Almost six months since the earliest detected cases of COVID-19 in Wuhan Province China, the pandemic has since spread rapidly in breadth and depth. The increased strain the disease has placed on healthcare facilities is being realised in countries with the highest number of cases. This insight is intended to provide an update on its impact on the X-ray market.

COVID-19 has diverted stimulus funds to diagnostic X-ray systems to help facilitate much needed diagnostic imaging facilities, resulting in a higher than anticipated uplift in the radiography market in Q1 and Q2 of 2020 than predicted previously pre-COVID-19. Mobile digital radiography (DR) systems are at the forefront in providing an initial screening for pneumonia, a secondary and more progressive stage of COVID-19 in severe cases.

Related: Scanning for certainty: Navigating the ultrasound market during the COVID-19 pandemic

Imaging is not routinely designated in asymptomatic individuals with mild COVID-19 symptoms unless they are at risk for disease progression. Mobile DR systems are used heavily to track progression of pneumonia due to the capabilities of bed side imaging enabling use in emergency rooms, A&E facilities and in the ICU. Mobile DR imaging has benefits of offering quicker, and less costly imaging services than other modalities.

Benefits of mobile DR systems for COVID-19 patient diagnosis

Portable mobile DR systems were recommended by the American College of Radiology (ACR) task force on COVID-19 on March 11, 2020, which endorsed the modality for use in ambulatory care facilities due to the ease with which surfaces can be cleaned.

One of the advantages that mobile radiography has for imaging COVID-19 patients is its portability. Mobile general radiography systems are a cost-efficient alternative to a fixed radiography room and allow technicians to bring the equipment to the patient, rather than having to bring the patient to the equipment.

This can help save critical time for serious cases of COVID-19 in reaching an initial diagnosis, resulting in more efficient workflows and usage in A&E facilities, ICU and designated COVID-19 units.  Mobile DR equipment dedicated to COVID-19 imaging can be set up closer to intensive care units, decreasing risk of virus transmission, with some mobile DR systems becoming dedicated for COVID-19 cases.

CT vs mobile DR

Even though industry consensus discourages the use of chest imaging for COVID-19 diagnosis, the role of both chest X-Ray (CXR) and chest CT continues to emerge.

• For emerging countries, mobile DR systems are relied upon more heavily to provide imaging capabilities for diagnosis of COVID-19 and due to their increased affordability over CT systems.
• The time required for a CT room to be decontaminated and sterilized after imaging COVID-19 patients is timely and heavy on resource. If a suspected or diagnosed patient with COVID-19 has been scanned, the room must be shut down and cleaned for 70 minutes
• CT should not be used to screen for or as a first-line test to diagnose COVID-19. CT should be used sparingly and reserved for hospitalized, symptomatic patients with specific clinical indications for CT.
• Chest X-ray is often the first imaging exam acquired after a positive RT-PCR if a patient is at risk for disease progression.
• Overuse of chest CT can exhaust hospital resources and bring infected patients into contact with non-infected individuals, thus increasing the risk of disease transmission.
• CT is appropriate in patients with functional impairment and/or low blood oxygen after COVID-19 recovery.

Expected uplift of mobile DR systems

Manufacturers have seen a rapid sale of mobile DR to hospitals in Q1 2020, the manoeuvrability of the systems make them essential for early diagnosis of COVID-19 patients.

On 6^th May 2020 the World Health Organization (WHO) reported a total of 3,663,222 cases of COVID-19, the high severity of the crisis worldwide has had a significant impact on the healthcare system across the globe, healthcare expenditures have accelerated as hospitals rush to treat COVID-19 cases.

Prior to COVID-19 the digital radiography (DR) segment (inclusive of fixed DR rooms and mobile DR systems) was forecast to increase by 9% in the number of unit shipments (base growth). However, due to a surge of demand for diagnosis of COVID-19, the unit shipment of the systems is forecast to sharply rise.

In the maximal-growth scenarios, the best-case scenario for growth, the global DR segment is forecast to increase by 35% in shipments in 2020; primarily driven by uplift in demand in the first half of 2020. Growth is then forecast to slow down in Q3 and Q4 2020 due to low availability of mobile DR systems and as the number of new COVID-19 cases declines.

In the minimal-growth scenario, worse-case growth, the growth of the global DR segment is forecast at 13% in unit shipments. This is due to the lack of availability of systems, mobile DR manufacturing capacities and a drop in demand for mobile DR systems as the number of new infections continue to fall in latter part of 2020.

The existing installed analogue mobile X-ray systems at hospital facilities have also seen an upgrade to digital mobile technology via retrofit solutions in another step towards increasing availability of mobile DR systems.

Impact on the wider X-ray market

With hospital funds being diverted to diagnostic X-ray systems, in particular mobile digital radiography, image guided therapy X-ray systems, such as interventional X-ray and mobile C-arm systems, have experienced a decline in demand in the first quarter in 2020. In countries most impacted by COVID-19, non-critical surgeries and diagnostic procedures have been postponed or delayed, most medical professionals have been redeployed to more critical departments to help tackle the pandemic.

The utilization of interventional X-Ray is projected to decline in 2020; as the number of interventional procedures are projected to fall in the short term, thus delaying new purchases until the COVID-19 pandemic subsides. Due to their saturated markets, similar declines are projected for mammography and mobile C-arm X-ray solutions, as priorities are focused on increasing diagnostic imaging in COVID-19 patients.

Demand for interventional X-ray, mobile C-arm and mammography X-ray systems is forecast with gradual return in 2021 and 2022, with delayed or pending orders being processed.

FDA change in legislation for imaging of COVID-19

To increase availability of key medical imaging supplies in response to COVID-19, the US Food and Drug Administration (FDA) is relaxing its guidelines on modification of radiology equipment.

FDA believes the policy included in this guidance will address the urgent public health concerns by helping to increase availability and capability of imaging products needed for diagnosis and treatment of lung disease in patients with COVID-19. Increasing the availability of mobile and portable systems could increase facilities to image patients both inside and outside of healthcare facilities, which could help to reduce the spread of COVID-19.

Healthcare facilities globally are attempting to tackle the surge in demand for diagnosis and treatment of COVID-19 patients, however the need to utilise imaging resources needs to also factor the safety of staff from potential infection.

As a result, providers of radiology services have modified mobile DR systems to enhance protection of staff by having glass barriers to increase separation and reduce risk of infection. Additionally, some imaging systems have also been modified into mobile systems to reduce the need of transporting patients who require imaging to large healthcare facilities. As a result, the FDA have declared that it will not oppose to such modifications to FDA approved systems.

2020 and beyond

As a result of the COVID-19 pandemic, pending orders for mobile DR systems for late 2020 and 2021-2022 have been brought forward to early 2020. Therefore, demand is forecast to retract in Q3 and Q4 of 2020, as well as in 2021. Spend has been diverted from image guided therapy X-ray systems to mobile diagnostic DR systems to increase and enable more diagnostic capabilities and treatment of COVID-19.

Due to demand plummeting for mammography, interventional and mobile C-arms in countries most highly impacted by COVID-19, recovery is projected in late 2020 through to 2022.

The sheer necessity to access mobile DR systems has meant purchasers have increased flexibility on specifications, with purchasing decisions purely founded on supply available by mobile DR manufacturers. In light of the COVID-19 pandemic there have not been any changes in pricing dynamics or price cutting of mobile DR systems.

In order to future proof against similar pandemics in the futures, hospitals may focus purchasing towards mobile DR systems with anti-microbial coatings and ease of sterilization, software and hardware features which enable increased patient and radiographer protection, quicker image processing, workflow optimization and artificial intelligence assisted clinical decision-making software.

Artificial intelligence tech companies are forecast to be more reactive in developing bespoke solutions to help tackle such pandemics. For instance, Qure.ai, a healthtech company specializing in artificial intelligence (AI), launched its COVID-19 progression monitoring software at Bolton NHS Foundation Trust.

Qure.ai’s software automates the interpretation of COVID-19 progression by quantifying changes on chest X-rays, enabling localization, qualification of lesions and a case priority score being generated in under a minute.

As part of a strong and multi-disciplinary healthcare team, nurses and midwives make a significant contribution to delivering on the commitments to healthcare provision. They are critical in health promotion, disease prevention and delivering primary and community care and providing care in emergency settings and are critical for the achievement of universal health coverage.

Omnia Health Insights spoke to Mohammed Bin Rashid University of Health Sciences and Medicine (MBRU)’s College of Nursing and Midwifery’s Dean Professor Kevin Gormley on the occasion of International Nurses Day (12^th May) about his views on the increased focus on nurses and nursing during global healthcare challenges such as the COVID-19 pandemic.

What roles do nurses play in emerging diseases prevention, management and treatment?

Nurses and the profession of nursing has always taken great pride in providing care and meeting the needs of patients and their families during periods of ill health. Nurses are always there to offer support and encouragement and to support healing, rehabilitation and the restoration of balance and health. The presence of pandemic and other emergencies does have an impact. It requires a refocusing of nursing needs and interventions, but essentially the philosophy and bedside support and continued care that has always been offered remains.

Going forward, nurses need to be resilient and empowered with decision-making and leadership qualities. They are also very much part of their local community – sharing its culture, strengths and vulnerabilities – and can shape and deliver effective interventions to meet the needs of patients, families and communities.

What aspects of nursing should be focused on during global healthcare challenges?

Nurses should be able to demonstrate competency in fundamental principles of effective public health and emergency preparedness, including effective crisis communications. Nurses will play an important role as advocates for vulnerable population and client groups to ensure they have access to care, and there is a fair and equal distribution of resources. Nurses and midwives are often the first and sometimes the only health professional that people see during periods of ill health and the quality of their initial assessment, care and treatment is vital.

What roles do nurses carry out that can influence healthcare outcomes?

Nurses and midwives are contributing significantly towards developing evidence-based practice, conducting health research and developing innovative practices as part of interdisciplinary teams. Nurses have taken on advanced and specialist roles, and globally many midwifery- and nurse-led services provide new and innovative models of care.

Nurse practitioners deliver many specialist services. For example, the care of patients with non-communicable diseases such as diabetes and chronic obstructive pulmonary disease (COPD) is now routinely managed in many countries by nurses, with doctors available when necessary. Advanced nurse practitioners, nurse consultants and nurse specialists now undertake many extended roles, including running clinics, undertaking procedures and prescribing medication.

Technology and informatics have expanded the role of nurses and the delivery of care. We also envisage that as part of the continued developing role and competencies of nurses, they will have the capability, in agreed clinical circumstances, to prescribe medications for patients.

Professor Kevin Gormley

 

How should we increase the nursing capacity to deal with future healthcare challenges?

Nursing has always been an attractive profession for people of all ages, and both men and women, and will continue to be, despite the presence of the pandemic. The attractiveness of nursing as a profession has been enhanced through important initiatives including university education, continued professional development, increased leadership and clinically based managerial responsibilities and well-developed career structure (research, academic and specialist roles) that encourages nurses to continually reflect upon their needs and how they can best contribute to practice.

Dr. Maryam Matar is a force to reckon with in the UAE’s healthcare industry. As the country’s first-ever woman Director-General of the Dubai Health Authority (DHA), Dr. Matar has donned many hats. She is a graduate of the Dubai Medical College and did her Postgraduation in Family Medicine. In 2006, she also became the first woman to be the Undersecretary of Public Health and Primary Healthcare in the history of the UAE. She told Omnia Health Insights: “When I was enrolled in the position there were only 52 primary clinics, within a short span of 13 months we upgraded it to 79.”

After her work as the Undersecretary, she was asked by the Dubai government to lead a new authority called the Community Development Authority. She highlighted: “I established it from the ground up and was asked by the Dubai government to be the Executive Team Leader for the Dubai Strategic Plan from 2008 till 2016 for Health, Education and National Identity. It was a huge responsibility and I had to do it right in order to forge a path for other Emirati women.”

Her interest in healthcare developed at a young age, when her grandmother, who was a traditional healer, passed away, and her patients were condoling her loss as though they had lost a member of their family. She shared: “I was surprised and asked my mother why were they crying? Were they her far off relatives? My mother told me that they were my grandmother’s patients and were crying because she was not there to heal them anymore. That greatly impacted me, and I decided to become a doctor and pursue the path of excellence.”

As part of her residency programme, she was selected by the DHA for a leadership programme held under the patronage of His Highness Sheikh Mohammed bin Rashid Al Maktoum, Vice President and Prime Minister of the UAE and Ruler of Dubai. Around 30 staff members from various Dubai government entities and were enrolled in a two-year leadership programme organised by Harvard University, Glenford and London Business School.

“Every month for five days we attended a condensed executive course in different areas such as negotiating, budgeting and strategy, etc.,” she said. “We were asked to do a graduation project programme. Being a physician and in the Department of Health, I was close to patients, especially when it came to the prevention part. I noticed that the majority of the patients who used to visit me at the clinic came in with a complication or a disorder, which would have been easily managed if it were identified in the beginning."

The Cyprus model

For the project, Dr. Matar chose to work on “UAE free from Thalassemia 2012”. She was inspired by the success of Cyprus, in 2004, when they celebrated the 10-year success of the fact that no child in the country was born with Thalassemia. “During the research, I found that Cyprus didn’t have a magic wand. All they had done was to implement pre-marital test and early screening for students before they graduate, and the Church would not approve the marriage of people who were carriers of the disease. Those who still decided to get married would be responsible for taking care of their children without the support of the government. So, it was indirectly forcing the community to make the right decision,” she explained.

For the “UAE Free of Thalassemia 2012” campaign, Dr. Matar decided to increase the awareness in the community and set the timeline from 2004 to 2012. She hoped that by then the project would be able to gain the support of the government.

“We got the law approved in 2006,” she exclaimed. “I was in the audience of the cabinet when His Highness signed the law! It became mandatory for everyone who wanted to approve their marriage in the UAE to be screened for common genetic disorders and sexually transmitted diseases.”

Focus on community health

In the early stage of her career, Dr. Matar used to do rotation shifts at the Thalassemia Centre in Latifa Hospital. She said that she would find it quite heart-breaking to see a child come in every three weeks and go through blood transfusion for 12 hours and witness the feeling of guilt in their parents’ eyes.

She said: “My mother suggested I create awareness in our local community gatherings and eventually there started to be a huge demand for this. The community started to recognise me as a voice they could trust.”

Prevention is essential for this part of the world because the UAE has a relatively young population, highlighted Dr. Matar. “We got a good response from the community and what we learnt can be an important lesson for the rest of the GCC. We involved the educated part of the community. We went to colleges and universities and focused on third-year students. In addition to that, we did it in a UAE community – we chose Emirati students in colleges and universities and chose them to be ambassadors in their families. That is a message I would like to emphasise on – try to utilise the youth as they have the power of change.”

Community projects

Dr. Matar has initiated 28 community projects, out of which 11 have been adopted by the UAE government. These include the UAE Genetic Disease Association (UAEGDA) and the UAE Down Syndrome Association.

She highlighted: “The UAEGDA is close to my heart. When we started with Thalassemia, we knew it was one of the most common blood disorders in the UAE. When we did the population screening programme for 11,282 Emiratis, the age group being between 18 to 28, I was surprised when I saw the result. When we analysed the data, we saw that the prevalence of thalassemia was only 2.9 per cent, not 12 per cent, the prevalence was dropping, and people were becoming more aware. But going through the results we realised that this was a pandora’s box and there were many other genetic disorders, which were not common, but their prevalence was quite high.”

The UAEGDA started with blood disorder initiatives, however, it is currently working on several others such as Familial hypercholesterolemia, G6PD, sickle cell, and thalassemia. One of them is also the fragile x chromosome, which is related to autism. There is a specific mutation that increases the risk of that child to have autism. The Association doesn't publish the results keeping community sentiment in mind.

The Association also has a breast cancer initiative along with two international centres with which they are able to identify 21 new mutations for breast cancer, which is very essential for their management. “Previously, a patient with cancer would be screened only for BRCA1 and BRCA2,” she explained. “With our exercise, we are able to specify mutations specific to our ethnicity such as people coming from the Middle East, Africa, India, Philippines, Pakistan, etc.”

For instance, if there is any patient diagnosed with breast cancer in the Middle East in these ethnicities, healthcare institutions can check for the 21 mutations, which are specific to the ethnicity. The impact of that would be that their medication and chemotherapy can be modified. “We have a complete circle of chain – prevention, counselling, early detection and management. We don’t do it ourselves but have a partner who is helping us to achieve this,” she added.

One of the other initiatives that make UAEGDA unique is that under its umbrella they host the GCC Genomic Society. As part of the society, doctors from member GCC countries gather once every year at a conference, where they decide what type of project and priority of mutation needs to be focused on. Furthermore, UAEGDA is also a member of the Global Rare Diseases Commission.

Dr. Matar shares: “What makes us special is that we received 5 Nobel laureates, who said that, “The UAEGDA is a spot of light in the Arab world in genetic research.” They said that they had been to reputed institutions around the region but had never seen them do screenings for free for both local population and other nationalities, and reach the level where they are able to get support from the government to issue a law and have an impact on generations to come.”

UAEGDA is also looking to increase the advocacy of stem cell donation and one of its upcoming projects is to launch a stem cell bank. The Association has also partnered with Harvard Genetic Institute to study recessive disorders in the region.

Currently, UAEGDA is working on an Epigenetics project that focuses on the impact of sleep and gene expression of common non-communicable disorders such as diabetes, hypertension etc. Epigenetics tries to address the relationship between the environmental factor and genetic make-up. In simple terms, the DNA inherited from parents is the hardware, while epigenetics is the software that can be updated.

“My advice to people is that if you cannot change your lifestyle, at least try to modify your sleeping pattern. If you have a better quality of sleep, you will help your body to maintain itself during the night so that it will switch off all those mutations that can increase the risk of obesity, hypertension, cancer etc.,” she concluded.

COVID-19 separation strategies

The COVID-19 pandemic has meant that different strategies are required for the delivery of newborn and well-child care, including childhood immunisation, Dr Yasser Nakhlawi, Consultant and Head of Paediatrics at Al Zahra Hospital explained to Omnia Health Insights.

Healthcare providers in communities affected by the pandemic are using separation strategies such as:

• Scheduling well visits in the morning and sick visits in the afternoon
• Separating patients spatially, such as by placing patients with sick visits in different areas of the clinic or another location from patients with well visits.
• Collaborating with providers in the community to identify separate locations for holding well visits for children.

As a result of personal, practice, or community circumstances related to COVID-19, some providers may not be able to provide well child visits, including provision of immunisations, for all patients in their practice.

If a practice can provide only limited well child visits, healthcare providers are encouraged to prioritise newborn care and vaccination of infants and young children (through 24 months of age) when possible.

Telehealth is also seeing increased popularity during the pandemic.

According to the COVID-19 forum on the International Society for Pediatric and Adolescent Diabetes website, rules for access to telemedicine have become more relaxed during the pandemic, with less attention paid to data safety. In less regulated countries, for instance, patients and doctors are communicating via WhatsApp or other messaging applications.

Further demonstrating the surging interest in telemedicine services for children, a telemedicine startup in India, Practo, shows that paediatrics is the fastest rising search on its platform, with growth of 350 percent since 1 March 2020.

Pediatric Multi-System Inflammatory Syndrome (PIMS)

Paediatric specialists in the UK and US are sharing stories of children experiencing symptoms that include persistent fever, extreme inflammation and evidence of one or more organs not functioning properly.

The health condition, named Pediatric Multi-System Inflamatory Syndrome (PIMS), is seen in children previously infected with, and who have recovered from, COVID-19. An immune response emerges resulting in significant levels of inflammation in organ systems. 

PIMS is said to be similar to other inflammatory conditions, such as Kawasaki disease, staphylococcal and streptococcal toxic shock syndromes, bacterial sepsis and macrophage activation syndromes.

By 6 May 2020, more than 50 cases were reported in Europe and 64 PIMS cases were reported by the New York State Department of Health.

Mental health support

According to an April 2020 survey of more than 2,000 US adults, young people aged 18-44, and Generation Z and Millennials in particular, experienced a tenfold increase in serious mental distress compared with 2018 (adults aged 60+ showed the small increases).

This suggested a major impact on young people's mental health brought by the COVID-19 pandemic. It's an effect seen worldwide. In China, 1 in 5 children reported symptoms of depression after their schools had been closed for a month. 

Health authorities are responding around the world with guidance. For instance, the child and adolescent psychiatry division of the Indonesian Psychiatric Association has issued guidelines through social media explaining how to help children and adolescents maintain their mental health during the pandemic.

In addition to guidance, innovative new methods are emerging to ease children's anxiety.

In the UK, for example, a mindfulness app was launched for children aged 3-5 - a game called Your Mindful Garden, narrated by mental health advocate Stephen Fry. In another example, in cooperation with the UAE's Ministry of Health and Prevention, the country's Ministry of Education launched Sanadcom ("your support"), an initative to ensure that children of medical staff receive educational and mental health support during the COVID-19 epidemic. 

The healing environment

Evidence-based design informs architects, designers and artists on how to create a healing environment in hospitals, surgeries and clinics that improve patient care.

Emirati artist Dana Al Mazrouei was recently commissioned to create a unique art installation for The Zayed Centre for Research into Rare Disease in Children in London. As an artist-in-residence at the hospital, she also led a number of creative workshops that explored the theme of genetics with children, young people and their families.  

CAR T-Cell therapy

In April 2020 researchers developed a novel approach that delivers appropriately-targeted CAR T-Cell therapy directly into the cerebrospinal fluid surrounding recurrent paediatric brain tumours.

CAR, or chimeric antigen receptor, T-cell therapy is a type of cancer immunotherapy that involves genetically engineering a patient’s disease-fighting T-cells, rewiring them to seek out, recognise and attack cancer cells. Studies showed it was highly effective in patients with chronic and acute lymphoblastic leukaemia, the most common form of blood cancer in children. Clinical trials of the gene cell therapy were approved by the US FDA in late August 2019. 

Scientists now describe CAR T as a “living drug” and a revolutionary new treatment for advanced blood cancers in children and adults.

Reem Hospital, a portfolio company of Investcorp, in collaboration with the Department of Health and SEHA, has commissioned Dar Al Shifaa Hospital in Khalifa City A, Abu Dhabi, to make 80 beds available to support the UAE government in its response to the COVID-19 pandemic.

Reem Hospital has volunteered to operate and manage 80 beds at Dar Al Shifaa Hospital, on a nonprofit basis, from April 22 for quarantine and care of COVID-19 patients with mild symptoms, in line with its commitment to support the UAE’s efforts in battling and eradicating the COVID-19 pandemic and safeguarding the community.

Zaid Al-Siksek, Chairman, Reem Hospital, said: “We are honoured to support the UAE’s leadership during this challenging time. Our management, employees and suppliers have worked around the clock over the past two weeks to allow Dar Al Shifaa Hospital to be operational and provide an additional supply of beds, supporting existing healthcare infrastructure. We are proud to be collaborating with SEHA, providing support and expertise as we come together in the nation’s fight against COVID-19.”

Curbing COVID-19

Investcorp invested in Reem Hospital in 2018, as part of Investcorp’s greater focus on healthcare in the MENA region. Investcorp’s Head of Private Equity MENA, Walid Majdalani, said: “With the growing demand for quality healthcare due to COVID-19, we at Investcorp, along with our portfolio companies, are looking at various ways to support in curbing the COVID-19 pandemic. We are confident that the activation of Dar Al Shifaa Hospital will help address the need for hospital beds and medical staff in Abu Dhabi.”

Reem Hospital is currently under construction on Abu Dhabi’s Reem Island and set to open in the second half of 2020. It will be a 200+ bed hospital focusing on post-acute rehabilitation and women and child health as well as Outpatients and Inpatient services.

The hospital has been designed and built and will be operated and managed, in partnership with Fresenius Vamed, a global developer and operator of healthcare assets focusing on post-acute rehabilitation. Reem Hospital aims to provide an integrated and value-based approach to healthcare with measurable patient outcomes.

Fasting during the Holy month of Ramadan is a great opportunity to modify certain cardiovascular risk factors. Patients who have stable chronic heart disease can fast if they are asymptomatic. If the patient is experiencing chest pain or shortness of breath, the recommendation is to seek medical advice. Patients with heart diseases who decide to fast need to consult with their cardiologist to adjust timing and doses of their cardiac medications.

Advantages of fasting during Ramadan

Fasting during Ramadan is also an opportunity to lose weight, lower blood pressure, lower bad cholesterol, lower blood sugar, modify stress, anxiety and to quit smoking. The major cardiovascular risk factors that lead to heart attacks and strokes are smoking, hypertension, high lipid, diabetes and positive family history.

Who can fast?

There are certain cardiac patients for whom fasting is not recommended, such as those with Type I Diabetes (diabetics who are insulin-dependent), heart patients on anticoagulation, heart patients on antiarrhythmic treatment, open-heart surgery patients, patients with severe heart valve disease, patients after a heart attack within 6 weeks, heart transplant patients, heart patients with symptoms such as chest pain, shortness of breath, leg swelling and uncontrolled congestive heart failure patients. Patients with chronic stable heart patients with no symptoms are advised to consult with their cardiologists to adjust the timing and dosages of their cardiac medications during the Holy month of Ramadan.

Tips

Below are a few cardiac recommendations for patients who are fasting:

1. Take Ramadan as an opportunity to modify your risk factors.
2. Eat healthy recommend 4 small meals (rich in water, fruits, vegetables) and not heavy, fatty, salty meals.
3. Avoid sweets. Eat 3-4 dates during Iftar and start with salads prior to the main meal.
4. During Iftar try to have one main meal.
5. For Souhour have a light meal of fruits, vegetables, yoghurt and consume it 30-60 minutes before Azan.
6. Pick healthy soups such as vegetable grain-based soups over the creamy versions.
7. Maintain good hydration.
8. Maintain an exercise programme, with not less than 10,000 steps per day.
   
   
   Dr. Mazin Chaheen

The rapid growth and changing environmental and social conditions have heavily affected the prevalence and patterns of cancer prevalence. Prostate cancer, in particular, has seen a significant rise in prevalence, attributed to change in the lifestyle of the modern man. One study found prostate cancer to be among the top three most prevalent cancers diagnosed, highlighting the scale of the problem.

Prostate cancer is one of the most common types of cancer in men worldwide, initially developing slowly before it grows and then can potentially metastasize – or spread – to other organs. Mutations in the cell’s DNA cause them to divide and grow rapidly, causing them to accumulate and form a tumour. When cancer spreads out of the prostate, it can travel to nearby organs such as the bladder, or travel to bones to cause pain and broken bones. Prostate cancer that is detected early when confined to the prostate gland has a better chance of successful treatment. 

Risk factors

There are many common risk factors seen among men. Apart from the common genetic risks we cannot influence such as older age, genetic history and ethnic background, there are many risk factors that can be changed, such an unhealthy diet. Some research has suggested excessive usage of calcium supplements can have an impact. Obesity can also increase the overall risk of getting prostate cancer and is a known epidemic, with a prevalence of up to 31.6 per cent of males.

“Poor diet as a risk factor for prostate cancer; red meat and a high-fat diet have been found to influence risk. The move towards a fast-food diet has seen an increase in the number of prostate cancer cases seen. This has also brought about concerns of obesity, another well-known risk factor for cancer,” said Dr. Amgad Farouk, Consultant Urologist from Medcare Hospital Dubai.

Symptoms

Symptoms in men can include trouble urinating, discomfort in the pelvic area and bone pain. “Men must attend regular screenings for prostate cancer as it is key to beating the disease. It is also incredibly important for patients to see their healthcare provider as soon as they suspect any symptoms related to prostate cancer – the earlier we detect cancer, the better the outlook is for treatment and recovery,” said Dr. Farouk.

Screening is carried out through a blood test that screens for a prostate-specific antigen to uncover cancer.

There are common steps men can take to lower their risk of prostate cancer. Doctors recommend ensuring a healthy diet, full of fruits and vegetables with minimally processed foods.

References available on request.

Under the direction of the Department of Health – Abu Dhabi (DOH), Malaffi, the region’s first Health Information Exchange (HIE) platform, has announced the release of new solutions. These will empower the Abu Dhabi healthcare sector and the healthcare providers to make more accurate, efficient and safer decisions during the current COVID-19 pandemic.

Malaffi’s extended solution offers access to the Abu Dhabi providers that are not yet connected to Malaffi and are part of Abu Dhabi’s COVID-19 response. This allows front-line workers to consult their patients using real-time test results and relevant information from the medical history of the patient, helping with the assessment of the risk level for those patients and the making of further appropriate decisions for their care. As a result, doctors, nurses and healthcare professionals can take necessary first-response decisions, such as the need for patient isolation or hospitalisation, quicker and more effectively.

Real-time data

Related: Malaffi, helping create a healthier Abu Dhabi for current and future generations

Malaffi’s centralised database of COVID-19 test results from all Abu Dhabi testing sites, available in real-time as data is recorded, helps the DOH strengthen its COVID-19 response by identifying and tracing the newly diagnosed cases. The solution facilitates well-founded pandemic clinical decisions and allows policymakers to efficiently allocate resources for better capacity utilisation and optimise planning and care coordination in the Emirate.

Commenting on the new developments, H.E Dr. Jamal Mohammed Al Kaabi, Acting Undersecretary of the Department of Health – Abu Dhabi, said: “Further to its efforts to ensuring ample testing capacities, as the first-line response to overcome the COVID-19 pandemic, the DOH is committed to enabling comprehensive digital solutions to ensure the health and safety of everyone in our society. Building on the existing advanced digital centralised information platform, Malaffi, we can have full visibility of the spread of the virus and empower the front-line healthcare workers with clinical information to make safer and more efficient decisions.”

Related: How is Malaffi accelerating the delivery of better-quality healthcare?

“By centralising all COVID-19 testing results from all testing sites in Abu Dhabi, through Malaffi, the DOH now has access to accurate and real-time key pandemics indicators. Having access to this information is most important in such situations as it enables us to assess and better plan the testing and healthcare capacities and coordinate the distribution of the response resources in the Emirate.” Al Kaabi added.

Created in partnership between the Department of Health – Abu Dhabi (DOH) and Injazat Data Systems, and launched in 2019, Malaffi’s portal for medical providers now has 450+ connected facilities and is available to over 20,000 users in Abu Dhabi containing 53 million unique clinical records for more than 3 million patients. Eventually, all 2,000 public and private healthcare providers in the Emirate will be connected.