 6-13 YEARS OLD ARE NOT GETTING THEIR DAILY NEEDS OF VITAMINS A, D, E OR CALCIUM. IRON DEFICIENCY IS ALSO RAMPANT IN THE REGION. SUCH FINDINGS MAKE IT EVEN MORE IMPORTANT FOR CHILDREN TO CONSUME FORTIFIED POWDERED MILK EVERY DAY TO AVOID HEALTH ISSUES.

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only consume this variety at risk of numerous nutrient deficiencies during this vital period of their life. Alternatively, fortified powdered milk is nutritionally designed for school age children, making it the right choice.

Recent studies have shown that 80% of 6-13 years old are not getting their daily needs of vitamins A, D, E or Calcium. Iron deficiency is also rampant in the region. Such findings make it even e more important for children to consume fortified powdered milk every day to avoid health issues that can include: 1. Insufficient growth 2. Fatigue and tiredness 3. Iron deficiency anemia 4. Higher rates of bone fractures and osteoporosis 5. Poor muscle mass 6. Weakened immune system Therefore, both parents and children should realize that drinking two glasses a day of fortified powdered milk that is designed specifically for school age children is important for overall growth and.

Parents should also teach children the benefits of drinking fortified powdered milk, which include: 1- Healthy hydration 2- Healthy physical and mental development, thanks to healthy fats, Iron, Calcium, and vitamins D and A 3- Combating fatigue and tiredness thanks to B vitamins 4- Building strong and healthy bones and teeth thanks to proteins, vitamin D, and Calcium 5- Maintaining muscle mass and a healthy weight thanks to Proteins, vitamin D and Calcium 6- Building a healthy immune system with the support of vitamins C and A, and Zinc Parents play a major role in encouraging children to develop healthy eating habits. They are ideal role models for their kids and can guide them to drink d milk by drinking a glass themselves every morning at breakfast. It’s also helpful to encourage a child to prepare their own glass of milk so they learn self-reliance, which helps them develop confidence and a sense of becoming all grown up.

PARENTS ARE GENERALLY UNAWARE THAT FORTIFIED POWDERED MILK IN PARTICULAR IS NOT ONLY NATURAL, AND FREE OF ADDED SUGAR, PRESERVATIVES AND COLORINGS, BUT ALSO CONTAINS ALL THE NUTRIENTS THEIR CHILD NEEDS FOR HEALTHY DEVELOPMENT.

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‘Networks, AI, Analytics & Security will Accelerate Digital Transformation Roadmaps in Middle East Healthcare Industry’: Aruba Expert of medical experts to rapidly solve the problem.

As the world continues to combat the COVID-19 pandemic, health organizations are quickly initiating Rapid Response plans.

Jacob Chacko Regional Business Head – Middle East, Saudi & South Africa (MESA) at HPE Aruba says, “Aruba sees itself as being an integral part of this multi-disciplinary team to help address the critical challenges facing Healthcare IT during this time. The company is responding to this crisis with the same ‘Customer First, Customer Last’ approach that has long endeared it to healthcare customers all over the world.”

Digital Transformation Technologies in Healthcare While the use of technology in healthcare has risen to prominence in the last few years, it is likely to take bigger strides during and post COVID-19. Aruba provides an insight into how technology in healthcare will evolve and how the company’s solutions are driving this transformation:

Remote Working and Connectivity

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ith the COVID-19 pandemic sweeping the globe over the past few months, prominent stakeholders in various industries have had to adjust their strategy with the rapidly evolving situation. The healthcare industry in the Middle East will have to undergo crucial reforms once the crisis takes a back seat.

Technological advancements, cost control, and greater access will be indispensable part of these reforms.

Expanded Network Coverage

In health systems all over the world, there is what’s known as a rapid response team. When a patient’s clinical status deteriorates, the best practice is to assemble a multi-disciplinary team

Many hospitals are building drive-through testing stations and rapid triage areas outside of their facilities. These environments can be challenging, but through the use of Aruba’s Zero-Touch Provisioning, a network can be

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Healthcare has traditionally been a worksite-dependent industry, but with the need to follow social distancing and self-quarantine guidelines, enabling workers to be productive at home is now essential. Aruba Remote Access Points (RAPs) extend the same network services and security policies to an employee’s home, just as if they were in a hospital, clinic or office.

THE GOAL OF A RAPID RESPONSE IS TO QUICKLY IDENTIFY AND SOLVE THE MOST CRITICAL ISSUES FACING A PATIENT AND STABILIZE THE TREATMENT PLAN GOING FORWARD. THIS IS THE RESPONSE HEALTHCARE IS SEEING, AS CARE-PROVIDING ORGANIZATIONS HAVE BEGUN ADAPTING TO THE COVID-19 PANDEMIC.

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installed and configured without IT being physically involved. Aruba Access Points (APs) can easily be made to work over cellular connections if needed.

Aruba technology helps organizations leverage the power of the cloud. One key facet of cloud service delivery is the ability to grow capacity as needed. This current pandemic is a great example of how this capability proves valuable. Aruba Central for cloud-managed networking allows healthcare institutions manage new (and existing) networks simply and without on-site presence. When the need for these temporary installations passes, they can simply scale back to normal delivery.

Easily Monitor the User and Mission Critical Application Experience Traditional methods of performance monitoring need to adapt to the current deployment and application needs. One way to ensure those who are working on the front lines and treating patients receive a quality network experience is by using Aruba User Experience Insight (UXI) to report on connectivity and application performance throughout the day. UXI also provides a simple way identify issues before they can cause problems – even if on-site support is not possible.

Telemedicine to Deliver Primary Care While the focus is on COVID-19, the regular healthcare needs of communities remain and many healthcare services cannot be electively rescheduled. Where possible, the Aruba solutions described above will allow providers (MD/DO, PA-C, ARNP, etc.) to see patients via traditional telemedicine apps from the security of their own homes. By securely extending the hospital’s network to a provider’s home, a semblance of normal patient-provider interaction can be preserved.

The goal of a rapid response is to quickly identify and solve the most critical issues facing a patient and stabilize the treatment plan going forward. This is the response healthcare is seeing, as care-providing organizations have begun adapting to the COVID-19 pandemic. This

proves yet again how powerful and essential those that provide care for our communities truly are. Aruba is honoured to be a part of the Rapid Response Team for many of its healthcare partners around the world.

Countering Cybersecurity Risks Most health systems have managed to stay ahead of cybersecurity attacks so far during the pandemic. However, it is a matter of time before cybercriminals swoop in to take advantage of heightened vulnerabilities. Health systems that have seen a doubling of their remote workforce have had to enable staff with remote connectivity devices to connect to enterprise IT systems seamlessly, with minimal data flow between devices in and outside firewalls.

The right technology, used at the right time, can be transformational for healthcare. Integrated correctly within the patient journey, it becomes a vital tool that supports clinicians, not hinders them, and contributes to a much-improved experience for patients.

The right technology, used at the right time, facilitates long-term change and creates an eco-system of integrated solutions that work as one to manage patient flow; think everything from a patient checking-in for their appointment on their smartphone, to clinicians booking follow-up appointments using electronic outcome forms.

IN HEALTH SYSTEMS ALL OVER THE WORLD, THERE IS WHAT’S KNOWN AS A RAPID RESPONSE TEAM. WHEN A PATIENT’S CLINICAL STATUS DETERIORATES, THE BEST PRACTICE IS TO ASSEMBLE A MULTIDISCIPLINARY TEAM OF MEDICAL EXPERTS TO RAPIDLY SOLVE THE PROBLEM. AS THE WORLD CONTINUES TO COMBAT THE COVID-19 PANDEMIC, HEALTH ORGANIZATIONS ARE QUICKLY INITIATING RAPID RESPONSE PLANS.

“While the world’s leading researchers race to uncover a vaccine, governments realize that the key to recovery is an increase in COVID-19 testing. The ability to test, track contacts, and quarantine those infected hinges on the ability to test large numbers of the population.

As the healthcare community in the Middle East continues to shift with these changing priorities, we will continue to support them with Rapid Response healthcare solutions that allow secure connectivity. Whether they are planning for pop-up testing, a triage tent, or a makeshift hospital in a stadium to prepare for a surge in patients, Aruba will be there to help,” concludes Jacob.

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Humania Closes a $360million Debt & Equity Platform for New Hospitals in North Africa

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umania, a group company of Bait Al Batterjee (BAB) Group, closed a $360million debt and equity platform in partnership with the International Finance Corporation (IFC) and a consortium of leading multilateral organizations. BAB Group owns and operates Saudi German Hospitals across the UAE, Yemen and Egypt, and is a majority shareholder in MEAHCO, who owns and manages the hospital group in KSA. The partnership will help grow the SGH footprint in Morocco and expand its presence in Egypt.

Humania has successfully closed over $100million equity raise for its North Africa healthcare platform with investments coming from the International Finance Corporation (IFC), Danish Sustainable Development Goals Investment Fund K/S managed by the Investment Fund For Developing Countries (IFU) and Société De Promotion Et Participation Pour La Coopération Economique (Proparco) along with Bait Al Batterjee (BAB) group to expand the Saudi German Hospital network in Egypt and Morocco.

Earlier in December 2019, Humania had closed Sharia compliant project finance for the same platform with IFC, OPEC Fund for International Development (OFID), Finnish Fund for Industrial Development (Finnfund) and European Bank for Reconstruction and Development (EBRD). This was the first Sharia compliant project finance for all the DFIs (except IFC).

Humania plans to build a new hospital in Alexandria and a medical tower in Cairo, Egypt.

The project will also include a new high-quality multi-specialty hospital in the new eco city of

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HUMANIA PLANS TO BUILD A NEW HOSPITAL IN ALEXANDRIA AND A MEDICAL TOWER IN CAIRO, EGYPT. THE PROJECT WILL ALSO INCLUDE A NEW HIGH-QUALITY MULTI-SPECIALTY HOSPITAL IN THE NEW ECO CITY OF ZENATA, MOROCCO. COMBINED, THE PLATFORM IS EXPECTED TO HAVE ABOUT 1,000 INPATIENT BEDS AND 300 OUTPATIENT CLINICS.

Zenata, Morocco. Combined, the platform is expected to have about 1,000 inpatient beds and 300 outpatient clinics.

While operating under the renowned Saudi German Hospital brand, Humania North Africa shall aim to provide best-in-class patient care to the region through world-class expertise and cutting-edge technologies. “Our partnership with IFC will help us make important investments during a time when the demand for quality healthcare keeps rising,” said Sobhi Abduljaleel Batterjee, Humania & BAB Chairman “It will allow us to provide affordable, high-quality healthcare, including specialty services to the community in Egypt and Morocco as they contend with the impact of COVID-19.”

Today’s closing and signing ceremony marks a new partnership for the BAB Group with leading multilateral development institutions who bring some of the best, yet diverse global practices. This complements Saudi German Hospital Group’s thirty years track record of providing international quality healthcare in the MENA region. “Our partnership will help redefine the private sector’s contribution to healthcare in these countries by building and operating hospitals in line with best global practice”’ adds Humania Vice Chairman & BAB President, Makarem Sobhi Batterjee.

IFC has led both the equity and debt rounds and is also the lead participant, contributing over $100 million to Humania North Africa.

“We are very excited to continue supporting Humania, our long-term partner and client in the healthcare sector,” said Sérgio Pimenta, IFC’s Vice President for the Middle East and Africa. “Today’s agreement is a testament to the strength of our partnership with IFU and PROPARCO. This project is a good example of how the private sector can be leveraged to expand access to medical care, strengthen human capital, improve social inclusion and spur innovation in the health systems of Egypt and Morocco.”

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Humania’s senior management team, which led the transaction from Dubai and Cairo, is equally excited. Thanking the financial partners, Aamir Rehan Managing Director Humania said “Humania North Africa is a multi-country, multi-asset platform built in partnership with six global institutions from different countries that will support us in building and operating greenfield tertiary care hospitals almost simultaneously in Egypt and Morocco. The complexity of this transaction shows our collective commitment to

healthcare in the region and the confidence of global institutions in us”.

Ahmed El Bakry, Managing Director Humania Africa added from Cairo “Based in North Africa, we witness, every day, the acute shortage of quality healthcare in our region, which we also saw further amplified during the Covid-19 crisis. Today marks a major milestone for us all in playing a role to address this shortage”.

Dubai Government Workshop and Emirates Specialty Hospital successfully holds webinar to define steps on how to ensure customer and employee safety

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s part of its continuing move to enhance public health and safety, Dubai Government Workshop (DGW), in cooperation with Emirates Specialty Hospital, recently organized a webinar. The special online session was aimed at familiarizing DGW staff with the essential precautionary measures to be taken in ensuring the safe return of customers and employees to the workshop's offices. The event falls in line with the pioneering efforts being made by Dubai and the rest of the UAE to prevent the spread of coronavirus (COVID-19).

THE WEBINAR SERVED AS A STRATEGIC CULTURAL AND AWARENESS PLATFORM TO HELP PREPARE GOVERNMENT OFFICES' RETURN.

According to the DGW's senior officials, the webinar served as a strategic cultural and awareness platform to help prepare government offices' return.

During the online event, Dr. Youmna Dirani, Specialist on Infectious Diseases at the Emirates Specialty Hospital, gave a presentation that explained the importance of following the recommended preventive measures. She emphasized on the need to comply with the safeguarding protocols as a means to ensure personal and public safety.

In response to the presentation, DGW employees participating at the webinar expressed their key commitment in following the set protocols and also placing full support for the country's continuing efforts to battle the spread of COVID-19--strictly following and adhering to precautionary measures that are in line with set international best practices.

The online session concluded with a special Q and A forum that sought to answer all questions fielded by DGW employees, which also helped in making them aware of the healthy habits that need to be applied before resuming 100 per cent capacity office operations.

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GE Healthcare Launches New AI Suite to Detect Chest X-ray Abnormalities, Including Pneumonia Caused by COVID-19 & Tuberculosis GE Healthcare continues to provide tools to support clinicians in today’s COVID-19 environment that data, analytics, AI and connectivity will only become more central to delivering care. For GE Healthcare, that means continuing to advance intelligent health and providing innovative technologies. This new offering is the latest example of how x-ray and AI can uphold the highest standard of patient care amidst the most modern of disease threats.”

To date, more than 8 million cases of COVID-19 have been confirmed worldwide – overwhelming radiologists, technologists, and physicians. As the spread of the virus stabilizes, clinicians continue to need tools to help manage new cases and complications caused by the virus

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E Healthcare introduced its Thoracic Care Suite, a collection of eight artificial intelligence (AI) algorithms from Lunit Insight CXR to help alleviate clinical strain due to COVID-19. The AI suite quickly analyzes chest x-ray findings and flags abnormalities to radiologists for review, including pneumonia, which may be indicative of COVID-19 as well as tuberculosis, lung nodules, and other radiological findings.

“The launch of our Thoracic Care Suite is a part of GE Healthcare’s larger effort to help ensure clinicians and partners on the front lines have the equipment they need to quickly diagnose and effectively treat COVID-19 patients,” says Kieran Murphy, President & CEO, GE Healthcare. “The pandemic has proven

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THORACIC CARE SUITE HARNESSES THE POWER OF AI TO SCAN FOR EIGHT CHEST X-RAY ABNORMALITIES, INCLUDING PNEUMONIA INDICATIVE OF COVID-19 – A KEY CAUSE OF MORTALITY IN PATIENTS WHO CONTRACT CORONAVIRUS.

NEWS – including pneumonia and acute respiratory distress – which have further increased pressure on radiologists to quickly read chest x-ray exams.

With approximately 1.44 billion chest x-ray exams taking place each year, radiologists are overwhelmed, especially as they may be looking for multiple indications per exam.

Thoracic Care Suite harnesses the power of AI to help alleviate these pressures by automatically analyzing images for the presence of eight abnormal radiologic findings, including suspected tuberculosis and pneumonia findings, which can be indicative of COVID-19. Upon reading the flagged report in picture archiving and communication systems (PACS), radiologists can quickly find the abnormality score for each of the eight possible abnormalities, an image overlay, and a written location description to help expedite diagnosis and treatment.

“Clinicians are looking for clinically proven methods to help identify symptoms early and determine which patients are at higher risk of complications and need to be actively monitored,” explains Professor Fergus Gleeson, Consultant Radiologist, Professor of Radiology at the University of Oxford, and the 2020 President of the European Society of Thoracic Imaging. “AI can help identify these distinctions and enable hospital resources to be targeted to those that will need them whilst in hospital and following discharge.”

Thoracic Care Suite provides much needed support to help quickly identify high-risk cases as well as monitor patients showing the progression and regression of mild respiratory symptoms. With 97-99% accuracy rate (Area Under the Curve - AUC), the powerful algorithms behind the AI suite have been trained to detect radiologic findings within seconds. In one study, results showed a 34% reduction in reading time per case. In addition to detecting pneumonia, Thoracic Care Suite also supports tuberculosis, atelectasis, calcification, cardiomegaly, fibrosis, mediastinal widening, lung nodule, and pleural effusion detection.

Thoracic Care Suite is available to GE Healthcare’s thousands of global fixed, mobile and

R&F x-ray customers at point of sale, meaning the technology can more quickly be deployed in market and in hospital without the fear of annual fees – an important consideration if a second wave of COVID-19 were to occur. Furthermore, installation of the technology does not require customers to engage with any enterprise IT projects, helping to lower the barrier for entry in adopting AI. “To have our AI made available with a market-leading vendor like GE Healthcare – especially as part of the Thoracic Care Suite – is a significant advancement in delivering solutions to various customers within GE Healthcare’s install base and bringing us all one step closer to embracing AI as a part of today’s standard of care,” says Brandon Suh, CEO of Lunit.

To provide this technology, GE Healthcare partnered with Lunit, a South Korean medical AI software company that develops AI-powered analysis of lung diseases via chest x-ray images.

Founded in 2013, Lunit has been recognized for its advanced, state-of-the-art technology and medical imaging applications in international competitions – including ImageNet, TUPAC, and Camelyon – surpassing top companies like Google, IBM, and Microsoft.

The collaboration between GE Healthcare and Lunit is one of the first of its kind to bring commercially available AI products from a medical AI startup to an existing X-ray equipment manufacturer.

TO PROVIDE THIS TECHNOLOGY, GE HEALTHCARE PARTNERED WITH LUNIT, A SOUTH KOREAN MEDICAL AI SOFTWARE COMPANY THAT DEVELOPS AI-POWERED ANALYSIS OF LUNG DISEASES VIA CHEST X-RAY IMAGES. FOUNDED IN 2013, LUNIT HAS BEEN RECOGNIZED FOR ITS ADVANCED, STATE-OF-THE-ART TECHNOLOGY AND MEDICAL IMAGING APPLICATIONS IN INTERNATIONAL COMPETITIONS – INCLUDING IMAGENET, TUPAC, AND CAMELYON – SURPASSING TOP COMPANIES LIKE GOOGLE, IBM, AND MICROSOFT.

REFERENCES 1. Provisional Death Counts for Coronavirus Disease (COVID-19). Published June 12, 2020. Accessed June 12, 2020, from https://www.cdc.gov/nchs/nvss/vsrr/covid19/ index.htm.

2. Available in select CE Mark countries. Not available in all regions.

3. Tuberculosis. (n.d.). Retrieved June 12, 2020, from https://www.who.int/health-topics/tuberculosis 4. WHO Coronavirus Disease (COVID-19) Dashboard.

Published June 17, 2020. Retrieved June 18, 2020, from https://covid19.who.int/.

5. Dutta, S., Lanvin, B., & Wunsch-Vincent, S. (Eds.). (2019). GLOBAL INNOVATION INDEX 2019 Creating Healthy Lives—The Future of Medical Innovation (12th ed.). Ithaca, NJ: Cornell University, INSEAD, and the World Intellectual Property Organization. https://www.wipo.int/ edocs/pubdocs/en/wipo_pub_gii_2019-chapter8.pdf 6. GE Healthcare data on file.

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Transasia steps up availability of ELISA test kits as ICMR prepares the country for mass antibody testing Transasia’s ErbaLisa COVID-19 IgG test kits, approved by ICMR, to play a crucial role in mass screening and easing of the lockdown tool for sero surveillance and to know where the disease stands in the curve. It is with this thought that Antibody ELISA tests are being widely conducted in the US and Europe,” said Mr. Suresh Vazirani, Chairman and Managing Director, Transasia-Erba Group.

Validated by ICMR and NIV, Transasia’s US-developed ErbaLisa COVID-19 IgG ELISA kit has more than 98% sensitivity and specificity, and is several times more affordable and accessible than RT-PCR.

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ransasia Bio-Medicals Ltd., country’s biggest Indian multi-national medical devices company, has announced wide availability of its recently launched ELISA antibody test kits through its countrywide network of over 50,000 diagnostic labs. Named the ErbaLisa COVID-19 IgG, the ELISA test kits are 98 percent accurate and come at 20 percent the cost of RT-PCR tests.

The ICMR, in its advisory dated June 23, has allowed private laboratories and hospitals to conduct serological tests across the general population with a view to easing the country out of the three-month lockdown. The directive takes the authorized labs for COVID-19 testing from the current 500 to over 80,000 labs spread across the country. With the government’s directive for serosurveillance and identification of asymptomatic individuals, the states have been asked to step up their testing capacity and make testing available to all symptomatic patients.

Several states like Maharashtra, Delhi, Haryana, Uttar Pradesh and Jharkhand have ramped up their testing with mega door-to-door serological surveys, and with the new ICMR directive, more states are likely to follow suit.

“With the country slowly trying to emerge from the lockdown and resume functionality, there is a need to scale up testing by at least five times in the next three months. ICMR’s mantra of Test, Track and Treat is very relevant in India to flatten the curve. ELISA test is a promising

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VALIDATED BY ICMR AND NIV, TRANSASIA’S US-DEVELOPED ERBALISA COVID-19 IGG ELISA KIT HAS MORE THAN 98% SENSITIVITY AND SPECIFICITY, AND IS SEVERAL TIMES MORE AFFORDABLE AND ACCESSIBLE THAN RT-PCR.

“Most labs in India are already equipped with ELISA automation and technicians are well trained for conducting ELISA tests, thus making it the ‘most conducive environment’ for testing. Compared to RT-PCR, the gold standard of testing, ELISA costs 80 percent lesser and allows for volume testing in a short time. The approved Rapid Ag tests, on the other hand, have a sensitivity of 50 percent, making it less reliable and requiring re-testing of large populations,” said Mr Ravi Kaushik, CEO, Transasia Bio-Medicals Ltd. “Transasia is well equipped to meet government’s current requirement of mass testing. Transasia’s US subsidiary, Calbiotech has a capacity to manufacture 25 lakhs tests per month. Further, our new COVID-19 dedicated manufacturing facility at AMTZ will localize ELISA antibody kits’ manufacturing that will increase the capacity by four times,” added Mr Kaushik.

Several majorly affected countries in the world are already using Transasia’s ELISA antibody test kits for past two months. “Being a global IVD player, Transasia has been at the epicenter of managing this crisis in the US, Europe, Latin American and Far-East countries.

Depending upon the level of sero-prevalence of infection, governments and policy makers can plan and implement for prevention and control of the disease, with periodic sero-surveys used to guide the policy makers,” said Mr. Vazirani.

Through the last three months, since the

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occurrence of the first positive case in India, ICMR has been adopting a calibrated approach.

In an effort to ramp up the testing capacity, the body recently released a comprehensive list of categories of people who should be tested as part of the sero survey, including high-risk or vulnerable populations like healthcare workers, frontline workers, immune-compromised individuals, individuals in containment zones, security staff, prisoners) to know who has been infected in the past and has now recovered.

“In view of the surge of returning migrant labourers, States/UTs need to focus on more effective surveillance, contact tracing, ade-

quate testing and timely treatment of all. This is especially true for 70 percent of the population who reside in 5,650 talukas in India. Through the recently launched iLAB, a state-of-the-art mobile lab, Transasia has partnered with the Government for conducting 400 ELISA tests per day in these remote areas,” cited Mr. Vazirani. “All through the lockdown, our manufacturing facilities continued to work to meet the demands of the Indian and global healthcare customers. Our sales and service frontline warriors, attended to close to 30,000 Doctors and lab technicians, to ensure uninterrupted services. With all these initiatives, Transasia remains committed to a Healthy and Atmanirbhar Bharat,” said Mr. Vazirani.

A CRUCIAL ROLE IN MASS SCREENING AND EASING OF THE LOCKDOWN.

SOTIO Presents New Data Showing Strong Anti-tumor Effect of IL-15 Superagonist SO-C101

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OTIO and Cytune Pharma from the PPF Group, presented new preclinical data highlighting the therapeutic potential of SOC101, an IL-15 superagonist, as a monotherapy and in combination with PD-1 inhibitors in multiple tumor models. The data were presented in a virtual poster presentation at the 2020 American Association for Cancer Research (AACR) Virtual Annual Meeting II. “SO-C101 is a highly promising modality in immuno-oncology given its ability to mobilize the two most important cell types driving anti-cancer immune responses, NK cells and CD8+ T cells. The preclinical data highlight the ability of SO-C101, an IL-15 receptor-b/g superagonist, to reduce and prevent tumor growth in multiple mouse models through the control of these two immune cell types when given as a monotherapy and in combination with PD-1 inhibitors,” said Radek Špíšek, Chief Executive Officer of SOTIO. “We look forward to completing the monotherapy arm of our Phase 1/1b dose finding study in advanced solid tumors before the end of the year and initiating the dose escalation in combination with pembrolizumab in summer 2020.”

The virtual poster was entitled “SO-C101 displays strong anti-tumor effect in TC-1 and

TRAMP-C2 tumor mice and in combination with PD-1 blockade prevents tumor development in an NK and CD8+ T cells dependent manner.” The data presented demonstrate the importance of NK and CD8+ T cells for the anti-tumor activity of SO-C101 as a monotherapy and in combination with PD-1 inhibition. Key findings presented include: • SO-C101 monotherapy decreases the rate of tumor development and tumor growth in the TC-1 mouse tumor model, a lung cancer model, in a NK and CD8+ T cell dependent manner.

• SO-C101 monotherapy induces proliferation and expands immune cells in the tumor, lymph nodes and spleen, and activates NK and CD8+ T cytotoxicity genes in the TC-1 tumor model.

• SO-C101 monotherapy decreases tumor growth of established tumors in the TRAMP-C2 mouse model, a prostate cancer model, and expands CD8+ T cells and NK cells, but not regulatory T cells.

• SO-C101 in combination with PD-1 inhibition prevents tumor development in TRAMP-C2 mice and delays tumor growth upon a re-challenge with tumor cells.

• SO-C101 mediated anti-tumor response in combination with PD-1 inhibition is dependent mainly on NK and CD8+ T cells in the TRAMP-C2 tumor model.

SO-C101 is currently being studied in a multicenter, open-label Phase 1/1b study (NCT04234113) to evaluate its safety and preliminary efficacy as monotherapy and in combination with pembrolizumab in patients with selected relapsed/ refractory advanced/ metastatic solid tumors.

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Cleveland Clinic Children’s Ranked Among the Best Children’s Hospitals by U.S. News & World Report 10 pediatric specialties ranked among the top 50 at American hospital that treats thousands of international patients each year

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leveland Clinic Children’s has been named a national leader in clinical care, according to the highly regarded U.S. News & Report’s 2020 - 2021 “Best Children’s Hospitals” rankings.

Cleveland Clinic Children’s – an integral part of Cleveland Clinic, which was ranked as the nation’s No.4 hospital in 2019 by U.S. News – earned national recognition in the U.S. in 10 specialties: cancer (17), cardiology and heart surgery (15), diabetes and endocrinology (44), gastroenterology and GI surgery (12), neonatology (14), nephrology (35), neurology and neurosurgery (25), orthopedics (26), pulmonology (32) and urology (23).

For 12 consecutive years, Cleveland Clinic

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FOR 12 CONSECUTIVE YEARS, CLEVELAND CLINIC CHILDREN’S HAS RANKED AMONG THE U.S.’S TOP 50 PEDIATRIC HOSPITALS.

Children’s has ranked among the U.S.’s top 50 pediatric hospitals. This year, four of those specialties ranked in the top 20 in the nation (cancer, gastroenterology and GI surgery, neonatology, and cardiology and heart surgery) and seven of those specialties ranked as best in Northeast Ohio (cancer, cardiology and heart surgery, gastroenterology and GI Surgery, neonatology, nephrology, neurology and neurosurgery, and urology). No children’s hospital in Northeast Ohio ranked in more specialties than Cleveland Clinic Children’s.

Each year, Cleveland Clinic also treats thousands of patients from around the world.

For patients who travel outside of their home country to receive services at one of its locations,

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the Global Patient Services team offers seamless care designed specifically to their unique needs and culture.

“We are incredibly honored to be recognized by U.S. News & World Report,” said Karen Murray, M.D., chair of Cleveland Clinic Children’s.

“This is a reflection of the dedication, compassion and hard work of our caregivers to provide the best, high-quality care to our patients and their families. While COVID-19 has transformed our world and the healthcare industry, it has not and will not impact our mission to continue to provide world-class care.”

Over the past year, Cleveland Clinic Children’s has been at the forefront of clinical innovation and research in pediatrics. Hospital highlights include: • A multidisciplinary team of specialists repaired spina bifida birth defect prior to birth, in a nearly 23-week-old fetus.

• An innovative split-liver and heart transplant surgery gave a young patient a second chance at life, with the best outcomes in the region.

• Magnetic spinal rods help improve outcomes and quality of life for young patients with scoliosis.

• A groundbreaking study showed that holding off a newborn’s first bath – 12 hours or more

after birth – can improve breastfeeding rates.

• A large data-mining study showed that digital conversations provide a needed emotional outlet for teens and adults coping with epilepsy.

Cleveland Clinic has cared for infants, children, and adolescents since its doors first opened in 1921. That history of pediatric caregiving has blossomed into Cleveland Clinic Children’s, standing today as one of America’s leading and largest providers of comprehensive pediatric care. Now, it’s more than 300 pediatric specialists and subspecialists– and more than 50 outpatient sites – provide the full spectrum of primary, specialty, and subspecialty pediatric care to the largest patient population of any children’s hospital in Northeast Ohio, and does so with the highest level of family-oriented care, as close to home as possible.

According to U.S. News, the “Best Children’s Hospital” rankings score the top 50 children’s hospitals in 10 specialties, based on clinical and quality data and an annual survey of pediatric specialists. The rankings methodology factors in patient outcomes, such as mortality and infection rates, as well as available clinical resources and compliance with best practices. Pediatric specialists around the country are also asked to provide their opinions on the best hospitals based on their inside knowledge of the delivered healthcare.

EACH YEAR, CLEVELAND CLINIC ALSO TREATS THOUSANDS OF PATIENTS FROM AROUND THE WORLD. FOR PATIENTS WHO TRAVEL OUTSIDE OF THEIR HOME COUNTRY TO RECEIVE SERVICES AT ONE OF ITS LOCATIONS, THE GLOBAL PATIENT SERVICES TEAM OFFERS SEAMLESS CARE DESIGNED SPECIFICALLY TO THEIR UNIQUE NEEDS AND CULTURE.

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OGT’s Cytocell portfolio to become available via Sysmex in China and Spain

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xford Gene Technology (OGT), A Sysmex Group Company, has announced that Cytocell® customers in China and Spain will now be able to benefit from the established, comprehensive sales and support services of Sysmex.

This significant addition to direct sales of Cytocell fluorescence in situ hybridisation (FISH) products demonstrates the extensive collaboration between OGT and Sysmex, as well as the continuing strategy to reinforce this—further expansions across the entire OGT portfolio are planned in the current financial year.

The expansion involves Sysmex Shanghai, Sysmex Hong Kong and Sysmex Espana. Customers in China will continue to be able to use the current Cytocell distributor, Youning Biotech, however, the addition of Sysmex Shanghai offers broader coverage of the market through a larger commercial organisation – providing OGT with improved access to the Chinese market via the existing Sysmex Shanghai sales team and its extensive network of distributors.

Sysmex Espana will be the country’s sole distributor for Cytocell products.

OGT’s Cytocell brand offers the widest range of FISH probes on the market and is well known

and respected for its high-quality, reliability and cost-effectiveness as well as its renowned customer support, service and expertise. When purchasing probes via Sysmex, users benefit from all this, as well as the vast reach and reputation that Sysmex has in their established markets.

Commenting on the announcement, Gareth Thomson, Executive VP sales at OGT said: “We’re very pleased to announce these new collaborations with Sysmex Group companies. It builds on a series of success stories in other territories where we work with Sysmex’s distribution network. It provides us with an excellent opportunity to grow significantly in these territories benefiting from the established relationships with major customers in the regions.”

OGT IS ALSO WORKING TOWARDS EXPANDING DIRECT SALES IN CERTAIN TERRITORIES OF ITS CYTOSURE™ CYTOGENETICS AND RARE DISEASE, AND SURESEQ™ CANCER NGS PORTFOLIOS.

OGT’s CEO, John Anson, added: “Today’s announcement also highlights the wider strengthening of our relationship with Sysmex that goes beyond sales and distribution. OGT became part of Sysmex Group three years ago and since then we’ve been seeing ever-closer collaboration in other parts of the company as well—for example in the development of new products for next generation sequencing.”

Gilead Sciences announces approval of Veklury® (remdesivir) in the United Arab Emirates for patients with severe Covid-19

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ilead Sciences, Inc. (Nasdaq: GILD) announced that the United Arab Emirates’ Ministry of Health and Prevention has granted regulatory approval of Veklury® (remdesivir) as an Emergency Medicine for treatment of SARS-CoV-2 infection, the virus that causes COVID-19.

The regulatory approval is supported by clinical data from the U.S. National Institute of Allergy & Infectious Diseases’ global Phase 3 trial, Gilead’s Phase 3 SIMPLE trial in patients with severe manifestations of COVID-19, and Remdesivir Compassionate Use Data, demonstrating the benefit of this treatment in helping patients recover faster, while having a trend towards a mortality benefit. Gilead understands the urgent needs of patients around the world, and the company has proactively scaled up manufacturing of remdesivir to increase available supply, as rapidly as possible. While there is currently limited global supply of remdesivir, the company anticipates new supply of the drug to start to become available in July, with supply continuing to increase through the end of this year and into next year. Gilead will work closely with the health authorities in UAE to provide guidance on anticipated drug supply based on local incidence and severity of disease.

JULY.AUG 2020

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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 JULY.AUG 2020

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