18 minute read
Bone Marrow Transplant
The best choice for leukemia patients
Bone 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 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 fghts 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 fght infections, and platelets that form clots to prevent excessive bleeding. Tissue
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 fuids. These treatments are relatively difcult, 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 frst 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 fowing 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 efectively, 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 frst period of transplantation. In the frst 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.
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
Everyone 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 afect heart patients, the work pressure and 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 sufers from blockage. Heart patients with psychological and emotional stress are 3 times more susceptible to developing heart attack than their peers who don't sufer from similar stresses", he added. It is widely known that a deteriorating psychological state plays a clear role in afecting 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 fowing 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 sufer 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 sufering 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.
Patients' experiences confrm 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
Al-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 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 fexibility in movement, walking, sitting on the ground and performing prayers.
The consultant orthopedic surgeon added: "The patient is given antibiotics and anti-infammatory drugs during the surgery. This leads to good results in the long and short terms.
Causes of Surgery
Dr. Maher Youssef pointed out that among the causes of knee joint replacement is knee joint stifness. Knee stifness afects the cartilage of the joint and causes its erosion. There are a number of external factors that lead to knee infammation, 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 sufering 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 afect sleep at night. Futhermore, joint stifness causes the patient difculty in doing his daily habits, such as changing clothes and wearing shoes and socks. It also afects 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.
advanced stages, as the patient will face difculties 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 frst day after the operation, the patient begins walking and doing exercises and the medical team begins to move the knee and starts efective exercises in the hospital. Further, the rehabilitation process for the patient is completed 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 ffties, who was sufering from knee stifness 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 diference. 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.
What is the link between insulin & weight gain?
Insulin 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 efect 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.
As a meal containing carbohydrates is eaten and digested, BG levels rise, and the pancreas turns on insulin production and turns of 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 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.
Insulin Resistance
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 efcient 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 efciency of insulin in introducing sugar into the cells decreases, sugar accumulates in the blood and the cells won’t be able to beneft from it. So cells will sufer 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
in the pancreas begin to produce a diferent 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 efects such as higher blood sugar levels. When this happens, the symptoms may include: • Lethargy (tiredness) • Hunger • Difculty 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 efective. 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.
Innovative Patient Care
The Multicare Bed with Automatic Lateral Therapy
The effect of Automatic Lateral Therapy (ALT) on the Multicare bed is through the promotion of ventilation distribution. Safe and radiation-free “Continuous, Individualised Ventilation Care” is based on a combination of frame-based lateral tilt and Electrical Impedance Tomography.
30° of rotation 24 hours
Arab Health 2021 Save the Date
28 May 2021 12.00–12.30 (Dubai timings GMT+4) Keynote: Body Positioning During Mechanical Ventilation Mikulas Mlcek, M. D., Ph. D. 14.00–15.00 (Dubai timings GMT+4) Industry Talks: Prone Program by LINET Koen de Doncker, Product Manager and Ergonomist Meet Us at Arab Health 2021 Online
