One of the more prevalent themes that emerged in speaker sessions and announcements at Arab Health 2020 was - unsurprisingly - technology, from AI to data. We were curious to learn more about the latest advancements from leading cardiologist Dr. Curtis Rimmerman, Chair of International Operations and Gus P. Karos Endowed Chair at Cleveland Clinic. 

Dr. Rimmerman, who has been practicing cardiovascular medicine for close to 30 years, revealed that technological innovation in his field has been "remarkable". He explained that surgical procedures are now performed through smaller incisions, resulting in less morbidity and mortality for patients, and equivalent - if not better – outcomes with expedited recovery times.

He attributed the success of this in part to effective customization of the procedure to the patient before it begins – a process that relies on new technologies that include artificial intelligence and advanced imaging.

The procedure itself, such as replacing a poorly functioning aortic valve, in increasing circumstances can be achieved through a catheter inserted in the upper leg of the patient, leaving only a small hole behind and the chest unmarked entirely. The patient is free to go home between 24 and 48 hours following the procedure.

Putting patients first

And it’s “home” where another major trend is unfolding. Dr. Rimmerman highlighted how outpatients are now being monitored live and remotely via computer from the comfort of their own surroundings, their heartbeat transmitted trans-telephonically though a worn peripheral.

All of this points to a future, defined in the short term at least, by less invasive surgery and faster recovery times – both of which reflect a principle and current trend of putting patients first.

In fact putting patients first - and advancing the healthcare of the world – was the prevailing sentiment observed by Dr. Rimmerman at Arab Health, where he described participants as definitively pointed in a unified direction.

He spoke of joining tables with direct competitors as well as partners, recognizing the same collaborative spirit in Cleveland Clinic, whose results-oriented Innovation Center works with different companies worldwide. It’s this “bridge building”, in the cardiologist’s words, that will see Cleveland Clinic’s continued return to the show in February 2021.

Amana Healthcare, part of Mubadala’s network of healthcare providers, was recently awarded Stroke Specialty Center accreditation by the U.S. Commission on Accreditation of Rehabilitation Facilities (CARF). The commission is an international, non-profit organisation founded in 1966 to assist and assess healthcare providers with a particular focus on post-acute services such as inpatient rehabilitation.

With this new speciality accreditation, Amana, which was the first in the UAE to receive accreditation in Comprehensive Intensive Inpatient Rehabilitation from CARF in 2016, becomes the first and only provider in the country to be specifically accredited in rehabilitation after stroke, fulfilling a key part of its mandate to provide the people of the nation with healthcare of the highest global standard.

Eng. Abdulla Abdulaziz Al Shamsi, Head of Mubadala Healthcare, said: “This new accreditation confirms Amana Healthcare’s status as a truly world-class provider of post-acute rehabilitation and a vital player in the UAE healthcare ecosystem. It is a source of pride to Mubadala and of hope to people with complex rehabilitation needs – especially the 10,000 or more people who suffer a stroke each year in the UAE.”

Stroke Rehabilitation

Stroke is a leading cause of disability in the UAE and strikes at a much younger age here compared with cases in Europe or North America. The average age of a stroke patient in the UAE is 48 years old; in the UK and US, by contrast, it is over 60.

Stroke rehabilitation is the process of regaining functions that are lost when a part of the brain is damaged by a stroke. The chances of recovery increase dramatically with the implementation of an effective, multidisciplinary rehabilitation programme. However, according to Amana Healthcare, as many as 90 per cent of stroke sufferers do not get the help they need, often because of poor awareness of the existence and importance of rehabilitation services.

A leading diabetes expert has called for a change in how people in the Middle East live and for people to take control of their health. Dr. Emran Khan, Consultant Endocrinologist and Diabetologist at King’s College London, UAE says: ‘The epidemic of “Diabesity”’ has taken on the world’. 

Dr. Khan says a new approach is needed to tackle the type-2 diabetes epidemic: “Because people are not as well informed as they should be, sadly I feel that it is accepted in the UAE society and culture as a norm to eventually develop diabetes. It is accepted that this disease is inevitable, and it does not surprise them at all when it happens because it is so prevalent. Obesity and a high BMI (Body Mass Index) has been accepted as not something unusual and is not considered a serious issue.”

The doctor wants to see people moving more, eating well and if they are overweight or obese, losing weight to avoid getting type-2 diabetes.

What is type-2 diabetes?

Type-2 diabetes is a serious condition in which the insulin made in the pancreas is unable to work properly, or the pancreas cannot make sufficient insulin.

Symptoms include:

•          Frequent urination

•          Intense thirst

•          Sudden weight loss

•          Blurred vision

•          Tiredness

Left untreated, it can lead to life-changing complications, including:

•          Heart attacks and strokes

•          Kidney disease

•          Vision problems (even blindness)

•          Pain or loss of feeling in hands and feet

•          Amputations of fingers, toes, or limbs.

What is the scale of the problem?

The UAE ranks third in diabetes prevalence in the Middle East and North Africa. According to the International Diabetic Federation, 38.7 million adults are diabetic. By the year 2040, the figure could rise to 82 million.

UAE nations are among the 15 countries in the world with the highest rate of diabetes per capita. Kuwait, Bahrain, Saudi Arabia and the UAE also rank in the top 15 for obesity. Being overweight or obese can contribute up to 85 per cent of the risk of developing type-2 diabetes.

What are the causes of the epidemic?

Dr. Khan says a key factor in the increase in diabetes is the region’s increase in wealth and an accompanying decrease in physical activity. He said: “This has led to sedentary lifestyles and fast food options replacing more traditional modes of work, travel and cuisine.”

England is no exception. NHS England, the government-funded organisation that delivers healthcare in England via the National Health Service (NHS), believes that ‘tackling diabetes is one of the biggest healthcare challenges of our time’.

What’s the cost?

NHS England says that, at £8.8 billion a year, type-2 diabetes treatment accounts for nearly nine per cent of the annual NHS budget. There are five million people in England at high risk of developing the condition. If these trends persist, one in three people will be obese by 2034 and one in 10 will develop type-2 diabetes. The condition is a leading cause of preventable sight loss in people of working age and is a major contributor to kidney failure, heart attack, and stroke.

Partners in expertise

Dr. Khan says it is ‘extremely encouraging’ to see world-class British-based institutions such as King’s College London coming to the region: “Institutions of great excellence are bringing their expertise, knowledge, skills and governance. They are not only helping patients; they are also contributing towards raising health standards.” Its diabetes clinic is staffed by UK-trained clinicians and nurses and offers screening, diagnosis and treatment.

The Imperial College London Diabetes Centre (ICLDC) is an out-patient facility that specialises in diabetes treatment, research, training and public health awareness.  More than 800,000 patients have visited the centre since its launch in 2006. 

Dr Khan’s five ideas to address type-2 diabetes

•          Provide walking tracks in shopping malls similar to cycling lanes in the West. Users would receive reward points or discounts on their grocery purchases.

•          Change food labelling so that the public understand more about what they are eating.

•          Harness the power of the entertainment industry – a commercial before each television programme and cinema movie. Print media need to provide easy-to-understand health information. And we need to spread the message via social media.

•          We need educational programmes, particularly in shopping malls, pharmacies and supermarkets. We need our food industries to help to promote healthier food options in supermarkets and restaurants.

•          Local pharmacists could provide support and free blood tests and weight checks, and perhaps provide a scorecard and education about BMI and the risks associated with ‘diabesity’. 

How to prevent type-2 diabetes

You can reduce your risk of developing type-2 diabetes by:

•          eating well

•          moving well

•          losing weight if you’re overweight.

Get support

Ask your doctor about:

•          a weight-loss programme or group

•          a registered dietitian or exercise specialist

•          a prevention programme

Be realistic

Set yourself goals that fit in with your life. Choose the healthy food and activities that you like best.

Patient empowerment: Innovation and support

Diabetes patients spend around three hours with a health professional every year. For the remaining 8,757 hours, they must manage their diabetes themselves.

The NHS is committed to the expansion of self-management services through an online self-management support programme and accompanying education pathway, Healthy Living for People with Type 2 Diabetes.

Originally developed at University College London, the programme provides information and emotional support and helps with adopting and maintaining healthy behaviours. It offers an alternative means of accessing support alongside more traditional group-based, structured education programmes.

A randomised control trial funded by the National Institute of Health Research demonstrated modest but significant improvements among the group using the Healthy Living diabetes tool in HbA1c (haemoglobin) levels.

The NHS is also to begin trials of low-calorie diets for obese people with type-2 diabetes. After a liquid diet of just over 800 calories a day for three months, there will be a period of follow-up support, including food reintroduction and weight maintenance.

As one of the most common chronic diseases in adults, the chances are that you or someone you know have suffered from acid reflux at some point in their lives. If acid reflux occurs more than twice a week, the condition is known as gastroesophageal reflux disease (GERD), the disorder affects not only the oesophageal tract but also the upper airways and can be associated with a wide array of symptoms. GERD risk factors are closely aligned with lifestyle choices.

Speaking to Omnia Health Insights, Dr. Mohamad Khair Ojjeh, Gastroenterologist at Medcare Hospital Dubai said, “GERD is an increasingly common condition that affects adults at almost any age. The condition develops when acid from the stomach escaped up the oesophagus, causing a burning sensation in the chest and neck. This can cause considerable discomfort and in severe cases, can even lead to tissue damage”.

One systematic review found that the prevalence of GERD in the Middle East ranged from 8.7 per cent to 33.1 per cent and is continuing to rise. The prevalence of GERD may be influenced by a wide range of factors from older age, gender, ethnic background, medications, consumption of certain types of foods and drinks, smoking, family history, excess weight and limited physical activity.

“Patients presenting with GERD typically have habits of eating large meals or lying down right after a meal. Snacking close to bedtime is also a risk factor for acid reflux. Moreover, certain types of foods can trigger excess acid production such as citrus fruits, tomatoes, spicy or fatty foods. Coffee and carbonated drinks can also cause the same effect. Certain medications that patients may be prescribed for other conditions can also increase their risk,” explained Dr. Ojjej.

Symptoms

Ageing, in particular, has been closely linked with GERD symptoms. As the body grows older, there are pathological changes within the gastric system, which may explain the effect, such as the weakening of sphincters. Sphincters at your oesophageal junction usually close after food passes through them. If the junction doesn't close all the way or if it opens too often, acid produced by your stomach can move up into your oesophagus.

When the acid from your stomach travels up the oesophagus, common symptoms of GERD can occur such as heartburn moving from your stomach to chest and throat, and regurgitation or a sour, bitter taste at the back of your throat. Other symptoms include bloating, burping, blood in vomit, hiccups, nausea and even dysphagia, which is the sensation of food being stuck in your throat. Some patients complain of cough, excessive phlegm, shortness of breath or asthma flare-ups, and other ENT symptoms.

Acid reflux may cause acute discomfort or pain but can have very serious, long-term complications. “Excess acidity can manifest in ulcers in the oesophagus due to its erosive effect of the lining of the tissue. In very rare circumstances, GERD can increase patients’ risk of developing pneumonia, pulmonary fibrosis, bronchial asthma, ear and sinus infections and dental caries,” Dr. Ojjej said. “In very extreme cases, GERD can lead to the formation of Barrett’s oesophagus where the oesophageal lining changes to intestinal-like mucus to cope with the chronic presence of excess acid. This change in tissue type holds the very dangerous possibility of turning into cancer. It is important to note this only develops in a very small percentage of GERD patients”.

“As with the majority of chronic diseases, the best outcomes arise from early detection and proper treatment. We encourage patients who experience common episodes of acid reflux to see their doctor for a correct diagnosis of their condition. Their doctor will also be able to advise on treatment and incorporate lifestyle changes to control the disease,” Dr. Ojjej added.

References available on request.

Is the 2019-nCoV virus present: yes or no? It’s a simple question many around the world are asking as worries grow over the spreading coronavirus. A detection kit launched at the end of January by Primerdesign, a business unit of diagnostics group Novacyt, is one of the first to deliver an answer – and it does so within two hours, meaning that all samples can be screened quickly.

Paul Eros, Corporate Business Development Director at Novacyt, explained that upon identification of a new strain of the coronavirus in Wuhan, before the Chinese province found itself the subject of worldwide attention, Primerdesign had correctly identified the outbreak as an emerging global issue – rather than a domestic concern – that required immediate tackling. The decision was made to quickly develop a coronavirus assay in direct response: the genesig 2019-nCoV test.

On January 30, the WHO declared the 2019-nCoV outbreak a global emergency; one day later, the Primerdesign testing kit was ready to be launched. In the days since interest has rocketed. In less than one week, orders and enquiries have been received from more than 30 countries, with demand concentrating in Asia, the Middle East and Europe. A robust supply chain is ensuring that this demand is met, with all labs expected to be running full validation of testing with the kits by the end of the week.

Unsurprisingly, Novacyt attracted a lot of attention at Medlab Middle East 2020, which concluded last week. Around 80 per cent of enquiries at their stand was in about the coronavirus assay, we were told.

The Primerdesign team is now looking at putting the genesis 2019-nCoV test through the FDA emergency use programme, and in Europe through a CE-IVD validation process to receive mark approval within the next two weeks.

Coronavirus detection kit designed specifically for 2019 virus

Eros attributed the surge in interest to the test’s sensitivity and ability to detect only the 2019 strain of the respiratory virus. This differentiates it from other current tests, which are less specific, possibly reacting to related species such as SARS and MERS and giving rise to a false diagnosis.

The Primerdesign test is also stable at ambient temperatures, which eliminates the need for cold chain shipping in tropical climates, therefore, improving the efficiency of the test and reducing transport costs.

Cost-wise, Eros added that the test represents exceptional value compared to some of the next-generation sequencing technologies, which are being used to test for the virus.

Coronavirus detection kit portability ideal for emergencies

Getting started with a genesis 2019-nCoV kit is straightforward for experienced PCR users. In the event that they’re running a real-time cycler from the likes of ABI or Rotor-Gene or LightCycler, they will be up and running quickly. Training will, however, be required for any new or inexperienced PCR user.

The test’s flexibility was also highlighted by Eros: it’s designed to run on multiple molecular testing platforms, including Primerdesign’s gensig q16 and q32 instrument, and can, therefore, be used in large and small laboratories as well as remotely where necessary.

When asked about the possibility of using the detection kit in a mobile situation, Eros revealed that the genesig q16 (weighing no more than 1.5Kg) can be run off a battery, making testing possible for an emergency. He nonetheless cautioned that it wasn’t a true point-of-care test.

How to acquire the Primerdesign coronavirus detection kit

Anyone interested in placing an order is encouraged to contact Primerdesign through their website at www.primerdesign.co.uk.

Randox to launch new coronavirus test

At Medlab Middle East, Randox Laboratories also announced that the company is in the final stages of developing a test for the potentially fatal 2019-nCoV strain of coronavirus.

The soon-to-be-launched test, developed on Randox’s patented Biochip Technology, will be available for immediate 2019-nCoV testing, but an additional enhanced multiplex array will also include tests for other respiratory viruses, which can display the same symptoms.

The new Biochip will, therefore, allow clinicians to quickly and efficiently differentiate between potentially lethal and non-lethal infections.

Dr. Peter FitzGerald, Managing Director of Randox Laboratories, commented: “Current technologies for the diagnosis of coronavirus are designed simply to detect the presence or lack of 2019-nCoV, and, therefore, neglect to differentiate between this strain and other respiratory infections.

“Whilst we’re very quickly developing an efficient novel test for this new strain of coronavirus, we are, therefore, also working on an extended Viral Respiratory Infection Array that will test simultaneously for 2019-nCoV and a range of other viruses. This will eliminate the need for multiple back-and-forth tests before the root cause of symptoms is found and empower clinicians to make fast and informed decisions.”

The test will reportedly be available for the Point of Care analyser, the Vivalytic, within 3 hours, and within 5 hours on the Randox Evidence Investigator.

Benefits of the new Randox 2019-nCoV test

• Quick turnaround times

• Multiplex array differentiates between mild and serious infection

• Automated and semi-automated options available

According to a recent report, the Ministry of Health and Prevention (MoHAP) has developed and activated a predictive electronic system to identify patients at high risk of contracting the novel coronavirus. The ministry announced that it has also activated an early warning system (Wareed) across all its healthcare facilities to quickly identify individuals at higher risk of acquiring the infection.

The early warning system reportedly coordinates and manages a potential outbreak. Once automated, algorithms identify patients at high-risk and the Wareed system places consecutive orders for the patient to be isolated and treated immediately.

In a statement, the ministry said the move was taken in cooperation with the UAE’s health authorities as a precautionary measure to protect the country against coronavirus.

A set of tests and treatment protocols has been automated according to the approved scientific standards to provide statistics and data analysis, monitor all suspected cases and standardise medical practices in all health facilities, the MoHAP statement added.

Awad Saghir Al Ketbi, Assistant Under-Secretary of the Support Services Sector was quoted saying: “With the risk and numbers of infected population rising globally, the MoHAP’s Wareed team immediately implemented protocols within the Electronic Medical Record that can efficiently identify patients at high risk of potential infection.

“The timely customisation of the Wareed system, which links patient data in 88 health facilities and contains an integrated database, has already started to save significant time for our clinicians on the ground, helping them quickly identify, coordinate and manage a potential outbreak. Once automated algorithms identify a patient as high-risk and the Wareed system places consecutive orders for the patient to be isolated and treated immediately.”

New technology and the latest innovations in laboratory medicine were the main focus of the inaugural Transformation Talks, taking place at Medblab Middle East until Thursday 6^th February at the Dubai World Trade Centre.

In line with the show’s theme of Transforming tomorrow’s diagnostics, a range of new features have been added to the 2020 edition of Medlab Middle East, including the Transformation Hub, where manufacturers have the opportunity to pitch their healthcare solutions to thousands of distributors.

Speaking on the second day of the Transformation Talks, Prof. Piotr Garstecki, CEO and Founder of Scope Fluidics Group, the company behind PCR|ONE, which is able to detect MRSA in just 15 minutes, said: “Technology is truly transforming medical diagnostics and healthcare and we are excited to take part in this process and contribute to faster and better access to information. This access to information is key to effective treatment because information allows for better formation of decisions. It saves lives and increases the comfort of patients and, ultimately, helps to reduce healthcare costs.”

According to the Centre for Disease Control and Prevention, MRSA causes more than 80,000 invasive infections and over 10,000 deaths annually in the U.S. alone. The most effective way to combat MRSA is via a search and destroy policy, which assumes every patient admitted to the healthcare system is at risk. The current procedures to identify MRSA carriers and antibiotic resistance are complicated and costly and put added pressure on the healthcare sector.

“The search and destroy policy urgently requires a rapid, accessible, and affordable diagnostic method than can be used in various settings. We believe PCR|ONE meets this crucial global need for a single-step method for rapidly and inexpensively identifying MRSA directly from nasal swabs,” added Prof. Garstecki.

What's trending?

Other innovations discussed during the second day of Transformation Talks included the use of cloud-based big data initiative for epidemiology; rapid, point of care DNA testing; automation; digital pathology; and genomics biology at high resolution.

Tom Coleman, Group Exhibition Director, Informa Markets Healthcare, said: “The advances in technology we see today will play a crucial role when speeding up the identification of a range of diseases. The new technologies and advances in technology we have seen on show will allow a lot of new cases to be diagnosed, in shorter periods of time, and, in some instances, as quickly as 15 minutes.”

“Medlab Middle East provides the ideal platform to showcase groundbreaking products to the medical laboratory industry here in the Middle East, while also sharing research and educational initiatives to visitors and delegates from around the world,” added Coleman.

Organised by Informa Markets, an estimated 600+ exhibitors from more than 35+ countries and 25,800+ professional visitors are expected to attend the 2020 edition of the show.

For more information visit www.medlabme.com or read the latest issue of the Omnia Health Medlab Middle East special magazine here 

His Excellency Humaid Al Qutami, Director General of the Dubai Health Authority officially inaugurated the 19^th edition of Medlab Middle East today followed by a tour of the exhibition.

Taking place at the Dubai World Trade Centre (DWTC) from 3-6 February, Medlab Middle East, the MENA region’s largest medical laboratory exhibition and congress, is set to welcome more than 25,800 laboratory industry professionals and more than 600 exhibiting companies from 135 countries during the four-day showcase.

“We have developed a show that is fundamental to the future growth of the laboratory industry in the MENA region. This year we are focusing on the innovation and technology that is driving the industry forward, and combining this with the thoughts and experience of some of the leading minds in laboratory medicine via multi-disciplinary educational sessions. Medlab Middle East provides the perfect platform to facilitate business opportunities within the region while advancing industry knowledge,” said Tom Coleman, Group Exhibition Director, Informa Markets Healthcare.

The importance of a niche event such as Medlab Middle East has never been more evident as the value of the Middle East & Africa (MEA) clinical services market is expected to reach over US$14 billion by 2023, with the global market estimated to top US$333 billion during the same time period, according to the latest statistics from Wise Guy Research Consultants.

In recognition of the technological advances in the laboratory industry and their contribution to the growth of the regional market, the show theme for Medlab Middle East 2020 is Transforming tomorrow’s diagnostics. In order to showcase how innovation is crucial to the development of the future of laboratory medicine in the region, the new Transformation Hub and Talks will address the opportunities in laboratory medicine.

The opening day of the Transformation Talks featured renowned speakers from around the world discussing the world’s first early detection universal cancer blood test, evolving bugs and the pressing need for diagnostics to keep pace with these developments, and the compliance and transparency of blockchain and medical devices, amongst other topics.

Running alongside the exhibition, the Medlab Middle East Congress also got underway with the introduction of four new tracks including Blood Transfusion Medicine, Laboratory Innovation, Digital Pathology and the Roundtable Discussions, taking the total number of CME-accredited conferences to 12. Over 4,500 delegates are expected to attend the four-day showcase.

Medlab Middle East is organised by Informa Markets and is officially supported by the UAE Ministry of Health and Prevention, Government of Dubai, Dubai Health Authority, Health Authority Abu Dhabi and Dubai Healthcare City Authority.

For more information visit www.medlabme.com or read the latest issue of the Omnia Health Medlab Middle East special magazine here