HOSPITALS Magazine issue 58

MINIMALLY INVASIVE SURGERY IN MULTIPLE SPECIALTIES. Rabii Madi, MD I Consultant Urology.

Ayman Al Harakeh, MD I Consultant Surgery.

Elias Abi Khalil, MD, Abdel Karim Nawfal, MD, Labib Edison Riachi, MD I Gynecological Surgeons.

CLEMENCEAU MEDICAL CENTER HOSPITAL DUBAI HEALTHCARE CITY 2.

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

HAMDAN CHARITY HOSPITAL A continuation of the loyalty approach and the service of humanity People will be remembered for their work, just like the late Hamdan bin Rashid Al Maktoum. His goodness had always been present even after his absence. Today, we see the goodness being embodied in the construction of Hamdan Bin Rashid Cancer Charity Hospital in Dubai that will be a comprehensive, high-level medical facility, outfitted with the latest treatment equipment and technologies.

With the support of His Highness Sheikh Mohammed bin Rashid Al Maktoum, Al Jalila Foundation, which is concerned with improving the lives of individuals and societies through medical innovation, and under the umbrella of the Mohammed bin Rashid Al Maktoum Global Initiatives (MBRGI), is building this medical facility as the first hospital of its kind to receive cancer patients in the UAE free of charge, who are unable to afford the treatment costs.

The hospital will attract qualified medical personnel of specialized doctors and trained nursing staff, in addition to being a pioneer in research and training, by exploring new treatment techniques for cancer disease, and investing in the preparation of medical and nursing talents and competencies to meet the hospital’s needs and improve its efforts.

The charity hospital was named after Sheikh Hamdan bin Rashid in honor of his rich journey through many humanitarian, relief, health, educational and economic initiatives that he sponsored across the world. Thus, Dubai succeeded once again in dedicating loyalty to the righteous people as a way of life, and providing medicine and a decent life for all. May God help you to keep humanity a supreme goal, and make health accessible to everyone.

Publisher

Photographer Hanna Nehme Copy Editor Jessica Achkar Editors Aline Debes, Mark Steven, Don Karn, Andrew Weichert, Colette Semaan, Abbas Moussa Advertising & Marketing advertising@tahmag.com Mirna Khayrallah mirna@tahmag.com Business Development Manager Ralph Rahal tahmag@tahmag.com Offices & Adresses AHMC, Lebanon Mansourieh High way, Jihad Wakim center, 3rd floor.

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

Distribution KSA - UAE - OMAN LEBANON - JORDAN SYRIA - KUWAIT BAHRAIN - QATAR - EGYPT 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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MAY . JUNE 2021

36 Clemenceau Medical Center Hospital Dubai introduces Robotic Surgery in multiple specialties

NEWS 10 Malaffi Supports the Abu Dhabi COVID-19 Vaccination Campaign 14 Medlab Middle East to address increased demand for COVID-19 testing 16 CAGS Webinar Series Continues with Webinar on Gene Therapy 18 New UAE IBD SOCIETY launched for those living with Inflammatory Bowel disease 20 Safeguard Medical Expands Emergency Medical Offerings with H&H Acquisition 26 How Deep Brain Stimulation Helped Michael Find a New Focus 30 Varicose vein treatment removes exercise barrier for nation’s obese 34 CAGS Conducts Webinar on Population Genetics 42 The first-ever truly personalised vision correction technology now in the UAE 46 Gulf Medical University’s Virtual Patient, secures Gold at QS MAPLE 2021 Education Awards 86 Omnicell set to showcase latest automation and intelligence solutions at Arab Health 2021 90 Al-Ahli Hospital Eradicates a Giant Splenic Cyst 114 A 60-year-old Man is saved from death by Al-Ahli Hospital

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116 Al-Ahli Hospital Performs Joint Replacement Surgeries Using the Latest Technology

COVER STORY 36 Clemenceau Medical Center Hospital Dubai introduces Robotic Surgery in multiple specialties, combining cutting-edge technologies and medical brilliance under one roof to bring healthcare standards in Dubai to international heights

MEDICAL INSTITUTIONS 62 Liv Hospital... Future of healthcare 84 Opening of the Ophthalmology Center LaserVision – Hôtel-Dieu de France 92 Neuronavigation in the surgical management of brain tumors: future trend now available at Almoosa Specialist Hospital

ARTICLES 80 Immunotherapy enhances survival in stomach cancer!

82 Radiotherapy today: Even some metastatic cancers can be cured 100 Protected and connected Restoring humanity in healthcare for health workers and their patients

Be Pure. Be Safe! palmapure.cz

Golden Drop Non-contact dispenser Gentle, fragrant disinfection for your hands

www.artincovid.com Calligraphy - Saleh Al Shukairi Graphic design - Pavel Šťastný

Golden Drop at the international traveling exhibition Helpful Art in Covid in UAE Made in Czech Republic

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66 Hospital Hotel Services 108 New Advances in Fetal-Maternal Medicine 110 Endometrioma and Infertility

INTERVIEWS 54 Dr. Fatih Mehmet Gul, MD, Chief Executive Officer of Fakeeh University Hospital 70 Dr. Martin Holcát, Deputy Director of the Motol University Hospital in Prague for curative and preventive care 88 Ralph Salloum, MD, Pediatric Neuro-Oncologist at Nationwide Children’s Hospital 94 Dr. Hisham Abu Al-Saud, Endocrinologist at NMC Royal Hospital - Khalifa City 96 Dr. Ahmed Kaabneh, HOD - Consultant Interventional Radiology - NMC Royal Hospital, Khalifa City

104 Single-use medical devices

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76 Infection control 97 Dr. Gilbert Ayoub, Chairman, HOD & Consultant General Surgeon 98 Dr. Sokiyna Al Ameer, Consultant Surgeon and breast surgery specialist at NMC Royal Hospital, Khalifa City 102 Dr. Neophytos Karamanos, MHSA Programme Coordinator at the University of Nicosia Medical School

FEATURES 66 Hospital Hotel Services 76 Infection control in coronavirus departments 106 Single-use medical devices 112 Bone Marrow Transplant 120 What is the link between insulin & weight gain?

110 Bone Marrow Transplant

NEWS

Malaffi Supports the Abu Dhabi COVID-19 Vaccination Campaign

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he UAE has set ambitious targets for COVID-19 vaccinations. Thanks to the Choose to Vaccinate campaign, the country is among the leading countries in the world in terms of vaccination rates, with over 11 million doses administered so far1.

In Abu Dhabi, the response to the pandemic has been exemplary from the beginning. As recently recognised by an independent survey

by London-based Deep Knowledge Group, which assessed the COVID-19 response of cities around the world, analysts ranked the Emirate on top. Against more than 50 parameters, including vaccination and testing rates, Abu Dhabi led the world with a robust and rapid response that helped protect the health and safety of the community. Mass testing centres, field hospitals, and drive-through facilities were established immediately to help contain the virus. The UAE Government took the strategic decision early on to secure vaccinations for residents as soon as possible, and the Ministry of Health and Prevention was among the first regulators globally to approve vaccines for emergency use. It then established vaccination stations in existing healthcare facilities and purpose-built facilities

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HAVING ACCESS TO THE MALAFFI VACCINES INFORMATION ENABLES MEDICAL STAFF AT THE POINT OF VACCINATION TO ESTABLISH THE STATUS OF THE PATIENT, VERIFYING WHETHER THEY HAVE BEEN PART OF ANY VACCINATION TRIAL OR WHETHER THEY HAVE ALREADY BEEN VACCINATED.

around the country to ensure that supply of vaccinations would meet the demand.

The country now has a vaccine distribution rate of 115.75 per 100 people1. From regulatory approvals to managing a supply chain, from setting up field centers to mass communications campaigns – all at record scale and speed – the logistical complexity of rolling out such a vaccination program at a national level successfully, is immense.

Malaffi, the established Health Information Exchange, has been an integral part of the Emirate’s pandemic response. Connecting electronic medical records to centralise patient information, the platform created a database of COVID-19 test results in the Emirate – a staggering 29,401,060 million tests to date. As part of the National Vaccination Program, Malaffi enables frontline healthcare workers and health authorities to manage patient vaccination data within the Emirate, which ensures that the right patients are getting the right dose at the right time, no matter where in the Emirate they go to be vaccinated.

"We are seeing good progress on a daily basis. Vaccination programmes are a challenge

NEWS

to manage but having Malaffi’s health information exchange technology in place is a significant enabler of the success of vaccination in the UAE. We can look at overall vaccination rates at an Emirate-wide level and monitor different indicators over time, that provides insights for the capacity planning, and at the patient level, we can record adverse reactions and check for any contraindications such as allergies. This makes the process more efficient and improves safety," notes Dr Farida Al Hosani, official spokesperson for the UAE health sector.

There are three main ways in which Malaffi is supporting the vaccination campaign:

Centralising vaccine information from points of vaccination Through a dedicated Vaccination Module, Malaffi is currently collecting and sharing vaccination information more than 100 facilities in Abu Dhabi that are part of the vaccination program. Due to the vaccination information being centralised in Malaffi, the DOH and the government have real-time insights about the Emirate's vaccination status. Having access to this information enables the authorities to generate operational reports, plan the vaccination capacities, streamline the logistics and the vaccine supply chain, and inform public outreach programmes. Healthcare professionals in Abu Dhabi have access to the COVID-19 vaccination information in Malaffi, which improves clinical decision-making and the efficiency of the vaccination program. In the near future, healthcare professionals will be able to see other immunisation data for patients – beyond the COVID-19 vaccine – easily within Malaffi.

Confirming eligibility for vaccination Having access to the Malaffi vaccines information enables medical staff at the point of vaccination to establish the status of the patient, verifying whether they have been part of any vaccination trial or whether they have already been vaccinated.

To enhance safety, medical staff at the point of care can also check the medical history of the

THROUGH A DEDICATED VACCINATION MODULE, MALAFFI IS CURRENTLY COLLECTING AND SHARING VACCINATION INFORMATION MORE THAN 100 FACILITIES IN ABU DHABI THAT ARE PART OF THE VACCINATION PROGRAM. DUE TO THE VACCINATION INFORMATION BEING CENTRALISED IN MALAFFI, THE DOH AND THE GOVERNMENT HAVE REAL-TIME INSIGHTS ABOUT THE EMIRATE'S VACCINATION STATUS.

patient and identify any possible contraindications to receiving the vaccine, such as allergies.

Access to these sources empowers informed decision-making and greatly improves the safety of the vaccination efforts.

Monitoring and reporting of adverse events Any vaccine side effect noted at the point of care by the clinicians in their electronic health records will be centralised through Malaffi. This information will be an invaluable source for the authorities to monitor the safety of the vaccines longer term. Looking toward the future, with the digital infrastructure provided by Malaffi, including the recently launched population risk management platform, the Department of Health will have a much clearer picture of the prevalence of chronic diseases or other conditions within the Emirate, that put patients at greater risk of developing severe illness. This information can be used to enhance its current outreach efforts to those individuals, and prioritise vaccine distribution accordingly. It is thanks to the foresight and strategic investments in such innovation that the UAE is one of the world leaders in COVID-19 vaccination. Malaffi is proud to play a supporting role in its success.

The information available in Malaffi and its population risk management tools will also contribute significantly to any advanced systems tailored for syndromic and pandemic surveillance and response. Such systems will be of the utmost value for early alerts and increased readiness to handle any potential future outbreak for the local and global population's safety, ensuring Abu Dhabi remains at the forefront of public health.

1. https/covid19.ncema.gov.ae/en

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21-24 June 2021 Live in Dubai and Online

12 Medical Conferences Empowering you to provide the most current medical care

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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 /Malaffi

NEWS

Medlab Middle East to address increased demand for COVID-19 testing

Tom Coleman

M

edlab Middle East, the MENA region’s largest medical laboratory exhibition and congress, in partnership with leading research firm Frost & Sullivan, has revealed the global in-vitro diagnostics (IVD) market grew by 14% in 2020 to US$85.9 billion, up from US$ 75.2 billion the previous year, as a result of meeting the demand for COVID-19 testing.

IVD, which refers to tests done on samples such as blood or tissue taken from the human body, can detect diseases or other conditions and can be used to help cure, treat, or prevent disease. The need for IVD has grown exponentially as a result of POCT and molecular diagnostics due to the surge of COVID-19 testing globally.

Tom Coleman, Exhibition Director for Informa Markets, said: “According to the Frost & Sullivan report, hospital-based testing unrelated to COVID-19, which accounts for 57% of the IVD market, was severely impacted as a result of reduced patient volumes. However, the IVD market is expected to witness robust growth in 2021 driven by new innovations and the ramp-up of rapid COVID-19 tests and the resumption of routine testing.”

The report also revealed the UAE and Saudi Arabia have already seen great progress in the clinical laboratory segment by introducing new technologies and the increasing penetration

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The Medlab Middle East Congress will host a dedicated session on 21 June addressing the challenges in laboratory management resulting from COVID-19, chaired

by Carlo Kaabar, Medical Director, MOHAP Laboratories, Purehealth, Sharjah, the conference will deep dive into the significant challenges clinical laboratories have faced, from initial testing and diagnosis to patient monitoring and treatment.

of private independent labs. The research has revealed a clear shift from hospital-based labs to independent labs with advanced technology, leading to lower-priced tests due to economies of scale.

“There are an anticipated four key growth areas for the POCT industry. We have already seen a rise in demand for rapid, economical, easy-to-use POCT devices for infectious disease diagnostics in the UAE to free up resources and monitor containment efforts. Other key areas that represent the biggest opportunities for growth are the adoption of managed clinical services in the region’s hospitals, smart labs-as-aservice for automation of laboratory services and the need for next-generation sequencing testing for genetic testing,” added Coleman.

On day two, a dedicated COVID-19 session will take place chaired by Dr Eiman Ahmed Al Zaabi, Chair of Department, Physician-Laboratory Medicine Services, Sheikh Shakhbout Medical City, Abu Dhabi, UAE and Dr Gehad Eltayeb ElGhazali, Consultant Physician and Service Lead Clinical Immunologist, Sheikh Khalifa Medical City, Abu Dhabi, UAE. The conference track will provide a unique opportunity for global experts and leading voices in SARS-CoV-2 virology, immunology, vaccines, clinical care, therapeutic guidelines, and trials to help shape development and response to the COVID-19 pandemic.

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NEWS

CAGS Webinar Series Continues with Webinar on Gene Therapy

Dr. Mahmoud Taleb Al Ali

T

he Centre for Arab Genomic Studies (CAGS) will continue the activities of its webinar series through its second webinar, to be held on 26th of May 2021 at 7 p.m Entitled “Gene Therapy” . The webinar will host talks from Dr. Denise Carbonaro-Sarracino, Orchard Therapeutics, USA and she will discuss an Overview on gene therapy, Dr. Isabelle Richard, Genethon, France and will discuss Innovative therapies & neuromuscular disorders: the scientist’s perspective, and Dr. Jon Andoni Urtizberea, Institut de Myologie, France will discuss Innovative therapies & neuromuscular disorders: the clinician’s perspective. The webinar will be moderated by Prof. Andre Megarbane, Lebanese American University, Lebanon.

CAGS started this series of webinars in February 2021, with each programme in the series featuring distinguished doctors and researchers in the field of genetics who share their most recent studies with the participants. The first webinar in this series focused on the genomics of infectious diseases, and was attended by

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CAGS STARTED THIS SERIES OF WEBINARS IN FEBRUARY 2021, WITH EACH PROGRAMME IN THE SERIES FEATURING DISTINGUISHED DOCTORS AND RESEARCHERS IN THE FIELD OF GENETICS WHO SHARE THEIR MOST RECENT STUDIES WITH THE PARTICIPANTS. THE FIRST WEBINAR IN THIS SERIES FOCUSED ON THE GENOMICS OF INFECTIOUS DISEASES, AND WAS ATTENDED

BY MORE THAN 400 PARTICIPANTS FROM ALL OVER THE WORLD.

Mr. Abduallah Bin Souqat more than 400 participants from all over the world and the second webinar focused on Population Genetics and attended by more than 600 participants.

Dr. Mahmoud Taleb Al Ali Manager of CAGS said” "Knowledge about gene therapy is still scarce, not only among patients and care givers, but also among medical professionals. This webinar is a small step towards mitigating this lack of information. We have designed the webinar in such a way that attendees will not only get an accurate understanding of gene therapy, but will also be able to see it from the perspective of both the research scientist developing the therapy as well as the clinician delivering it."

For his part, Mr. Abduallah Bin Souqat the executive manager of the award stressed the importance of continuing to organize such important events, which contribute significantly to the advancement of the medical sector and follow-up on the latest developments in the field of scientific research.

NEWS

Under the patronage of H.H. Sheikh Khalifa bin Sultan bin Hamdan Al Nahyan

New UAE IBD SOCIETY launched for those living with Inflammatory Bowel disease

Sheikh Khalifa bin Sultan bin Hamdan Al Nahyan

U

nder the patronage of H.H. Sheikh Khalifa bin Sultan bin Hamdan Al Nahyan, Dr Maryam Al Khatry, Gastroenterologist and Head of Department at IBHO Hospital and former President of the Emirates Gastroenterology and Hepatology Society, is proud to announce the formal launch of the UAE IBD Society. The society has been established under the supervision of Ministry of Community Development to help improve the lives of people living with this disease.

IBD (inflammatory bowel disease) is a broader term used to describe conditions that cause inflammation of the digestive system, with Crohn’s disease and ulcerative colitis being the two most common forms. It can be a debilitating condition, for which there is currently no cure. Whilst it is not known exactly how many people in the UAE suffer from IBD, it is thought to be between 2-4% of the population, with the onset occurring most commonly in adolescents and young adults aged 20-30.1 The society was founded by Dr Al Khatry, who has worked for many years with IBD patients and has seen first-hand how the condition affects all aspects of daily life, not only for patients, but also for their loved ones. Moved by the lack of support available to patients and the misunderstandings that exist around IBD, she pledged to formalise a group dedicated to supporting those affected

by IBD and advocate for their needs.

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The society will offer an inclusive programme aimed at improving the quality of life for patients. Connecting people is crucial, and efforts will be aimed at empowering patients to share experiences and support one another so they don’t feel alone, whilst working with significant figures who can be an active voice for the community to advocate their needs. Addressing misunderstanding and stigma are also key objectives for the society and with the launch of the region’s first dedicated IBD patient website (www.IBDUAE. ae), the society will use education and awareness activities to elevate public understanding and empathy. As the exact number of people affected by IBD in the UAE is not fully understood, the society also aims to develop a UAE patient registry.

Dr Maryam Al Khatry Commenting on the launch of the society, H.H. Sheikh Khalifa bin Sultan bin Hamdan Al Nahyan said “Since the formation of the UAE in 1971, our great father HH Sheikh Zayed bin Sultan Al Nahyan’s vision and leadership has invested in healthcare, recognising that the wealth of our nation is in the health of the people who live and work here. As a result, today, and under the great leadership of HH Sheikh Khalifa bin Zayed Al Nahyan, president of the United Arab Emirates, we have developed a healthcare system of the highest international standards. Supporting our population and directly addressing their needs results in a healthier, happier community.

Commenting on the launch of the society, Dr. Al Khatry said “Inspired by the achievements made by the sons of Zayed, we decided to contribute to making a difference for the people in the UAE who are affected by IBD. My aim was to create a community that is a welcoming, informative, and safe environment within which patients can talk comfortably about their condition. We want to encourage people to come forward, to actively seek advice, to share knowledge, and to ultimately support one another to achieve a better quality of life.”

1.

Centres for Disease Control and Prevention: Data and Statistics, Inflammatory Bowel Disease at https://www.cdc.gov/ibd/data-statistics.htm

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NEWS

Safeguard Medical Expands Emergency Medical Offerings with H&H Acquisition Comprehensive portfolio of life-saving products helps heroes save lives

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afeguard Medical, a global leader in emergency medical technologies and specialized training for first responders, announced that it has acquired H&H Medical Corporation. Highly regarded for its proprietary line of military-grade trauma products used in the critical minutes immediately following a traumatic event, H&H further expands the Safeguard Medical portfolio, better enabling those who respond to emergency situations to save lives.

"Our mission at Safeguard Medical is to equip and enable responders at every skill level to preserve life in any environment. The acquisition of H&H adds another trusted brand to our market-leading portfolio and expands our ability to partner with life-saving responders around the world," said Adam Johnson, chief executive officer of Safeguard Medical. "This acquisition is another important step toward fulfilling our vision to provide first responders with the most differentiated technologies and training."

Safeguard was formed in 2020 through the merger of Combat Medical Systems, Prometheus Medical, Trauma FX Ltd., and Water-Jel Technologies. With the addition of H&H Medical Corporation, Safeguard remains well positioned to not only solve the emergency medical needs of today, but also to prepare for the demands of tomorrow.

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DRIVEN BY INNOVATION AND REAL-WORLD EXPERIENCE, SAFEGUARD MEDICAL AIMS TO SOLVE NOT ONLY THE EMERGENCY MEDICAL NEEDS OF TODAY, BUT PREPARE FOR THE DEMANDS OF TOMORROW.

"Safeguard Medical is the ideal company to advance our vision of providing people with simple and effective medical solutions that make the difference between saving a life or witnessing a death," said Paul Harder, president, H&H Medical Corporation. "Safeguard's extensive range of emergency medical products and training, combined with its global reach, will give our customers access to an entirely new level of support."

About Safeguard Medical Safeguard Medical is home to the world's leading and trusted brands for emergency medical product technologies, and skills training. Offering a powerful portfolio of innovative, high-quality products, simulation capabilities, training courses and consultancy programs, Safeguard Medical is dedicated to advancing its mission of equipping and enabling responders at every skill level to preserve life in any environment. Driven by innovation and real-world experience, Safeguard Medical aims to solve not only the emergency medical needs of today, but prepare for the demands of tomorrow. Safeguard Medical is a company of Water Street Healthcare Partners, a strategic investor focused exclusively on the healthcare industry.

For more information, visit www.safeguardmedical.com

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1 Based on 6 month field test at the University Hospital Vinohrady – Department of Anaesthesiology and Resuscitation II 6 month field test at the Medizine Hochschule Hannover – Department of Neurology.

Nurses confirmed that SafetyMonitor did help prevent up to 5 falls. No falls were documented during the period of field tests.

2 Hoffman, et al. Claims-based Identification Methods and the Cost of Fall-related Injuries Among US Older Adults. Medical Care. Volume 54, Number 7, July 2016.

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NEWS

“Shedding light on your heart health to brighten up your life” Campaign Breathes New Life into Heart Failure Care diseases,” said Dr. Hiba Baroudi, Medical Affairs Head, Cardiovascular, Renal and Metabolism at AstraZeneca Near East & Maghreb. “We are counting on the media’s support to help alert people at risk of Heart Failure, especially those with symptoms, so they consult with their physicians on how best to prevent, diagnose, and treat their condition.”

About Heart Failure

T

he Lebanese Society of Cardiology (LSC), the World Heart Federation (WHF), and AstraZeneca have launched the “Shedding light on your heart health to brighten up your life” campaign to help improve Heart Failure prevention, diagnosis, and treatment in Lebanon through media outreaches and the regional “Your Health is Your Life” Arabic Facebook page: https://www.facebook.com/Sehtak.Hayatak/1-5 “It’s vital that people learn more about Heart Failure so those at risk or living with the disease can reach out to their doctors, especially once they recognize its symptoms which include shortness of breath, persistent coughing, persistent fatigue and weakness, ankle swelling, and impaired thinking,” said Dr. Malek Mohamad, LSC president, at a campaign launch event which also featured presentations from Dr Tony Abdel Massih, Chairman of the Heart Failure Working Group at the LSC; Dr Hadi Skouri, Heart Failure specialist at the American University of Beirut Medical Center; and Dr Georges Saade, the WHF representative at the LSC. “This is more and more important as there are novel treatments that can reduce mortality and hospital admissions; and provide improved quality of life through comprehensive therapy which offers many more event-free years.”6 “Medical advances only materialize into concrete health benefits when all those concerned come together to prevent and treat

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LEBANESE SOCIETY OF CARDIOLOGY, WORLD HEART FEDERATION, AND ASTRAZENECA AIM TO TRANSFORM HEART FAILURE PREVENTION, DIAGNOSIS, AND TREATMENT.

Heart Failure is a disease in which the heart cannot pump enough blood around the body.7 It is a chronic and degenerative disease with approximately half of patients dying within five years of diagnosis.8 Despite its seriousness, common symptoms are not always easily recognised.

They include shortness of breath, persistent coughing, persistent fatigue and weakness, ankle swelling, and impaired thinking.9 Public awareness about heart failure and its impact is worryingly low, leading to underdiagnosis, costly hospital admissions, and premature deaths.10 Heart Failure affects approximately 64 million people worldwide11 and can be as life-threatening as some of the most common cancers in both men (prostate and bladder cancer) and women (breast cancer).12 References 1.

Heart Failure is the number one cause of hospital admissions among those over 65 years old; and impairs to a great extent the patient’s quality of life as it feels like growing old overnight.13 While Hypertension, Cardiovascular Disease and being overweight are key risk factors, Diabetes in particular doubles the risk of developing Heart Failure.14

2.

3.

4.

5.

6.

7.

8.

9.

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12.

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https://www.facebook.com/Lebanese-Society-of-Cardiology-1582285291828185/ https://www.world-heart-federation.org/ https://www.astrazeneca.com https://www.facebook.com/Sehtak.Hayatak https://www.spotlightonheartfailure.com Vaduganathan M, et al. Lancet 2020;396:121−128 Mayo Clinic. Heart failure; 2020/05/29 [cited 2020 Jun 26]. Available from: URL: https://www.mayoclinic.org/diseases-conditions/ heart-failure/symptoms-causes/syc-20373142.

Mozaffarian D et al. Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation 2016; 133(4):e38-360.

American Heart Association. Warning Signs of Heart Failure [cited 2020 07 Aug]. Available from: URL: https://www.heart.org/en/ health-topics/heart-failure/warning-signs-of-heart-failure World Heart Federation. Accelerate Change Together: Heart Failure Gap Review; 2020 [cited 2020 Aug 6]. Available from: URL: https://www.world-heart-federation.org/wp-content/uploads/ HF-Gap-Review-Final.pdf Vos T et al. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016. The Lancet 2017; 390(10100):1211–59 Mamas MA et al. Do patients have worse outcomes in heart failure than in cancer? A primary care-based cohort study with 10year follow-up in Scotland. Eur J Heart Fail 2017; 19(9):1095–104.

Azad N, Lemay G. Management of chronic heart failure in the older population. J Geriatr Cardiol 2014; 11(4):329–37. https://www.everydayhealth.com/diabetes/diabetes-nearly-doubles-risk-of-developing-heart-failure/

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NEWS

How Deep Brain Stimulation Helped Michael Find a New Focus data about seizure patterns, which doctors can review and use to develop custom treatments.

The electrodes then deliver stimulation to these specific regions to stop seizures in their tracks.

With the power of deep brain stimulation and a single medication, Michael has been seizure-free since March 17, 2017.

M

ichael Francis, a law enforcement agent in Houston, Texas, has dealt with seizures all his life. As the first step in treating almost any chronic condition, Michael’s doctor prescribed medication to reduce his seizure activity and keep his epilepsy under control.

While Michael initially saw an improvement in the frequency and duration of his seizures, they quickly returned with full force. When increasing his dosage didn’t work, Michael’s doctor tried another medication, only to find the same results.

Medication after medication offered the same outcome: a temporary reprieve followed by a return of his seizures. Michael and his doctor kept trying different prescriptions, hoping that something would work in the long term. However, one of the last medications he tried caused him to lose nearly 90 pounds in five months. His frequent seizures and extreme weight loss meant Michael had to leave behind his job in law enforcement.

Hoping for a solution that could help him get back to the life he loved, Michael turned to the doctors at Baylor St. Luke’s Medical Center. After reviewing Michael’s history of drug-resistant epilepsy, Dr. Sameer Sheth knew the NeuroPace RNS System had the potential to help Michael heal. This technology works similarly to a pacemaker – a small device is implanted in the chest, and it is connected to electrodes placed in specific locations in the brain. These electrodes gather

“The most excitement for my future comes from the fact that I can see a long-term career, I can actually get my own vehicle, and that I can then spend more time out on my own getting back into a public life,” said Michael Francis.

“That’s what I’m looking forward to more than anything else.”

HOPING FOR A SOLUTION THAT COULD HELP HIM GET BACK TO THE LIFE HE LOVED, MICHAEL TURNED TO THE DOCTORS AT BAYLOR ST. LUKE’S MEDICAL CENTER. AFTER REVIEWING MICHAEL’S HISTORY OF DRUG-RESISTANT EPILEPSY, DR. SAMEER SHETH KNEW THE NEUROPACE RNS SYSTEM HAD THE POTENTIAL TO HELP MICHAEL HEAL.

Renowned Neurological Care St. Luke’s Health offers comprehensive care for a broad range of neurological conditions and brain disorders, giving hope to stroke victims and patients with some of the most debilitating diseases. Using breakthrough research and a collaborative approach, we are able to help patients recover function that is lost due to a brain tumor, stroke, or ruptured brain aneurysm.

Being the first in Houston to use CyberKnife® technology and the first in Montgomery County to use Gamma Knife® technology, our facilities offer the latest advancements in neurological medicine to treat patients effectively and with shorter recovery time. Our DNV-certified Comprehensive Stroke Centers at Baylor St. Luke’s Medical Center and The Woodlands Hospital have the capability to quickly intervene to stop the progression of stroke damage and prevent permanent impairment through minimally invasive techniques. Not only are we offering the latest treatment options, we are continuing to develop new, advanced treatments. Building a brain computer to restore vision to the blind and revolutionizing benign pituitary tumor removal are examples of our projects progressing the standards of healthcare—and we are focused on continuing to lead the way in neuroscience in Houston for years to come.

For more information: www.stlukeshealth.org/bslmcinternational l international@stlukeshealth.org l +1.832.355.3350

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Being ranked nationally in adult specialties means a lot to us. And it could mean a lot to you.

This year, U.S. News & World Report ranked us as one of the best hospitals in the country in multiple adult specialties: cardiology & heart surgery, neurology & neurosurgery, gastroenterology & GI surgery, cancer and geriatrics.

The best doctors, in one of the best hospitals, are here for you.

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

NEWS

Cancer therapies, Alzheimer’s and data sharing in pandemics discussed at WCM-Q Grand Rounds

Dr. Anas Hamad, Dr. Patrick Tang and Professor Takeshi Iwatsubo

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he safe use of anti-cancer therapies, the importance of sharing data during pandemics, and early treatment of Alzheimer’s disease were discussed by three expert speakers at Weill Cornell Medicine-Qatar’s (WCM-Q) Grand Rounds.

Dr. Anas Hamad, Director of Pharmacy at the National Center for Cancer Care & Research of Hamad Medical Corporation, discussed common causes of cancer-related medication errors and outlined effective error prevention strategies in his presentation. Dr. Hamad, who also holds the position of Adjunct Assistant Professor in the College of Pharmacy at Qatar University, also explained the importance of multidisciplinary teams for safe and effective cancer treatment to the audience of physicians, nurses, dentists, pharmacists, allied health professionals, students, researchers and educators.

In a separate Grand Rounds session, Dr. Patrick Tang, Division Chief of Pathology Sciences at Sidra Medicine, gave a talk titled ‘Breaking the Cider House Rules: Tales from a Global Epidemic and Two Pandemics’. Dr. Tang, who also holds the position of associate professor of pathology and laboratory medicine at WCM-Q, demonstrated the importance of data and sample sharing during outbreaks, epidemics and pandemics,

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ALL THREE LECTURES WERE ACCREDITED LOCALLY BY THE MINISTRY OF PUBLIC HEALTH’S DEPARTMENT OF HEALTHCARE PROFESSIONS – ACCREDITATION SECTION AND INTERNATIONALLY

BY THE ACCREDITATION COUNCIL FOR CONTINUING MEDICAL EDUCATION (ACCME).

identified barriers that hinder the effective management of outbreaks, and discussed the roles of individuals in identifying and stopping outbreaks. His talk drew upon his observations of the 2002-2004 global SARS epidemic, the 2009-2010 swine flu epidemic and the current COVID-19 pandemic.

Dr. Patrick Tang said: “We have learned from these three examples that sharing of knowledge, information and samples is essential for outbreak management. We have also learned that we have to be flexible, to keep adapting our methods based on what we have learned, we have to be accepting of new ideas and new collaborations.

Finally, we have to act swiftly and offer solutions, not barriers, which means we have to be prepared to use the best solution we have available rather than waiting for the perfect solution.”

A further Grand Rounds event featured Professor Takeshi Iwatsubo of the University of Tokyo discussing molecular neuropathy and very early treatment of Alzheimer’s disease. Prof.

Iwatsubo explained the basic characteristics of neuropathy in Alzheimer’s disease and outlined current strategies to develop disease-modifying therapies for use in the very early stages of the condition.

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NEWS

Varicose vein treatment removes exercise barrier for nation’s obese on their overall health,” explains Dr. Francesco Serino, a vascular surgeon and Director of the Cleveland Clinic Abu Dhabi’s vein clinic.

As obesity rates in the UAE and across the developed world continue to rise, doctors expect to see similar growth in the number of people affected by varicose veins. While easily treated in their early stages, some of the later stage complications such as painful skin ulceration, aching leg muscles and a feeling of heaviness in the legs cannot be reversed. As a result, doctors fear this will further discourage people from getting the exercise they need to help control their weight and maintain a healthy heart.

Dr. Francesco Serino

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hysicians at Cleveland Clinic Abu Dhabi, an integral part of Mubadala Health, are encouraging the community to seek specialist care for varicose veins to help them unlock a healthier future. Often seen as a cosmetic or minor issue, varicose veins are abnormal, dilated blood vessels caused by a weakening in the vessel wall that look like swollen, twisted clusters of blue or purple veins under the skin on the legs.

Although varicose veins do not usually present with symptoms in their early stages, if left untreated they can cause pain, discomfort, ulcers and even raise a person’s risk of blood clots.

“Many people simply think that varicose veins are unsightly and a natural result of ageing. This is not the case. Without treatment, they can progress to greatly affect a person’s quality of life and in their advanced stage, limit a person’s mobility.

As they are most common among people struggling with obesity, this reduced mobility can make their situation worse and have a profound effect

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“It’s never too late to make a healthy change in life by eating the right foods and moving our bodies more. If we are to tackle obesity, it’s important that we make that choice as easy as possible for people. By treating varicose veins early, we can help people feel empowered to make a healthy change and importantly, keep them mobile. It’s not a silver bullet but anything that encourages a more active life at any age is a true lifeline,” says Dr. Serino.

Cleveland Clinic Abu Dhabi’s ‘one stop’ vein clinic is designed to provide fast and convenient access to assessment, testing and treatment for varicose veins in a single visit. Following an initial consultation, more detailed testing can be ordered on the same day before proceeding to treatment if required. Staffed by vascular surgeons, scientists and specialized nurses, the vein clinic provides personalized care for each patient, helping them step into a healthier future.

“Varicose veins can be treated very easily, particularly in their early stages. The problem is that people don’t think they have a problem until they begin experiencing symptoms that affect their quality of life. As soon as you notice a varicose vein, you should consult a doctor for specialist advice to avoid more serious problems down the line,” continues Dr. Serino.

The vein clinic at Cleveland Clinic Abu Dhabi offers patients a range of treatment options from individualized compression technology to medications and a minimally invasive procedure that uses medical adhesive to quickly and effectively close a varicose vein. This procedure eliminates the need for invasive vein stripping surgery and avoids the high temperatures needed for laser treatment, allowing patients to return to normal activities the following day.

With 4 centers of excellence to provide best human centered care to our patients Orthopedic and Heart sports injuries center center

Cancer center

Neuroscience center

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NEWS

SEHA PIoneers the transfusion of washed platelets in SEHA care facilities Experts at ADBBS – Al Ain quickly jumped into action, adopting a new protocol for washing of blood platelets provided by donors and administering them to the patient in record time, to which the patient responded well.

Following the procedure, the patient’s platelet count returned to the optimal range without causing any further reactions or symptoms.

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bu Dhabi Health Services Company, (SEHA), the UAE’s largest healthcare network, provided washed platelets to a patient with very low platelets count who experienced an anaphylactic shock when transfused with platelets. An anaphylactic shock is a sudden and severe allergic reaction characterized by a marked drop in blood pressure, shortness of breath, and a significant decrease in oxygen saturation. The washing of platelets provided by donors, a procedure performed by Abu Dhabi Blood Bank Services (ADBBS), removes the plasma and proteins from blood products significantly reducing the risk of allergic transfusion reactions.

Dr. Saad Muhallab, Medical Director, ADBBS – Al Ain, said: “Five minutes following the start of platelets transfusion, which is required to treat his pre-existing condition, the patient presented with symptoms consistent with an anaphylactic reaction. This extremely rare reaction is caused by the presence of antibodies to a protein that is deficient in the patient’s blood due to hereditary causes. Patients who react like this to platelets transfusion must only be given washed platelets free from plasma containing proteins to caveat a reoccurrence.”

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“To ensure we meet this patient’s and others acute and ongoing demand for platelet transfusions, ADBBS has now adopted a platelet washing protocol, which requires two and a half hours for preparation. With the appropriate expertise and a validated protocol in place, we catered for the patient’s daily needs of washed platelets for two weeks and will be able to quickly react to any future cases of similar reactions,” added Dr. Muhallab.

WITH A FIRSTOF-ITS-KIND PROCEDURE IN SEHA CARE FACILITIES. THE NETWORK SUPPLIED WASHED PLATELETS TO RESOLVE A PATIENT’S VERY LOW PLATELET COUNT WHO REACTED WITH AN ANAPHYLACTIC SHOCK TO PLATELETS TRANSFUSION.

ADBBS was established in 2020 and is overseen by the Department of Health – Abu Dhabi (DOH) and managed by SEHA. Operating within a network of blood donation centers located in Abu Dhabi, Al Ain and Al Dhafra regions, ADBBS provides blood products and transfusion-related medical services across the Emirate of Abu Dhabi. By collaborating with the relevant authorities, stakeholders, hospitals, clinicians, and volunteer blood donors, ADBBS is an active and integral contributor to Abu Dhabi’s healthcare system, ensuring quality that adheres to international and local standards of excellence, established by the American Association of Blood Banks (AABB), the UAE Federal Regulation of Blood Transfusion, and the Department of Health – Abu Dhabi.

NEWS

CAGS Conducts Webinar on Population Genetics

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he Centre for Arab Genomic Studies (CAGS) conducted the second webinar in its monthly webinar series. The program focused on Population Genetics, and was attended by more than 600 participants from all over the world. The webinar started with a short remembrance speech about the Late Sheikh Hamdan bin Rashid Al Maktoum, the Patron of the Hamdan Medical Award, who passed away on March 24th, 2021.

In her speech, Dr. Stephany El- Hayek, Assistant Director of CAGS, emphasized that the late Sheikh Hamdan was a true visionary who dedicated a large part of his time and efforts towards improving the state of healthcare here in the UAE and also around the world. “It was actually his vision of reducing the burden of genetic disorders in the Arab World that led to the establishment of our Centre. His passing is a big loss for us at CAGS and the Award, and also for the wider medical and humanitarian community. We truly hope that we can continue our

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THE WEBINAR SERIES HAD BEEN LAUNCHED BY CAGS IN FEBRUARY WITH A WEBINAR THAT DISCUSSED THE “GENOMICS OF INFECTIOUS DISEASES”, WITH MORE THAN 400 PARTICIPANTS FROM ALL OVER THE WORLD. THE NEXT WEBINAR IN THIS SERIES, ON “GENE THERAPY”, WILL BE HELD ON MAY 26TH.

work on the path guided by Sheikh Hamdan’s vision”, she said.

His Excellency Abdullah Bin Souqat, Executive Director of the Award, highlighted the richness of the webinar topic and praised the efforts of the CAGS and the Award team. He also stressed that the Centre's organization of this webinar aims to enhance communication between specialists even during the Covid-19 pandemic.

The webinar hosted talks by Dr. Pierre Zalloua, Professor of Genetics at the Khalifa University, Abu Dhabi and Dr. David Comas, Head of the Human Genome Diversity Group at the Universitat Pompeu Fabra (UPF) in Barcelona.

The program was moderated by Dr. Riad Bayoumi, MBRU, UAE. The webinar series had been launched by CAGS in February with a webinar that discussed the “Genomics of Infectious Diseases”, with more than 400 participants from all over the world. The next webinar in this series, on “Gene Therapy”, will be held on May 26th.

COVER STORY

Clemenceau Medical Center Hospital Dubai introduces Robotic Surgery in multiple specialties, combining cutting-edge technologies and medical brilliance under one roof to bring healthcare standards in Dubai to international heights

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COVER STORY

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COVER STORY

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he healthcare sector is set to witness a leap in the UAE with Clemenceau Medical Center hospital Dubai - a center of excellence for diagnosis and treatment across several health specialties in the United Arab Emirates (UAE) - acquiring innovative robotic surgery technologies that allow the hospital to perform minimally invasive surgeries, including the da Vinci Surgical System which promises to transform patient care in the country.

Clemenceau Medical Center hospital Dubai is one of the few hospitals in Dubai and the region to offer this type of surgeries in multiple specialties led by a team of expert surgeons including: Dr. Rabii Madi (Urinary, Kidney & Prostate Tract Surgeon), Dr. Ayman Harakeh (Gastroenterology, Colon & Obesity Surgeon), and gynecologic surgeons Dr. Elias Abi Khalil, Dr. Abdul Karim Nofal and Dr. Labib Riachi.

The newest da Vinci robot does not replace the skills and expertise of surgeons. Instead, it

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THE DA VINCI SURGICAL SYSTEM BOASTS 4 ROBOTIC ARMS COMMANDED

BY THE SURGEON THROUGH A COMPUTER THAT OFFERS A 3D HIGHDEFINITION VIEW OF THE SURGICAL FIELD.

offers them the robust technology that enables them to perform complex surgeries with more precision. In fact, the da Vinci Surgical System boasts 4 robotic arms commanded by the surgeon through a computer that offers a 3D high-definition view of the surgical field.

Commenting on the importance of acquiring the da Vinci robotic technology, Dr. Rabii Madi said: "Robotic surgery has established itself as one of the most important and promising breakthroughs in medical innovation as it greatly expands our surgical capabilities and allows us to work with extreme precision on microscopic parts of the human body, which helps us make a difference on many levels. The advanced lens system magnifies body parts by 10 times their normal size, allowing us to perform highly precise minimally invasive procedures through a very small, 8-mm incision. Also, the robotic arms and specialized instruments that come with the system extend the capabilities of our eyes and hands, enabling us to work

COVER STORY

with extreme accuracy and move with ease. As a result, we are able to provide our patients with more effective treatments while reducing the possibility of blood loss and human errors; significantly improving the appearance of surgical scars; speeding up surgeries, hospital stay and recovery period; and alleviating pain." da Vinci is used in multiple disciplines to treat a range of conditions in general surgery (obesity, stomach cancer, reflux, hernia); in urologic surgery (prostate, kidney and bladder cancers); and in gynecologic surgery (removal of the uterus or uterine fibroids, ovarian diseases, organ prolapse and gynecologic cancers).

Talking about the impact of the surgical system on the healthcare industry, Mr. Abdul Rahman Khansaheb, Chairman of the Clemenceau Medical Center hospital Dubai, said: “Providing robotic-assisted surgeries at Clemenceau Medical Center represents significant progress in

DA VINCI IS USED IN MULTIPLE DISCIPLINES TO TREAT A RANGE OF CONDITIONS IN GENERAL SURGERY; IN UROLOGIC SURGERY; AND IN GYNECOLOGIC SURGERY.

medical and healthcare, knowing that patients no longer need to travel abroad to benefit from technological advancements as they can have access to them here in Dubai. Investing in this type of global technology reflects our ongoing commitment to providing premium healthcare in the UAE, allowing our patients to enjoy peace of mind and feel in safe hands."

From his end, Dr. Mounes Kalaawi, Chairman and CEO of Clemenceau Medicine International (CMI), said: "The introduction of robotic surgery at Clemenceau Medical Center hospital Dubai is a landmark in the history of medicine in Dubai and the region. This new technology positions our hospital at the forefront of leading-edge procedures, medically and technologically, and shows our full commitment to making the investment needed for our patients to benefit from groundbreaking technologies, led by brilliant medical specialists, as it is the case in all Clemenceau Medicine International hospitals."

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NEWS

HEPA filter reduces airborne respiratory particles generated during vigorous exercise

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espiratory aerosols are a common component of breath, and they are a common way for respiratory viruses such as COVID-19 to spread to other people and surfaces. Researchers who conduct exercise stress tests for heart patients at Mayo Clinic found that exercising at increasing levels of exertion increased the aerosol concentration in the surrounding room. They also found that a high-efficiency particulate air filter (HEPA) effectively screened out the aerosols and decreased the time needed to clear the air between patients.

Both studies are published in the journal CHEST. "Our work was conducted with the support of Mayo Cardiovascular Medicine leadership who recognized right at the start of the pandemic that special measures would be required to protect patients and staff from COVID-19 while continuing to provide quality cardiovascular care to all who needed it," says Thomas Allison, Ph.D., director of Cardiopulmonary Exercise Testing at Mayo Clinic in Rochester, Minnesota, and senior author of both studies. "Since there was no reliable guidance on how to do this, we put a research team together to find answers through scientific testing and data."

To characterize the aerosols generated during various intensities of exercise in the first study, Dr. Allison's team set up a special aerosol laboratory in a plastic tent with controlled airflow. Two types of laser beam particle counters were used to measure aerosol concentration at the front, back and sides of a person riding an exercise bike. Eight exercise volunteers wore equipment to measure their oxygen consumption, ventilation and heart rate.

During testing, a volunteer first had five minutes of resting breathing, followed by four bouts of three-minute exercise staged ― with monitoring and coaching ― to work at 25%, 50%, 75% and 100% of their age-predicted heart rate. This effort was followed by three minutes of cooldown. The findings are published online in CHEST. The aerosol concentra-

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tions increased exponentially throughout the test. Specifically, exercise at or above 50% of resting heart rate showed significant increases in aerosol concentration.

"In a real sense, I think we have proven dramatically what many suspected ― that is why gyms were shut down and most exercise testing laboratories closed their practices. Exercise testing was not listed as an aerosol-generating procedure prior to our studies because no one had specifically studied it before,” Dr. Allison says. “Exercise generates millions of respiratory aerosols during a test, many of a size reported to have virus-carrying potential. The higher the exercise intensity, the more aerosols are produced.”

The follow-up study led by Dr. Allison focused on how to mitigate the aerosols generated during exercise testing by filtering them out of the air immediately after they came out of the subject's mouth. Researchers used a similar setup with the controlled airflow exercise tent, particle counter and stationary bike, but added a portable HEPA filter with a flume hood.

Six healthy volunteers completed the same 20-minute exercise test as the previous study, first without the mitigation and then with the portable HEPA filter running.

Also, a separate experiment tested aerosol clearance time in the clinical exercise testing laboratories by using artificially generated aerosols to test how long it took for 99.9% of aerosols to be removed. Researchers performed the test first with only existing heating, ventilation and air conditioning, and then with the addition of the portable HEPA filter running.

"Studying clearance time informed us of how soon we could safely bring a new patient into the laboratory after finishing the test on the previous patient. HEPA filters cut this time by 50%, allowing the higher volume of testing necessary to meet the clinical demands of our Cardiovascular Medicine practice," Dr. Allison says.

The research team translated U.S. Centers for Disease Control and Prevention guidelines for aerosol mitigation with enhanced airflow through HEPA filters and showed that it worked well for exercise testing: 96% (plus or minus 2% )of aerosols of all sizes generated during heavy exercise were removed from the air by the HEPA filter.

AS A RESULT, WE HAVE BEEN ABLE TO RETURN TO OUR PRACTICE OF PERFORMING UP TO 100 STRESS TESTS PER DAY WITHOUT ANY RECORDED TRANSMISSION OF COVID IN OUR EXERCISE TESTING LABORATORIES.

NEWS

The first-ever truly personalised vision correction technology now in the UAE

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IFC-based digital healthcare start-up, Diginova Health Solutions, has now partnered with Vivior, a Swiss-based digital health company, to market precision diagnostics that uses behavioral data to personalize spectacle selection and refractive surgery.

"We are excited to introduce this breakthrough innovation in the UAE market. Be it an intraocular lens for cataract patients, laser eye surgery or progressive spectacle lenses – the Vivior Monitor allows optical solutions to be customised to the customer's and patient's lifestyle and visual needs", says Dr. Sarper Tanli, Co-Founder and CEO of Diginova Health Solutions.

A first in the global optical industry, the Vivior Monitor, is a wearable that provides accurate and objective real-life visual behaviour and not based on statistics or studies, to optimise vision correction solution.

Mario Stark, CEO at Vivior, adds: "Everybody has a unique viewing lifestyle, therefore needs unique vision correction, and we are delighted to partner with Diginova in bringing our cutting-edge optical solution to the region."

More about the Vivior Monitor and how it works When a patient visits the Ophthalmologist, information about his/her lifestyle and observable behaviour are recorded through interviews,

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THE VIVIOR MONITOR OFFERS OBJECTIVE DATA ON YOUR PATIENTS’ LIFESTYLES TO SUPPORT THE OPTIMAL SELECTION OF INTRAOCULAR LENSES, REFRACTIVE SURGERY SOLUTIONS AND PROGRESSIVE SPECTACLES.

surveys, and digital applications. This subjective manner of gathering information can lead to misunderstandings and impairs the selection of the best intraocular lens (IOL) and refractive surgery solutions for the patient.

• The Vivior Monitor offers objective data on your patients’ lifestyles to support the optimal selection of intraocular lenses, refractive surgery solutions and progressive spectacles.

• It is a wearable which consists of sensors measuring key parameters: distance, ambient light, orientation and motion.

• It does not include a camera or any other sensors which might infringe the privacy of the patient or other people. It is worn on prescription or clear glasses and records the patient’s activities.

The Vivior Monitor Customer/Patient Journey Step 1 - The customer receives the Monitor and wears it for 36 hours, including working and non-working days.

Step 2 - Once data collection is complete, the customer brings back the Monitor to the optician/optometrist, who will upload the data to the Vivior cloud, where AI algorithms process it.

Step 3 - The optician/optometrist can then visualize all the customer data and make recommendations for the lens selection.

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Please check with your local BD representative.

© 2021 BD. BD and the BD Logo are trademarks of Becton, Dickinson and Company.

NEWS

Gulf Medical University’s Virtual Patient, secures Gold at QS MAPLE 2021 Education Awards involving males and females of different age groups and ethnic backgrounds.

Gulf Medical University’s Chancellor, an international authority in medical education and developer of VPL, Professor Hossam Hamdy, said: “The ‘Virtual Patient’ uses artificial intelligence to create an authentic patient simulation through which students interact with patients which guides their learning and develop their reasoning and boost their communication skills used with the patients who later send feedback about their experience.” “It also helps students build a strong rapport and communication with virtual patients in the future, and receive feedback from the patients”

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harton-QS Reimagine Education Steering Committee, after three rounds of independent judging and three rounds of internal moderation, the project by Gulf Medical University, “Using AI and High-fidelity Simulation in Health Professions Education”, was awarded Middle East GOLD Winner.

QS MAPLE 2021 promotes the development of higher education in the Arab region and Africa in the global context, with the goal of stimulating international partnerships and supporting the processes of institutional evaluation and upgrading. This year’s theme ‘The Future Today: Sustainable growth towards 2030’ was the focus on the significant changes have been made within the education systems of the Arab and African regions with further advancements planned.

MAPLE 2021 – Arab region and Africa looked at the next ten years of innovations in the region, and how they can sustainably grow towards their targets for economic and societal prosperity.

Virtual Patient Learning, a unique educational innovation, was selected by 200 judges from projects submitted by 1400 entries by academic institutions from across 72 countries at the conference. First of its kind in the region, the application exposes medical and health professions students to 60 different patient problems

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PROFESSOR HAMDY INDICATED THAT ‘THIS ACHIEVEMENT IS AN EVIDENCE THAT UAE EDUCATIONAL INSTITUTIONS ARE NOW NOT ONLY USERS OF UP-TODATE TECHNOLOGY BUT PRODUCERS OF INNOVATION AND TECHNOLOGICAL CREATIVE SOLUTIONS”.

The problem-based learning (PBL) application invokes critical thinking, clinical reasoning, and communicational skills amongst students by giving them authentic medical problems presented by virtual patients including history and clinical examination, investigations, lab results, vital signs, X-rays, and interaction with virtual patients to obtain information that would help them correctly identify medical problems of each case and prescribe treatments. In VPL, Learning takes place through the interaction with the patient during which students are not given information but given the opportunity to look for the information that will help them come up with a diagnosis then decide a treatment.

Gulf Medical University (GMU) is a leading medical university in the Gulf region offering Medical and Health Professional Education in the field of Medicine, Dentistry, Pharmacy, Physiotherapy, Nursing, Medical Laboratory Sciences, Anesthesia & Surgical Technology, and Medical Imaging Sciences. GMU offers postgraduate programs in Toxicology, Public Health, Clinical Pathology. In addition, the university also offers Short-Term Certificate Courses for Health workforce development and career enhancement. GMU differentiates itself having its own network of Thumbay hospitals, clinics, and institutes.

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NEWS

WCM-Q researchers study the role of proteins in obesity

Dr. Karsten Suhre

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study of proteins circulating in the bloodstream has identified several proteins that may play a causal role in obesity, making them potential targets for drugs and therapies.

Researchers at Weill Cornell Medicine – Qatar examined more than 1,000 proteins in samples taken from individuals in Qatar as part of the Qatar Metabolomics Study on Diabetes, alongside data from European studies. In total, more than 4,600 individuals were involved in the three previous studies. The work was conducted in collaboration with the German Research Center for Environmental Health.

Using genetics to isolate the relevant proteins, they found that six proteins had a causal relationship with body mass index, even when other lifestyle factors were taken into consideration. Three of those proteins were found to contribute towards obesity, and at the same time, reflect the biological mechanisms resulting from increased body mass index.

The findings do not negate the need for people to avoid smoking, eat balanced diets, and perform exercise, but they do open up the possibility that medicinal interventions may one day be used to mitigate the role that these proteins play.

Dr. Karsten Suhre, professor of physiology and biophysics and director of Bioinformatics Core at WCM-Q said: “Common diseases are a

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PROTEINS ARE THE BUILDING BLOCKS OF THE BODY AND WCM-Q HAS THE TECHNOLOGY TO EXAMINE THEM AT A HIGH DEGREE OF DETAIL. IN ADDITION TO FINDING EVIDENCE THAT SIX PROTEINS HAD A CAUSAL RELATIONSHIP WITH OBESITY, THE RESEARCHERS ALSO IDENTIFIED A FURTHER 150 PROTEINS THAT WERE SIGNIFICANTLY ASSOCIATED WITH A HIGHER BODY MASS INDEX.

Dr. Shaza Zaghlool result of a complex interplay between genetics and a broad range of environmental perturbations. Environmental and lifestyle factors such as diet, physical activity and exposure to toxins can activate highly interacting protein networks, which in turn, may drive molecular mechanisms toward disease. This is likely the case for obesity, where environmental contributions to body mass index are well recognized.”

Dr. Shaza Zaghlool, research associate in physiology and biophysics at WCM-Q, and first author of the paper, said: “Although we could not prove evidence for causality by these proteins, their association with obesity is still important. Such associations provide us with a greater understanding of the biological role that these proteins play in the development of obesity, and ultimately, in the role that obesity plays in the risk of developing diabetes, well beyond the usual lifestyle factors that everyone knows.

This increases the possibility of developing drugs and therapies in the future that target obesity on a molecular level, together with the standard therapies like diet and exercise.”

The work was supported by the Biomedical Research Program at WCM-Q, a program funded

by Qatar Foundation. Dr. Suhre’s work is also supported by Qatar National Research Fund. The study can be read in full at: https://www.nature. com/articles/s41467-021-21542-4

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INTERVIEWS

Dr. Fatih Mehmet Gul MD, Chief Executive Officer of Fakeeh University Hospital

“We have a pioneering model that provides an ideal integration of healthcare services."

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INTERVIEWS

F

akeeh University Hospital provides a qualitative addition to the healthcare scene in Dubai, to offer a pioneering model as a fully digital and smart hospital and provides an ideal integration of healthcare services through the adoption of smart technology, in addition to the highly skilled medical staff. Dr. Fatih Mehmet Gul, CEO of Fakeeh University Hospital, gave an interview to “Hospitals” magazine in which he discussed the hospital’s strategy and the vision adopted to provide the finest health services that fit the patients’ needs through smart services that makes it one of the smartest medical institutions in the region.

First, we would like to talk about your strategy to provide a pioneering model in the healthcare sector.

Our group aims to be a leading integrated healthcare services provider in the region. Our key goals include enhancing clinical outcomes and patient experience using our tested care giving model. The group’s strategy focuses on being an integrated healthcare entity with

footprint across the entire region. With special impetus on medical academia and training.

Hence, Fakeeh University Hospital’s pioneering model provides a perfect fusion of healthcare services with academic excellence, which has been developed over the last 43 years.

What is the vision adopted in patient care that has made you today the benchmark of excellence and a patient destination?

Fakeeh University Hospital’s vision is to deliver the highest quality of outcomes for its patients, which is attained through adoption of smart technology and our carefully-chosen staff. All our staff members are custodians of our value system, along with being highly skilled, compassionate, and empathetic, which helps them to provide innate care for the patients.

It was a conscious decision to build Fakeeh University Hospital as a fully smart and digital hospital. The hospital’s integrated electronic medical records, provide supporting improvements to the quality and efficiency of health-

OUR GROUP AIMS TO BE A LEADING INTEGRATED HEALTHCARE SERVICES PROVIDER IN THE REGION. OUR KEY GOALS INCLUDE ENHANCING CLINICAL OUTCOMES AND PATIENT EXPERIENCE USING OUR TESTED CARE GIVING MODEL.

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care services for patients and the community at large. What makes the hospital a preferred destination, is that along with our highly-trained staff, our entire facility keeps patients at the center. All the patient rooms have been articulately designed with their comfort in mind. The rooms are all encompassing of the latest helpful medical technologies, an infotainment system and various assistive services. Fakeeh University Hospital also has an unmatched Patient App that places access to care and medical records at the fingertips of patients.

We have created our own benchmarks. An instance, the hospital’s Centralized Command Centre (C3), which is used extensively to monitor the entire hospital operations in real time. This supports us in delivering patient care at its epitome of efficiency. The hospital’s design has been curated thoughtfully with all life-saving services next to each other, thus being easily accessible.

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Perhaps one of the hospital’s main features is the combination of medical expertise and academic research. How does this contribute to providing the finest health services that suit patients’ needs?

Healthcare is an ever-evolving industry.

Every day we see newer inventions, innovations, and techniques being introduced. The advancements help healthcare providers like us to push the level of patient care even higher.

Thus, academic research is a key feature of the hospital, which will provide our doctors the necessary tools to improve patient outcomes.

Our research will be targeted towards filling vital gaps in patients’ needs. We have a roadmap prepared to build a university in the near future.

Fakeeh University Hospital will also lead the way in creation of Centers of Excellence in medical education and research.

WHAT MAKES THE HOSPITAL A PREFERRED DESTINATION, IS THAT ALONG WITH OUR HIGHLYTRAINED STAFF, OUR ENTIRE FACILITY KEEPS PATIENTS AT THE CENTER.

INTERVIEWS

The opening of Fakeeh University Hospital in Dubai is the first expansion of Fakeeh Healthcare Group outside the Kingdom of Saudi Arabia. What is the reason for choosing Dubai, Dubai Silicon Oasis in particular?

One of the group’s key strategies for growth has been to geographically diversify the business beyond Saudi Arabia. The decision to choose and expand into Dubai was arrived at because of the stable regulations and a developed infrastructure here.

Additionally, a key consideration was that Dubai is the hub for healthcare in the region.

Dubai Silicon Oasis was particularly chosen, as the group felt it suited the business growth strategy, wherein a smart hospital can be established and all nearby locations can also be brought under the umbrella of care delivery. It is easily accessible through two main highways and the distance to DSO from all other Emirates is almost the same.

What are the main elements of excellence that you are committed to and that have brought you to this global position after four decades of experience?

We follow a multidisciplinary approach and ensure cohesive teamwork. In the treatment plan of the patient, staff from different levels of the treatment pyramid are engaged. Such an approach is known to improve healthcare outcomes, reduce mortality rates and elevate patient satisfaction.

Our integrated data system gives the care model an additional edge. It seamlessly manages large unstructured patient data information, thereby aiding the doctors to make right treatment decisions at right time and thus, improve the overall quality of care. It also assists doctors to remotely monitor and manage the patient’s health, while either one of them being in any part of the world.

Lastly, Fakeeh University Hospital provides

OUR INTEGRATED DATA SYSTEM GIVES THE CARE MODEL AN ADDITIONAL EDGE.

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connected services across the continuum of hospital care, home care, and also virtual care.

This way, we can make sure that there are no gaps in the care delivery track for our patients.

Learning from the legacy of our parent group, Fakeeh Care, we have arrived at care delivery models that have the capability to transform lives through clinical excellence, compassionate care and health education.

Today, the Hospital is one of the smartest medical facilities in the region.

What are the systems in place that enabled you to achieve this?

True. The hospital has been built as a smart and future-ready facility. Some of the systems and facilities that make us ‘smart’ are, the elaborate and user-friendly app for patients – FUH Care, the hospital’s Centralized Command Centre (C3), an unmatched Hospital Navigation System, a multi-disciplinary team approach, and enhanced recovery protocols for faster healing.

FUH Care app is a wonderful tool developed by our team. With the use of Artificial Intelli-

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gence, it helps in patient registration and token generation from the comfort of the patient’s homes. Not only it saves time for the patients, it also allows us to be prepared in advance, and run the care process more efficiently.

Other highlights of the App include physician counseling, treatment planning, treatment information like access to lab reports and real time access to medications prescribed, early triage, post-discharge follow-ups, availability of informative healthcare content, and full data sharing with the patient.

Our international patients have benefitted immensely from the App. They can easily submit their existing medical record, while staying in their home country. Patient data integration and treatment planning can take place much before they travel and reach our hospital.

The patient infotainment system is also one of our key highlights. For today’s tech-savvy patients, it provides easy access to patient’s own medical information (in their regional language) and entertainment platforms, by a simple click of a button.

THE HOSPITAL HAS BEEN BUILT AS A SMART AND FUTURE-READY FACILITY. SOME OF THE SYSTEMS AND FACILITIES THAT MAKE US ‘SMART’ IS, THE ELABORATE AND USER-FRIENDLY APP FOR PATIENTS – FUH CARE.

INTERVIEWS

Other features that are being appreciated by our patients are region specific entertainment channels, meal ordering options where patients can also customize their meal/s (specific to their regional taste), concierge services management, and patient education content. From the infrastructure point of view, we have a 100% green building, and a smoke-free environment, to help patients recover faster and to enable our staff to perform better.

What about the latest smart medical equipment provided by the Hospital?

Although it may not be possible to include every detail here, let me provide you with a glimpse on the smartness quotient of the hospital. We have a robotic pharmacy, which has a fully automated medicine dispensing mechanism.

In turn, reducing waiting time at the pharmacies, eliminating language barriers, and getting the right medication without any manual flaws.

WE HAVE A 100% GREEN BUILDING, AND A SMOKE-FREE ENVIRONMENT.

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The hospital uses robot-assisted services for surgeries and physiotherapy as well. Robotic procedures are known to yield precise results, aid faster recovery, and reduce post-operative complications. We also have AI-enabled radio diagnostics, that help physicians in arriving at better diagnosis and patient treatment plans.

The hospital is equipped with smart beds, which essentially contain wireless communication features, nurse call options, various sensors, are ergonomic in design and reduce patient falls and injuries, among other utilizations. We have installed a Central Command Centre, for automated management of waiting times, OR utilization, bed utilization and patient volumes.

Ultimately, improving the efficiency of the hospital functions.

Our hospital likewise has specially-designed patient rooms to allow for sunlight in every room. This provides a spacious healing environment for our valuable patients.

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Some of the other advanced medical technologies and equipment include a nuclear medicine set-up, an evolved surgery suite, and a catheterization laboratory.

What is the role of global technology companies that you deal with to develop innovations that smartly serve patients and the medical team?

We can be training centre and a research hub for their medical professionals from across the region can come and learn about the latest technologies and procedures using the latest equipment’s available in the industry.

What are the Hospital specifications in terms of capacity, state-of-the-art equipment, as well as human resources’ competence and long-standing experience?

The hospital is built with a capacity to cater

THE HOSPITAL IS EQUIPPED WITH SMART BEDS, WHICH ESSENTIALLY CONTAIN WIRELESS COMMUNICATION FEATURES, NURSE CALL OPTIONS, VARIOUS SENSORS, ARE ERGONOMIC IN DESIGN AND REDUCE PATIENT FALLS AND INJURIES, AMONG OTHER UTILIZATIONS.

INTERVIEWS

more than 700,000 patients every year, which can be achieved through our 350-bed facility and 55 clinics.

The hospital has 4 hospital towers, and the facility comprises of 2 basements and 6 aboveground floors. The smart design has ensured that there are interconnecting bridges at all locations. For the ease of patients and their families, we have also built a spacious car park and a utilities block.

Our atrium has been designed to provide a

soothing environment, is spacious and well lit with natural light. It also has a café for patient relatives and family to relax and unwind during their stressful hours at the hospital. The latest addition to the atrium is the ever-changing artwork exhibition from various artists. A hospital with improved aesthetics is known to have positive impact on patients and their families.

THE LATEST ADDITION TO THE ATRIUM IS THE EVER-CHANGING ARTWORK EXHIBITION FROM VARIOUS ARTISTS.

To know more about Fakeeh University Hospital visit www.fuh.care

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MEDICAL INSTITUTIONS

Liv Hospital... Future of healthcare

L

iv Hospital was designed with the inspiration for the self-healing ability of the human body. Liv Hospital has become an institution forming Turkey's health vision at the global level with its flawless service concept and its healthbased attitude. It also offers the best services and solutions to improve the quality of life.

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Liv Hospital Vadistanbul Our center offers the highest level of health services with its experts and doctors who are specialized in many fields, designed to make you feel the same hospitality, professionalism and comfort every time you enter. Our center is equipped with the highest technology

OUR CENTER OFFERS THE HIGHEST LEVEL OF HEALTH SERVICES.

MEDICAL INSTITUTIONS

standards used in the world and thanks to its "smart building" technology, it is ready to carry you to the future not only in healthcare services but in all areas. Liv Vadistanbul is the only center in the world where you will not feel yourself in a hospital while receiving the highest healthcare service. Liv Vadistanbul offers a “Living Center” approach, which is the first of its kind in Turkey and rarely seen in the world. It will not only be an institution where you will receive quality healthcare, but also an area where you will leave your daily routine. We offer you a 7-star accommodation service as the hospital is surrounded by many social services such as shopping stores, restaurants, gyms and the beauty of the surrounding nature.

The International Guest Center at Liv Hospital offers a complete range of services such as: Second medical opinion with estimated treatment cost, medical appointment reservation, translation service for 20 different international languages, VIP service for all VIPs. Liv Hospital also has branches from outside with 9 international offices, 4 of which are in Arab countries, Iraq (Sulaymaniyah), Algeria, Somalia and Djibouti. These offices are provided with a doctor and a team for free medical examination. It serves you with the Turkish visa application team to make reservations for medical appointments and residence affairs.

Pediatric Health and Diseases

LIV HOSPITAL PEDIATRIC HEALTH AND DISEASES CLINIC AIMS TO PROVIDE THE BEST HEALTH SERVICES WITH THE AWARENESS OF PROTECTING THE HEALTH OF OUR CHILDREN IN THE FUTURE.

Liv Hospital Pediatric Health and Diseases Clinic aims to provide the best health services with the awareness of protecting the health of our children in the future.

With 24/7 service, all pediatric patients aged 0-18 can be diagnosed and treated in the pediatric clinic for 24 hours in both pediatric clinics, patient services and emergency services. The pediatrics clinic is open 24 hours a day, including holidays, with periodic vaccinations and regular follow-up. Medical branches within the Department of Pediatric Health and Diseases • Kidney Disease in Children • Rheumatism in Children

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• • • • • • • • • •

Heart Diseases in Children Endocrinology in Children Infectious and Common Diseases in Children Allergy and Immunology in Children Gastroenterology in Children Neurology in Children Cancer and Blood Diseases in Children Child and Adolescent Psychiatry Urology in Children Infant Risk Clinic

Breast Clinic In the Breast Clinic, patients are examined by doctors of different specialties and a combined treatment protocol is applied that diagnoses and treats breast diseases with the latest technological methods. The clinic of breast diseases provides services with its team consisting of breast surgery, nuclear medicine, oncology, radiation oncology, plastic surgery, genetics and psychiatry, and breast diseases specialists and nurses.

for couples in the field of reproductive health.

Unlimited support service, high clinical experience and final treatment protocols are offered to the guests in accordance with the determined quality standards and international standards.

WITH 24/7 SERVICE, ALL PEDIATRIC PATIENTS AGED 0-18 CAN BE DIAGNOSED AND TREATED IN THE PEDIATRIC CLINIC FOR 24 HOURS IN BOTH PEDIATRIC CLINICS, PATIENT SERVICES AND EMERGENCY SERVICES. THE PEDIATRICS CLINIC IS OPEN 24 HOURS A DAY, INCLUDING HOLIDAYS, WITH PERIODIC VACCINATIONS AND REGULAR FOLLOW-UP.

Orthopedic Clinic Spine surgery requires close collaboration between various departments, especially orthopedics and neurosurgeons. Congenital anomalies of the spine (premonitions) are treated by experienced specialists with advanced technology. Joint Surgery Unit offers solutions to all degenerative joint diseases including meniscus repair and pelvic and knee joint prosthesis with the MAKOplasty method.

IVF Center The road to parenthood can sometimes be hard and long Liv Hospital IVF Center team turns couples' dreams into reality with high success rates.As with all medical procedures, the IVF Clinic offers the most advanced treatment options

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Chemotherapy cabinets in Liv Hosptial Vadistanbul

MEDICAL INSTITUTIONS

1,5 Tesla MR-Linac Unity

Radiation Oncology Radiation therapy aims to eliminate cancer cells or stop cells from dividing. 70% of all cancer patients need radiation therapy at any stage of treatment.

Maximum protection of healthy tissues Technological advances help improve patients' quality of life and contribute to increasing the chances of treating cancerous tumors, especially in pancreatic cancer and other cancers, thanks to MR-Linac technology, promising progress has been made in the treatment of pancreatic cancer that has killed many. Because it can only be diagnosed in its final stages, its symptoms are due to its insidious nature. The treatment plan is divided into three:

1. Scanning MRI is taken daily in anticipation of physical development of the patient.

2. Planning Rescheduling done by clinicians and has fast, real-time adaptive features. As emergency plans for medical intervention are laid out, it is carried out taking into account the immediate changes of the patient.

3. Treatment It is applied with continuous targeted imag-

ing during radiotherapy. Brachytherapy is a form of treatment performed by bringing radioactive sources closer to the tumor.

It is generally used successfully in the treatment of gynecological cancers (uterus, cervix, vagina), lung cancer and skin cancers. Today, brachytherapy can be applied in 3D in combination with imaging methods with the principle of segmental anatomy such as CT scans and magnetic resonance imaging.

"WITH 1,5 TESLA MR-LINAC UNITY, YOUR RADIATION ONCOLOGY TREATMENT TIME WILL DECREASE 6 TIMES. MR-LINAC UNITY CAN CHANGE THE PROCESS ACCORDING TO POSITION, SHAPE AND BIOLOGY OF THE SENSITIVE ORGANS SUCH AS STOMACH, KIDNEYS, HEART, SPINE, BLADDER AND INTESTINE DURING THE TREATMENT.

Steam Cell Center In the stem cell production center of Liv Hospital, which is the first hospital in Turkey with GMP standards for regenerative medicine, safe and high-quality formulated biological products are produced.

Our aim is to provide our patients with both cellular and tissue-based medical treatments, using advances in genetic science and biotechnology, as well as providing the expertise and infrastructure to solve complex legal, financial and industrial issues related to the transport of cellular and tissue products to patients.

The mission of the Stem Cell Production Center for Regenerative Medicine is to provide a comprehensive service to patients through the coordinated work of clinicians, researchers and bioengineers, and support newly approved biological therapies and stem cell production and applications.

IN THE STEM CELL PRODUCTION CENTER OF LIV HOSPITAL, WHICH IS THE FIRST HOSPITAL IN TURKEY WITH GMP STANDARDS FOR REGENERATIVE MEDICINE, SAFE AND HIGH-QUALITY FORMULATED BIOLOGICAL PRODUCTS ARE PRODUCED.

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ARTICLE FEATURES . Hospital Hotel Services

Hospital Hotel Services Welfare, physical and psychological health, and a new step towards the future

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mong the numerous developments that hospitals are constantly witnessing in order to meet the patients’ aspirations and provide them with the best service, hotel services have been at the core of these developments, whether in terms of hospital engineering or the quality and level of service provided. It is known that hospital hotel services are non-medical services provided by the hotel services department in the hospital to patients with the aim of improving the patient’s psychological and physical condition while improving the impression of the hospital services. The main motivation behind this qualitative step stems from the medical sector's realization of the importance of the patient's psychological comfort and its reflection in the improvement of his medical condition and his recovery. Arab hospitals have been introducing this development into their programs as part of their pioneering achievements.

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Hospital hotel services include many aspects, namely nutrition, cleaning and laundry services, entertainment and recreational areas, such as the hospital garden, as well as the courtesy of employees who are selected among the specialists in these services in hospitality schools. In addition, attention is paid to mattresses and furniture etc. to ensure patient comfort at all levels.

In order to achieve these services in the best way possible, it is imperative to allocate a sufficient budget to improve the quality of these services, train new workers before assuming their duties, educate citizens on how to deal with hospital facilities, in addition to the hospital administrations’ attention, follow-up and monitoring of the quality of hotel services.

The importance of this sector is that it opened the door to cooperation between hospitals and hotels on the one hand, and between hospitals and hotel service training schools in the hospital on the other hand. It also opens new job opportunities and, more importantly, leads to a better service for the patient, which is the ultimate goal of every hospital.

Diversity of services Hospital hotel services are non-medical services provided by the hotel services department in the hospital to patients with the aim of

ARTICLE FEATURES . Hospital Hotel Services

improving the patient’s psychological and physical condition while improving the impression of the hospital services. The program provides a comprehensive definition, quality concepts, characteristics and methods of measurement. It also reviews hospitality departments and sections in hospitals, including the internal supervision department and food and beverage management. For example, workers in this field are trained to: • Communication and information services, public services, as well as treatment and courtesy of employees • The concept of hotel service quality in hospitals • Dimensions and characteristics of hotel service quality • How to improve the quality of hospital hotel services • Methods of measuring hotel service quality SERVQUAL – SERVPERF • Operational problems within the hospital hotel sector and how to overcome them • Job description for employees working with internal supervision • The SOP (Standard of Procedures) for the job tasks of internal supervision workers • Cleanliness of public places, rooms and bathrooms • Cleanliness of critical areas (operating rooms - intensive care, etc.)

• Food and beverage management in hospitals • Job description for hospital food and beverage management personnel • Health requirements that must be met in food preparation and processing premises • Health control over food handling procedures (receipt - storage - preparation and processing - cooking - serving) • Methods of food and beverage services in hospitals • Room service • Therapeutic nutrition and how to plan patient menus.

THE PROGRAM OF HOSPITAL HOTEL SERVICES DEALS WITH THE QUALITY MANAGEMENT OF WHAT THE HOSPITAL PROVIDES TO THE PATIENT. IT AIMS TO UPGRADE THE PARTICIPANTS' EXPERIENCES AND PROVIDE THEM WITH THE NECESSARY SKILLS AND EXPERTISE TO ENSURE QUALITY IN HOSPITAL HOTEL SERVICES.

In order for these programs not to stop in light of the coronavirus pandemic, remote training is adopted, and lectures are interactive using the latest virtual classroom systems to implement a direct and fully interactive training process between the lecturer and the trainees.

These lectures are recorded throughout the learning period in the training program until trainees can watch it again later after the end of the lecture.

The training program, as written in the certificate granted to the trainee: Quality Management in Hospital Hotel Services Course, discusses the hotel services provided to patients during their hospital stay in terms of quality and services available and missing from the perspective of patients benefiting from these services, in order to learn about patients' satisfaction with the quality of these services.

A study conducted in this regard reached several results, namely that the level of quality of hotel services and satisfaction with them is a relative matter that varies from one person to another according to his gender, age, educational level, place of residence and other factors. The study contributed to the inclusion of new themes and elements for the quality of hotel services, including allocating a budget to improve the quality of hotel services, training new workers in hotel services before assuming their duties, educating citizens on how to deal with hospital facilities, in addition to the hospital administrations’ attention, follow-up and monitoring of the quality of hotel services.

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ARTICLE FEATURES . Hospital Hotel Services

The Development of Arab hospitals The performance of the Hotel Services Department in any hospital depends on scientific methods and spreading a culture of quality among employees in order to move towards providing unique services to address the competitive challenges it faces in the market and reach success. This can only be achieved by providing high-quality services that are able to fulfill the patients’ needs and desires of patients in a way that is consistent with their expectations and achieves their satisfaction and happiness.

To achieve this, there are several departments that can be relied upon, including: the food education department, the food production department, the food service department, the housekeeping division, the public cleaning department, the laundry department, among others. The hotel service has become an integral part of the hospital health service, and Arab hospitals have begun to adopt these services, and are constantly developing them in a way that meets patients' satisfaction. Many of these hospitals now have a unique hotel department that provides comfort and welfare for the patient and his family inside the hospital and throughout his stay.

For instance, the department representative welcomes the patient once he is admitted in the hospital, then takes him to his room, even if his health condition does not require him to be accompanied by paramedics; the representative makes sure that the patient is comfortable in it.

Then, the kitchen receives instructions to deliver hot and healthy meals to the patient at their specified times. If a woman is going into labor, the department makes sure that the room is decorated and ready to welcome the newborn.

The department is also keen - through room service employees - to keep the room clean in particular, and the hospital in general on a regular and continuous basis. As for any inquiries and remarks about the service, the department managers receive them and work to solve them immediately.

Of course, hospitality department managers in Arab hospitals possess skills in leadership, communication with clients and solving ev-

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Because the Arab countries have firmly launched the medical tourism revitalization, in terms of competition and patient attraction, which only occurs if the hospital provides top-notch service, this has pushed the process of converting hospitals into hospitals with hotel services.

eryday problems. These hospitals are spread across most Arab countries from the Arab Gulf to Egypt, Jordan and Lebanon, as well as in a number of northern African countries. For these hospitals, hotel services have become an integral part of the health service therein, given the importance of providing psychological and physical comfort to the patient and improving his impression of the hospital services, which contributes to comprehensive quality in hospitals, improving the work environment and gaining customers’ trust, and then achieving excellence and distinction at the clinical and service levels.

Although the repercussions of the Covid-19 pandemic have made this matter difficult and has limited its speed, however, it is expected that they will witness a promising surge, and preparations for it have begun, whether by spending more, adopting favorable laws, or holding seminars and conferences that shed light on this topic and encourage it.

5th Consecutive JCI Accreditation Against All Odds

2020 has been a challenging year filled with obstacles.

Despite all, CMC is honored to announce that it has been accredited for the 5th consecutive time by the Joint Commission International (JCI)-7th edition with distinction for the highest standards of healthcare quality and patient safety.

INTERVIEWS

Deputy Director of the Motol University Hospital in Prague for curative and preventive care

Dr. Martin Holcát “Art is part of a positive therapy and it cures”

M

artin Holcát, M.D., MBA, is the deputy director of the Motol University Hospital in Prague for curative and preventive care, the largest hospital in the Czech Republic. A former Health Minister, he’s one of the founders of DiApp Foundation – Centre for Telemedicine and has contributed to the creation of the exhibition and project Helpful Art in Covid.

How do you see the situation in the Czech healthcare system and what is the current operation of outpatient clinics at the University Hospital in Motol, the largest in the country? Are you already thinking about returning to prepandemic Covid-19 operations?

Motol Hospital has relaxed some restrictions on medical procedures that were introduced in

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THE WAVES OF THE COVID-19 PANDEMIC HAVE FUNDAMENTALLY CHANGED AND INTENSIFIED THE PSYCHOLOGICAL PRESSURE AND STRAIN WITH DEMANDING DAILY SCHEDULES OF HOSPITAL OPERATIONS.

connection with the Covid-19 epidemic. The surgeries have remained open since the outbreak for patients in need of urgent medical care and some procedures that were not necessary for the immediate maintenance or improvement of health were only postponed, and now we are gradually attending patients who had to wait for them. It’s premature to estimate now when a return to normal will be possible, but as soon as the situation so allows, we will provide care to the same extent as before the emergency measures. A big problem, though, is the mental health of doctors and medical staff. The waves of the Covid-19 pandemic have fundamentally changed and intensified the psychological pressure and strain with demanding daily schedules of hospital operations.

How can mental health be helped in such challenging times?

We have set up an in-house acute psychological assistance unit with a Help line and also, thanks to the Helpful Art in Covid project, we have linked up with Neo Centrum, a private psychological clinic, who have offered their services free of charge to help our doctors and medical staff get through this psychologically challenging days. This is valuable real help.

INTERVIEWS

I’m also convinced that art is part of a positive therapy and it cures, and that's why at the beginning of this year we placed the exhibition Helpful Art in Covid in our hospital's headquarters building, which has helped us survive the pandemic in a better mood and with common sense. The pandemic has affected the whole world, and artists from many countries responded to it in specific ways. The works are inspiring and capture the ideas and impressions they had during the pandemic. We organised the exhibition together with artist Pavel Šťastný not only as a way to show our gratitude, but also with the intention of mapping the unique results of the creative processes of artists here and abroad.

I’M CONVINCED THAT ART IS PART OF A POSITIVE THERAPY AND IT CURES.

The international travelling exhibition maps over 2,000 works of art from 90 countries and I hope that we can present it in the Middle East, too. I have been working with Pavel Šťastný for decades on various healthcare projects.

The exhibition travelled from Motol to the central University Military Hospital and then to the Kotva department store in Prague, where it’s been complemented by the sale of innovative anti-covid products from Czech companies that were developed in the span of one year under the name Czech Anti-Covid Industry.

New prototypes of other products are still being developed and one of them is the Golden Drop touchless disinfectant dispenser. Thanks to

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the collaboration of visionary Serge Borenstein, designer Federico Díaz and artist Pavel Šťastný, a design was created specifically for the Middle East with Arabic calligraphy by Saleh Al Shukairi.

The Palmapure disinfectant, mixed according to a Czech recipe, is gentle to the skin and fragrant.

So your range of interests is much broader. You have also taken care of Czech presidents...

Yes, the first president I took care of was Václav Havel, who was a playwright and an artist. While it’s a position of high responsibility, presidents are only human and have their normal human ills, such as smoking. I must say that all three presidents I have cared for have been very humble and disciplined patients.

What problems is hospital management solving nowadays?

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THE MATERIALS, THE TECHNOLOGY AND THE BUILDINGS, TOO, AGE VERY QUICKLY AND RENOVATION IS VERY EXPENSIVE. THIS IS ESPECIALLY TRUE FOR THE MOTOL UNIVERSITY HOSPITAL, THE LARGEST IN THE CZECH REPUBLIC.

I cannot ignore the current situation and everything related to the Covid-19 pandemic. This means responding to ever-changing conditions in a timely manner, to ensure sufficient care for affected patients and their hospitalization, to provide intensive care for the severely affected, to provide care and rehabilitation for post-covid syndromes, to prepare antigen and PCR testing centres, to manage the vaccination centre and the inpatient antibody administration centres, and also to attend the urgent and acute care needs of non-Covid patients.

In terms of running the hospital, one of the most important priorities is to ensure economic stability and sufficient resources. This is related to the maintenance or better development of modern health care towards patients, and the appreciation of the work of the staff.

Medicine is developing very fast, we have to apply new trends, diagnostic and therapeu-

INTERVIEWS

tic methods and keep a high professional and ethical level. The materials, the technology and the buildings, too, age very quickly and renovation is very expensive. This is especially true for the Motol University Hospital, the largest in the Czech Republic.

And what about beds?

The bed stock at Motol Hospital was reorganized in record time to provide care for patients with COVID-19 in an environment that minimizes the risk of transmission to other patients and hospital staff, and we’ll be keeping these capacities on immediate standby for the time being.

Should there be a sharp increase in hospital admissions, we will be able to release them immediately. Other inpatient areas have not been not significantly affected by these changes, and so we can keep these capacities in reserve for as long as the situation requires.

What do you think will help the Czech healthcare system in the future?

I think there is a need for a broader, primarily professional consensus on a future concept of the Czech healthcare system and then some continuity in the implementation thereof. The worst is the constant changing of goals without concept, and political populism. Healthcare should not be held hostage by political parties. I know that's a lot of idealism, healthcare is unfortunately a very easy to use card in politics. I'm artificially separating medicine and healthcare here. The former is advancing very rapidly, and the latter should be able to apply the new discoveries,

WE COLLABORATE ON VARIOUS MEDICAL PROJECTS AGAINST COVID-19 WITH CZECH COMPANIES THAT HAVE DEVELOPED AND PUT INTO PRODUCTION DOZENS OF NEW PRODUCTS AND TECHNOLOGIES VERY QUICKLY IN THE PAST YEAR.

which is very expensive. Medicine is progress, healthcare is political application. Therefore, in order to help the health sector it’s important to set priorities and clarify value criteria. It must be made clear whether the priority is to treat a cold or a serious illness. And, of course, we need to have a stable concept and coordination.

What are the trends in medicine that you see in the future?

With diagnostics, we're going to an even lower elementary level. For instance, modern imaging methods can zoom in on individual cells or even molecules. Genetics is not only improving the diagnosis of diseases, but also tells us whether or not the drugs will have a therapeutic effect, or whether a very expensive drug is worth administering.

Transplantation medicine is developing significantly, too. Cardiology and cardiac surgery are at a high level. In surgery, on the one hand, there is a trend towards less invasive procedures where many cases are using endoscopic approaches and robotic surgery. On the other hand, we are moving to procedures described as heroic medicine, i.e. large-scale transplants of several organs; we have already seen the first transplants of intestines, limbs, faces, and even uterus. Another trend is the implantation of electronic devices, both in cardiology and neurosurgery, various stimulation implants, cochlear implants. As a university hospital, we are trying to support and develop these trends.

We also collaborate on various medical projects against Covid-19 with Czech companies

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that have developed and put into production dozens of new products and technologies very quickly in the past year. During the year of the pandemic, the Czech Republic became one big technological Start-Up.

And DiApp, where you work, is also part of this trend?

Yes, we’re also developing the field of telemedicine in the DiApp Foundation - Centre for Telemedicine, which we established last year, at the time of the coronavirus. Telemedicine is permeating many medical disciplines, the transmission of information remotely, e.g. via mobile apps, enables continuous monitoring of patients' health condition and helps them lead a better quality of life despite their disabilities.

In the first phase, we’ve focused on a project to support children with type 1 diabetes, and

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PAVEL ŠŤASTNÝ IS ALSO AN AMBASSADOR OF OUR FOUNDATION. TOGETHER WITH THE HELPFUL ART IN COVID PLATFORM, WE WANT TO FOCUS ON PROFESSIONAL PSYCHOLOGICAL HELP.

their families. More than 800,000 people are affected by the disease and many more are not yet aware of it.

We’re working together with Motol’s diabetologists and thanks to the technologies we have developed and applied, diabetic children can finally take active part in sports, which not only can improve their health (e.g. their glycaemic values), but also has a significantly positive effect on their psyche. We want to foster a closer interaction of sports clubs and coaches with these kids, which is something that is often lacking due to unfounded fears. The foundation’s main motto is to tell society that diabetic children are "our children" and deserve not only treatment, but our active approach and to fully participate in social life.

Pavel Šťastný is also an ambassador of our foundation. Together with the Helpful Art in

INTERVIEWS

Covid platform, we want to focus on professional psychological help. We would like to offer diabetics and those around them the opportunity to consult with psychologists in the form of face-to-face or online support.

Our goal is to build a strong foundation focused on multidisciplinary medicine that will improve the quality of healthcare, primarily by sharing health data remotely through information and communication technologies (telemedicine) to improve health, prevention, education and medical research.

The future of medicine undoubtedly lies in the combination of increasingly sophisticated technology and healthcare, which is why we’ve decided to take this path. We are also looking for and connecting with foreign partners, because the international exchange of experience in telemedicine and psychological support for diabetes is the most valuable for us.

THE FUTURE OF MEDICINE UNDOUBTEDLY LIES IN THE COMBINATION OF INCREASINGLY SOPHISTICATED TECHNOLOGY AND HEALTHCARE, WHICH IS WHY WE’VE DECIDED TO TAKE THIS PATH.

What do you like doing in your free time?

I used to take part in light athletics, scuba-diving, and skiing, but now I play golf with my wife – I play bad, but I like it. I also enjoy travelling, literature and art, and relaxing at our cottage in South Bohemia. I collect sea shells from all over the world.

Martin Holcát is the deputy director of the Motol University Hospital in Prague for curative and preventive care.

His speciality is ENT medicine.

He’s a former Health Minister of the Czech Republic.

He was in charge of the teams that took care of the health of the presidents of the Czech Republic and other top representatives of the state.

He founded the Transplant Coordination Centre of the Czech Republic and was director of the General University Hospital in Prague.

As Minister of Health, he was instrumental in revising the financing of hospitals and spas, activated the launch of cancer prevention programs, and contributed to the completion of the Psychiatric Care Reform Strategy.

He is active in the DiApp Foundation - Centre for Telemedicine, which is dedicated to the creation and application of innovative telemedicine approaches in the lives of patients.

He has collaborated on the project and exhibition Helpful Art in Covid.

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ARTICLE FEATURES . Infection Control

Infection control in coronavirus departments Precautionary measures to protect the medical staff

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ARTICLE FEATURES . Infection Control

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he medical staff working in the coronavirus departments are at the highest risk for getting COVID-19, especially after the number of infections among doctors, nurses, and other teams working in those departments has spiked. They are like soldiers in a battle fighting this deadly and rapidly spreading virus.

There are infection control programs and international protocols in place that require the application of precautionary measures to limit the spread of infection within the hospital. The focus on these programs has increased recently in the coronavirus departments, especially since respiratory infection is the second most common hospital infection and the first most common infection within ICUs. To prevent infection, standard precautions are the minimum infection prevention practices that apply to all patient care, regardless of suspected or confirmed infection status of the patient, in any setting where healthcare is delivered. These practices are designed to both protect DHCP and prevent DHCP from spreading infections among patients. Standard Precautions include hand hygiene, use of personal protective equipment (e.g., gloves, masks, eyewear), respiratory hygiene / cough etiquette, sharps safety (engineering and work practice controls), safe injection practices (i.e., aseptic technique for parenteral medications), sterile instruments and devices as well as clean and disinfected environmental surfaces.

The hospital environment, whether rooms or corridors, should be sterilized to prevent virus transmission, and here we must emphasize the need to sterilize doorknobs, elevator buttons and office surfaces because they are the primary driver for infection.

HAND HYGIENE IS ONE OF THE MOST IMPORTANT MEASURES THAT PREVENT THE SPREAD OF INFECTION IN HOSPITALS, AND IT IS A GENERAL TERM THAT INCLUDES WASHING HANDS WITH SOAP AND WATER, USING DISINFECTANTS BY RUBBING THEM WITH ALCOHOL AND DISINFECTING THEM IN PREPARATION FOR SURGICAL PROCEDURES.

and it is crucial for everyone working in the health facility to follow it, as it has been shown that washing hands contributes to reducing infection cases in hospitals by up to 50 percent.

The importance of hand hygiene urged the World Health Organization to celebrate Hand Hygiene Day given its role in preventing the transmission of infections.

Medical teams and healthcare providers follow the seven handwashing steps in order not to neglect any area during handwashing and ensure that their hands have been thoroughly cleaned and sterilized. But handwashing in hospitals must be done in a specific technique that guarantees getting rid of germs, and this technique is as follows: 1. Wet hands with water and apply single shot of soap 2. Rub hands palm to palm 3. Rub back of each hand with the palm of other the hand with fingers interlaced 4. Rub palm to palm with fingers interlaced 5. Rub with backs of fingers to opposing palms with fingers interlocked 6. Rub each thumb clasped in opposite hand using rotational movement 7. Rub tips of fingers in the opposite palm in a circular motion 8. Rub each wrist with the opposite hand 9. Rinse hands with water & dry thoroughly

Handwashing is the first step Infection control programs focus primarily on the hands, as they are the primary source of transmission of infection and germs, which requires washing them in the best way recommended by the World Health Organization.

Cleaning, sterilizing and disinfecting hands before and after dealing with the patient, especially when taking samples, is the first procedure to stop and prevent the risk of cross-infection,

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Healthcare workers must follow a stricter handwashing process as recommended by WHO: • Before touching a patient, • Before clean/aseptic procedures, • After body fluid exposure/risk, • After touching a patient, and • After touching the patient surroundings Knowing how to wash your hands properly is an important step in preventing the spread of infections in the workplace, home or schools.

Also important is knowing when to wash your hands. Here are the key times when handwashing should be conducted: • At the end of each work/school period • Before each break • Before eating or preparing food • After going to the restroom • Whenever hands are dirty or contaminated

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Medical waste The COVID-19 outbreak has increased medical waste all across the world and it has also led to a huge amount of face masks and medical waste. In particular, another aspect of the spread of COVID-19 is improper solid waste management. If waste is not managed properly, it may lead to the spread of the virus. Consequently, the number of confirmed cases has rapidly increased and the amount of medical waste associated with COVID-19 has also significantly increased.

According to the World Health Organization (WHO), infectious waste is defined as waste contaminated with blood and other bodily fluids, cultures and stocks of infectious agents from laboratory work, or waste from patients with infections. But WHO interim guidelines suggest all healthcare waste produced during patient care, including those with confirmed COVID-19 infection, is considered as infectious medical

ACCORDING TO THE WORLD HEALTH ORGANIZATION (WHO), INFECTIOUS WASTE IS DEFINED AS WASTE CONTAMINATED WITH BLOOD AND OTHER BODILY FLUIDS, CULTURES AND STOCKS OF INFECTIOUS AGENTS FROM LABORATORY WORK, OR WASTE FROM PATIENTS WITH INFECTIONS.

ARTICLE FEATURES . Infection Control waste, but the waste generated in waiting areas of healthcare facilities can be classified as non-hazardous and disposed of by municipal waste services.

The Centers for Disease Control and Prevention (CDC) claims medical waste coming from healthcare facilities treating COVID-19 patients is no different than waste coming from facilities without COVID-19 patients, and management of medical waste should be performed in accordance with routine procedures.

The black bags inside the health facilities are used for the disposal of non-hazardous and recyclable medical waste, while the red bags are used for hazardous waste, as there are thousands of gloves, masks, protective jackets and medical syringes used on a daily basis.

Surfaces and windows are also cleaned with dilute chlorine, and waste locations lying on the ground are sterilized, after collecting the bags containing medical waste.

Medical waste includes materials that transmit infection such as syringes, needles, scalpels, and blades, chemicals used in laboratory formulations, disinfectants, mercury in thermometers and batteries, as well as pharmaceutical preparations such as used and expired drugs and vaccines. Medical waste and waste provide a fertile environment for the growth of the most vicious microbes, viruses, and fungi that can be transmitted to workers through inhalation, touch and other methods of exposure.

Waste with high contents of heavy metals should normally be treated in specific recycling/ treatment facilities. Alternatively, as for chemical waste, it may be encapsulated. Waste with high contents of heavy metals, in particular mercury or cadmium, should never be incinerated.

Therefore, it is essential to safely dispose of medical waste contaminated with COVID-19 in order not to pose a threat to the persons dealing with it.

According to the WHO, waste and by-products cover a diverse range of materials including infectious waste or waste contaminated with blood and other bodily fluids, cultures and stocks of infectious agents from laboratory work, or waste from patients with infections (e.g. swabs, bandages and disposable medical devices); pathological waste: human tissues,

organs or fluids, body parts and contaminated animal carcasses; sharps waste: syringes, needles, disposable scalpels and blades, etc.; chemical waste: for example solvents and reagents used for laboratory preparations, disinfectants, sterilants and heavy metals contained in medical devices (e.g. mercury in broken thermometers) and batteries; pharmaceutical waste: expired, unused and contaminated drugs and vaccines; cytotoxic waste, radioactive waste and non-hazardous or general waste: waste that does not pose any particular biological, chemical, radioactive or physical hazard.

With the COVID-19 outbreak, the use of medical materials has increased dramatically.

The World Health Organization warned of the dangers of using these materials repeatedly, especially through contact with patients and working in infected environments.

The waste usually includes microscopic bacteria that transmit the infection to patients, medical personnel and the general public.

Therefore, workers in waste management are subject to strict controls in terms of wearing protective suits, masks and gloves to prevent them from catching deadly germs or viruses.

MEDICAL WASTE INCLUDES MATERIALS THAT TRANSMIT INFECTION SUCH AS SYRINGES, NEEDLES, SCALPELS, AND BLADES, CHEMICALS USED IN LABORATORY FORMULATIONS, DISINFECTANTS, MERCURY IN THERMOMETERS AND BATTERIES, AS WELL AS PHARMACEUTICAL PREPARATIONS SUCH AS USED AND EXPIRED DRUGS AND VACCINES.

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Immunotherapy enhances survival in stomach cancer!

6 critical signs of stomach cancer!

PROFESSOR FAYSAL DANE EMPHASIZES THAT REDUCTION OF THOSE RISKS MAY PARTIALLY PREVENT THE STOMACH CANCER. STOMACH CANCER IS USUALLY DIAGNOSED IN LATE STAGE BOTH IN OUR COUNTRY AND WESTERN COUNTRIES. ONLY ONE THIRD OF PATIENTS CAN BE DIAGNOSED IN AN EARLY STAGE Professor Faysal Dane

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lthough stomach cancer is globally the fifth most common cancer, it is the second most common cause of cancer deaths. Almost one million people are diagnosed with stomach cancer annually around the world, while around 780 thousand people die due to stomach cancer. Approximately 12 thousand people are diagnosed with stomach cancer annually in Turkey and around 10 thousand people die due to stomach cancer.

The most important underlying cause is lack of symptom in early-stage stomach cancer and late diagnosis due to ignorance of complaints that emerge when the tumor grows, as patients consider ‘indigestion’ for the underlying cause of the complaints. The relieving news is about the results of trials conducted on immunotherapy that is regarded as the major step recently taken in anti-cancer treatment.

According to recent studies, immunotherapy delays progression of the disease and thus prolongs the survival by contributing to the shrinkage of the tumor in patients with stomach cancer. Also, it acts without deteriorating patient’s quality of life and it does not result in severe side

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effects. Professor of Medical Oncology Faysal Dane, M.D., from Acıbadem Hospital in Istanbul, Turkey says “Thanks to advancements in treatment of the stomach cancer, not only quality of life is boosted, but also the survival is prolonged.

However, it is necessary to keep in mind that as is the case with all cancer types, early diagnosis is very critical for stomach cancer.”

6 critical signs of stomach cancer!

Stomach cancer has certain risk factors, including but not limited to Helicobacter pylori infection, smoking, alcohol, obesity, too salty foods, certain food preservatives, deep fried foods and genetic predisposition. Professor Faysal Dane emphasizes that reduction of those risks may partially prevent the stomach cancer.

Stomach cancer is usually diagnosed in late stage both in our country and Western countries. Only one third of patients can be diagnosed in an early stage. There are certain reasons for this fact: the condition does not cause any symptom in early stage; stomach cancer does not have specific symptoms; and screening methods are seldom used. “From this perspective, one may speculate that stomach cancer progresses insidiously”, says Professor of Medical Oncology Faysal Dane and adds that the complaints emerging due to progression of the tumor should not be ignored

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a doctor should be seen immediately and she lists the 6 critical signs: “Persistent nausea and vomiting, long-standing stomach ache, getting full easily, blood in vomit, difficulty swallowing and weight loss”.

Treatment is planned depending on stage of the disease “Success of treatment varies substantially in stomach cancer depending on the stage the cancer is diagnosed” says Professor Faysal Dane, who emphasizes that as is the case with all cancers, early diagnosis is also very crucial in stomach cancer. Clarifying that the treatment approach varies according to the stage of the disease, Professor Faysal Dane adds “Proper removal of the tumor with a surgical procedure may be curative in a small part of patients who are diagnosed in a very early stage. However, deep invasion of the gastric wall or presence of tumor in surrounding lymph nodes requires pre- and post-operative medication treatments depending on patient- and disease-related factors. Moreover, chemotherapy is combined with radiotherapy in certain patient groups, although it is not a viable option for all patients.”

Professor Faysal Dane states that if the disease spreads to distant body parts in addition to the lymph nodes located around the stomach, the management mostly involves medication treatments, such as chemotherapy, targeted drugs and immunotherapy.

Striking outcomes from immunotherapy!

As is the case with other cancers, advancements in targeted drugs and immunotherapy that are, recently, combined with chemotherapy excite the medical community in terms of the stomach cancer. Cancer immunotherapy is defined as treatment modalities that prevent formation of cancer cells, control their growth or kill them by strengthening the immune system.

On the contrary to other anti-cancer treatments, immunotherapy activates the immune system to promote their attack to the tumor rather than exerting a direct effect on the cancer cell.

“SUCCESS OF TREATMENT VARIES SUBSTANTIALLY IN STOMACH CANCER DEPENDING ON THE STAGE THE CANCER IS DIAGNOSED” SAYS PROFESSOR FAYSAL DANE, WHO EMPHASIZES THAT AS IS THE CASE WITH ALL CANCERS, EARLY DIAGNOSIS IS ALSO VERY CRUCIAL IN STOMACH CANCER.

Today, efficiency of immunotherapy, both alone and in combination with chemotherapy, in stomach cancer is intensively investigated.

Results of those trials have been presented in meetings for several years. At last instance, it is reported in the Congress held by the European Society for Medical Oncology (ESMO) held in September 2020 that when combined with chemotherapy, immunotherapy delays progression of the disease and thus enhances the survival by contributing to the shrinkage of the tumor in patients with stomach cancer. Emphasizing that this advancement in treatment of stomach cancer is very significant, Professor Faysal Dane says “Although it is, today, not clearly known, based on the results of the study, which patients will respond to the treatment, certain tests help us predict which patients will be a good candidate for immunotherapy. Therefore, all patients with stomach cancer are evaluated regarding immunotherapy based on the striking results demonstrated by scientific studies.”

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Radiotherapy today: Even some metastatic cancers can be cured Doctors and patients can benefit from various options in well-equipped hospitals ONE OF THE LATEST ADVANCEMENTS IN RADIATION TECHNOLOGY IS THE MR LINAC DEVICE WHICH COMBINES MR IMAGING AND LINEAR ACCELERATOR IN ONE SINGLE MACHINE. ACIBADEM WAS AMONG THE FIRST WORLDWIDE TO IMPLEMENT THE NEW TECHNOLOGY IN SEPTEMBER 2018.

Professor Mehmet Ufuk Abacioglu

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0 to 60% of all patients diagnosed with cancer need radiotherapy at some point in their lives. It is a key part of the cancer treatment process and can be used either as a primary treatment or complementing the other treatment options like surgery and chemotherapy. Radiation treatment is painless, non-invasive, and takes only minutes per session. But still many people are afraid of it and the negative connotation of the word ‘radiation’. When used the right way, radiation is an effective tool both for diagnosis and treatment, states Professor Dr. Ufuk Abacıoğlu, Radiation Oncology specialist with more than 25 years of experience.

Prof. Abacıoğlu works at ACIBADEM Altunizade Hospital in Turkey, where doctors and patients can take advantage of the latest devices in this ever-evolving medical field. For all those who might not understand how exactly the radiotherapy works or what makes it effective for cancer treatment, the expert provides some useful information and debunks misconceptions about the medical applications of radiation.

Radiation affects the DNA of the tumor cells and their vessels

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Radiation is thought to be one of the causes for cancer, and that is certainly true. But we can also use radiation for treating cancer.

How exactly radiation kills tumors? Prof. Dr. Ufuk Abacıoğlu explains: “The radiation affects the DNA of the tumor cells. That’s what we knew for many years, and we can cause some DNA damage. We can just focus the radiation on the tumor masses and damage the tumor cells, and finally the tumor may diminish in size and disappear. It is a kind of chain reaction that starts with the radiation. That’s physical, chemical and biological effect of radiation that causes the tumors to disappear. But recently we have found that it’s not only the DNA damage on the tumor cells; there is also a vascular effect. We can also obliterate the vessels that are feeding the tumor cells.”

Obliteration of blood vessels is possible by striking the tumor with high doses of radiation in one or a few fractions: then we treat the tumor not only through DNA damage but also with vascular effects. “We call this stereotactic radiosurgery or stereotactic radiotherapy. As you can see from the name radiosurgery, it’s like a single-shot treatment; it’s causing ablative effect, so it’s like a surgical effect or surgeon’s knife. It is very precise irradiation, we just focus dose to the tumor cells and we have a very rapid dose fall-off around the target that causes less harm to the normal tissue but very high effect

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over the tumor cells,” the specialist points.

Protection of healthy tissues is achieved by detailed calculations of the applied doses, as well as distribution of irradiation through multiple beams from different angles. “We use multiple beams around the patient, so when we collect all of them in the center we have a very high dose for the tumor itself, but the beam passes through the normal tissue with very low doses,” explains Prof. Abacıoğlu. Nowadays, sophisticated technology devices allow precise targeting of tumor masses for effective results and less side effects.

‘Seeing’ the tumors during treatment One of the latest advancements in radiation technology is the MR Linac device which combines MR imaging and linear accelerator in one single machine. ACIBADEM was among the first worldwide to implement the new technology in September 2018. More than 300 patients have been treated with the new device with very good results, says Professor Dr. Ufuk Abacıoğlu and adds: “It has been a revolutionary device for us because it has three main advantages.

MR is very useful for seeing the soft tissues in the body. The CT or X-ray based imaging is very useful for the bones, but for seeing soft tissue MR is much more useful.

The second advantage of MR Linac is the opportunity to adapt the treatment plans and treat the patients with the anatomy of the day.

And the third is that you can see the tumor itself while you are treating it. That’s not possible with other technologies. That gives us the opportunity to reduce the clinical target volume which covers the potential movement. If we have a 3 cm tumor, you have to add just 3 mm around it and we irradiate this volume. Otherwise, we have to give 5 mm, 1 cm, 2 cm, depending on the motion of the tumor with breathing. That gives us the ability to irradiate tumors with proximity to very critical structures.”

Radical treatment is now possible even for some metastatic patients

RADIATION THERAPY CAN BE APPLIED FOR TWO MAIN PURPOSES: TO KILL THE CANCER CELLS COMPLETELY WHICH IS CALLED CURATIVE RADIOTHERAPY, OR TO RELIEVE THE SYMPTOMS IN ADVANCED STAGE DISEASE WHICH IS REFERRED TO AS PALLIATIVE RADIOTHERAPY.

Radiation therapy can be applied for two main purposes: to kill the cancer cells completely which is called curative radiotherapy, or to relieve the symptoms in advanced stage disease which is referred to as palliative radiotherapy.

Recent advances in radiation oncology brought new options for cancer patients, including those with metastatic disease. Prof. Ufuk Abacıoğlu explains: “In recent years we have a new definition.

In the past we used to call stage 4 ‘metastatic’ disease, as a time period when we only do palliative treatments. We didn’t want to give radical treatments like surgery and ablative radiation treatment; we just wanted to palliate for example the pain of bone metastasis or relieve the symptoms of brain metastasis. But nowadays, we call some group of patients ‘oligometastatic’.

That means that we have a primary cancer for example in the lung, but only a few metastases, one or two or three metastases in the brain, one metastasis in the adrenal gland – then we call this patient ‘oligometastatic’. And we treat this patient with still radical intent; we want to cure these patients. When you give locally ablative treatments like surgery or stereotactic radiotherapy for these patients, the studies have shown that they live much longer than the other metastatic disease patients. So, we are treating more patients with metastatic disease with radical intent nowadays.”

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MEDICAL INSTITUTIONS

Opening of the Ophthalmology Center LaserVision – Hôtel-Dieu de France

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fter months of hard work and planning, the efforts of Hôtel-Dieu de France and LaserVision succeeded in establishing the Ophthalmology Center LaserVision – Hôtel-Dieu.

Through this recent collaboration, this eye specialist center aims to offer the highest quality of medical and surgical care.

The Ophthalmology Center LaserVision HDF will provide comprehensive ophthalmic services, including all types of surgeries, laser

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QUALITY MEDICAL AND TECHNICAL PROFESSIONALS WILL PRACTICE AT THIS CENTER.

procedures, treatments, x-ray services and medical consultations... Quality medical and technical professionals will practice at this Center and the team will be composed of around 20 ophthalmologists having different subspecialties, specialized nurses, nursing assistants, optometrists and technicians who are qualified to conduct all types of tests and examinations. It will also be equipped with the latest techniques, technologies, medical facilities, high-precision laser machines and lenses to treat cataracts and

MEDICAL INSTITUTIONS

other eye disorders and diseases.

Three floors will be reserved in the hospital’s outpatient clinics for the Ophthalmology Center, its technical equipment and operating rooms. The Center is currently operating as per its first phase of opening: it is welcoming patients for consultations, tests, x-ray services and laser treatments. However, the official opening is scheduled for late June, once the second phase will be completed.

In the coming phase, the Center will have 14 surgical chairs and will open four fully-equipped operating rooms reserved for ophthalmic surgeries only. This is a first in Lebanon within the context of a hospital. By reserving these rooms exclusively for eye surgery, the Center will contribute to enhancing the patient's hospital experience and improving the patient flow, since traditional operating rooms are not suitable for these quick surgeries, but rather complicate the procedure. The Center's team worked hard to provide an easier and more practical system for ophthalmic surgeons in order to meet the growing needs of patients without having to postpone surgeries. When the patient arrives, they will be welcomed in their room and assigned a surgical chair designed specifically for eye surgery. The nursing team will prepare the patient before surgery, take them to the operating room on the same chair, without the need to move them from one bed or gurney to another, since the chair can also be transformed into an operating table. After surgery, the patient will wait 10 minutes in the anesthesia department to recover and wake up on the same chair before returning to their room, in which they will remain one to two hours before going home.

The adopted path and arranged procedure allow focusing more on efficiency and offering the patient the opportunity to be treated solely at the eye Center within HDF hospital, without the need to refer directly to traditional hospitalization, since all services and treatments are provided in the Center interior space. This new effective structure in the Ophthalmology Center LaserVision-HDF is believed to be the future of hospitals that are slowly moving towards establishing specialized centers for each medical field within their premises.

OPHTHALMOLOGY CENTER LASERVISION - HDF WILL PROVIDE COMPREHENSIVE OPHTHALMIC SERVICES, INCLUDING ALL TYPES OF SURGERIES, LASER PROCEDURES, TREATMENTS, X-RAY SERVICES AND MEDICAL CONSULTATIONS.

On another hand, being part of a reference university hospital is one of the advantages of choosing this Center among other eye specialist centers. The Center is capable, in case the patient has any kind of complications during the operation, of treating them and quickly requesting the intervention of a specialized medical team for any emergency.

This common expertise in ophthalmology brought together Laser Vision’s competency and Hôtel-Dieu de France’s solid structure and deep knowledge in medical education, in an effort to provide high-quality eye care and the best possible patient experience. Despite the many difficulties and challenges faced, the two teams remained determined to proceed with the opening of the Center that aspires to be at the service of society and to serve as a cornerstone for health services and a pioneer in the field of ophthalmology.

For more information or booking an appointment, please call 01/604800 or 01/604801.

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NEWS

Omnicell set to showcase latest automation and intelligence solutions at Arab Health 2021

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mnicell Inc (NASDAQ:OMCL), a leading provider of medication and supply management solutions and adherence tools for healthcare systems and pharmacies, is set to unveil its latest robotic dispensing system – Medimat - to the Middle East pharmaceutical industry at this year’s Arab Health (21-24 June, 2021), Dubai World Trade Centre.

The next generation Medimat is the latest enhancement to Omnicell’s portfolio of technologies for central pharmacy workflows, helping to dramatically improve all aspects of the dispensing process. By simplifying the dispensing process and minimising the number of human interactions in the pharmacy workflow, Medimat’s new functionality will further reduce the poten-

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tial for errors. For pharmacists in particular, a lack of inventory precision and control can result in large quantities of expired stock and significant monetary losses. Smarter and safer medication management technology is key to reducing the burden on healthcare teams, supporting them in providing the right medication, at the right dose, at the right time.

“Automation has become an integral part of any healthcare setting and we are committed to the continual development of our technologies in order to support the vital process of medication and supply management,” said Sara Dalmasso, International Vice President and General Manager for Omnicell International. “We are thrilled to be a part of such a well-respected and dedicated platform as Arab Health, which is

MEDIMAT TAKES CENTRE STAGE AS OMNICELL SHOWCASES PORTFOLIO OF CUTTING-EDGE TECHNOLOGY FOR CENTRAL PHARMACY.

NEWS

recognised as the Middle East’s largest in-person healthcare event. It will provide an outstanding opportunity to introduce Medimat to healthcare professionals in the region, as well as showcase Omnicell’s other industry-leading solutions.

“Medimat will support the healthcare industry by improving efficiency, driving savings, and freeing up staff from administrative and logistical tasks, such as unpacking medication, stock management and searching for medication. Crucially, it will enable pharmacists to spend more time on clinical work and building patient relationships.”

Additional benefits of Medimat include: Pharmacists will know where the drug is within the robot and what quantities are available.

Ability to track slow-moving items and eliminate wasted or out-of-date stock.

Ability to generate a real-time report on stock usage, so manual stock counts are no longer needed, saving valuable time.

Highly effective scan station means inputting of medication supports safety.

Direct mode option enables users to have medication available for immediate dispensing.

Input speed of up to 750 packs per hour* allows for more prescriptions to be processed with a higher level of accuracy

controlled drugs through automation cabinets while still maintaining legal compliance.

SupplyX – helping healthcare settings improve management and traceability of medical supplies. This solution simplifies and automates the inventory management process with a real-time web-based dashboard and reporting suite for materials’ managers.

Omnicell XT Medication and Supply Cabinets – supports a safer and smarter process for getting the right medication to the right patient at the right time.

Omnicell Supply RFID cabinet – ideal for high-cost items, implantable devices and trauma trays. The system scans everything quickly, and records what has been taken, returned or restocked.

Omnicell technology has been supporting healthcare providers in the Middle East for 17 years, including King Faisal Specialist Hospital (KSA), National Guard Health Affairs (KSA) and Dubai Health Authority (UAE). The Company’s proven and streamlined range of solutions and services are designed to reduce medication dispensing errors, improve patient safety, drive efficiency, and allow healthcare professionals to spend more time on face-to-face patient care.

Omnicell will be at Stand Number H4 C10 Arab Health 2021.

To learn more, visit www.omnicell.com

Sara Dalmasso

OMNICELL TECHNOLOGY HAS BEEN SUPPORTING HEALTHCARE PROVIDERS IN THE MIDDLE EAST FOR 17 YEARS.

Omnicell will also be showcasing other key point-of-care solutions at this year’s event, including: MedX – the only web-based, software solution for medication management and inventory in both open and closed stores. It allows complete visibility on all pharmaceutical stock holding areas and its data capture assists in reducing unnecessary spend and medication waste. This also includes OmniCD which eliminates the need for double processing, with the ability to fully automate a location by managing and ordering

*based on Omnicell internal testing and validation

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INTERVIEWS

Pediatric Neuro-Oncologist at Nationwide Children’s Hospital

Ralph Salloum, MD “We are fortunate to have our own Institute for Genomic Medicine, which combines a robust clinical laboratory with genome scientists and clinical geneticists”

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ationwide Children’s Hospital is one of the largest pediatric hospitals and research institutes in the United States. It is consistently ranked as one of America’s top 10 children’s hospitals by U.S. News & World Report, the recognized authority in United States hospital rankings. Ralph Salloum, MD, is a pediatric neuro-oncologist with clinical focus in adolescent and young adult oncology, and brain tumor survivorship. His research is focused on developmental therapeutics, early phase clinical trials and late effects of central nervous system (CNS) tumors.

Hospitals magazine recently interviewed Dr. Salloum about Neuro-Oncology at Nationwide Children’s Hospital.

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INTERVIEWS

How are brain and spinal cord tumors different in children than adults?

Although they may look similar microscopically, CNS tumors in children and adults are quite different molecularly. Generally speaking, tumors in children are driven by different genetic and epigenetic changes and carry a lower mutational burden than those seen in adults.

Some embryonal tumors are unique to young children, but rare cases have been reported in adults. Adults are also more likely to experience treatment-related tumors such as high-grade gliomas or meningiomas (from radiation exposure for example) and metastatic tumors to the brain from cancers originating outside of the CNS.

What physicians, staff and researchers make up a complete neuro-oncology team?

Given the complexity of the care of neuro-oncology patients, a complete team is truly interdisciplinary, one with the expertise of many different providers.

Neuro-oncologists work closely with neurosurgeons, radiation oncologists, neuropathologists and neuro-ophthalmologists. Neurology, endocrinology, genetics, palliative care and physical medicine and rehabilitation are also fundamental. Psycho-social care is also essential, which requires the expertise of psychologists and neuropsychologists, as well as social workers and even a liaison for the child’s school.

What are some of the latest advancements in pediatric neuro-oncology?

One of the major discoveries made in the field is the role of the epigenome in tumorigenesis. The biological mechanisms that switch genes on and off have been found to be at the origin of more than one type of CNS tumor in pediatric patients. This is a precious tool that can be used to establish a diagnosis, refine the classification of a tumor and most importantly, provide targeted treatment.

What organizations are leading in research and discovery?

I think most academic U.S. and international institutions offer something unique and valuable to pediatric neuro-oncology. The most important discoveries in the field have been the fruit of international efforts and a reflection of how the pediatric medical community is united and determined to fight CNS tumors, find cures and deliver them to our patients.

What does the future of pediatric neurooncology research and treatment look like at Nationwide Children’s Hospital?

With the presence of expertise than spans bench and bedside care I think the future of pediatric neuro-oncology care at Nationwide Children’s Hospital is very bright. Recently, we have markedly expanded our clinical trial portfolio by becoming the operation center for CONNECT – an international consortium focused on developing and testing novel therapies in early phase clinical trials. We are also one of the 16 centers participating in the National Cancer Institute’s Pediatric Brain Tumor Consortium (PBTC), as well as the Pediatric Early Phase Clinical Trials Network (PEP-CTN).

We continue to offer numerous clinical trials through National Experimental Therapeutics (NEXT) Consortium, Pacific Pediatric Neuro-Oncology Consortium (PNOC) and Children's Oncology Group. We also continue to work closely with our own basic and translational scientists to develop new trials with innovative approaches, such as radioimmunotherapy and cell therapy.

At Nationwide Children’s Hospital, we are fortunate to have our own Institute for Genomic Medicine, which combines a robust clinical laboratory with genome scientists and clinical geneticists. Among the institute’s many capabilities is the ability to validate assays using the very latest technology, which allows us to further refine the classification and characterization of our CNS tumors.

To learn more about Nationwide Children’s Hospital and Dr. Salloum, visit NationwideChildrens.org/Specialties/Neuro-Oncology

WITH THE PRESENCE OF EXPERTISE THAN SPANS BENCH AND BEDSIDE CARE I THINK THE FUTURE OF PEDIATRIC NEURO-ONCOLOGY CARE AT NATIONWIDE CHILDREN’S HOSPITAL IS VERY BRIGHT. RECENTLY, WE HAVE MARKEDLY EXPANDED OUR CLINICAL TRIAL PORTFOLIO

BY BECOMING THE OPERATION CENTER FOR CONNECT – AN INTERNATIONAL CONSORTIUM FOCUSED ON DEVELOPING AND TESTING NOVEL THERAPIES IN EARLY PHASE CLINICAL TRIALS.

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NEWS

A Rare and Successful Surgery

Al-Ahli Hospital Eradicates a Giant Splenic Cyst

By Abdul-Azim Abdul-Wahab, Senior Consultant Surgeon & the Chief of the medical staff at Al-Ahli Hospital / Qatar

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l-Ahli Hospital recently performed a successful operation to remove a giant splenic cyst; a scarce and rare case in the field of surgery.

Dr. Abdul-Azim Abdul-Wahab, a senior consultant surgeon and the chief of the medical staff at Al-Ahli Hospital, said that the 56-yearold patient went to a private hospital in Doha complaining from chronic pains in the back after experiencing severe pains.

He explained that the patient also suffered from chronic hypertension, hyperlipidemia, and hypothyroidism. He was taking drug on a regular basis for all these chronic diseases. Upon an abdominal C.T, it was found that he has a splenic cyst as large as 10 cm x 10 cm with a 9-cm left kidney cyst. He pointed out that the patient visited the urology clinic at Al-Ahli Hospital and

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was assessed in terms of the left renal cyst. He was given the necessary directions and advice regarding it. He was advised that it doesn't need a surgical intervention, as it is a simple renal cyst.

Accordingly, the patient was referred to the general surgery clinic at Al-Ahly Hospital where he was clinically assessed by Dr. Abdel-Azim Hussein who advised him to have a surgery for removing the splenic cyst due to its large size and the accompanying symptoms.

He noted that the reaction of parasitic cysts in the patient was found to be negative. Accordingly, the possibility that this cyst is a parasitic-origin splenic one was excluded. Thereafter, the patient received the necessary preventive vaccinations about 2-3 weeks before the splenic surgical intervention.

Dr. Abdul Azim Hussain said "The patient was operated on 2 November 2020. It started with a laparoscopic surgery, where the investigation of the abdominal cavity showed a giant cyst (acromegalic), occupying most of the spleen tissue and large areas of the cyst wall were found severely calcified causing severe adhesions to the neighboring organs, including the stomach, colon and diaphragm. Thus, a laparotomy was performed instead due to the inability to perform the excision by laparoscopic surgery because of the severe adhesions of the splenic cyst to the neighboring organs. The cyst was successfully isolated from the neighboring structures and was removed completely, along with the remainder of the relatively little splenic tissues".

"The patient recovered well and quickly after the surgery, and was discharged from Al-Ahli Hospital on the third day in a good general condition with almost no complications".

He pointed out that the result of the autopsy showed that the splenic cyst is of the type of Giant Splenic Pseudocyst. The existence of this type of giant splenic cysts are scarce and rare

SPLENIC CYSTS ARE CLASSIFIED INTO PARASITIC CYSTS AND NON-PARASITIC CYSTS, WHILE NON-PARASITIC SPLENIC CYSTS ARE CLASSIFIED INTO PSEUDOCYSTS AND TRUE CYSTS. TRUE SPLENIC CYSTS ARE THOSE CONTAINING AN EPITHELIAL LINING (SUPERFICIAL EPITHELIUM.

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and, scientifically speaking, splenic cysts are a very rare clinical case that occurs in about 0.07% of the total population.

He explained that patients with splenic cysts, in general, do not show any specific clinical symptoms, and that these cysts are often accidently discovered during the radiological examination.

Ultrasound, CT and magnetic resonance imaging can be used for the initial diagnosis.

Splenic cysts are classified into parasitic cysts and non-parasitic cysts, while non-parasitic splenic cysts are classified into pseudocysts and true cysts. True splenic cysts are those containing an epithelial lining (superficial epithelium). Pseudocysts do not contain epithelial lining (superficial epithelium) and are usually formed after trauma, inflammation, or partial splenic infarction.

Splenic pseudocysts are very rare. They are found in less than 1% of splenectomies performed. However, pseudocysts in the spleen are four times more common than true cysts.

In 1829, Andral described the first non-parasitic cyst in the spleen.

In 1978, Robbins reported a series of 42,327 autopsies over a 25-year period, which revealed only 32 patients with splenic cysts, In 1953, Fowler published a collective review to include 265 cases of non-parasitic splenic cysts.2 Until 1978, nearly 600 surgical and cyst autopsy cases were reported in the global literature. It is important to distinguish between splenic pseudocysts and other benign and malignant splenic cysts, including parasitic hydrocysts, in order to follow the appropriate course of treatment. Typically, splenic pseudocysts show no symptoms and rarely grow to a large size and only require treatment when they become symptomatic. Typically, only large cysts are symptomatic, and they are surgically treated by removing the spleen. They only require surgery when symptoms appear and, in such cases, the chances of preserving the spleen are usually less.

SPLENIC PSEUDOCYSTS ARE VERY RARE. THEY ARE FOUND IN LESS THAN 1% OF SPLENECTOMIES PERFORMED.

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MEDICAL INSTITUTIONS

Neuronavigation in the surgical management of brain tumors:

Future trend now available at Almoosa Specialist Hospital

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ur Neuroscience Center, led by Dr. Mohammad Kassab, a consultant neurosurgeon, managed to treat a grade 2 brain tumor that causes recurrent epileptic seizures, using a combination of modern technologies and a Neuronavigation device.

Dr. Kassab states that the patient came to the emergency department in a critical condition after suffering from severe seizures, leading to loss of consciousness while at home.

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BASED ON THE EXAMINATION & THE INVESTIGATION, THE DOCTOR DECIDED TO TRANSFER PATIENT FAISAL TO THE NEUROSCIENCE CENTER.

Dr. Hasan Salama, a consultant neurologist, received the case, a head CT scan was requested, it pointed to changes in the left side of the frontal lobe.

To confirm the diagnosis, Dr. Salama ordered an MRI scan, which showed an infiltrated tumor spread locally in the left frontal lobe.

Based on the examination and the investigation, the doctor decided to transfer patient Faisal to the Neuroscience Center, where a specialized medical team was formed to treat Fais-

MEDICAL INSTITUTIONS

al's case. After full discussion with the patient's family, the surgical team decided to remove the tumor and discover its histological nature.

Dr. Kassab adds that we have faced several challenges in treating Faisal's case, the most prominent of which is that the tumor is widespread adjacent to the motor area and partially infiltrating into it. The excision process may lead to paralysis on the right side of the body, in addition to the possibility of affecting the speech control area (pronunciation) located on the left side of the brain.

The medical team decided to remove the tumor under local anesthesia and keep the patient in a state of wakefulness so that the team can perform repeated movement and speech tests during surgery to ensure that the movement and verbal area adjacent to the tumor area is not breached or damaged during the surgical excision.

Accurate localization of the tumor was another challenge. To face this challenge, a Neuronavigation technology was used to help identify the brain's different sensitive functional areas and accurately determine the tumor's location to avoid making a wide opening to the skull, thus avoiding further complications. The operation took around three hours, and the tumor's nature was confirmed by histological examination of the sample and biopsy taken during surgery. The operation went successfully and smoothly. Praise be to God. The patient is currently in good health

and did not have any complications or any new deficit, and was discharged from the hospital 48 hours after the surgery.

It is worth noting that such cases' success requires accurate diagnosis, wise decision-making, excellent surgical and anesthesia expertise, and the availability of modern high-tech surgical equipment available in the hospital.

Case: grade 2 brain tumor that causes recurrent epileptic seizures Diagnosis: infiltrated tumor spread locally in the left frontal lobe.

Challenges: the tumor is widespread adjacent to the motor area and partially infiltrating into it. The excision process may lead to paralysis on the right side of the body, in addition to the possibility of affecting the speech control area (pronunciation) located on the left side of the brain.

Techniques used: Neuro-navigation technology was used to help identify the brain's different sensitive functional areas and accurately determine the tumor's location to avoid making a wide opening to the skull, thus avoiding further complications.

Medical team: • Dr. Mohamed kassab, consultant neurosurgeon • Dr. Hassan Salama, consultant neurologist • Team of anesthesiologists

THE OPERATION WENT SUCCESSFULLY AND SMOOTHLY. PRAISE BE TO GOD. THE PATIENT IS CURRENTLY IN GOOD HEALTH AND DID NOT HAVE ANY COMPLICATIONS OR ANY NEW DEFICIT, AND WAS DISCHARGED FROM THE HOSPITAL 48 HOURS AFTER THE SURGERY.

Dr. Mohamed kassab, consultant neurosurgeon

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INTERVIEW

Dr. Hisham Abu Al-Saud Endocrinologist at NMC Royal Hospital - Khalifa City

“We adopt a multidisciplinary approach to diagnose and treat endocrine disease”

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MC Royal Hospital provides all necessary tests to diagnose and follow up on endocrine disease, in addition to diagnostic radiology, such as X-rays and MRI, depending on the need of each case.

The hospital also provides a team of medical staff with the highest level of expertise in the field of endocrinology, as well as an integrated team of dieticians and nurses to raise health awareness among patients. The endocrinologist at NMC Royal Hospital - Khalifa City, Dr. Hisham Abu Al-Saud, spoke to the "Hospitals" Magazine about the most prominent medical services provided by the medical team at the hospital.

The endocrinology team treats patients over the age of 16 who require diagnosis and ongoing management of medical conditions affecting the endocrine system, including: • Type 1 and type 2 diabetes • Adrenal gland disorders • Pituitary hormone disorders • Endocrine disorders, including hypothyroidism and hyperthyroidism • Thyroid cancer • Osteoporosis (a condition in which the quality and density of the bones is reduced) • Vitamin D deficiency • Hypercalcemia (high calcium levels in the blood) • Hypocalcemia (low calcium levels in the blood) • Paget's disease (a disease that causes fragile and misshapen bones) • Osteomalacia • Osteoporosis associated with organ transplants

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The team of endocrinologists also treats obesity, in addition to running tests and managing diseases related to it, such as: • Polycystic ovary syndrome • Hyperlipidemia (high cholesterol) • Hypertension

Endocrine Disease Diagnostic Tests The endocrinology team adopts a multidisciplinary approach to diagnose and treat endocrine diseases. On the first visit, the patient is required to provide a detailed medical history and undergo a physical examination. Depending on the symptoms experienced by the patient, the doctor requests a specific set of laboratory tests and radiographic examinations. These tests may include the following: • Blood and urine tests: These tests use blood or urine samples to measure certain hormone levels.

• Radiographic examinations: They provide images of a specific organ or area in the body and include: X-ray scans, CT scans,

DEPENDING ON THE SYMPTOMS EXPERIENCED BY THE PATIENT, THE DOCTOR REQUESTS A SPECIFIC SET OF LABORATORY TESTS AND RADIOGRAPHIC EXAMINATIONS.

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MRI, thyroid and parathyroid imaging, and radiography to measure bone density (also known as dual-energy X-ray absorptiometry that assesses bone mineral density).

Glandular function tests: Two or more samples of blood are taken at specific times, as some pituitary and adrenal gland disorders require this type of test.

Treatment of Endocrine Disease The treatment provided to the patient depends on the diagnosis, which is often with medication. Radioiodine therapy is used in cases of thyroid cancer and thyroid disorders. However, surgery may still be required, and in this case, endocrinologists cooperate with surgeons at the hospital.

Certain health conditions, such as diabetes,

lipid disorder, and obesity, require a consultation with a dietician and patient counselor, who both constitute a part of the endocrinology team. Follow-up visits are determined according to the health condition of each patient. Doctors may ask patients to rerun laboratory tests and radiographic examinations during the follow-up period, if necessary.

All members of the endocrinology team have extensive experience in endocrinology and metabolism. The team includes: • Endocrinologists • Pathologists • Radiologists • Psychiatrists • Surgeons • Nursing staff • Dieticians

RADIOIODINE THERAPY IS USED IN CASES OF THYROID CANCER AND THYROID DISORDERS.

NMC Royal Hospital Khalifa City is considered to be the flagship hospital within the NMC Group with 500 beds, the NMC flagship hospital Royal Khalifa City is a tertiary referral center treating not only Covid-19 cases, but also its patient base, which relies on its pediatric ICU, neonatal services, cancer program, and international collaborative research initiatives. It’s the only hospital that holds a tripe 9 rating in the emirate of Abu Dhabi, meaning it can receive emergency cases on behalf of Government hospitals. Strategically located between Abu Dhabi and Al Ain, the facility is extremely accessible for immediate medical care, as well as hospital transfers.

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INTERVIEW

Dr. Ahmed Kaabneh HOD - Consultant Interventional Radiology - NMC Royal Hospital, Khalifa City

“Non-surgical thyroid cyst treatment is available to all patients”

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MC Royal Hospital, Khalifa City has recently launched a non-surgical thyroid cyst treatment program, which is one of the comprehensive programs within the Thyroid Disorder Clinic. Dr. Ahmed Kaabneh, Consultant Interventional Radiology - NMC Royal Hospital, Khalifa City, talks about this program in the following interview.

When is this procedure necessary?

Thyroid cysts are benign fluid-filled cysts inside the thyroid gland. Depending on their size, they cause neck pain, difficulty swallowing, and swelling at the bottom of the neck. Non-surgical treatment is usually necessary in a patient with these symptoms.

What are the conditions that require non-surgical treatment?

This treatment is available to all patients because it obviates the need for surgical intervention. There are no medical conditions that would prevent the patient from receiving this treatment.

What are the advantages of this treatment in terms of safety and accuracy? In this context, to what extent does the doctor’s skill contribute to the success of the treatment?

This treatment or non-surgical intervention is entirely performed in the clinic by a specialist doctor using an ultrasound device,

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which allows the doctor to locate the thyroid cysts with high accuracy in order to treat them.

Studies and scientific research that focused on this treatment have proven that it is very safe and has rare complications.

The experience of the treating physician, like any medical intervention, plays an important role in the success of this treatment, especially in terms of helping to determine the appropriate amount of the substance used in the injection of these cysts to eradicate them.

What types of non-surgical treatments are adopted in the Thyroid Disorder Clinic?

There are currently two types of non-surgical treatments adopted for the treatment of thyroid nodules or lumps. The first treatment is used to remove the thyroid cysts, where the fluids are withdrawn from these cysts and then injected with a special substance to ensure that they do not return. The second treatment is available for non-fluid small and benign nodules, as these nodules are cauterized with a special device to eliminate them.

THYROID CYSTS ARE BENIGN FLUIDFILLED CYSTS INSIDE THE THYROID GLAND. DEPENDING ON THEIR SIZE, THEY CAUSE NECK PAIN, DIFFICULTY SWALLOWING, AND SWELLING AT THE BOTTOM OF THE NECK.

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Dr. Gilbert Ayoub Chairman, HOD & Consultant General Surgeon

“We have the State-of-the-art Techniques and Instruments for Thyroid Surgeries"

There’s several Indications for Thyroid Surgeries: 1.

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Nodular Goiter causing local Symptoms, Compression of the Trachea and difficulty swallowing.

Visible or sightly Mass.

Nodule which might be Thyroid Cancer.

Thyroid Cancer

There are many specific faced Challenges during the Thyroid Surgery because the Area of Interest is a high-Risk area since it contains the Vessels going to and from the Brain which can lead to severe Bleeding and even Brain Damage in extreme Cases, adding to Identification of the Parathyroids to the Damage Trachea, Esophagus or the vocal Cords Damage etc..

For all these Challenges we are using the Best available Machines and Methods in the Word including The Vocal Cord Neuromonitoring, and the State-of-the-Art Microscope for delicat Dissection. Last and not Least the Huge Experience of our Thyroid Surgeons.

The Type of Surgery is individually decided for each Patient which varies from partial Removal/Lobectomy to complete Thyroidectomy with or without Lymph nodes Neck Dissection in Cancer Cases. We use usually a minimal invasive

access with 2-2,5 cm Incision length.

We are currently working on Our new know how, the Scarless transoral Thyroidectomy Approach known to be the only Approach with invisible Incision Scar. We have the State-of-theArt Techniques and Instruments including the Vocal Cord Neuromonitoring System, the newest Dissection Microscope for Thyroid and Neck Dissection Surgeries and the Latest Laboratory Frozen Section technique to get the Tissue histopathology Results even during the Surgery.

Adding to this we established a unique “One Step Thyroid Clinic” where the Patient gets all the Workout done in one day, starting by getting checked by an endocrinologist, referred to interventional radiologist for diagnostic (US, Uptake Scan, and Fine Needle Biopsy if needed), finishing by discussing the Treatment Plan with the Surgeon. This Time Management gives the Patient the best and pleasant Hospital Experience, quick Service and best Outcome. Our Thyroid Surgeon is one of the few accredited and renominated Surgeons by the DOH for Complex Thyroid Surgeries and especially Redo Cases for recurrence and complicated Cancer Cases with a Vast Experience of several Thousands of done thyroid Cases in one of the Biggest and best Endocrinology centers in Germany.

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INTERVIEW

Dr. Sokiyna Al Ameer Consultant Surgeon and breast surgery specialist at NMC Royal Hospital, Khalifa City

We created the “One Stop Breast Clinic” to spread awareness and prevent cancer

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he One Stop Breast Clinic provides all comprehensive care services for patients in one location, and these services are divided into non-surgical or surgical interventions. Non-surgical interventions include running tests and diagnosing the patient's condition, as many breast fibroids are benign and breast fat may need to be monitored for a certain period of time to monitor their development and growth. If these tumors change over time or if these are complex or giant breast masses, then they are surgically removed.

Breast cysts are also a common breast condition that are monitored periodically and do not need surgical treatment; if they are large in size and painful, they are emptied with a needle without surgical treatment.

Breast abscess is treated most of the time with antibiotics, and it may need to be drained without surgical intervention, but sometimes we resort to opening it surgically if the abscess is large in size and has not been completely emptied by aspiration.

Dilation of the mammary ducts, which affects women over age 50, only needs follow-up without surgical intervention. It can be treated with antibiotics if it is accompanied by nipple discharge, redness and pain in the nipple and surrounding tissues. In some cases, a biopsy is needed to rule out breast cancer.

As for breast cancers, the breast clinic offers treatment options by experienced personnel in providing this type of care by preparing the best treatment plans depending on the type of cancer, its size, location, disease severity, laboratory test results and the patient’s general health.

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Breast problems are not always cancer, but there are many benign tumors that are not dangerous, but in one way or another they cause fear and anxiety in women.

The patient’s medical history is taken, clinically examined, and then the appropriate X-rays are determined for her condition.

• Mammogram • Breast Ultrasound • MRI Mammography The results of the required tests are taken on the same day, with the possibility of conducting a biopsy for cases that require this directly.

Medical conditions that require surgical treatment: • • • •

Breast cancer and precancerous stage DCIS (Ductal carcinoma in situ) Phyllodes tumor and precancerous tumors due to the presence of an atypical tissue Complex or giant fibroadenoma Intraductal papilloma that grows in the milk duct

To relieve this anxiety, we have created the One Stop Breast Clinic.

The clinic seeks to spread awareness about breast health and cancer prevention, as well as providing early detection, diagnosis and treatment services for malignant and benign breast tumors. The patient is received in the clinic by breast health and surgery specialists.

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• •

Breast abscess that does not respond to antibiotic therapy and aspiration Large fatty cysts and lipomas associated with chronic pain

Breast cancer surgery is a key factor in breast cancer treatment, and it involves removing the cancer through surgery. Breast cancer surgery may be used alone or in combination with other treatments such as chemotherapy, hormone therapy, targeted therapy and radiation therapy. NMC Royal Hospital has highly experienced breast surgeons, and is working with other specialists to develop an individualized treatment approach and provide the patient with the comprehensive care she needs.

The care team includes breast cancer surgeons, oncologists, pathologists, plastic surgeons to perform the necessary breast reconstruction, physiotherapists, nurses and radiologists. The patient’s appointments are coordinated with the different specialties and often within days. If surgery is chosen first, the operation will be carried out quickly to avoid long waiting times.

State-of-the-art equipment and technologies Diagnostic services in the clinic include: •

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Mammography: An X-ray imaging method that allows the radiologist to enlarge and adjust the size, brightness and contrast to easily detect any abnormalities.

3D mammogram: An imaging test that combines multiple breast X-rays to create a three-dimensional picture of the breast. A 3D mammogram is used to look for breast cancer in people who have no signs or symptoms.

Magnetic Resonance Imaging (MRI): A contrast material is used in this imaging technique to distinguish between different tissue structures in the breast.

Breast MRI uses radio waves and strong magnets to make detailed pictures of the breast tissue.

Ultrasound: This technique uses an ultrasound device on the surface of

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•

•

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the body. The device emits sound waves that bounce off the tissues of the body to be converted into digital images that are useful for detecting any abnormalities.

Computer-assisted breast exam: It is used in conjunction with a traditional or digital mammogram. The image is analyzed by a computer to provide the radiologist with an image of suspicious areas that require further study.

Minimally invasive diagnostic breast biopsy: It is usually performed by a surgeon or radiologist using computer imaging to guide him in taking small tissue samples with a sterile needle.

Vacuum-assisted stereotactic breast biopsy: A minimally invasive diagnostic technique in which a radiologist uses a suction probe inserted through a small incision to take small samples of breast tissue under the guidance of the mammogram images.

Ultrasound-guided vacuum-assisted breast biopsy: A minimally invasive diagnostic technique in which a radiologist uses a suction probe inserted through a small incision to take small samples of breast tissue guided by the ultrasound images.

Surgery Techniques Women with early stage breast cancer may undergo breast-conserving surgery (lumpectomy), in which only the tumor is removed from the breast while preserving the breast. The choice between mastectomy and lumpectomy can be difficult. Both measures are equally effective in preventing recurrence of breast cancer. However, lumpectomy is not an option for all breast cancer patients, and mastectomy is preferred by others. We have mastectomy techniques that preserve breast skin and allow for a more natural breast appearance following the procedure. This is also called a skin-sparing mastectomy.

Nipple sparing and areola sparing mastectomy where only breast tissue is removed while preserving the skin, nipple and areola.

BREAST PROBLEMS ARE NOT ALWAYS CANCER, BUT THERE ARE MANY BENIGN TUMORS THAT ARE NOT DANGEROUS, BUT IN ONE WAY OR ANOTHER THEY CAUSE FEAR AND ANXIETY IN WOMEN.

Our plastic surgeons perform the surgery to restore the shape of the breast, called breast reconstruction, during the mastectomy or during another operation. Sentinel node biopsy in which we remove only the first few nodes into which the tumor drains (sentinel lymph nodes).

Lymph nodes removed during a mastectomy are then tested for cancer. If no cancer is present, no further lymph nodes need be removed. If cancer is present, all lymph nodes are removed or other options such as radiation to your armpit will be discussed. If this is what you decide to do, no further lymph nodes will need to be removed during the operation.

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Protected and connected Restoring humanity in healthcare for health workers and their patients burnout and cognitive overload before the pandemic — now it is amplified. We will see people with post-COVID stress disorder syndrome, it is real, and this is a global issue.”

One of Dr Duffy’s major concerns is that people will choose to leave the healthcare profession in droves and people will choose to not enter nursing or medical school.

“If we don’t fix the system issues, we will lose a generation of practitioners and that will cripple healthcare systems around the globe.

We need to remove the preventable trauma and deploy technology that keeps people safe and enables them to do their jobs more easily, and we need to do it now.”

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rontline healthcare workers across the world are facing unimaginable challenges, pushing on to deliver care after 18 grueling months entrenched in the pandemic.

Bridget Duffy, MD — Chief Medical Officer of Vocera Communications — has witnessed harrowing scenes in the US health system and is working to determine what healthcare leaders, governments and technology companies can do to protect the physical, emotional and psychological wellbeing of nurses, doctors and other frontline healthcare workers.

“Healthcare workers are exhausted, burnt out and fearful of bringing COVID-19 home to their families,” Dr Duffy said. “Nurses in particular are at risk— they have the most direct, hands-on patient contact, and face the greatest risk of infection of all healthcare workers.

In many scenarios, PPE has been inadequate, leaving nurses feeling unsafe in their working environment. “The fatigue that is setting in is not good. There was a public health crisis of

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If there’s anything positive to come from the pandemic, it’s the drive that propels the industry to move faster to design environments that protect and connect the healthcare workforce and restore joy amongst those in the profession. Dr Duffy explained that a new declaration of safety is being drafted to safeguard the physical and psychological safety of healthcare workers. The standard should focus on PPE as well as technology (PPET) that enables healthcare staff to communicate safely with colleagues, creating a connected care team through voice.

“We need some basic standards around protecting the physical safety of our healthcare workforce, as well as those that ensure psychological and emotional wellbeing.”

“We’re going to need to rebuild trust and put in assurances that we can protect the physical safety of healthcare workers. This is why the new Vocera Smartbadge has a dedicated panic button with real-time location and broadcast capabilities — if a nurse is subjected to violence, he or she can hit the panic button, which will broadcast to the local hospital security or the police,” Dr Duffy explained.

“We want nurses and other front-line team

VOICE-ACTIVATED, HANDS-FREE TECHNOLOGY WOULD ENABLE THEM TO STAY SAFE, CONNECTED TO THEIR CARE TEAM AND AT THE BEDSIDE PROVIDING THE BEST POSSIBLE CARE TO PATIENTS.

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members to go to work with this device knowing they are safe. Having the badge means that a health worker is never alone, when they are isolated in a patient’s room or elsewhere within the hospital.”

Communication is at the core of safety, so PPE needs to include technology that keeps people safe. According to Dr Duffy, the greatest risk to healthcare staff is taking on and off their PPE to contact a colleague or get the supplies they need to do their job. They should not have to risk contamination to reach their colleagues.

“Voice-activated, hands-free technology would enable them to stay safe, connected to their care team and at the bedside providing the best possible care to patients.”

Historically, psychological wellbeing has been seen as a ‘soft’ concern. Dr Duffy explained that, as a result of the pandemic, most institutions in the US are appointing senior roles to address the wellbeing of staff. One U.S. hospital implemented a distress index to help measure and monitor staff wellbeing. The index, powered by human-centered technology, allows staff to record on a scale of one to five, how distressed they are on a given day. A high

distress response is immediately routed to a support system. Health workers are witnessing numerous traumas every day, so it is vital that support and resources are available to them.

“The pandemic has forced us to separate loved ones at their greatest time of need. There are technologies that can restore humanity at the bedside by connecting the patient with their loved ones. We now have technology that allows us to take video and photos and connect families in a secure way.”

Dr Duffy explained that Vocera can broadcast to a whole family simultaneously, creating a connected community around the patient.

“It is our hope to restore humanity through improved smart communication that creates a connected care team inside and outside the walls of the hospital. “With a connected care team, features like our panic button, and a smart workflow management system that alleviates cognitive overload, we can design a healing healthcare ecosystem in which people will want to work and where patients will receive the compassionate care they deserve.”

First published in Hospital + Healthcare

THE NEW VOCERA SMARTBADGE HAS A DEDICATED PANIC BUTTON WITH REAL-TIME LOCATION AND BROADCAST CAPABILITIES — IF A NURSE IS SUBJECTED TO VIOLENCE, HE OR SHE CAN HIT THE PANIC BUTTON, WHICH WILL BROADCAST TO THE LOCAL HOSPITAL SECURITY OR THE POLICE.

www.vocera.com/me

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INNOVATION AND TECHNOLOGY LAUNCH HEALTH SERVICES INTO A NEW ERA

MHSA Programme Coordinator at the University of Nicosia Medical School

Dr. Neophytos Karamanos Interview by Constandinos Tsindas

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he pandemic has forced professionals to look at more effective, faster collective management methods and realise that multi-dimensionality must be part of a modern healthcare system. Dr Neophytos Karamanos, Programme Coordinator of the Master of Science in Health Services Administration (MHSA) at the University of Nicosia Medical School, believes that innovation and technology can place patients where they should be; right at the heart of services.

These are dynamic times for the Health Services Administration Sector as a result of the pandemic and technological change. Can professionals in the field rise to the occasion and propose more effective ways of making the system work for people?

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INNOVATION MANAGEMENT IS EXTREMELY DIFFICULT.

We live in very challenging times as far as the entire health services sector is concerned.

New innovative approaches and technologies are fundamentally reshaping the sector. Telemedicine, artificial intelligence and big data analysis, real-time patient monitoring through wearables and blockchain are merely examples of the new technologies being introduced.

The pandemic, among other factors, accelerated the rate of change and has highlighted the need for effective crisis management.

Knowledge on how pandemics spread within a population, evaluation of measures which could limit such spread, an understanding of how hospital settings and facilities should be structured to increase effectiveness and ensure the safety of both patients and healthcare practitioners, an understanding of how technology could be of assistance, even basic skills about drawing up crisis management plans and redistributing resources are all essential competencies needed in order to effectively cope with the pandemic.

When there is so much change and a need for new competencies, it is a signal to return to

INTERVIEW

education and facilitate personal development to meet the greater needs of the public. And this is exactly where the novel and modern MHSA programme aims to improve: providing the essential skills to health services professionals in these critical, developing areas.

Where does innovation come in when it comes to cooperation across different disciplines?

Innovation management is extremely difficult. You need to achieve the collaboration of several partners (e.g. hospitals, healthcare groups, insurances, universities, research centres, biotech and government) in order to develop new innovations. The real challenge however remains to embed new innovations in the processes and systems of your organization and turn them into everyday practice. The new MHSA programme places special emphasis on innovation management and entrepreneurship.

It also challenges students to pursue advanced initiatives to address existing problems in their current work environments through the development of business plans and the implementation of field projects.

What is the role of emerging technologies and innovation in building those working relationships towards a more patient-centred health services system?

I would say that developments here are truly exciting. New technologies and innovations enable a more personalized approach for patients and also individuals managing their wellness. The emphasis continues on treatment and increasingly on preventive medicine. The ability to collect real-time information about a person’s health and physical condition, dietary habits, the monitoring of someone’s biomarkers including genetic predisposition, all enable healthcare services to provide more personalized treatment, counselling and coaching towards improving health and well-being. The ability to collect, analyse and cross-relate extensive patient health data, including relating this information with the data of the larger population, enables

the calculation of health risks and scores at an individual basis, leading to corrective actions and improvement.

How has technology use altered the health service sector, considering the pandemic?

The pandemic has manifested how new technologies have the potential to transform health services. Telehealth usage rose sharply and mobile apps were used for social distancing and contact detection. Artificial Intelligence applications aided treatment discovery efforts.

When it comes to the MHSA programme, this course is offered fully online benefitting from UNIC’s experience as the first university globally to receive triple accreditation for its online learning quality. Harnessing global experience in the digital platform is an essential part of the MHSA so that students benefit from leaders and experts with real-life experience in combating pandemics.

What is your own background and what do you think this experience brings to the University of Nicosia MHSA?

NEW TECHNOLOGIES AND INNOVATIONS ENABLE A MORE PERSONALIZED APPROACH FOR PATIENTS AND ALSO INDIVIDUALS MANAGING THEIR WELLNESS. THE EMPHASIS CONTINUES ON TREATMENT AND INCREASINGLY ON PREVENTIVE MEDICINE.

I come from a business and technological background, with experience on how organizations can innovate and transform themselves during periods of dramatic change, such as this one. The very design of the MHSA places significant emphasis on how change can be practically embedded into organizations through innovation and entrepreneurship.

How does e-learning work in practical terms for a degree as Health Services Administration?

The e-learning mode of programme delivery presents several advantages for the busy professionals who will be interested to pursue an MHSA degree. Firstly, there is no location constraint and the programme can be attended from anywhere in the world. The majority of the programme’s activities are asynchronous and the students can undertake them when their schedule permits. The few synchronous activities are also recorded and can be attended offline. Interactivity (teacher-to-students, stu-

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dent-to-student and student-to-material) is continuously built into the programme’s activities and webinars so that group learning and sharing of experiences is achieved.

What are the advantages of the Medical School online programmes?

The University of Nicosia is a regional leader in distance learning education at the Bachelor and Master level. It is the first university in Europe to have received a triple recognition for excellence in online education by: • QS Stars (5 stars): It is one of only 14 universities in the world to-date that has been awarded a 5-Star rating • The European Association of Distance Teaching Universities (EADTU): The university is a recipient of the E-xcellence label • The European Foundation for Quality in e-Learning (EFQUEL) The University offers students a state-ofthe-art online platform, supported by experienced academics who employ the latest pedagogical approaches for online learning. The learning platform is supported by engineers who work to provide timely support. The 2020 Times Higher Education (THE) University Impact Rankings, ranked the University of Nicosia (UNIC) as the number 42 university in the world in the core area of Quality Education,

Looking to the future, what are the lessons to be learned, and how can we prevent the same mistakes?

The future will be inevitably be different from the past as the whole health services sector is being radically transformed by new technologies and approaches. Yet the past and its lessons are also critical. Take the pandemic; humanity has witnessed a number of pandemics like, for instance, the Spanish influenza which taught us the value of wearing masks, social distancing, school closures, prohibition of social gatherings. Yet, in responding to Covid-19, many countries were late to implement effective measures while early warning signals were ignored. The world is more vulnerable today due

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to global connectivity.

The importance of providing timely and accurate information to the public must also be stressed. Contradictory views (even from experts) traversed instantly across the globe adding to the public’s confusion. The role of WHO and other formal health bodies is critical towards coordinating the protection efforts and providing accurate information.

How can we implement health services management for the people?

The ongoing developments in the sector allow placing patients and individuals at the centre of services. Working in the health services, our role is to continue to innovate to meet the varying needs of patients, as technology and research expands globally.

Treatment will be complimented by prevention and lifestyle medicine with increasingly personalized services through collection and correlation of a massive amounts of patient data, including data collected from wearable health devices. We can anticipate expanded use of a person’s biomarkers including genetic predisposition and enabling of behaviour change to reduce health risk. All of these point towards a brighter health-related future.

For more information about the MHSA programme at the University of Nicosia Medical School visit www.med.unic.ac.cy/education/master-health-administration-mhsa/

THE E-LEARNING MODE OF PROGRAMME DELIVERY PRESENTS SEVERAL ADVANTAGES FOR THE BUSY PROFESSIONALS WHO WILL BE INTERESTED TO PURSUE AN MHSA DEGREE. FIRSTLY, THERE IS NO LOCATION CONSTRAINT AND THE PROGRAMME CAN BE ATTENDED FROM ANYWHERE IN THE WORLD.

NEWS

Upcoming Events at UNIC Medical School 19 April

5pm EEST 3pm GMT 10am EST

Master in Family Medicine (MScFM) Online Open Day

Family Medicine and Primary Care are crucial for healthcare systems. Join us online to discover more about this programme for practising doctors.

24-30 April

World Immunization Week

17-31 May

European Public Health Week

Monday, 17 May Tuesday, 18 May Wednesday, 19 May Thursday, 20 May Friday, 21 May

31 May

5pm EEST 3pm GMT 10am EST

Faculty and students celebrate World Health Organization events to increase trust and confidence in vaccines and to maintain or increase vaccine acceptance.

Faculty, students and the community join to expand public health awareness based on this year's themes: Communicating science and health New challenges in mental health Your local community All for one health Leaving no one behind

Healthcare Professional Leadership Series - ‘Not Just a GP’

Presented by Prof Sir David Haslam and Dr Ourania Kolokotroni This webinar will discuss the different roles a General Practitioner (GP) plays in the delivery of primary care, and how personal practice and extensive knowledge can bridge gaps across a national healthcare system.

Visit University of Nicosia Medical School website to register to attend med.unic.ac.cy

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ARTICLE FEATURES . Single-use medical devices

Single-use medical devices To improve patient safety by reducing the risk of cross-contamination

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ARTICLE FEATURES . Single-use medical devices

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ingle-use medical devices are medical equipment and instruments that are used only once in a hospital or clinic and then disposed. Some medical devices are difficult to sterilize or reprocess to make them safe to use on another patient, so the alternative was single-use devices.

Using disposable items improves patient safety by eliminating the risk of patient-to-patient contamination because the item is discarded and not used on another patient. The most important single-use devices are syringe needles, scalpel blades, gauze and others.

The goal of using single-use medical supplies is to prevent germs and viruses from spreading from one patient to another, which is essential in infection control.

These medical devices have become popular in the world with the spread of the coronavirus pandemic and the need to limit its spread, so the focus was on single-use medical devices and their disposal after each use, as part of the global efforts to break the cycle of spreading the virus from one patient to another.

Single-use devices or equipment should not be reused, and they should only be used on one patient during a medical intervention or a single medical procedure and then disposed and should not be used again even on the same patient. Reusing it affects its efficacy and the safety of the medical procedure itself, exposing the patient and the doctor to unnecessary health risks.

This type of medical supplies is a reliable option to ensure that all devices are not contaminated and that germs and microbes are not transferred from one patient to another, which reduces the chances of cross-contamination.

Single-use medical devices in hospitals and health facilities instead of those that are used again after sterilization have numerous benefits.

Improving patient safety The main priority for all health workers is to eliminate preventable diseases during the provi-

THESE MEDICAL DEVICES HAVE BECOME POPULAR IN THE WORLD WITH THE SPREAD OF THE CORONAVIRUS PANDEMIC AND THE NEED TO LIMIT ITS SPREAD, SO THE FOCUS WAS ON SINGLE-USE MEDICAL DEVICES AND THEIR DISPOSAL AFTER EACH USE, AS PART OF THE GLOBAL EFFORTS TO BREAK THE CYCLE OF SPREADING THE VIRUS FROM ONE PATIENT TO ANOTHER.

sion of healthcare that may develop in patients while receiving medical services, which increases the need for safe and effective tools.

Single-use medical devices reduce the risk of cross-contamination, including infections during surgery and those that can be transmitted during medical procedures. Thus, these single-use medical supplies can alleviate healthcare providers' concerns regarding the cleanliness of their surgical instruments. With reduced risk of contamination and increased infection control, single-use devices can improve patient safety and overall quality of care.

Saving time Single-use medical supplies reduce the burden of sterilization and disinfection after any medical intervention, which saves time because they are disposed immediately after use and there is no need to clean them after each use.

Hospital workers and healthcare providers don't have to spend time decontaminating and sterilizing the way they do with reusable devices.

Saving time with minimal preparations or work that follows any medical intervention, all factors increase the efficiency of medical facilities and allow them the opportunity to serve more patients. Healthcare facilities can easily adhere to scheduling and avoid any kind of incidents.

Reducing cost Although single-use medical supplies may be more expensive than reused ones, the long-term benefits remain the most important for healthcare providers, especially in terms of reducing cross-contamination.

In addition, relying on this type of supplies eliminates the cost of reprocessing, sterilization, and maintenance of the machines used for this purpose, as well as saving time. All these benefits make it difficult to calculate the financial cost as these tools simplify the medical procedure for healthcare providers. Therefore, we can say that over time, reusable supplies provide the same quality of services as single-use supplies.

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New Advances in Fetal-Maternal Medicine

By Dr. Asmaa Abdulsalam, Consultant of Obstetrics and Gynecology at Al-Ahli Hospital / Qatar

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etal-Maternal medicine has achieved a lot of progress in the last three decades looking for better prognosis for both the mother and the newborn by looking for early detection of any abnormalities related to the mother and the fetus so all precautions could be taken to prevent and to treat these disorders. Fetal-maternal medicine does not start with onset of pregnancy but starts even before, preparing the mother to coop at the best with her pregnancy

Pre-conception care Mother should start folic acid at least 3 months before getting pregnant to minimize and prevent neural tubal, defects in the fetus like Anencephaly. Hydro- Cephalus and Spina Bifida. A woman who is known to have past history of gestational diabetes mellitus should control her blood glucose at least 3 months before pregnancy to avoid miscarriages and minimize risk of congenital abnormalities in addition to minimizing fetal and maternal morbidity and mortality during pregnancy and delivery.

This also applies to other medical problems like auto-immune diseases, hypertension, cardiac disorders, iron and vitamins deficiency, obesity and metabolic disorders not only this but the woman also should be psychologically stable and ready for getting pregnant.

Every effort should be done to prevent unwanted, unplanned pregnancy to avoid unsafe abortion and to minimize the stress on the mother which subsequently will be reflected on her and the newborn's health.

Post-conception Once a woman gets pregnant and pregnancy is confirmed by BHCG (Pregnancy Hormone) and during the first three months of pregnancy, it is essential to screen for congenital abnormalities

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WOMAN KNOWN TO HAVE PAST HISTORY OF GESTATIONAL DIABETES MELLITUS SHOULD CONTROL HER BLOOD GLUCOSE AT LEAST 3 MONTHS BEFORE PREGNANCY TO AVOID MISCARRIAGES AND MINIMIZE RISK OF CONGENITAL ABNORMALITIES.

using the ultrasound to check for the nuchal translucency and nasal bones as a predicting test for trisomy, recently with new advanced ultrasound machines combined with proper training, many other congenital abnormalities could be detected as early as 11-13 weeks.

To increase the predictability of detecting trisomy. Recently, by the ultrasound, fetal measurements combined with level of certain hormones and proteins in the mother blood can can, through specific computer programs, calculate the risk of having trisomy what is called Double and Triple tests. Another predicting test is the PANORAMA test where the fetal cells are separated from maternal blood and submitted to chromosomal tests. It can also predict the trisomy and other genetic disorders with high accuracy. If the predictive tests proved to be at high risk for fetal abnormalities, more certain and invasive tests can be done - if the parents give consent - like Chorionic villous biopsy and amniocentesis.

Uterine artery doppler is another test that can be done early in pregnancy to predict pre-eclampsia, recently a new test has been developed which combines uterine artery doppler readings together with many predicting factors like medical, family history of chronic hypertension, renal disorders, autoimmune diseases,

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pre-eclampsia together with specific hormonal levels in maternal blood, the result of this test is reliable in determining those who are at high risk for developing pre-eclampsia before 34 week. Accordingly, high-risk group should start Aspirin of 100 mg tablet daily before 16 weeks pregnancy and continuously taken till 34 weeks, this prophylactic treatment is effective by 97% in preventing pre-eclampsia subsequently decreasing maternal and fetal morbidity significantly and proving to be cost-effective.

Ultrasound in the second trimester has also achieved a huge progress with the development of the skills of the obstetricians and the accuracy of the machines that can detect a lot of morphological abnormalities of the fetus including the heart, brain and fetal circulation and cervical length of the uterus.

In the last trimester, ultrasound is a useful tool in the diagnosis of intrauterine growth restrictions and small for gestational age and to decide on the time of delivery based on umbilical artery and middle cerebral artery doppler.

It can also diagnose with great accuracy the placental situation and its relation to the cervix, previous scars and degree of penetration in the endometrium and myometrium in other words ultrasound can diagnose different degrees placenta previa, accreta and scar pregnancy.

UTERINE ARTERY DOPPLER IS ANOTHER TEST THAT CAN BE DONE EARLY IN PREGNANCY TO PREDICT PREECLAMPSIA.

And the most important is to standardize the examination to minimize the human errors and differences in estimation between different care givers in the labor room Intrauterine surgery became a routine in certain centers all the world to correct the congenital abnormalities before delivery like Spina Bifida repair which is closing of a defect in the back of the fetus by 20 weeks gestation through direct open surgery or fetoscope. This operation is successful in correction of the defect and protecting the baby from complications of neural tubal defects after delivery.

However, intra uterine surgery is not always beneficial with other congenital abnormalities correction and should be done only when the benefit exceeds harms.

Ultrasound During labor Obstetricians are now active in using ultrasound during labor to examine the progress of labor during first and second stage of labor and in properly diagnosing malpresentation of the fetal head before application of the forceps or vaccum so minimizing the fetal injuries. Intrapartum ultrasound can assess the presenting part and its relation to maternal pelvis, station and degree of engagement of the head using angle of progression, fetal perineum distance.

Fetal head -Symphysis pubis distance and attitude of the fetal head in the pelvic curve as parameters of progress of labor, it can also assist the dilatation and effacement of the cervix without digital examination which is more convenient and less stressful and painful to the delivering woman.

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Endometrioma and Infertility When To Operate

By Dr. Mazen Bashtawi, FRCOG FACOG, Consultant in Obstetrics and Gynaecology, Subspecialist in Gynaecological Oncology and Advanced Laparoscopy at Al-Ahli Hospital / Qatar

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ndometriosis has been estimated to affect up to 10% to 15% of reproductive-age women. Most women with endometriosis have a delay on average of 7 years from the onset of symptoms until the diagnosis is made, the symptoms could be irregular bleeding, menstrual dysfunction, pain and infertility.

The association between endometriosis and infertility is well supported throughout the literature, but a definite cause-effect relationship is still controversial.

The prevalence of endometriosis increases dramatically to as high as 25% to 50% in women with infertility, and 30% to 50% of women with endometriosis have infertility. The fecundity rate in normal reproductive-age couples without infertility is estimated to be around 15% to 20%, whereas the fecundity rate in women with untreated endometriosis is estimated to range from 2% to 10%.

Women with mild endometriosis have been shown to have a significantly lower probability of pregnancy during a period of 3 years than do women with unexplained fertility.

Ovarian endometriomas have always been subject for controversy, controversy on pathogenesis and controversy on treatment. We see many patients coming with endometriomas and infertility, these patients usually get conflicting advice whether to go for surgery and remove endometrioma or proceed for IVF. Ovarian endometrioma affects 17-44% of

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IF SURGERY IS TO BE CONTEMPLATED, LAPAROSCOPY IS THE SURGERY OF CHOICE, AS IT OFFERS QUICKER RECOVERY AND RESUMPTION OF EVERYDAY ACTIVITIES. SURGEON'S EXPERTISE AND TECHNIQUE IS OF PARAMOUNT IMPORTANCE TO MINIMIZE DAMAGE TO THE OVARIES.

women with endometriosis, endometriomas also known as chocolate cysts containing thick old hemorrhage that appears as brown fluid. In 50% of cases the endometriomas are bilateral, they are more frequently located in the left ovary. Pathogenesis still controversial many theories trying to explain the nature and the cause of this disease. The most acceptable theory is invagination of ovarian cortex secondary to implant of metaplastic cells in the coelomic epithelium. Pelvic ultrasound is usually enough to make the diagnosis of endometrioma, however MRI is the gold standard.

The causes of infertility in women with endometrioma can be attributed to many factors such as adhesions and blockage of the fallopian tube, inflammatory response may participate in degradation of oocyte and sperms. Endometrioma might lead to poor embryo quality, poor ovarian reserve and inflammation affecting endometrial receptivity.

Management ovarian endometrioma can be complex and should be individualized, the optimal treatment will depend on the patient age, severity of pain, characteristics of the

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ULTRASOUND

LAPAROSCOPY

cyst, unilateral or bilateral, the presence of coexisting deep infiltrating lesion and clinical history of previous surgery. Laparoscopic surgeons believe that surgery should be the first step in management of endometriomas as these lesions are less likely to disappear on their own, surgery will improve pain, improve fertility, reduce risk of ovarian cancer, reduce risk of pelvic infection at the time of oocyte retrieval, reduce risk of contamination by the chocolate material which affects the quality of oocytes, and surgery is less costly compared to IVF treatment.

While IVF specialists believe that surgery might increase the damage to the ovary and further reduction ovarian reserve. Royal College of obstetricians and gynaecologists (RCOG) guideline advised for surgery before IVF in highly symptomatic women and those with good ovarian reserve, patients with unilateral large cysts, and cysts with suspicious features.

If surgery is to be contemplated, laparoscopy is the surgery of choice, as it offers quicker recovery and resumption of everyday activities.

Surgeon's expertise and technique is of paramount importance to minimize damage to the ovaries. The best technique is to strip the endometrioma wall, but it is not always possible to do in all cases.

Laparoscopic cystectomy for ovarian endometriomas greater than 4 cm improves fertility compared to cyst drainage and coagulation, which is associated with a high risk of cyst

OVARIAN ENDOMETRIOMA AFFECTS 17-44% OF WOMAN WITH ENDOMETRIOSIS.

recurrence. Proper assessment before surgery is extremely important as a significant number of women with endometrioma had reduced ovarian reserve due to pathology itself. Transvaginal aspiration before IVF cycle is useless, dangerous and should not be contemplated.

Postoperative medical therapy has been advocated as a means of eradicating residual endometriotic implants in patients with extensive disease in whom resection of all implants is impossible or inadvisable. Postoperative hormonal therapy also may treat microscopic disease; however, none of these treatments has been proven to enhance fertility. But these therapies are sometimes to reduce pain.

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ARTICLE FEATURES . Bone Marrow Transplant

Bone Marrow Transplant The best choice for leukemia patients

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one marrow transplant is considered the only option to treat blood diseases when other approved treatments fail. These diseases include common blood cancers, such as acute and chronic leukemia, lymphoma, acute lymphocytic leukemia, bone and soft tissue tumors (sarcoma), brain tumors, bone marrow failure syndromes, thalassemia, aplastic anemia, and sickle cell anemia. Recovery from a bone marrow transplant takes a long time.

Bone marrow transplant is a medical procedure that replaces your damaged bone marrow cells with healthy cells. The replacement cells can either come from your own body or from a donor who is often a family member, provided that the match between the patient and the donor is 100% and that the latter is in good health.

Bone marrow is the soft, spongy tissue inside bones that helps them produce and store most of the body’s blood cells and the cells

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BONE MARROW TRANSPLANT CAN ALSO BE PERFORMED TO TREAT NON-CANCEROUS DISEASES, SUCH AS APLASTIC ANEMIA AND THALASSEMIA MAJOR.

that make up the immune system. Before the transplant process, the patient undergoes chemotherapy or radiotherapy to destroy the bone marrow cells, which are later replaced.

Bone marrow transplant can also be performed to reconstitute a new immune system that fights existing or remaining leukemia or other cancers that are not killed by chemotherapy or radiotherapy. In some cases, chemotherapy and radiotherapy may not cure the condition, even after many sessions. The doctor has to resort then to the bone marrow transplant to eradicate malignant diseases, such as leukemia.

Bone marrow transplant can also be performed to treat non-cancerous diseases, such as aplastic anemia and thalassemia major. The bone marrow contains stem cells that mature into three types of blood cells: red blood cells that carry oxygen throughout the body, white blood cells that help fight infections, and platelets that form clots to prevent excessive bleeding. Tissue

ARTICLE FEATURES . Bone Marrow Transplant

incompatibility represents a major barrier to hematopoietic stem cell transplantation. Usually, the ideal donor is a sibling who has a compatible tissue type, whether a twin or a sibling who has the same biological mother and father. When the patient doesn’t have a matched donor in the family, the doctor can search for a match in the National Marrow Donor Program's Registry and cord blood banks where the cord blood donated voluntarily is stored.

Pre-transplant When a match is found, both the donor and the patient must undergo a series of tests to verify if the tissues are compatible and if the donor has any infectious disease or cancer.

The patient must undergo comprehensive blood tests to detect any viral infections, such as hepatitis or AIDS, and other infectious diseases, in addition to an echocardiogram to check for heart function, an X-ray examination to check the heart and lungs, a bone marrow biopsy, and a PET scan to check for organs functions within the body.

The patient also undergoes preparatory treatment before the transplant process in order to remove damaged cells from the body.

This step takes about ten days during which the patient is given a strong chemotherapy as an infusion into a vein, in addition to radiotherapy if necessary.

The patient is also provided with fluids.

These treatments are relatively difficult, so the patient must be in a condition that allows him or her to have a transplant.

In some cases, the transplant may be autologous, i.e. from the patient’s own body. This procedure is usually done after receiving chemotherapy. The collected cells are stored until the patient is given high-dose chemotherapy to remove the remaining damaged cells. The stem cells are then reintroduced to help the bone marrow heal.

If a donor is found, he or she must first undergo tests to see how compatible the tissues are. Matching tests include detection of blood type matching between the patient and the donor, tissue typing (HLA test), in addition to blood tests to detect any viral or other infections, such as hepatitis, AIDS, and other infectious diseases.

THE PATIENT MUST REMAIN IN THE HOSPITAL IN A COMPLETELY ISOLATED AND STERILE ROOM FOR A PERIOD OF APPROXIMATELY 18 UP TO 30 DAYS. EVEN THE AIR MOLECULES ARE UNDER CONTROL BECAUSE IT IS A VERY DELICATE STAGE DUE TO THE PATIENT’S LACK OF IMMUNITY AND INABILITY TO RESIST ANY GERMS OR PATHOGENS THAT MAY SWEEP HIS OR HER BODY DURING THE FIRST PERIOD OF TRANSPLANTATION.

During the Process After the patient has undergone all the necessary tests, and after he or she has been prepared for a bone marrow transplant, the journey towards having a healthy bone marrow begins.

Bone marrow transplants may use cells from the patient’s own body (autologous transplant), where the stem cells are obtained after the patient is given a set of stimulant injections to stimulate the production of these cells and their exit into the bloodstream. Then the doctor takes a blood sample from the patient and places it in a device that separates blood components, including the stem cells which are frozen until transplant time.

The stem cells of the donor (allogeneic transplant), if found, are collected and frozen also until it is time to infuse them into the patient's body. During this stage, the patient undergoes chemotherapy or radiotherapy to eliminate existing cancer cells or damaged or abnormal cells, inhibit immunity in the body, and to prepare the bone marrow to receive new stem cells. The patient may experience some side effects, such as nausea, vomiting, fatigue, and other complications. During the transplant process, the patient remains awake and receives local anesthesia only as the injection does not cause pain that requires general anesthesia. Then the stem cells start flowing in the bloodstream and reach the marrow where they will produce new blood cells. It takes about 18 to 30 days for them to produce effectively, noting that the number of stem cells given to the patient is accurately calculated and based on proportions related to weight and size.

The patient must remain in the hospital in a completely isolated and sterile room for a period of approximately 18 up to 30 days. Even the air molecules are under control because it is a very delicate stage due to the patient’s lack of immunity and inability to resist any germs or pathogens that may sweep his or her body during the first period of transplantation. In the first days after the transplantation, the patient experiences exhaustion, loss of appetite, nausea, and even the need to vomit, in addition to some symptoms resulting from the preparatory chemotherapy that preceded the process.

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After experiencing blockages in the main arteries,

A 60-year-old man is saved from death by Al-Ahli Hospital

By Dr. Atef bin Youssef, Open Heart and Vascular Surgery Consultant at Al-Ahli Hospital / Qatar

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veryone should have regular heart checks.

A large portion of people do not recognize that they are at risk of having a heart attack, says Dr. Atef.

Dr. Atef bin Youssef, a consultant cardiovascular surgeon, together with the medical team at Al-Ahli Hospital's Cardiac Department, performed an aortic bypass surgery operation for a 61-year-old man.

In this context, Dr. Atef bin Youssef said: “This operation was successful, praise be to God, despite the severe blockage in the main artery of the heart, which reached 90%. "Despite the healthy lifestyle of the patient and despite being free of diseases, especially chronic ones which affect heart patients, the work pressure and

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stress were the main reasons behind the heart attack experienced by the patient in 2012, and behind the recurrence of blockage of the main arteries" he explained. "The patient almost felt no symptoms until he discovered, during a periodic examination at work, that he suffers from blockage. Heart patients with psychological and emotional stress are 3 times more susceptible to developing heart attack than their peers who don't suffer from similar stresses", he added. It is widely known that a deteriorating psychological state plays a clear role in affecting the health of the bodies, as it has a strong impact on them. Dr. Atef also added “Psychological stress can cause blood vessels to constrict, raise blood pressure, increase the number of heartbeats, and thus increase the heart’s need for oxygen. This, in turn, leads to reduction of the blood flowing into the heart muscle; a medical condition known as "myocardial retention".

Dr. Atef bin Yusef pointed out that there are indications that those who are exposed to work pressures and depression and those who are irritable and easily anxious, are more likely than others to suffer from cardiovascular disease.

He also stressed the need for having periodic heart checks, as many patients may not feel any symptoms of a blockage in the arteries or the possibility of suffering a heart attack.

PSYCHOLOGICAL STRESS CAN CAUSE BLOOD VESSELS TO CONSTRICT, RAISE BLOOD PRESSURE, INCREASE THE NUMBER OF HEARTBEATS, AND THUS INCREASE THE HEART’S NEED FOR OXYGEN.

NEWS

Patients' experiences confirm its unprecedented success

Al-Ahli Hospital Performs Joint Replacement Surgeries Using the Latest Technology

By Dr. Maher Youssef, Consultant orthopedic surgeon at Al-Ahli Hospital / Qatar made of ceramics and chrome which are similar to natural human joints and replace them to perform the function of the natural joint, especially in terms of performing movements. Patients who have undergone the operation have had flexibility in movement, walking, sitting on the ground and performing prayers.

The consultant orthopedic surgeon added: "The patient is given antibiotics and anti-inflammatory drugs during the surgery. This leads to good results in the long and short terms.

Causes of Surgery

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l-Ahli Hospital's Department of Orthopedics and Joint Surgery, which is specialized in treating knee and pelvic joints and their related problems and damage, has performed successful knee joint replacement operations using the latest surgical techniques.

On this occasion, Dr. Maher Youssef, a consultant orthopedic surgeon at Al-Ahli Hospital, said: "The joint replacement surgery aims at achieving freedom of movement without pains, restoring the full functionality of the joint, and restoring the stability to the patient, while achieving a full range of movement in all directions. We use the best technologies to replace the knee joint. There are several methods used for full or partial replacement of the knee joint.

Some of these methods are better than others in terms of the method used and the experience of the surgeon who performs the operation. In Al-Ahli Hospital, we use the best types of joints

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Dr. Maher Youssef pointed out that among the causes of knee joint replacement is knee joint stiffness. Knee stiffness affects the cartilage of the joint and causes its erosion. There are a number of external factors that lead to knee inflammation, for example previous knee injuries, partial removal of the meniscus, rheumatoid arthritis, fractures and some congenital factors. There may be also some genetic factors which cause erosions and changes in the knee joint, such as obesity, aging, knee curvature and exposure to injuries.

Dr. Maher Youssef pointed out that pain is one of the most common complaints of people suffering from knee joint erosion, and the pain is mostly in the knee itself. However, patients often can feel pain on the inner or outer side or behind the kneecap. At the beginning, the patient feels pain during the rest periods, which is called "onset pain". Few minutes later, the pain slowly fades. However, when the knee becomes more worn out, the pain occurs during rest and can affect sleep at night.

Futhermore, joint stiffness causes the patient difficulty in doing his daily habits, such as changing clothes and wearing shoes and socks. It also affects the rest of his various daily activities, especially when the wear on the knee reaches

THE PATIENT IS SUBJECTED TO A KNEE JOINT REPLACEMENT SURGERY IF IT IS URGENTLY NEEDED, SUCH AS WHEN THERE ARE SEVERE LIMITATIONS ON MOVEMENT. THE SURGERY TAKES FROM 60-90 MINUTES. IT INCLUDES PLACEMENT OF PARTS OF THE KNEE, A PART OF THE THIGH BONE, A PART OF THE SHIN BONE AND, SOMETIMES, PART OF THE KNEECAP, AS WELL AS POLYETHYLENE.

NEWS

advanced stages, as the patient will face difficulties in walking, then after passage of time, the patient will need walking aids, such as crutches.

The patient is subjected to a knee joint replacement surgery if it is urgently needed, such as when there are severe limitations on movement. The surgery takes from 60-90 minutes.

It includes placement of parts of the knee, a part of the thigh bone, a part of the shin bone and, sometimes, part of the kneecap, as well as Polyethylene.

On the first day after the operation, the patient begins walking and doing exercises and the medical team begins to move the knee and starts effective exercises in the hospital. Further, the rehabilitation process for the patient is com-

pleted by the physical therapist in the environment where the patient lives. The therapist will train the muscles to increase their strength and make muscle stretch exercises to achieve a full range of joint motion.

Patient Experience A man in his fifties, who was suffering from knee stiffness and a severe pain and can't carry on his normal lifestyle, underwent a surgery where the left knee joint was replaced. After the surgery, he realized a difference. He restored the natural functions of the knee. Therefore, the patient decided to go back to the hospital and make a replacement to the right knee. Such is the case with most patients.

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Al-Ahli Hospital / Doha - Qatar Orthopaedic and Traumatology Center

We’re Back! to serve you in full range of our Orthopedic Center services.

+974 44898000 or +974 44898888 Doha - Qatar

ARTICLE FEATURES . Insulin and weight gain

What is the link between insulin & weight gain?

I

nsulin is one of the most important hormones in the body, as it regulates the body’s metabolism of carbohydrates and fats while increasing the ability of cells to store sugars.

The pancreas produces the insulin hormone and uses glucose as a source of energy. It has a great effect to avoid constant hunger and thus prevent obesity. In type 2 diabetes, your body’s cells aren’t able to respond to insulin as well as they should. In later stages of the disease, your body may also not produce enough insulin.

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ARTICLE FEATURES . Insulin and weight gain

As a meal containing carbohydrates is eaten and digested, BG levels rise, and the pancreas turns on insulin production and turns off glucagon production. Glucose from the bloodstream enters liver cells, stimulating the action of several enzymes that convert the glucose to chains of glycogen—so long as both insulin and glucose remain plentiful. In this postprandial or “fed” state, the liver takes in more glucose from the blood than it releases. After a meal has been digested and BG levels begin to fall, insulin secretion drops and glycogen synthesis stops.

When it is needed for energy, the liver breaks down glycogen and converts it to glucose for easy transport through the bloodstream to the cells of the body.

When does insulin lead to weight gain?

Insulin causes weight gain when the cells absorb too much glucose and the body converts this into fat. During digestion, insulin stimulates muscle, fat, and liver cells to absorb glucose.

The cells either use this glucose for energy or convert it into fat for long-term storage. When a person takes insulin as a therapy for diabetes, their body may absorb too much glucose from food, resulting in weight gain.

Untreated diabetes can cause weight loss because the body is not converting food into energy correctly. Taking insulin solves this problem. This is why people may notice weight gain when they start to take insulin.

Diabetics, insulin and weight gain Weight gain is a common symptom of diabetes and other insulin-related medical conditions.

Compared with people who do not have diabetes, young adults with type 1 diabetes have a higher risk of developing excess body weight or obesity. Premeasuring portions and keeping a food log can prevent a person from eating more calories than their body needs. Eating more calories than the body needs will lead to excess glucose levels. If the cells do not remove glucose from the blood, the body will store it in the tissues as fat.

Insulin Resistance INSULIN IS A HORMONE THAT MOVES GLUCOSE FROM YOUR BLOOD INTO THE CELLS FOR ENERGY AND STORAGE. PEOPLE WITH DIABETES HAVE HIGHER-THANNORMAL LEVELS OF GLUCOSE IN THEIR BLOOD. EITHER THEY DON'T HAVE ENOUGH INSULIN TO MOVE IT THROUGH OR THEIR CELLS DON'T RESPOND TO INSULIN AS WELL AS THEY SHOULD.

Obesity causes an overproduction of insulin, which leads to a decrease in the satiety hormone, and a person loses the feeling of fullness.

The solution is to urge the body to reduce insulin secretion so that the satiety hormone returns to its activity and thus it becomes possible to control the amount of food and lose weight over time.

On the other hand, the higher percentage of body fat, the less efficient is the work of the insulin hormone. Obesity causes the deposition of fats on the cell wall, which reduces the response of insulin receptors on the cell wall and the development of insulin resistance. Over time, the efficiency of insulin in introducing sugar into the cells decreases, sugar accumulates in the blood and the cells won’t be able to benefit from it. So cells will suffer from lack of energy and a person feels hungry despite eating a large amount of food. All of this increases the risk of obesity, in addition to many diseases, namely diabetes and cardiovascular disease.

How does insulin work?

Insulin is a hormone that moves glucose from your blood into the cells for energy and storage. People with diabetes have higher-than-normal levels of glucose in their blood.

Either they don't have enough insulin to move it through or their cells don't respond to insulin as well as they should. Your body is designed to keep the level of glucose in your blood constant.

Beta cells in your pancreas monitor your blood sugar level every few seconds. When your blood glucose rises after you eat, the beta cells release insulin into your bloodstream. Insulin acts like a key, unlocking muscle, fat, and liver cells so glucose can get inside them.

After your body has used the energy it needs, the leftover glucose is stored in little bundles called glycogen in the liver and muscles. Your body can store enough to fuel you for about a day. After you haven't eaten for a few hours, your blood glucose level drops. Your pancreas stops churning out insulin. Alpha cells

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ARTICLE FEATURES . Insulin and weight gain

in the pancreas begin to produce a different hormone called glucagon. It signals the liver to break down stored glycogen and turn it back into glucose.

Insulin resistance occurs when excess glucose in the blood reduces the ability of the cells to absorb and use blood sugar for energy. If the pancreas can make enough insulin to overcome the low rate of absorption, diabetes is less likely to develop, and blood glucose will stay within a healthy range. A lot of blood sugar enters the bloodstream; the pancreas pumps out more insulin to get blood sugar into cells. Over time, cells stop responding to all that insulin—they’ve become insulin resistant. The pancreas keeps making more insulin to try to make cells respond, eventually, the pancreas can’t keep up, and blood sugar keeps rising. Lots of blood sugar in the bloodstream is very damaging to the body and needs to be moved into cells as soon as possible. There’s lots of insulin, too, telling the liver and muscles to store blood sugar. When they’re full, the liver sends the excess blood sugar to fat cells to be stored as body fat.

Initially, insulin resistance presents no symptoms. The symptoms only start to appear once it leads to secondary effects such as higher blood sugar levels. When this happens, the symptoms may include: • Lethargy (tiredness)

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• • • • •

Hunger Difficulty concentrating (brain fog) Weight gain around the middle (belly fat) Hypertension High cholesterol levels

How do we avoid insulin-related weight gain?

When we lead a healthy lifestyle, we are able to control the insulin hormone and prevent weight gain, as eating healthy foods and exercising regularly help prevent unwanted weight gain. Some of the tips that help achieve this: • Follow a moderate diet, count calories, and focus on fruits, vegetables and whole grains because they make you feel full and contain fewer calories.

• Make a good meal planning by reducing the meal portion, increasing the number of small meals, avoiding additional dishes, and not missing any main meal, especially breakfast in the morning.

• Reducing calorie intake is very necessary, but meals must never be skipped and the person should follow a healthy diet.

• Exercising is one of the most important steps that help burn fat and calories, as exercise helps the body use insulin to become more effective.

WHEN WE LEAD A HEALTHY LIFESTYLE, WE ARE ABLE TO CONTROL THE INSULIN HORMONE AND PREVENT WEIGHT GAIN, AS EATING HEALTHY FOODS AND EXERCISING REGULARLY HELP PREVENT UNWANTED WEIGHT GAIN.

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