Dr Charles Badr Nagy Rafael, who works at the Medcare Women & Children Hospital (MWCH) in Dubai has been recognised for providing the highest quality of care and patient safety by Surgical Review Corporation (SRC). The certificate makes the consultant obstetrics and gynaecologist the second physician in the world to receive the accreditation as a Master Surgeon in Multidisciplinary Endometriosis Care.

According to the Royal College of Obstetricians and Gynaecologists, endometriosis is a condition where tissue similar to the inner lining of the womb (endometrium) is found elsewhere, usually in the pelvis around the womb, ovaries and fallopian tubes. It is a very common condition, affecting around 1 in 10 women.

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Omnia Health Insights sat down with Dr Rafael to get his take on endometriosis care in the region and hear about the latest treatment options for those suffering from the condition.

What are the stages of endometriosis? 

There are several classifications for endometriosis, the most widely used one is the American society of reproductive medicine ASRM classification, where endometriosis is classified into one of four stages (I-minimal, II-mild, III-moderate, and IV-severe) based upon the exact location, extent, and depth of the endometriosis implants as well as the presence and severity of scar tissue and the presence and size of endometrial implants in the ovaries. 

Does it worsen with age? 

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 Endometriosis is an estrogen-dependent disease, that’s why women who have their first menstruation at a young age and menopause at an advanced age are at higher risk. The disease tends to progress with age and causes more symptoms and complications in women in their thirties. 

What are the emerging and future treatments? 

In addition to the traditional medical treatments available such as contraceptive pills, progestogens and gonadotrophin agonist injections, there are new medications under research for their effect on endometriosis.

Those treatments such as progesterone receptor modulators (Mifepristone), aromatase inhibitors (Letrozole) and also immunomodulatory medications, all are still within the research context and not yet licensed for use for the treatment of endometriosis patients. 

The most crucial development in managing endometriosis patients is the establishment of multidisciplinary centres of excellence for integrated management of endometriosis, which has significantly improved outcome for those patients.

Are these available in the UAE yet? 

All treatment options are available in the UAE, especially the recent establishment of dedicated multidisciplinary centres of excellence for endometriosis care with highly experienced specialists in laparoscopic surgery, colorectal surgeons, urology and pain management specialists.

Diginova Health Solutions, a digital healthcare start-up based at the DIFC, recently announced its partnership with Finnish firm Cardiolyse, to bring its award-winning cloud ECG & HRV analytics platform in the UAE. Cardiolyse is an ECG & HRV predictive analytics platform for real-time remote heart health and fatigue risks monitoring, providing plain personalised reports, detection and up to two months data-based prognosis on dangerous heart events.

“An estimated 80 per cent of cardiovascular disease (CVD), including heart disease and stroke, are preventable, but sadly it remains one of the leading causes of death in the UAE and around the world. CVD complications are accountable for more than 50 per cent of all deaths among people with diabetes, which unfortunately is a grim reality in the UAE, with over a million people living with it,” says Dr. Sarper Tanli, Co-Founder and CEO of Diginova Health Solutions.

Related: COVID-19 reminds us why modern medicine needs modern technology tools

Cardiolyse's proprietary patent-pending machine-learning algorithms process all vital ECG parameters to create an alerting feature that notifies both patient and his doctor on increased stroke or heart attack risks, enabling the prevention of critical heart events up to two months before they occur. As a device-agnostic cloud platform, Cardiolyse cuts off the need for complicated time-consuming integration by pairing its solution with any type of digital ECG device via universal API (application programming interface).

The ecosystem is comprised of customised web dashboards for both patients and physicians, as well as independent Android and iOS applications for each user type needs. "Global healthcare is in obvious and desperate need for disruptive technologies, and we are grateful for the opportunity to partner with Diginova in bringing Cardiolyse to the UAE to support the region’s digital transformation as it serves the emerging challenges of both healthcare providers and personal health-conscious patients," commented Anna Starynska, Co-Founder and CEO at Cardiolyse. "Our primary goal here is to provide timely and data-driven insights for physicians and cardiologists to support the cost-effective patient-centric diagnosticating approach and more accurate self-care solutions for patients.

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Dr. Sarper adds, “The MENA digital healthcare space is severely underserved, with per capita spending lagging behind EU and the U.S. by as much as 60 per cent. Our job at Diginova is to identify gaps in the market and facilitate digital health products and solutions through entrepreneurs and accelerator programmes. Through our partnership with Cardiolyse we are committed to amplify the impact and scale of digital heath solutions in the region. Diginova also confirmed that the UAE launch of Cardiolyse will be followed by a region-wide entry across the GCC, starting immediately with KSA.”

Healthcare has been on a modernisation path for many years. Hospitals, clinics, and ambulatory surgery centres all around the world have been striving to fully digitalise and automate data capture and communications processes for decades. While some facilities move faster than others, most have made significant progress toward achieving their technology utilisation goals. Yes, COVID-19 has led many healthcare practitioners to question whether enough has been done to improve the quality, efficiency, and safety of patient care.

Most healthcare systems have spent the last several months scrutinising policies, procedures, processes, and systems to see if they facilitate or hinder real-time data capture, analysis, and distribution. Many have started to accelerate planned technology implementations or scale already-deployed solutions to support additional use cases. However, the speed at which change is needed continues to exceed the speed at which change is occurring.

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Technology can be deployed right now, making an immediate impact across many healthcare functions. Care teams have been mobilised and clinical workflows automated in record time to address some of the systemic issues exacerbated by the COVID-19 outbreak. Mobile technologies have been deployed in days to help increase the efficiency and accuracy of patient intake and diagnostic actions, mitigate supplies shortages, and inform treatment decisions.

From these experiences, we’ve learned ways in which the healthcare community can use technology to improve the management of its people, patients, assets, and facilities:

Staff management

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Any type of event that impacts a large percentage of the population could impact hospital capacity and strain resources. Giving care team members clinical mobile computers that allow for real-time communication and collaboration with geographically dispersed colleagues via text, voice or other data-sharing tools helps “expand” staffing without having to hire more staff or overwork existing employees. These devices also help increase clinician efficiency by providing access to patient records at the point of care so they can be updated in real-time without requiring a trip to a nurses’ station.

Patient management

Giving patients a barcoded wristband upon admission ensures positive identification (PPID) during medication and treatment administration. It can also help with patient locating. The wristband can be scanned using a handheld mobile computer to automatically retrieve and update records with patients’ current locations every time they’re moved. Alternatively, radio frequency identification (RFID) tags could be affixed to the wristband for visibility by larger scale RFID or real-time location systems (RTLS) to verify patients’ locations. Other types of remote monitoring technologies, such as the Internet of Things (IoT) thermometers, can be implemented to alert staff about urgent status changes and minimize direct contact with patients for routine vital checks. Artificial intelligence (AI) tools can help with remote triage to better direct patient care actions before they step into a facility.

Lab management

Accountability starts at the point of specimen collection. Barcoded or RFID labels should be affixed to every container to help with PPID, specimen tracking and the accurate input of testing results into patient records. Mobile printers synced with clinical mobile computers can make this easy after a quick scan of a patient’s wristband to retrieve and populate label data. A simple scan of the label at every subsequent touchpoint can confirm who handled what and when. Once the lab technician scans the barcode to retrieve a patient’s record and report testing results, notifications can be sent to the care team for further action. These capabilities are especially important when there’s a surge in specimen volume for the same types of tests and diagnostic panels.

Vaccine and pharmaceutical administration

We know that both practitioners and patients around the world are concerned about whether the cold chain will be maintained during massive COVID-19 vaccine distribution campaigns. But the truth is that all vaccines are temperature sensitive, as are several pharmaceutical products. Every single day, we (meaning anyone who is responsible for manufacturing, distributing, storing or administering these items) must take care to ensure that a temperature excursion hasn’t occurred at any point as the vaccine or drug makes its way to the patient. That’s why best practices in temperature monitoring recommend multiple layers of temperature monitoring technologies depending on whether the assets will be transported on pallets or coolers and stored in refrigerators, freezers, or temperature-controlled rooms. Manual reporting methods can only capture the temperature of an item at a particular point in time. There is no way of knowing if a temperature excursion occurred between those readings and whether it may have compromised the efficacy of a vaccine or medication. But electronic data loggers can continuously monitor the environmental temperature and alert stakeholders to potential heat events so that they know not to administer the compromised doses. Even better, temperature sensing labels can be applied to individual vaccine and prescription medication units (i.e., vials, bottles, boxes) to indicate to those administering the medication whether the proper temperature has been maintained all the way to the moment of injection or consumption.

Inventory management

Inventory management has long been an issue that becomes easier to solve with the right labels and location tracking technologies, such as RFID readers and barcode scanning devices. If staff scan the packaging every time an item such as a mask, blood vial, medical device or medicine is used and input the quantity used, then inventory management system accuracy would automatically improve. This, in turn, helps improve utilization of (and access to) consumables within a ward, hospital or entire healthcare system. These same technologies can be used to comply with government reporting requirements such as the European Union’s Falsified Medicines Directive or to report items nearing expiration to ensure prioritization and prompt disposal if warranted.

Supply chain management

Having staff scan items every time they’re used also enables synced back-end inventory reconciliation systems to alert procurement teams when supplies are running low and trigger automatic replenishment. This information can also help identify overstocks and minimize unnecessary purchases. At the same time, implementing RTLS, barcodes or even blockchain-based track and trace tools throughout the supply chain will help confirm an order status in real time and alert care team members if and when they may need to be more judicious in their use of supplies due to supply chain shortages or production and delivery delays. They also increase accountability to mitigate fraud and theft.

Patients with COVID-19 are at risk for neurologic complications, including encephalitis, or inflammation of the brain.

"Encephalitis cases have been reported in patients with COVID-19, although on the whole it appears to be a relatively rare complication," says Michel Toledano, M.D., a Mayo Clinic neurologist.

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In the case of encephalitis caused by communicable diseases for which there is a vaccine available, getting vaccinated is the best way of preventing the disease.

"It is important for the public to know that COVID-19 is now a vaccine-preventable disease. The best way to avoid developing potential neurologic complications from COVID-19 is to not get the virus in the first place," Dr. Toledano says.

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Encephalitis affects nearly 500,000 people of all ages worldwide each year, according to the Encephalitis Society. The inflammation can be caused by an infection invading the brain, but it also can be caused by the immune system attacking the brain in error, called autoimmune encephalitis. Sometimes the immune attack can be triggered by an infection in the body without the infection itself invading the brain.

Symptoms of encephalitis evolve over days to weeks and include fever, confusion, headache, vomiting, weakness, and seizures

"This is a very serious condition; encephalitis can lead to coma and death,” says Sebastian Lopez, M.D., a Mayo Clinic neurologist. "Early diagnosis and prompt treatment are critical for achieving better neurologic outcomes. Diagnosing the exact cause of encephalitis is important because treatments vary, depending on whether patients have an underlying infection, or a reaction caused by the immune system."

Despite significant progress, encephalitis is still associated with high mortality. Those who recover from the initial illness may struggle with fatigue, paralysis, language impairment, memory difficulties, personality changes and memory problems that may persist for months or permanently.

"The recovery process can be very challenging for those who are struggling with the residual effects of a disease process that family and friends often do not understand," says Marie Grill, M.D., a Mayo Clinic neurologist. "Increased awareness of encephalitis can help these patients be better supported."

Entirely curable due to breakthroughs once thought impossible in medicine, Hepatitis C (HCV) is among the leading causes of preventable death globally. Despite the availability of life-changing treatments and testing improving, the Middle East and North Africa region has the highest prevalence of HCV infections worldwide.

To play their role in reducing preventable deaths, the healthcare industry has the responsibility to support government efforts to build sustainable systems for screening and treatment alongside backing civil society efforts in reaching high-risk groups through targeted approaches that combine education, screening and care. We as an industry must play an active role within public health initiatives that seek to diagnose, treat and cure patients, and to prevent new infections.

Related: Stepping up the fight against Hepatitis C

Innovation has ensured that HCV today can be easily cured with just 12 weeks of oral direct-acting antiviral drugs, offering significant clinical, economic and public health value to patients, their families and healthcare systems. However, the gravest and most pressing concern is that many people with HCV have not been diagnosed, and accordingly didn’t receive medical treatment for the disease.

Delayed diagnosis and treatment often result in chronic infections with HCV that can in turn lead to serious and life-threatening liver damage, including cirrhosis, cancer and the need for transplantation. This means that time is of the essence towards ensuring healthy communities, with the World Health Organization aiming to eliminate the disease globally by 2030. To achieve this, the global community will increasingly require treatments that are highly effective and have simple dosing regimens with broad clinical utility.

Related: World Hepatitis Day: fast-tracking the elimination of hepatitis B among mothers and children

These treatments will support the Global Health Sector Strategy that calls for the elimination of viral hepatitis as a public health threat by 2030. An approach that combines empowering general practitioners with a focus on at-risk communities will allow the industry to support governments in eliminating the disease. There needs to be greater teamwork on maintaining quality data on HCV epidemiology that are required for the GP to target key populations. Multi-stakeholder collaboration between governments, primary care providers, other healthcare specialists, policy makers and pharma companies are key to achieving WHO HCV elimination targets, together covering ground to ensure early detection, treatment and the prevention of the virus within the community.

Targeted scale-up of HCV treatment especially within at-risk communities can dramatically reduce prevalence. By quickly curing micro-population segments through short-term yet high efficacy HCV treatments, the frequency of healthcare visits and hospitalizations will be drastically reduced, lowering expenditure and the need for patients to undergo long-term medications to manage side effects and complications. WHO’s strategy defines elimination as an 80 per cent reduction in new HCV infections and a 65 per cent reduction in HCV mortality.

Focusing clearly defined populations is crucial as wider populations not being screened routinely for HCV. The micro-elimination approach enables a more realistic allocation of support from medical professionals who can tailor interventions to suit the need of a target group. To support global micro-elimination efforts, the Gilead Medical Affairs team has funded up to 30 projects around the world. An effective concept in the fight against HCV, micro-elimination ultimately achieves full national elimination by targeting one risk group at a time and tailoring treatments to the unique needs of these populations, delivering significantly faster results and reducing costs than a full-scale initiative.

Further to micro-elimination, on a worldwide basis, Gilead is developing programmes and partnerships to help ensure patient access with licensing agreements with generic pharmaceutical manufacturers to expand access to HCV medicines in 91 developing countries, representing more than half of the global HCV-infected population.

In the Middle East, we have been helping the HCV community by supporting disease awareness programmes for patients and expanding knowledge and skills for healthcare through programs such as the “Ready to Be Cured” programme in markets including KSA, the UAE and Kuwait further to treating more than 10,000 patients between 2014 and 2019. In partnership with the UAE MoH, Gilead launched the MAAK Access Programme which improved access to Gilead HCV drugs for patients in need. More than 350 patients have been enrolled, from 50 referring physicians in over 30 hospitals & clinics. Gilead continues to support and facilitation of the implementation of the HCV elimination program led by the Dubai Health Authority.

References available on request.