MEMP July 2018 Final Singles v3

MIDDLE
EAST Medical
JULY 2018 | MiddleEastMedicalPortal.com
Vision 2030 New UAE visa

and system will benefit
healthcare
healthcare professionals
in Saudi
LATEST
NEWS
REVIEW
OF CANCER
AND
IN EGYPT JOBS
Blockchain,
AI and
the end of
PROFILES
Dubai
Business
doctors?
by Brian de Francesca
Park
Aldara,
Riyadh,
Hospital
Contents
12
COVER STORY
Blockchain,
AI and the end
of doctors?
Could the Middle East
healthcare providers leapfrog
the West by using blockchain
and Artificial Intelligence (AI)
to connect people, machines,
and data in an intentional and
intelligent manner? Written by
Brian de Francesca, Founder and
CEO of Ver2 Digital Medicine.
24 28 32
Saudi Vision 2030 Stretching the Four lessons on
The opportunities in boundaries of science at innovation from a classic
healthcare Dubai Science Park science experiment
Our CEO, Nathan Nagel explores the A company profile on Dubai Science Marwan Abdulaziz Janahi, Executive
opportunities for foreign healthcare Park (DSP). This hub is a vibrant, Director of Dubai Science Park
companies emerging in The Kingdom holistic, science-focused community of highlights how 21st Dubai is in itself a
through the Saudi Visiion 2030. over 350 companies. living experiment in innovation.
38
Cancer in Egypt: A special report
An historic, present, and future perspective on the state of
cancer in Egypt written by Aalaa Abdou, a Clinical Oncology
Specialist in Ministry of Health of Egypt. Aalaa’s career has
spanned cancer hospitals in Egypt such as the governmental
Nasser Institute and Aswan Cancer Centre, charity hospitals
like Baheya Cancer Centre and Shefaa Orman Cancer hospital.
2 July 2018 MiddleEastMedicalPortal.com

Regulars
4 News briefings
Read the latest medical news
from around the Middle
East, including the Turkish
Professor who has found a ray
of hope against cancer.

20 Hospital Profile
42 48 We highlight Aldara Hospital
and Medical Centre, Riyadh,
Atavistic Chemotherapy: Compounding tablets in Saudi Arabia which provides
Breaking away from the Middle East: Benefits an exceptional employee
expensive and ineffective of small-scale tablet experience.
cancer drugs manufacturing systems
23 Company profile
Dr Frank Arguello, MD Director of Dr Michael Gamlen explains the benefits
SURGINS is among the fastest
Atavistic Chemotherapy Clinical Trial of using the GAMLEN M-Series for
growing stainless-steel and
explains how this treatment works. compunding tablets.
titanium surgical instrument.

36 Zaineb Interviews
Our reporter investigates
how the new UAE visa
system will benefit healthcare
professionals

64 A day in the life of
British Paramedic Rachel
McDonald details her time
working at one of the biggest
hospitals in Riyadh, Saudi
Arabia.

66 Books
A selection of medical books
to provide food for thought,
including a new release from
one of the world’s most
eminent heart surgeons.
67 Job portal
Find your dream medical job
52
in the Middle East via our
jobs portal. Vacancies include
Consultants, Directors, and
Nurses.
Middle East Respiratory System
Coronavirus - Latest update 72

Events
Enhance your skills and
Lauren Bolton, Knowlex’s Research Specialist, provides a detailed update about the knowledge by attending one
infectuous disease Middle East Respiratory System Coronavirus (MERS-CoV), there of these cutting-edge medical
have been 2,143 cases including 705 deaths. The article explains how the disease events taking place across the
spreads, symptons, and preventative measures. Middle East.
MiddleEastMedicalPortal.com July 2018 3

Contents
54
FEATURE STORY
Is the Middle
East prepared
for Influenza?
Dr Hina Naveed investigates
influenza across the Middle
East and highlights the benefits
of healthcare professionals
being vaccinated against
the virus.
58
A breakthrough in managing diabetic
foot ulcers (DFUs)
Diabetic foot ulcers are a major issue, and with Diabetes on
the increase across the Middle East, effective wound care is
needed. Dominiek Viaene, introduces Vacutex - a breakthough
in managing diabetic foot ulcers explains how Vacutex can help
manage these wounds
60
Multifaceted approach to diabetes
According to the International Diabetes Federation, without
lifestyle changes, a quarter of the Middle East’s population
will be affected by 2035. Alyson Smith, BSc, an experienced
diabetes nurse investigates how the Middle Address can
effectively address diabetes and the associated mental health
conditions that may occur alongside the disease.
62
Non-alcoholic fatty liver disease:
Does genetics have a role?
Dr Ravi Kanth, Group Leader of genetics at the Asian Institute
of Gastroenterology explores the role genetics plays in NAFLD.
Furthermore, he provides background to the disease and how
researchers can move forward.

CEO Letter
The purpose of MEMP is to be the premier

resource for medical professionals in the Middle
East providing useful articles, job opportunities,
education, and events through the magazine and website.
MEMP will have a special focus on the latest digital
advancements in medicine, surgery, and healthcare in
general. Why digital? The Middle East is not restrained
by old legacy systems, so the region could adopt the latest
digital advancements with minimal healthcare politics and
depreciation/amortisation issues. This all means that within
the next 5-10 years if you, or your loved one, wanted to receive
the best possible care you might no longer be thinking of the
UK or US but one of the GCC countries. When I talk about the
best possible care I do not mean the hospitals that are more like
5-star hotels or where the worlds’ best human doctors practice,
but where the medical community have got over their human
ego and come to accept that the best care is the AI augmented
doctor. The leading edge of medical education and research
now know that the robots will not be taking over soon and AI
alone is not the solution. However, neither are us humans with
our limited (versus cloud) hippocampal memory chips and
pre-frontal cortex CPU’s (versus AI and ML). The best possible
care is, surprise, the best of both humans and machines can
offer in combination such as AI decision making support for
Welcome to the Middle medical professionals. For those of you that are neither in
camp human or camp machine, you might agree that providing
East Medical Portal the best possible care to humans is both an art and science. I
hope you enjoy our magazine and please give us feedback, as
(MEMP) Magazine. all I know for sure, is that I know nothing.
MIDDLE
EAST Medical THE TEAM
CEO Nathan Nagel
T H E P R E M I E R P O R TA L F O R M E D IC A L EDITOR-IN CHIEF Anna-Lisa Hasedžic
P R O F E S S I O N A L S I N T H E M I DDL E E A S T
SUB-EDITOR Siham Tawfiq
MEMP Ltd ART DIRECTOR Michael Thomson
Registered company number: 11455285 SPECIAL ADVISER Zaineb Al Hassani
Email: info@MiddleEastMedicalPortal.com MARKETING Muhammed Kahn
MiddleEastMedicalPortal.com OPERATIONS Liz Godbolt
DISCLAIMER: All views, opinions and content expressed in the Middle
East Medical Portal Magazine are those of the individual authors and CONTRIBUTING WRITERS
do not reflect the MEMP Ltd position. MEMP Ltd have no preference or
affiliation on the basis of race, color, religion, creed, sex, sexual orientation, Brian de Francesca Lauren Bolton
pregnancy, gender identity, national origin, ancestry, age, disability,
genetic information or other protected status. All rights reserved 2018. No Dr Rizwan Qureshi Dr Hina Naveed
part of this magazine may be reproduced or transmitted in any form or Marwan Abdulaziz Janahi Dominiek Viaene
by any means without written permission of the publisher. Images used in
Middle East Medical Portal Magazine are credited whenever possible. Zaineb Al Hassani Alyson Smith
Aalaa Abdou Dr Ravi Kanth
JOB SEEKERS: The Middle East Medical Portal is NOT a recruitment
Dr Frank Arguello Rachel McDonald
company. Please do NOT call or email us, please respond direct to
the vacancies in the job section. Dr Michael Gamlen Nathan Nagel

News
MIDDLE EAST
Latest medical news from
around the region
Photo courtesy of Al
Jalila Children’s Hospital
Al Jalila Children’s Kuwait’s polio laboratory Bahrain to commence

Hospital launches has been approved work on a new multiple
residency programme sclerosis centre
Kuwait’s Health Ministry announced
The Al Jalila Children’s Hospital in that their polio laboratory has Bahraini authorities have reported that
the United Arab Emirates has launched been approved by the World Health work will soon commence on a $4.5
a four-year training programme for Organisation (WHO) as the Middle million multiple sclerosis centre in the
aspiring physicians. It is being run East’s main centre for the testing of Muharraq region of The Kingdom, with
in academic partnership with the the viral disease. Dr Majda Al-Qattan, the 100-bed facility being developed
Mohammad Bin Rashid University of the ministry’s assistant undersecretary as part of the Muharraq Medical
Medicine and Health Sciences (MBRU), of Public Health Services, said in Complex, which is set to be completed
Dubai Healthcare City Authority’s first a statement, ‘Our facility has been by mid-2020. It will also include an
medical university. Dr Mohammad approved by WHO as the regional 85-bed maternity hospital and an elderly
Al Awadhi, Chief Operating Officer laboratory for polio testing in the care centre. An agreement was signed by
of Al Jalila Children’s, told the Saudi Middle East,’ she said. Furthermore, Works, Municipalities Affairs and Urban
Gazette, ‘The launch of the residency it is stated on KUNA the lab has also Planning Minister Essam bin Abdulla
programme is in line with the objectives garnered accreditations by the College Khalaf and National Bank of Bahrain
of the establishment of the hospital as a of American Pathologists (CAP) and (NBB) chairman Farooq Youssef
centre for learning, research, and clinical the International Organisation for Almoayyed for the supervision of the
excellence.’ Standardisation (ISO). construction of the medical project.
Photo courtesy of FOCP Joy Cart brings happiness to young cancer patients
The Friends Of Cancer Patients (FOCP) Joy Cart initiative recently
visited the Dubai Hospital in order to bring hope and happiness to
young patients fighting cancer. The UAE-based charity visits paediatric
cancer wards around the country and brings a range of fun activities
including arts and crafts. The visit to Dubai Hospital was sponsored by
Dubai Municipality and held in collaboration with Sharjah Museum of
Islamic Civilisation (SMIC).

Al-Balsam International
Organisation. Image via
Saudi Press Agency
Al-Balsam International Organisation conducts 93 Jordan Government

heart surgeries in Yemen within 5 days providing insurance cover
The medical team of Al-Balsam International Organisation has con-
for cancer patients
cluded its visit to Mukalla of Hadramout Governorate, Yemen by Upon the recommendation of the
performing 13 open-heart surgeries and nearly 80 catheterizations for Health Minister, Mahmoud Sheyyab,
citizens across Yemen. the Jordanian Cabinet recently decided
Dr. Emad bin Abdullah Bukhari, Chief Executive Officer (CEO) of to provide free health insurance for all
Al-Balsam International Organization, said that the medical team also patients diagnosed with cancer. Each of
examined 300 heart diseases conditions, who came from different these citizens will receive an insurance
Yemeni regions, assuring that more than 90% of patients returned to card to be renewed annually till the end
their homes while the rest will leave soon. of their treatment, the Jordan News
Agency, Petra, reported.
Dr Adel Mahmoud,
global health leader,
dies aged 76
Dr Adel Mahmoud, the Egyptian born and educated pioneer in
preventing and treating diseases through vaccines, sadly passed
away, aged 76. Many people around the world, including the
founder of Microsoft, Bill Gates are mourning Dr Mahmoud’s
death. On Twitter, Bill Gates stated, E’arlier this month, the
world lost one of the greatest
vaccine creators of our time.
Dr Adel Mahmoud saved the ‘Adel’s keen
lives of countless children.’ intelligence,
He is credited for producing
a range of vaccines including
wit and
one which protects babies genius for
from rotavirus. Furthermore, problem-
he pioneered the vaccine solving were
which protects against human
papillomavirus (HPV) as well
legendary’
as a vaccine against shingles.
Dr Mahmoud also produced a combination vaccine against
four diseases: measles, mumps, rubella, and chickenpox.
‘Adel’s keen intelligence, wit and genius for problem-solving
Dr Adel Mahmoud were legendary,’ said Dr Pamela Davis, dean of the School of
Photo courtesy of Princeton University, Woodrow
Wilson School of Public and International Affairs Medicine at Case Western Reserve University. ‘The world is a
little less bright without his light.’

News
Doctors Without Borders

to launch Jordon Office
Jordanian authorities have recently approved, an application from
the medical NGO Doctors Without Borders (Médecins Sans Frontières)
to launch an office in Jordan. The organisation is known for its projects
in conflict zones and in countries affected by endemic diseases.
Photo courtesy of Heart Hospital, Qatar
Ground-breaking
technology
transforming the lives
of patients with heart
failure in Qatar
Image via AstraZeneca
Patients at Hamad Medical
Corporation’s (HMC) Heart Hospital
in Qatar are benefiting from a new
Health Body to Regulate Technology transfer of
technology that is being used to treat
Use of A.I five medical products
the most advanced forms of heart Healthcare providers, drug producers, AstraZeneca and Saudi Pharmaceutical
failure. The technology, known as a researchers, and insurers operating Industries & Medical Appliances
ventricular assistor, or ‘HeartMate’, is in Abu Dhabi must now comply with Corporation (SPIMACO) officially
an electrically powered heart pump that artificial intelligence laws. ‘With initiated the launch of the Contract
improves blood flow and, in turn, the the policy on the use of artificial Manufacturing Operation arrangement
long-term health outcome for patients intelligence, we will not only provide the in Saudi Arabia. Representatives from
with heart disease. Open-heart surgery best of quality healthcare services to our both companies signed the agreement to
is performed to place the pump above people by using the best international conclude an Investment, Development
the patient’s left ventricle. According to practices and technologies, but will and Technology Transfer initiative,
the surgical team at Heart Hospital, the cement Abu Dhabi’s standing on the during a ceremony which took place in
new technology will both save lives and global artificial intelligence map,’ said Gothenburg, Sweden, in the presence of
significantly improve the quality of life Mohamed Al Hameli, undersecretary of His Excellency, Dr Tawfiq Al Rabiah,
for patients with end-stage heart failure. the Department of Health. Saudi Arabia’s Minister of Health.
Al Moadamya primary health care centre in rural

Damascus, Syria, reopens with WHO support
With support from the World Health Organisation (WHO), Al
Moadamya primary health care centre in rural Damascus, Syria, has
reopened after extensive rehabilitation made possible by a generous
donation from the United Kingdom’s Department for International
Development (DFID).
The centre serves overs 3,800 people in the area, including almost
1,800 people displaced from other parts of rural Damascus. Services
provided by its 19-strong team of doctors, nurses, and midwives
include vaccinations, maternal, newborn and child health, mental
health, trauma care, nutrition, and treatment for communicable and
Photo courtesy of WHO
noncommunicable diseases.

National
Hyperbaric
Centre opened
in Oman
A National Hyperbaric Centre
(NHC) has been opened at
the Royal Hospital, Sultanate
of Oman, Muscat. The
centre’s main room has three
hyperbaric oxygen therapy
(HBOT) devices, which the
Ministry of Health (MOH) state
are the latest of its kind at
international level. Two of the
devices can accommodate
up to twelve people and the
other device is intended for
one person only. The centre’s
healthcare professionals were
trained in specialised centres in
Europe and recieved practical
training at the medical
polyclinic on the Said Bin Sultan Photographs of the NHC courtesy of MOH
Naval Base (SBSNB).
Gold Certification for Excellence in person-centred

care awarded to Bellevue Medical Centre (BMC)
The Bellevue Medical Centre (BMC) management of the patient’s care is region in the provision of compassionate
in Beirut, Lebanon has been awarded different; it is innovative, as it looks and person centred care delivered in a
the Gold Certification for Excellence at the patient as a person, a human. safe, healing and state-of-the art facility,’
in Person-Centred Care by the NGO This achievement is a one step further said Mrs Remie Maalouf, Executive
Planetree International. BMC is one to reach our vision of being a leading Manager and Planetree and Person
of only 85 healthcare organisations hospital in Lebanon and the MENA Centred care coordinator.
worldwide to receive the Person-
Centred Care Gold Certification since
the programme’s launch in 2007. It is
the second in the Middle East North
Africa (MENA) region and the first in
Lebanon.
This Person-Centred Care Certification
recognises BMC’s achievement and
innovation in the delivery of person-
centred care, including the quality of
patient-provider interactions, access to
information, family involvement, and
the physical environment of care.
‘At Bellevue Medical Centre, we want
Photo courtesy of BMC
to make healthcare a better place. The

News
Beatle’s poison may be a

‘ray of hope’ against cancer
states Turkish researchers
Professor Sinan Anla

Photo courtesy of
Anadolu Agency
A team of researchers from Manisa Researcher and Professor Sinan Anlaş stated that one gram of pederin poison
Celal Bayar University (MCBU) in called the toxin a ray of hope for cancer is obtained from four kilograms of
western Turkey have spent the last three treatment.’ He told Anadolu Agency, Paederus beetle.
years working on a project that studies that ‘during the study, it was found ‘First findings are extremely
the effect of beetles on agriculture, out that the life of mice with various promising. Our studies are new but
ecology, and medicine. Through their cancer tumours was extended after this we know that many vital treatment
research, they discovered that the poison substance was given to them.’ methods and medicines will be procured
of the Paederus beetle shows an adverse The Paederus beetle weighs about for cancer treatment. We will produce
effect to cancer cells. four milligrams and Professor Anlaş projects in the future,’ he added.
Hala Zayed appointed as Minister of Health

During a recent new governmental line-up, Hala Zayed has been
appointed as Egypt’s Minister of Health and Yasmin Fouad as
Environment Minister. The government has eight female ministers, the
largest number in the country’s modern history.
Hala Zayed has a Master’s degree in Obstetrics and Gynecology,
as well as a Doctorate and Master’s degree in Business
Administration. She was the president of the 57357 Academy of
Health Sciences and the chairwoman of the Supreme Committee for
Hala Zayed
Combating Corruption at the Ministry of Health.

First training programme in The Guidance and Training
Centre for the Child and Family
Applied Child Psychology (GTC) has launched the first
training programme in applied
launched in Palestine psychology, in collaboration with
its partners in Glasgow, Scotland,
UK including the Local Authority,
the NHS and Glasgow and
Dundee Universities.
The programme will integrate
clinical and applied educational
approaches to develop
competencies of psychologists
working with children in institutions,
schools, and other mental health
centres in Palestine. The GTC has
developed the programme as the
first training programme of its kind
based on scientific research. This
was done in collaboration with
Scottish institutions and universities
after declaring Bethlehem and
Glasgow as twin cities.
During the launch event
in Bethlehem, Dr Nael Abdul
Rahman, Chairman of the Board
of Directors of the GTC, said that
‘the programme is part of the
objectives of Guidance and
Training Centre for the Child
and Family to contribute to the
development of mental health
PHOTO INFO: The launch ceremony was held in Bethlehem attended by Lord Provost of Glasgow
and increase competencies of
Councillor Eva Bolander, and deputy Mayor of Bethlehem in addition to representatives of the Ministry
of Education, the Ministry of Health, and the Ministry of Social Development. Also present were those working in this field
representatives working in the field of mental health and education. Photo courtsey of GTC. in Palestine.’
Award-winning Doctor returns to help

patients in his native Iraq
Iraqi born and educated award-winning medical specialist,
Dr Laith Al Rubaiy, who now lives in the UK has recently
returned to Iraq to help some of the country’s poorest
citizens. He spent several days with the British NGO, AMAR
International and its mobile health clinic during a visit to
Basra, in southern Iraq.
‘When I left Iraq in 2005 to study in the USA and later in
the UK, I always dreamt that one day I would return home
permanently to my country, despite it being a place where war
and instability are almost ever-present,’ he stated in an article
in Wales Online. He added, ‘Though I am still waiting for that
dream to become a reality, I have finally managed to return, if
only very briefly, after many years.’
Dr Laith Al Rubaiy.
Photo courtesy of Dr Laith Al Rubaiy was educated in Iraq and graduated from
AMAR Foundation
Basra School of Medicine in 2003.

Could Middle East
healthcare providers
leapfrog the West by
using blockchain and
Artificial Intelligence
(AI) to connect people,
machines, and data
in an intentional and
intelligent manner?
Article written by
Brian de Francesca,
Founder and CEO of
ver2digimed.com
Blockchain, AI, and

the end of doctors?
Cover story
I should have taken heed of

the Socratic paradox that ‘all I
know is that I do not know
anything’, as in January of 2016, I
publicly expressed to the scientific and
medical community that ‘There are
certain things that a human brain does
much better than any piece of
technology – such as solving a crossword
puzzle or playing the game Go.’ In
January of 2016, I was in lofty company,
as the majority of the big brains of
Artificial Intelligence (AI) felt that it
would take at least 50 years for a
computer to beat any human at Go.
Three months later the Google
DeepMind Alpha Go system did just

that, when it beat not any average
human Go player – but the world’s
18-time world Go champion, Lee Sedol.
This is a non-trivial occurrence.
Because there are many tasks that are
performed in healthcare each day by
humans, that are well suited to be better
performed by intelligent thinking
machines. For example, the foundation
of healthcare – the diagnosis, consists of
pattern recognition and algorithms,
both of which are superior strengths of
machine over humans. My take away
from this is that the changes are
occurring much more quickly than I
realised, not only in the development of
AI, but in many other areas such as the
global dispersion of high-speed
connectivity, blockchain, plummeting
costs of data storage, and tremendous
improvements in biosensors of all shapes
and sizes. The future that many felt was
at least 50 years away, appears to already AI manged to beat the
world Go champion.
be behind us – and these powerful
thinking machines will not stand alone,
but will play a central role in our All the technological (storage in the cloud). Telemonitoring
increasing global connectivity. I often advancements still via sensors is already happening with
refer to Connecting Minds and explain need input for the the continual monitoring of the
it as ‘facilitating collaborative programmes to run. presently ill – like in advanced chronic
information transfer between connected: Data is what to Connected Minds - what disease management. However, within a
people, things, and data in an food is to humans, we are what we eat. handful of years, once gene sequencing
intentional and intelligent manner, so Data comes from many places: Nurses is a common occurrence, we will start to
that the total value created is typing into keyboards, the output from continually monitor the currently well,
exponentially greater than the sum of diagnostic imaging devices and more but who have the potential of becoming ill
the individual parts; of greatest according to their genetic profile.
this allows us to do importance is the Eventually, biosensors will be implanted
more, better, faster, ‘The Middle flood of data from at birth. Hopefully, we will not be forced
less expensively, sensors attached to to incorporate these sensors into our
everywhere and all
East has a real patients and bodies, but if you choose to opt-out of
of the time, for opportunity to otherwise. These are the network life maybe more difficult,
more people.’ benefit from not big pieces of expensive, and risky. Certainly, there are
The Middle East Connecting medical equipment many yet to be answered questions
has a real or devices – but concerned with giving up a significant
opportunity to
Minds and use it small sensors, that amount of our privacy. Will we have the
benefit from to leapfrog’ are getting smaller, ability to turn these sensors off at will?
Connecting Minds, better, faster, and This is just one, of a growing list of
as it does not have a cheaper. Soon, the continual remote monitoring questions.
deeply entrenched elderly legacy sensors will be inside of you – it is really When you combined the coming billions
healthcare system. Therefore, it is not only a matter of time. They will be of sensors with thinking machines and
stuck with an antiquated inbred small enough to be injected, float massive memory in the cloud, that is
healthcare system, like in the USA and around your body and be powered by shared by everyone and everything, the
EU. It can embrace the immense power your own body motion and chemistry. power is truly exponential.
found in Connecting Minds and use it to Sensors will provide a torrent of data So, all of this big data will come from
leapfrog Western Healthcare in into our collaborative network. As data trillions of sensors in and around us, but
healthcare delivery, research, and is generated by these sensors, it then sits where will it reside?
medical education. quietly in buckets we call memory banks Human brains have extraordinary

Cover story
‘Doctor’ Whether the label ‘Doctor’ remains in

the future; the following will change
Who will will take (it will be on site at the

1 become faster). hospital or centre.
doctors – it will How much The daily tasks
continue to
3 money it 5 of a doctor
become less of an will costs to create provided remotely.
elitist men’s club. and maintain a The current
How they will doctor (it will be
6 daily tasks of
2 be trained to cheaper) a doctor, that have
become doctors The daily task been replaced by
and how long this
4 of a doctor automation (AI).
need when, we need it, and to also be massive shared storage systems, and
able to understand this information. But sensors everywhere, including inside of
it is not possible for humans to our bodies. This is changing
effectively sort-through and utilise these everything. While before it was mainly
capabilities; however, there are huge amounts of data. We need the humans on phones or sending
limitations as well. There are limits in assistance of many powerful processors messages via email; now we are
what information our brains can hold and massive shared storage devices for sharing cloud resident memory,
and how much of it. Most this herculean task. Therefore, we will augmented by powerful processing
computational neuroscientists tend to rely on machines, information, and computers that are receiving data from
estimate functional human storage computer technology as a mandatory millions, and soon billions of
capacity somewhere between 10 and 100 step to move forward. connected sensors that are cheaply
terabytes. More importantly, our In the age of ubiquitous connected all of the time, everywhere.
memory retrieval is not as accurate as connectedness, we know that one According to healthcare futurist Jeff
we like to believe it is. It is also difficult person, thinking, Goldsmith, ‘Simply
to share our memory bank with others, deciding and acting connecting people,
and when we die – we take our memory in isolation is ‘We will rely things, and data is
with us. Thus, as a shared storage limited by who they not enough.
medium, the human brain is less than are, what they know
on machines, Something must
ideal. Today, we have almost endless and the information information, assist in framing and
amounts of cheap (roughly $0.021 per they have readily and computer processing an ocean
GB) cloud-based storage space that is available to them. technology as of knowledge and
quickly accessible from almost any place My excitement is stuff that hasn’t
on the Earth. Every bit and byte of data not only about the
a step to move become “knowledge”
and information, instantly available – value of connecting forward’ as yet. It all must be
always – to you and your new powerful people (that is old connected in a
computer brain friends. And you really news), but also functional,
will need the assistance of your binary what is now being connected in organised, intelligent manner.’ What
buddies – because today we are addition to people. While there is does intelligently mean? It is not as
generating more data in one day, than obvious power in the collaborative simple as just plugging everything
was generated in total from the networking of humans - there are new together there needs to be some central
beginning of time until the year 2000. A factors (non-human) that are making a nexus, thoughtful, rules based, routing
repository of data and information does great thing, even better. Today, we are and organising function to make it all
not think it holds vast amounts of not only connecting people within work together and minimise the clutter,
potentially valuable data. The challenge these powerful collaborative networks, junk and mistakes. There needs to be a
is to access stored information that we but also very powerful computers, digital ghost in the machine.

The missing link
has been found
What has been missing from the internet
since its inception is the ability to trust
any transaction over the internet.
Blockchain technology, being cognizant
of the Socratic paradox, will allow us to
trust transactions made over the internet
more than we can now.
The blockchain technology is an
undeniably ingenious invention – the
brainchild of a person or group of
people known by the pseudonym,
Satoshi Nakamoto. Originally devised
for the digital currency, Bitcoin, the tech
community is now finding healthcare
uses for the technology.
Hosted by millions of computers
simultaneously, its data is accessible to
anyone on the internet. Blockchain
technology has the real potential to
significantly transform healthcare.
Placing the patient at the centre of the Brian de Francesca
healthcare ecosystem whilst increasing
Brian de Francesca is the founder and CEO of Ver2 Digital
the security, privacy, and interoperability
Medicine. He has over 20 years experience of using connectivity
of health data. Ultimately blockchain
to improve healthcare. Brian writes and speaks extensively on
could provide a new model for health
the use of connectivity to improve care globally.
information exchanges (HIE) by making
electronic medical records more efficient,
disintermediated, and secure. A
blockchain supported HIE could have optimising processes - incorporating connecting of minds is the tremendous
the potential to reduce or eliminate the technology in our systems to change value to be found at the heart of the
costs of current HIE systems; however, what we do, how we do it, where we do digitalisation of medicine.
the real benefit is the potential to it and who does it. Simply buying With all these technological
connect fragmented systems to generate technology without changing processes advancements what is the future of
insights and to better assess the value of will result in wasteful disaster. Some the doctor?
care. In the long- Western examples to On many occasions I have been
term, each country keep us sober and accused of wanting to replace doctors
should run a ‘Blockchain sombre - The UK with computers; I was even brazen
nationwide NHS failed enough in one presentation a few years
blockchain network
technology Connected for ago, of stating that the age of doctors
for electronic has the real Health programme was coming to an end. I have learned,
medical records as potential to and wasted up to 20 that I was not correct. For years there
this will improve significantly Billion Pounds. The was talk of the possibility of a computer
efficiencies and Americans dropped beating a chess Grand Master – and that
support better health
transform US$35 Billion into finally happened in 1996 when IBM’s
outcomes for healthcare’ HITECH with little Deep Blue beat chess Grand Master
patients. These to show for it. We Garry Kasparov. Mr Kasparov then went
national networks must become big on on to discover that while a computer
could, and should, integrated into a process management before being so big could in fact beat a human – the
cohesive global network. on data. So, while connectedness, combination of a computer and a
Connecting Minds is not only about sensors, processors, and memory in human was better than a computer
the use of technology such as combination are great, we must become alone. This gave birth to Advance Chess
blockchain. It is about changing and much more process literate. The or Centaur Chess as it is called. Doctors

Cover story
humans.’ His response was that

‘computers will think as computers.’
There are some tasks best suited for Michael
human minds and other tasks are better
performed by synthetic processors and
Schelper,
storage devices. For now, there are General Manager UAE &
certain things that a human brain does Kuwait – COO MEA at Cerner
much better than any piece of stated ‘We are at an exciting
technology – such as writing a book, time as healthcare is being
drawing a painting or composing a profoundly disrupted. It is
symphony iIn the back of my mind, I refreshing to find more and
am aware that as I write this – more likeminded people
computers are creating literature, art, such as Brian and David
and music). Today when we speak of to challenge the status
connecting minds we are no longer only quo, inject innovative
talking about connecting human brains technologies in a new way
– but human brains that are augmented into the healthcare space
by synthetic brains like Minwa, Watson, and drive the advancements
Deep Mind and an increasing host of towards the consumerization
others - that are all fed tremendous of health, life, and wellbeing.
amounts of real time data from sensors In the end our health is
and that have access to all of the world’s personal, and it requires
are smart – many doctors in coordinated knowledge and medical information. We all of us collaborating
combination, are smarter. Computers are able to access these massively to make the future of
are smart. Many collaborating doctors parallel processing computers today, healthcare a reality.’
augmented by computers with access to from the cloud on a pay-as-you-need-
shared memory – are the smartest of all them basis. They are not replacing
– and getting more so every day. human thinking but complementing it analysis, diagnosis, information retrieval
There is a scene in the movie The – remember Centaur Chess. and more. We are starting to use
Imitation Game, where Alan Turing is In healthcare, we are progressing thinking computers to analyse and
asked ‘do you think that computers will further into augmented thinking for process mountains of noisy data,
ever be able to think as good as medical decision support, medical generate and retrieve relevant health
information, using the network of
millions of doctors and medical
technologies cheaply, quickly,
everywhere. Online resources like
UpToDate provide doctors access to the
latest medical research and practice
standards, helping to drive evidence-
based practice in even the most remote
regions.
Whatever label we assign to those who
give care, really does not matter. It is
what they do each and every day, and no
longer need to do, that will matter the
most. Historically, healthcare was
delivered by people in-person at
hospitals (or local clinics). Over the past
decade or so, we have started to see
some of this work being done remotely
via telemedicine such as radiology
reporting, ICU monitoring by remote
Blockchain
technology
intensivists, virtual tumour boards and
remote monitoring of a patient’s vital

signs from their homes. Workers who do
not require physical presence to provide
their work value, we refer to as
Healthcare Knowledge Workers – it is
possible that up to one third to one half
of all healthcare tasks are performed by
knowledge workers.
The development of this digital
knowledge worker category, is having a
significant impact on healthcare staffing
models. For example, one pathologist
can work at theoretically, an infinite
number of hospitals, providing remote
reporting. A smaller facility that Modern digital tools
normally would not have on-site access can help teach
doctors
to all sub-specialties of radiology
covered because of their caseload, can
now have access to every sub-specialty in taught by the thought leader of the healthcare in this region received our
radiology 24/7/365. And this is just the particular topic. Using digital tools and education in the West and many also
beginning. Improved access to more connectivity, we are developing needs- worked for some time in Western
empathetic caregivers physical with based continuing medical education that healthcare. There is a general tendency
support from virtual an artificial is the will be taught by the to consider much
future model of healthcare. best and brightest Western Healthcare
The New Healthcare

from around the ‘Using modern as world class
world. Think of this healthcare to be
Workforce Composition as precision
digital tools and emulated. While
Physical Virtual Artificial personalised collaborative there are certainly
continuing medical connectivity, we many best practices
It takes a long time to become a education. can teach more and inspiring
doctor, and it is expensive. Once you are Current medical examples of
a doctor, you are required to take so education is also
doctors, better excellence worth
many hours of continuing medical way-out of sync and faster’ replicating, there are
education, to keep your licence active. compared to also a host of
There are problems with both primary education for other negatives that are
medical education as well as continuing industries. Using modern digital tools best left right where they are. One
medical education. Starting with and collaborative connectivity, we can example of what to leave behind is
continuing medical education (CME) teach more doctors, better and faster at medical errors.
most of it is not needs-based and is not a lower cost. Many of us working in Medical errors are the third leading
cause of death in America.
Although IBMs Watson is moving out
of healthcare, when it was challenged to
David Taylor glean meaningful insights from the
genetic data of tumour cells, a task that
Managing Director of global healthcare workforce solutions took human experts about 160 hours to
company, Medacs Healthcare commented, ‘With a solid history review and provide treatment
of delivery traditional staffing solutions for nearly 30 years to clients recommendations based on their
across the globe, we know that the impact of digitalization in findings. Watson took just ten minutes
the healthcare industry is going to have a direct impact on the to deliver the same kind of actionable
staffing industry. The sooner we adopt our business models to fit advice. In this respect, when it comes to
with the objectives of the variety of healthcare facilities we service, healthcare, AI isn’t necessarily about
the sooner we will be able to support the changing landscape replacing doctors, but optimising and
ultimately resulting in supporting delivery of better and outstanding, improving their abilities.
cost effective care to patients.’ AI is highly sited to diagnostics in
critical areas such as heart disease.

Cover story
Researchers at the John Radcliffe improve care as their Japanese Doctors will remain, but the definition
Hospital in Oxford, UK developed a researchers reported that a new AI aided of a doctor will change, as will the daily
diagnostics algorithm system that’s endoscopic system can reveal signs of tasks they perform. Albert Einstein
more accurate than doctors at potentially cancerous growths in the could have been referring to Western
diagnosing heart disease at least 80 colon with 94% sensitivity, 79% healthcare leaders when he said, ‘We
percent of the time. The doctors then specificity, and 86% accuracy – all of cannot solve our problems with the
went on to treat the people and caregiver which is better than current human same thinking we used when we created
to support them. Another example ability. The evidence of AI use in them.’ Being cognizant of Einstein’s
where non-human decision-making supporting doctors was published in warning, the West continues to be
supports doctors is Harvard University 2017 in the Journal of the American restrained and the Middle East could
researchers smart microscope that can Medical Association where it was found become the leader for the future in
detect potentially lethal blood infections that deep learning algorithms were able healthcare – if it thoughtfully takes the
and identify the responsible bacteria better diagnose metastatic breast cancer leap forward.
with a 95% accuracy rate. Cancer is than human radiologists were when
another critical area where thinking under time pressure, such as in an Western concrete
machines can be used to optimise and emergency room. Many of the technological innovations
are currently invented in western
countries, but their healthcare systems
The big question

have become ossified monstrosities and
sadly do not embrace these magnificent
home-grown technological inventions.
The western countries are stuck in
Why are these innovations not being broadly implemented today?
legacy concentrate which leaves an
The following are the reasons why:
opportunity for the Middle East to
overtake them. Each of the important
Regulators so that we can urgently needed innovation in digitalisation and
1 have globally keep pace with the innovations, connectivity such as AI, Blockchain,
improved changing face of because they Telepresence, Sensors, Shared Cloud
healthcare. realisable better would not get paid Storage have value, but when combined
However, in 2018 medicine. to provide them. In thoughtfully in unison and connected,
they are out of a fee for service they provide truly exponential benefits
date and could be Without system, the provider far greater than the sum of their parts.
the single largest
2 regulatory benefits from sicker These connected synergies are proving
drag on approval, payers chronically ill to greatly improve access, safety and
progression. They will not reimburse patients – because quality healthcare; while tremendously
are not approving for their use. I have they are frequent reducing costs at the same time. It is
innovations for a heard time and flyers to the cash important and urgent, that we safely
variety of reasons. again, we would register. This is a and prudently get these innovations out
In some cases, they reimburse for it, if perfect case in in the field, in broad application as soon
are not aware of the regulators point – home as possible, as healthcare around the
them, or do not approved of it – monitoring for world is in a state of crisis. We are
have the current and of course, if it chronic disease moving too slowly and making too many
internal resources/ will also save the management is costly mistakes.
staff to assess these payers money, taking aeons to be The majority of these innovations
innovations and which it most implemented and is have already been piloted many times
develop certainly will – and urgently needed – it over and proven to significantly improve
appropriate lots of it. has provided to be patient care and reduce overall
regulations and highly effective in healthcare costs tremendously. There no
guidelines for their If payers will saving tremendous need for more time and resource
safe and effective
3 not reimburse amounts of money consuming ‘pilot projects.’ It is time for
use. It is time for an for their use, then and significantly leaders to act.
overhaul of our there will be no improving the lives
regulatory systems, providers of these of the chronically ill. FOR FURTHER INFORMATION VISIT
ver2digimed.com

Hospital profile
Aldara Hospital and

Medical Centre,
Riyadh, Saudi Arabia
In the first edition of our magazine, we profile a leading hospital
which provides an exceptional employee experience
Aldara Hospital and Medical

Centre (AHMC) is a leading
healthcare centre consisting AHMC vision replicate the highest standards
of patient care, they seek
of a state-of-the-art hospital with an
‘To set new standards for clinical to optimise, customise, and
advanced outpatient facility in Riyadh,
excellence and the patient enhance it by collaborating with:
Kingdom of Saudi Arabia. AHMC is at
experience.’
the forefront of healthcare technology, • The best healthcare
providing superior healthcare services professionals in the industry
and promoting wellness within the ACMC values they will set and uphold better
community. Developed by Aldara Med- standards of care.
ical Corporation in partnership with Trust and respect • Insurers and employers they will
Henry Ford Health System, the AHMC They promise to treat every improve medical outcomes.
represents Aldara’s dedication to make patient with respect and • The Government, they will
quality healthcare services accessible to consider their long-term advance overall population
and affordable. health and overall wellbeing health.
Aldara strive to deliver clinical while providing their medical
excellence and singular patient care, treatment. Access and accountability
underpinned by a high-level of integrity They are accessible in every
Excellence and efficiency
and transparency in everything they do. sense of the word. From
Delivering quality healthcare isn’t
Aldara aim to be a role model for the beginning to end they make
just about medical outcomes;
Saudi healthcare system. They echo the the experience as simple as
it’s about the entire patient
Saudi Vision 2030 of transforming the possible. They communicate
experience. The state-of-the-art
healthcare sector of KSA. clearly, empowering patients
healthcare facility is designed
Aldara is continually focusing its to make informed decisions
to be light, modern, and spa-
efforts on the advancement of the about their care. Access also
cious. The staff are experienced,
healthcare industry with the objective means affordability. They offer
highly-trained and respectful at
of bringing Saudi healthcare on par healthcare at competitive
all times.
with the most advanced in the world. Dr prices but never compromise on
Adnan Ezzat, CEO of AHMC, states Collaboration and advancement quality. They are accountable for
‘It stems from the vision and mission Collaboration is at the heart of the care they deliver, and plan
of being transformational in the way their business. They work with to make AHMC the first hospital
healthcare is delivered by focusing on carefully selected partners in the Kingdom of Saudi Arabia
high-quality care and an unparalleled across industries in pursuit of to publish data on medical
patient experience.’ best practice. They don’t just outcomes.

The Aldara story
Aldara was born from a dream to extend the best medical care
to the people of Saudi Arabia while setting new standards in
clinical excellence and patient experience. The journey for
Aldara started in 2010. They recognised that patients want to
be treated in a human, respectful way, in an efficient manner
and by knowledgeable and professional staff. To make this a
reality, they brought together a team of highly experienced and
passionate medical professionals, led by an experienced global
executive team equipped with robust & state of the art
technologies. The Aldara business model is unique and aims to
adapt and localise the best North American and Eastern
healthcare practices for the Kingdom of Saudi Arabia. Aldara’s
strategic alliance with the Henry Ford Health System added
strength to those efforts and a new perspective to their vision. Left: Dr Adnan Ezzat, CEO of AHMC
The ability of to draw on the System’s vast experience,
heritage, and knowhow of delivering healthcare has been healthcare professionals. Whether medical, clinical or support
instrumental in the design of AHMC. services, they invest in their people to ensure they are
technically proficient and will champion their vision of Aldara.
Working at Aldara Patient and family comfort and service quality are important
People are Aldara’s most prized possession, which is why to them. The modern, light and spacious centre was designed
special attention is given to recruiting and inducting their by the leading US healthcare architectural firm, HOK and

Hospital profile
Hobbs and Black. It is a purpose-built Living at Aldara

healthcare facility, with state-of-art At AHMC they strive to provide the
medical equipment. At Aldara, they conditions for their employees to achieve
believe that a passionate and an and maintain a work-life balance. They
experienced team of healthcare know that when their staff are happy
professionals is necessary to extend the they will give their best to the patients.
best patient care. They provide secure, housing in villas
They are dedicated to fostering an and apartments for many of the staff
environment that encourages Dr Adnan Ezzat,
and their families, in a residential
professional and personal growth. If you CEO of AHMC community which is approximately five
are passionate about extending care minutes away from AHMC.
within the community and looking to
excel in your career, Aldara Hospital Providing an
and Medical Centre is the place to do so. exceptional employee
experience
AHMC benefits At AHMC the employees are the most
include: precious resource and employee health
• A conducive work environment to and well-being is important to them.
enhance personal and professional Mr Osman Within the residential community,
Minkara,
growth. Managing there are excellent amenities for the
Director of
• Advanced medical technology led by AMC residents including a swimming pool.
renowned medical experts. There is an appointed amenities hall
• Talent recognition and opportunities and a well-equipped gym. There is
to maximise potential. also a busy social and well-being calendar of events.
• World class infrastructure and state-of-the-art medical Whether you prefer privacy or enjoy socialising, there are
technologies. activities for everyone.
Mr Osman Minkara, Managing Director of AMC, states
AHMC is located in the heart of the capital, close to major ‘[Aldara] is a phenomenal and unique model in the
shopping malls, supermarkets, pharmacies, restaurants, and a Kingdom of Saudi Arabia.’
range of international embassies, yet close enough for outdoor
pursuits such as hiking, camping, and desert trips. LEARN MORE AT aldaramed.com
AHMC’s
state-of-the-
art facilities
include:
• Up to 250 licensed
hospital beds
• 68 clinics
• 188 examination rooms
• 18 outpatient procedure
rooms
• 10 operating theatres
• 8 procedure rooms
• Personalised preventive
medicine services
(Executive Health)
• Concierge services
• A world-class emergency
department
• Pharmacy
• Laboratory
• Imaging centre

Company profile
SURGINS
“The quality of surgical instruments can sometimes literally mean the
difference between life and death,” says Dr Rizwan Qureshi CEO of Surgins
brought this dynamic network onto the platform, thereby

enabling the development of surgical instruments to the highest
quality with scope for continuous innovation.
SURGINS believe that providing surgeons with exactly the
instruments they want, when they want them, and how they
want them is the key to a successful surgery. This, in turn,
should better facilitate the treatment of surgical diseases
around the globe.
All SURGINS product ranges have been endorsed by British
surgeons of relevant surgical disciplines. These include dental
Dr Rizwan Qureshi MB, FCPS,

FRCS, Cardio-Thoracic Surgeon
SURGINS is among the fastest growing stainless-steel

and titanium surgical instrument British companies
based in England, the United Kingdom. Its aim
is to carry a global reputation for surgical instruments of
outstanding quality, precision, and cost-effectiveness - all based
on profound surgical wisdom.
SURGINS is the dream child of the vision of a group and veterinary surgeon endorsements. By manufacturing
of surgeons from different surgical disciplines in the in the UK, SURGINS can ensure close contact at all times
United Kingdom led by the CEO of SURGINS, Dr Rizwan between its advisory panel of Surgeons, its product designers
Qureshi. Not only was this body of surgeons using surgical and production engineers. This streamlines the process and is
instruments on a daily basis, they were also aware of the need the most effective way of ensuring cost-effective production of
for instruments of outstanding quality, precision and cost- precisely the right instruments.
effectiveness. Therefore, profound surgical wisdom derived The company has over 10,000 instruments currently available
from appreciating the significance of individual expertise has to meet the needs of most surgical requirements and its ranges
are constantly under development.
Whether purchasing a single instrument or equipping
a whole new hospital or surgery, whether left-handed
instruments or keyhole surgical instruments, SURGINS has
the right solution for every need. In summary, SURGINS is
focused on the functional quality of surgical instruments,
which is key to successful surgery and treatment of surgical
diseases across the globe.
The quality of surgical instruments can sometimes literally
mean the difference between life and death.
FOR FURTHER INFORMATION surgins.co.uk

SAUDI
(L) Deputy Crown Prince
of Saudi Arabia
Mohammad bin Salman
Al Saud (M) the
Custodian of the Two
VISION
Holy Mosques King
Salman bin Abdulaziz Al
Saud (R) First Deputy
Prime Minister and the
Minister of Interior of
Saudi Arabia
2030
Muhammad bin Nayef.
Photo courtesy of
vision2030.gov.sa
The opportunities in healthcare

Nathan Nagel, CEO of the Middle East Medical Portal,
highlights the opportunities being presented to
foreign healthcare companies
The Kingdom of Saudi Arabia accounts for around quality overhaul and a lack of primary healthcare, the latter of
half of the GCC’s $1.6trn economy, making it the which has resulted in over-stretched services at the tertiary
biggest market in the Arab world and the 19th-largest level. According to data from the Open Journal of Emergency
worldwide. Known for its rich oil reserves, the likes of which Medicine, the average waiting time to be seen at a hospital is
have allowed Saudi to remain the world’s biggest oil supplier three hours, with a quarter of patients waiting more than four.
for decades, times are now changing. On a global scale,
tumbling oil prices and subsequent OPEC cuts in oil
production over the last two years have dealt heavy blows to Dependent on oil
Saudi’s economy. Oil revenue as a ratio of total revenue,
With this in mind the kingdom is shifting from a dependence 2000-2015 in Saudi Riyals
on oil by restructuring its economy – including the 1,400,000
privatisation of healthcare. According to theWorld Health
1,200,000 Oil revenue
Organisation (WHO), Saudi Arabia’s public health sector is Other revenue
1,000,000
‘overwhelmingly financed, operated, and monitored by the
Ministry of Health (MoH).’ With 2,390 healthcare centres and 800,000
279 hospitals there are significant needs to be met. 600,000

However, the ministry faces an uphill struggle due to an ageing 400,000
population. The kingdom’s existing healthcare model will be 200,000
unable to meet the future healthcare needs of its population. 0
Nor is it sustainable on an operational or financial level. 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Large-scale issues include a system which needs an overall Source: Saudi Arabian Monetary Agency, Annual Statisitics 2016

Healthcare strategy
Furthermore, there are the medical challenges: Saudi Arabia The NTP also places a great deal of emphasis on healthcare
has one of the highest rates of obesity worldwide, with some education and training, with plans to link up with world-
80% of its population categorised as such according to data renowned institutions and increase public-private partnerships
from The Lancet. Provisions will need to be made for the future in order to increase homegrown talent. There is a recognised
health complications brought on by an overweight population. need for qualified Saudi healthcare practitioners and support
Another key challenge is the fragmentation of provision of staff as healthcare requirements increase. At present the sector
care, which has resulted in a silo approach to delivery of is mostly supported by expatriate workers.
healthcare services. Saudi health officials also lack data to help Saudi Arabia is mostly dependent on imports for its
them create an accurate picture of outcomes and costs, and pharmaceutical requirements and there is a need for medicines to
gaps within the country’s education system mean there are not be manufactured locally to ensure a constant and adequate supply.
enough healthcare graduates entering the workforce. However, Foreign pharmaceutical manufacturers are being actively
changes are being made. In April 2016 the government encouraged to establish plants in Saudi Arabia through
announced Saudi Vision 2030, an initiative to transform the public-private partnerships and joint ventures with national
kingdom’s economy and pull away from a dependence on oil. entities. Incentives are being offered in the form of preferential
In the meantime the Saudi Cabinet also treatment in future volume tenders. As an
launched the National Transformation additional incentive, foreign pharmaceutical
Programme 2020 (NTP). Revealed in June ‘Foreign manufacturers already operating in Saudi
2016, NTP will assess the progress of Arabia can distribute and sell medicines
Vision 2030, of which one of the key focus
pharmaceutical themselves, whereas imported
areas is healthcare. manufacturers pharmaceuticals can only be distributed
The NTP has an objective of increasing are being through a local distributor.
private healthcare expenditure from 25% to actively Currently the majority of medical
35% of total expenditure by 2020. This devices and equipment are manufactured
represents an annual increase in healthcare
encouraged to abroad and are imported into the country.
revenue from SAR3bn to SAR4bn. In establish plants’ The Ministry of Health is supporting
addition, the MoH plans to spend more local manufacturers by partnering
than SAR23bn on new initiatives over the multinationals with Saudi companies with
next five years, with the NTP having identified the following the incentive of guaranteed volumes for Ministry of Health
strategic objectives for the ministry and the Saudi Food and purchases and preferential treatment in future volume tenders.
Drug Authority. Furthermore, foreign owned manufacturers within Saudi
Innovations in digital healthcare are another key part of Arabia have the additional benefit of being able to distribute
Vision 2030, with the MoH aiming for at least 70% of citizens and sell medical devices within the country without the need
to have unified digital records by 2020. It is also hoped that of a local distributor.
improvements in IT will strengthen the quality of services To discuss these opportunities further, please contact
offered by healthcare providers. Nathan Nagel, CEO, of Middle East Medical Portal.
Vision 2030 and the NTP also present major opportunities for
foreign companies looking to enter the healthcare market
by allowing them the ability to:
• Establish medical facilities;

• increase medical insurance;
• use local information technology;
• receive healthcare education;
• access improved training facilities;
• provide professional development; and
• manufacture medicines using local pharmaceuticals.

Stretching the
boundaries
of science
In 2005, a plan was made to create a hub that boosted the
UAE’s scientific sector. Today, Dubai Science Park (DSP), is a vibrant,
holistic, science-focused community of over 350 companies.
Company profile
Marwan Abdulaziz Janahi, Executive

Director of Dubai Science Park
At Dubai Science Park (DSP), their ultimate goal where they enjoy close relationships with key players from
is to emerge as the most innovative and vibrant the government, academia, and business. Therefore, DSP’s
community for all segments of the science sector, stakeholders view their regular events, such as our Business
whilst branching out into new avenues to facilitate the Partner Breakfasts, Green Leadership Series, DSP Career
growth of their business partners. Fair, and Arab Health Gala Dinners as valuable networking
They aim to play a significant role in the realisation of opportunities that allow them to forge synergies with a wide
Dubai’s leadership vision by facilitating a more sustainable spectrum of relevant entities.
and self-sufficient future that maximises In line with DSP’s belief in the important
the use of indigenous resources and talent. role policy work plays in their success,
DSP will achieve this goal by supporting
innovation in the sciences.
‘Dubai they are collaborating with The Executive
Council of Dubai on the rollout of the
Today, DSP is home to more than 350 Science Park Dubai Industrial Strategy 2030. As the
companies of all sizes – from startups
and SMEs to MNCs – that together
is home to Chairing Member of the Pharmaceuticals
and Medical Equipment Taskforce of
employ over 3,600 industry professionals. more than 350 the strategy, DSP is mandated to identify,
They provide offices, private labs, and
warehouses to entities such as Alexion,
companies of develop, and promote key opportunities in
the local healthcare sector that will help
Amgen, Bayer, Merck Serono, Pfizer, all sizes’ transform Dubai into an international
and Pharmax. healthcare hub.
With an occupancy rate that is nearing DSP’s mandate for the future is clear.
full capacity, it is their overarching goal to continue their They will continue to strengthen Dubai’s position as a
growth trajectory and expand their portfolio of facilities. destination for science companies, as well as a hub for research
Apart from physical infrastructure, DSP will remain and development, manufacturing and prototyping activities by
committed in their efforts to consolidating their status providing a conductive environment that fosters innovation and
as an industry enabler. They are in a unique position an entrepreneurial spirit.

Company profile
Dubai Science • Warehouse space designed

Park features: specifically for storage, show-
room, distribution, logistics, and
• State-of-the-art offices in a
light manufacturing for the
variety of sizes, giving businesses
science sectors.
the flexibility to choose the
space that suits their needs.
• A laboratory space at the DSP hosts a
highest global standards. The wide-range of
core and shell spaces are
equipped with air exhaust and events, including:
ventilation systems, an acid • An annual career fair showcas-
resistance drainage, pH neutral- ing professional opportunities.
ization system, • Fun-filled family dayS for aspiring
• A valuable Business Centre scientists aged 4-12.
specifically equipped for the • A range of leading scientific
needs of startup businesses and industry events.
offers contemporary, furnished
offices, and open-space work- FOR FURTHER INFORMATION ABOUT
stations to the science sector. DUBAI SCIENCE PARK VISIT dsp.ae

Four lessons on
innovation from
a classic science
experiment
Writen by Marwan Abdulaziz Janahi, Executive Director of Dubai Science Park
Marwan Abdulaziz Janahi,

Executive Director of
Dubai Science Park
Innovation
Put the building blocks

together and you can create
something amazing.
This time-tested lesson from a classic
chemistry experiment, the results of
which were first published 65 years, in
my opinion offers four useful lessons for
continued innovation in the science
industry – indeed, industry as a whole in
Dubai today.
It makes sense to seek lessons in
history’s innovative experiments,
because 21st century Dubai is in itself a
living experiment in innovation, and also
because we have always looked to the
past in designing the future.
Let me begin by giving you some
background. In the autumn of 1952, a
22-year-old chemist named Stanley
Miller made a rather outrageous
proposition to his supervisor, Nobel
laureate Harold Urey. Miller challenged
that in their lab at the University of
Chicago he would attempt to recreate
the chemical soup of primordial earth,
and then watch to see what transpired.
Miller’s apparatus was simple. conclusive, has proven insightful for ideas, they are outside the norm, and
Startlingly so, indeed resembling a decades and continues to influence the further outside the norm, the greater
high-school experiment in more ways discussions of the mechanism by which the risk.
than one. To mimic the primordial soup life originated on earth some 3.5 billion Dubai has always been willing to take
of planet earth, he used two inter- to 3.8 billion years ago. risks. An island shaped like a palm tree,
connected sterile flasks containing water People of different faiths will have flying taxis, the world’s tallest building,
(for the primordial ocean) and methane, divergent views on the nature of the a giant port built almost from scratch:
ammonia and hydrogen (to recreate the creator who propelled this grand Dubai is in many ways an experiment,
early atmosphere on moment – when and today we have sufficient proof
earth). Miller and human life was points of its successes to benchmark this
Urey heated the
water to produce
‘Put the created on earth.
However, there is a
city as a model for others that aspire to
become the Dubai
vapour, while firing building blocks consensus in the of Africa (Addis Ababa), and the
sparks throughout
the apparatus to
together and scientific community
that there was also
Dubai of Central Asia (Astana).
simulate long-ago you can create an earth-bound Second

lightning.
Within a day, some
something process by which life
evolved from its
The Miller-Urey experiment was not an
expensive one. This lesson is especially
unexpected things amazing’ moment of creation. valuable to Dubai during downturns in
started to happen. Life was an the business cycle - while money can
An interesting pink innovation. Let us help finance innovation, it is not
solution appeared. One week later, now consider the lessons the Miller-Urey fundamental to the process. Ideas are the
Miller found that his flasks had experiment into this early innovation most important currency of all.
spontaneously yielded 11 of the amino can impart to fast-track Dubai’s own While any researcher will admit that
acids deemed essential raw materials for industrial strategy. their project could use more funding,
life on earth. (Later analysis of Miller’s Professor Magnus Gulbrandsen of the
experiments using modern instruments First University of Oslo believes that such
and advanced techniques raised that We need to remember that this was an funding can actually be
figure to more than 20). experiment. There was a high chance of counterproductive. Innovative people
This experiment, while obviously not failure. Innovative ideas are not safe find their motivation from within, and

Innovation
“expectations or able to sustain itself.

promises of
monetary or other
‘21st century The seed needs to
spread roots and
tangible rewards in Dubai is grow, it should be
most cases will
reduce the
in itself a replicable.
individual’s inner living That is the challenge

motivation for the
activity.”
experiment in for the long term.
The key is to keep
innovation’ experimenting, like
Third Miller and Urey did
65 years ago,
Marwan
The key takeaway
from within the experiment itself is that
regardless of success or failure. Today, Abdulaziz
innovation is not just one thing, it is a
the yen to experiment and innovate is
gathering momentum at free zones and
Janahi
combination of different elements, a
innovation centres throughout Dubai. Marwan Abdulaziz Janahi is
sum of all parts. You need an ecosystem
This is how our city can build on our Executive Director of Dubai
awaiting its spark, and you need a spark
past innovations and shape future Science Park, a community
awaiting its ecosystem.
innovations, all the while developing a dedicated to serving the
system that as it matures becomes entire value chain of the
Fourth self-sustaining, a system that is the science sector
And last, the innovative process must be driving force of life.

Zaineb interviews
New UAE visa

system will benefit
healthcare
professionals
Our reporter Zaineb Al Hassani investigates
The introduction of 10-year residency visas for And by giving doctors stability and the offer to stay put for
certain highly skilled workers should have an longer, the healthcare system can only stand to benefit – both
all-round positive impact on the UAE’s healthcare financially and in terms of the quality of care provided, Mr
industry, experts say. Firdaus said.
The visas, which should be available towards the end of ‘From [an] economic perspective I think [it’s] helpful,’
the year and which were green lit by the UAE Cabinet in May, he said, adding that patients will also benefit from having
affect specialists working in medicine, science, research, and doctors who have more time to get to know the system. ‘To be
technical fields, and also cover family members. Once available, culturally correct in terms of representation, understanding the
they will likely ‘have a positive impact on both the healthcare healthcare system, the insurance care system, all of that I think
system and the professionals delivering it’, said one doctor comes from being in the system for some time.’
who has worked at a major Abu Dhabi hospital for the last few It is a sentiment shared by the Abu Dhabi doctor. ‘I think
months. the longer visas will improve the retention of healthcare
‘I believe that it may impact those who are planning to only professionals,’ he said. ‘Longer visas eliminate the
stay for a few years. It will likely make it easier for them to administrative work one must complete to renew their visa,
continue working here longer than they may have expected,’ making it easier for someone to continue working and living
said the doctor, who works as an emergency medicine in the UAE. The longer a healthcare professional has been
consultant physician. working here, the more familiar they are with the culture.
At present, expatriate employees are generally given They also have a better understanding of how the healthcare
residency visas lasting between one and two years, while system works here. I believe this would improve the quality of
expatriate employers can receive visas lasting three years. healthcare delivery.’
But for those doctors who are only still considering living in The ten-year visas could also help reduce gaps in the market
the UAE, the idea of a reduction in paperwork and time spent for certain skilled workers. In March of this year, a report on
renewing visas comes second to the stability the long-term
visas could offer, said Amir Firdaus, the CEO of Burjeel Group.
‘I myself am only here for four to five months at the moment
and in that time, in speaking with doctors, especially when Amir Firdaus
we do share with them that it’s a two-year plan [and keeping is Group CEO of Burjeel -
in mind] it’s an automatic renewal and what not, it’s still VPS Healthcare. Mr Firdaus
obviously does set perhaps what would be a little bit of is in charge of overseeing
trepidation within professionals,’ Mr Firdaus said. a number of hospitals and
‘It’s not only doctors, it could be also healthcare workers, medical centres in the
people of my category as well to consider. Will it be a short region including Burjeel
stint or will there be some sense of longevity? That was there Hospital in Abu Dhabi.
to a certain extent. Not too profound but nonetheless there.’

future healthcare demands compiled by investment bank Alpen hub for healthcare, could potentially rise.’
Capital showed a need for more nurses. The research also As for medical tourism, ‘potentially, it will certainly help
indicated a rise in demand for specialised healthcare workers differentiate [the] UAE from that particular perspective and
based on plans by Dubai to attract half a million medical that could add value in creating centres of excellence where
tourists annually by 2021. we’ve got doctors who are highly trained,’ he said.
‘Although there is not too much of a gap in the supply of The 10-year visas could also be handed out to ‘exceptional
physicians and dentists, there is a sizeable university graduates’, The National
gap in the amount of nurses that are reported, with foreign students being given
required,’ Krishna Dhanak, executive
director of Alpen Capital Middle East, told
‘I think the five-year visas instead of having to renew
their residency on a yearly basis. Such
The National. longer visas moves could result in foreign graduates
‘Competition is very high to attract staff
when there is an oversupply of facilities.
will improve choosing to take on longer degrees – such
as medicine – before settling in the country
‘We are seeing a lot of interest in the retention to work.
investing in specialised healthcare centres
in the market, such as obesity, diagnostics,
of healthcare And so, as future graduates and those
healthcare professionals already workingin
postnatal, and homecare.’ professionals’ the industry contemplate a longer stay in
Overall, the entire country’s global the UAE, will the 10-year visas affect the
ranking in medical tourism could benefit, Abu Dhabi doctor’s long-term plans? Not
said Mr Firdaus. really, he said. Aside from the paperwork.
‘It means that job attractiveness and [the] UAE being a ‘Personally, it will not likely affect how long I stay in the UAE
potential area where you may have doctors that are basically as I have always planned to stay for many years. It will be very
looking to settle, [thereby] making the UAE what would be a nice not to have to renew my visa earlier, though.’
About Zaineb Al Hassani

Zaineb Al Hassani was a health reporter and senior editor at The National
newspaper, the premier English-language paper in the Middle East,
between 2010 and 2016. She spent the following two years working as a
senior editor at the Delma Institute, a think tank covering the economic,
political, security, and social issues affecting the Middle East and North
Africa, before moving back to Europe. Zaineb is a regular contributor to
The New York Times, Oxford Business Group and The Guardian.

Oncology
Cancer
in Egypt
An historic, present, and future perspective on the state of
cancer in Egypt written by Aalaa Abdou
The earliest written the auspices of the National Health

description of cancer is Insurance General Authority. At a cost
found in the Edwin Smith of EGP 91 million, the centre aims to
Papyrus that dates to Dynasties 16–17 provide a variety of health services
of the Second Intermediate Period for patients, including chemotherapy
in ancient Egypt. Authorship of the and surgeries for breast and uterine
Edwin Smith Papyrus is debated but tumours.
it might be Imhotep, an architect, The bad news is that Egypt does
high priest, and physician of the Old not yet have an accurate national
Kingdom, 3000–2500 BCE. In this cancer registrar, so, the magnitude of
papyrus, the writer concluded that the cancer problem in Egypt is not
bulging tumour of the breast was yet well-known. For Egyptian men
a grave disease, but the Egyptians the most common types of cancers
attempted to treat tumours and Aalaa Abdou are liver and bladder. For women,
cancers with cautery, knives, and salts, breast cancer is the most common.
Is a Clinical Oncology
and introduced arsenic paste that None of these geographically-limited
Specialist in Ministry of
remained in use as ‘Egyptian ointment’ statistics and published rates could be
Health of Egypt. Aalaa’s
until the 19th century. considered as representative of Egypt
career has spanned cancer
Fast forward to recent years, an and could not give an understanding of
hospitals in Egypt such as
international team has discovered the the current situation of cancer at the
the governmental Nasser
world’s oldest known cases of breast national level.
Institute and Aswan Cancer
cancer by conducting CT scans of According to WHO Global Cancer
Centre, charity hospitals
two mummies found in the pharaonic Country Profiles; HCC is the most
like Baheya Cancer Centre
necropolis of Qubbet el-Hawa in common cancer in men. Patients with
and Shefaa Orman Cancer
Aswan, Egypt. chronic infection with hepatitis B or C
hospital. She is a European
The first specialised cancer centre viruses are at higher risk for developing
School of Oncology Club
started to work in Egypt was the HCC. Due to the alarming increase in
member.
National Cancer Institute in 1970. As the incidence of HCC in Egypt, there
the burden of the problem is increasing is a need to further investigate the
due to better diagnosis, more exposure contribution of these emerging risk
to risk factors and increased population and life expectancy, factors to the development of HCC in Egypt. This may enable
the ministry of health established almost one specialised cancer us to determine the susceptibility to HCC among high-risk
centre for every two governorates, in addition to the oncology groups and to provide these individuals with effective measures
departments in every university hospital and many different for early prevention or intervention.
ministry of health hospitals. Egypt’s Minister of Health It has been well documented that Egypt has one of the
Ahmed Emad El-Din inaugurated on the Women’s Cancer highest prevalence rates of HCV infection in the world. The
Centre at Nasr City Hospital for Health Insurance in mid- natural history of HCV infection and disease progression,
2018. It is the first such public centre to be established under however, are influenced by additional factors such as duration

of infection, age at infection, sex, co-infection with HBV,
Cancer incidents in Egypt
the level of HCV viraemia and its genotype. In Egypt, HCV
Males
20,000 infection is highly prevalent and is largely attributed to the
parenteral antischistosomal therapy campaigns conducted from
18,000
the 1950s through the 1980s.
16,000
Additionally, history of blood transfusion was identified
14,000
12,493 in 24.3% and needle reuse in 20.6% of HCV-positive cases.
Number of cases
12,000 To overcome this challenge, Egypt developed a national

10,000 strategy for HCV control and established HCV prevention and
treatment programmes. Following successful negotiations for
8,000 6,902
99% discounted treatment
6,000
prices, Egypt launched an
4,000 3,634 3,023 2,889 ambitious national HCV ‘Breast
2,000 treatment programme cancer is
0
Liver Bladder Lung Non-Hodgkin Brain, nervous
aiming to treat over the most is
250,000 chronically infected
prevalent
lymphoma system
individuals per year for free,
with the goal of achieving type among
Females
20,000
18,660
a national chronic infection Egyptian
18,000
prevalence of <2% by 2025. women’
In the past in Egypt, where
16,000
schistosomiasis was endemic,
14,000 bladder cancer diagnoses were made at younger ages (<50
Number of cases
12,000 y) than in developed countries, and 68% of the cases were

10,000 identified histologically as SCC. With the government’s efforts
8,000
to eradicate schistosomiasis and treat infected individuals over
the past three decades, a shift from SCC to UC and an increase
6,000 5,128
in the mean age at diagnosis have been reported. However, the
4,000
2,606 2,515 2,395 incidence of bladder cancer in Egypt has not decreased; this
2,000 malignancy remains the second most commonly diagnosed
0 in men.
Breast Liver Non-Hodgkin Brain, nervous Ovary
lymphoma system Carcinoma of the breast is the most prevalent cancer among
Cancer incidents in Egypt Source: World Heath Organisation Egyptian women. Median age at diagnosis is one decade

Oncology
younger than in countries of Europe and North America and

most patients are premenopausal, and hence, it has particularly
marked familial, societal, and economic consequences.
Breast cancer is relatively advanced at presentation leading
to poor survival. Low awareness, unavailable mass-screening
programmes, and sociocultural beliefs have been proposed
as possible reasons for the late presentation. In additional
screening policy makers need to design more culturally relevant
strategies to motivate women to utilise screening services.
Egyptian women have historically not sought care until they
were ill, and studies have shown that 77% are unwilling to have
a mammogram until it was strongly request by the doctor. In
the same studies in shows that a median of 71.4% blamed the
lack of privacy, 69.2% thought that medical checkups were not
worthwhile, and 64.6% blamed the cost of services.
To move towards supporting women in Egypt the Women’s
Cancer Centre at Nasr City Hospital for Health Insurance Edwin Smith Papyrus, the earliest record of cancer
was opened in June 2018 and is the first such public centre
to be established under the auspices of the National Health
Insurance General Authority. The centre aims to provide a Referencs for this aticle are available at:
variety of health services for patients, including chemotherapy MiddleEastMedicalPortal.com/references
and surgeries for breast and uterine tumours.
Global Prevalence of Hepatitis C

More than 150 million people worldwide are infected with hepatitis C virus (HCV), and HCV-related
complications cause up to 500,000 deaths each year
HCV Prevalence
<1%
1-1.9%
2-2.9%
>1%
Not Studied Source: Centre for Disease Analysis

Oncology
ATAVISTIC CHEMOTHERAPY
Breaking away
from expensive and
ineffective
cancer drugs
Written by Dr Frank Arguello, MD
Director of Atavistic Chemotherapy Clinical Trial
Despite our apparent progress in cancer research

and treatment, cancer is threatening our societies
Dr Frank more than ever before in recorded medical history,
Arguello killing today more than 8 million people annually in the
world, 100,000 of whom are children. The World Health
Dr Frank Arguello, Organisation estimates that about 70% of those deaths occur
born in Mexico, was in low and middle-income countries. Due to poor healthcare
a recipient of the access for patients, which can lead to late diagnosis, an
James P. Wilmot adoption of American style fast food, fatalism, and change in
Cancer Research lifestyles have meant that cancer incidence in the Middle East
Award, and an is due to rise faster than any region in the world. In 2030 the
Assistant Professor cancer incidence will be almost double what it was in 2012.
of Oncology, and The significant rise of the number of people being diagnosed
Paediatrics Haematology and Oncology at the with cancer in the Middle East.
University of Rochester School of Medicine and Cancer is creating an extraordinarily heavy economic
Dentistry, New York. A Senior Investigator in the burden for the health care systems of most of the Arab
Laboratory of Drug Discovery, Research and countries. alarming rise in the incidence of the disease and the
Development, Division of Cancer Treatment and exceptionally high cost of its treatment, is further compounded
Diagnosis, National Cancer Institute, National by the fact that most current anticancer drug therapies have
Institutes of Health, Bethesda Maryland. He has only a marginal benefit for cancer patients.
published several articles and books on bone In fact, with the exception of a few rare forms of leukaemia
and bone marrow metastases and spinal cord and lymphoma, the testicular seminoma and the gestational
compression. He discovered the anti-leukaemia choriocarcinoma; all cancers that affect humans (>95%)
and anti-lymphoma properties of Flavopiridol remain incurable and invariably lethal today if not cured with a
(Alvocidib), a CDK inhibitor. radical surgery in an early stage. Even for those cancers curable
today with radical surgeries, such as mastectomies for breast

cancer or the enucleation of the eyes for ocular retinoblastoma,
we continue employing the same primitive and disfiguring
procedures developed centuries ago (Figure 1).
With the continued failure to cure inoperable and metastatic
cancer, coupled with the great toxicity generated by current
treatments, we are generating prolonged morbid states which
are not only physically and emotionally exhausting to patients
and their families, but also result in what a senseless waste
of limited human and financial resources. The misgivings of
traditional chemotherapy are further exacerbated by the
recent evidence that it does not appear to improve the quality
of life of patients with metastatic cancer, and that current
anticancer drugs appear to facilitate the spread and growth of
some cancers.
Although it is overwhelmingly obvious that the status quo in
cancer treatments cannot be maintained, and indeed must be
changed as the poor to middle income Arab countries cannot
afford big pharma drugs. According to a recent report of the
Zion Market Research, the global cancer drugs market was
valued at approximately USD 112.90 billion in 2015 and is
expected to generate revenue of around USD 161.30 billion
by the end of 2021. Remarkably, the global sales of oncology
FIGURE 1: We have been performing mono and bilateral drugs in 2017 were monopolised the global sales of blockbuster
mastectomies with the removal of the axillary lymph nodes for cancer drugs in 2017 were monopolised by ten pharmaceutical
the treatment of early breast cancer for more than 500 years. companies: Roche, AbbVie, Pfizer, Novartis, Merck, Bristol-
We have been removing the eyes of children with an early Myers Squibb, AstraZeneca, Eli Lilly, Johnson & Johnson, and
diagnosis of retinoblastoma for more than 200 years. If we need
Celgene. An oligopoly concentrated in four countries.
to resort to these radical and disfiguring surgeries for localized
to malignant tumours the size of a lentil or a pea, what can we It is crucial to point out that the problem of cancer does
realistically offer to those with inoperable masses or metastatic not only encompass an increasing incidence of the disease,
tumours in the bones, brain, liver, etc.? the skyrocketing costs of its treatment, or a pharmaceutical

cancer industry controlled by a few foreign powers. Rather, the me to employ combinations of several existing, inexpensive
fundamental problem in cancer has been for centuries, failure and widely available approved drugs used for the treatment of
to understand the biology of the cancer. The consequence other diseases. With them, I have achieved complete clinical
is our incapacity to develop efficient regressions of a variety of inoperable
preventive and curative treatments. and metastatic cancers. This new and
Paradoxically, the author of this article
believes that this global cancer crisis
‘The revolutionary form of a drug-based
approach to treat cancer, which I call
offers a great opportunity for the Middle fundamental Atavistic Chemotherapy, is based on
Eastern and other countries to break
away from cancer concepts which are
problem in the biological and therapeutic principles
elaborated in a book the author published
unfounded or manipulated to promote cancer has in 2011, entitled Atavistic Metamorphosis:
expensive drug therapies, the benefits
of which are questioned by empirical or
been for A New and Logical Explanation on the
Origin and Biological Nature of Cancer .
clinical evidence. centuries’ This form of chemotherapy has been in
The author invites the reader to consider evaluation and optimisation since 2012 in
a biological phenomenon known in a clinical trial and proved over time to be
evolutionary biology as ‘atavism’ -- re-expression of traits an effective treatment in inoperable and metastatic disease. It
that were present in past evolutionary ancestors). It could is not toxic at the degree of traditional chemotherapies. It is
allow us to demystify the cellular phenomenon we know of largely inexpensive when compared to traditional treatments
as ‘malignant transformation,’ which has remained elusive and does not require hospitalisation. Patients take their
for centuries. This evolutionary cell hypothesis has allowed medicines orally in the privacy of their homes.

Oncology
FIGURE 2: Large metastatic nodules in the lungs of a patient

with colon cancer. (A) Coronal CT scan of the chest obtained
prior to atavistic chemotherapy shows five large metastatic
nodules in the lungs (arrows). This patient also had metastases
to the liver, bones, and brain (no shown). (B) A coronal CT scan
of the chest obtained after approximately 4 months of atavistic
chemotherapy shows that the metastatic lung nodules have
almost completely vanished.
Due to limitation of space in a publication of this

nature, we would obviate a long explanation
about the rationale behind new treatment by
citing a visionary statement made by British
cancer surgeon, Herbert L. Snow, in 1893:
‘We need to remember that our

bodies are formed by minute FIGURE 3: Inoperable malignant astrocytoma in the left parietal
cell elements, which were in lobe of a 61-year old male patient. (A) Axial MRI section of
the brain showing in panel (A), a large primary brain tumor in
the past, for all practical intents the left parietal region reported to be a Grade III Malignant
Astrocytoma (circled). (B) Same section as (A), but 11 months
and purposes, independent cell after initiation of atavistic chemotherapy.
organisms such as the amoeba.
Cancer is just a process of
de-evolution or reversion of
one of our differentiated cells
back to that primitive ancestral
independent cell form, becoming
once again a cell parasite, or
rather, an autosite. But for our
perfected bodies, in which all
organs depend upon one other,
these ancestral and independent
cells overrun the differentiated
FIGURE 4: Six large metastatic tumours in the lungs from a colon
cells, they destroy their functional cancer removed years earlier. CT scan of the lungs of a patient
harmony, bring about our death, with metastatic disease from colon cancer. (A) Arrows point at
several metastatic colonies in both lungs prior to treatment. (B)
and perish with us.’ Metastatic nodules are no longer visible after four months of
atavistic chemotherapy.

Oncology
Frank Arguello, MD
Director, Atavistic
Chemotherapy Clinical Trial
atavisticchemotherapy.com
FIGURE 6: Metastatic melanoma in the mediastinal lymph

nodes and lungs after multiples surgeries and conventional
treatments with Ipilimumab (Yervoy), Interferon, dacarbazine,
and radiation. On the left column, panels A and C, metastatic
lymphadenopathy is documented on a CT scan of the
chest (arrows). After 12 months of atavistic chemotherapy,
left column, panels B and D, the metastatic lesions in the
mediastinal lymph nodes had decreased slightly in size and
had become calcified (arrows in inserts). The presence of
eggshell-like, central or spotted calcifications of lymphoma
metastatic lymph node lesions after radiation or conventional
chemotherapy, are regarded as radiological indicators of a
complete clinical response to treatment.
Referencs for this aticle are available at:

MiddleEastMedicalPortal.com/references
FIGURE 5: Five hemorrhagic metastatic tumours in the brain,

4 years after removal of a cutaneous melanoma. MRI of the
head revealed a hemorrhagic tumor is pointed with arrows at
the left Column. Panels A, and C, a tumor is seen in the right
parietal lobe (“P” arrows). Another hemorrhagic lesion was
seen in the left occipital lobe depicted in panels A and E with
an “O” arrow. Two foci of T1 hyperintensity with enhancements
were also seen within the right cerebellar hemisphere
(“C1” arrows in A and C), and another in the left cerebellar
hemisphere (“C2” arrow in A). MRI images of the right
column, panels B, D, F, were obtained ten months after
completion of atavistic chemotherapy showing the elimination
of those tumours.

Pharmacology
Compounding
tablets in the
Middle East
Dr Michael Gamlen, explains the benefits of using
small-scale tablet manufacturing systems in the Middle East
Tablets are the most compounder relationship in the course

frequently prescribed of professional practice.”
dosage form. Commercially
produced tablets are manufactured DRUGS MAY BE COMPOUNDED FOR
in high volumes at fixed doses which A VARIETY OF REASONS, SUCH AS:
may not meet the specific needs of all • To replace drugs which are unavailable
patients. When a patient is unable to or discontinued.
take the commercially available drug, • When a patient is allergic to certain
compounding in tablet form may ingredients in commercially
provide a route to meeting each specific available medications.
patient’s needs. • To tailor dosages for certain patients,
Compounding is the creation of such as children.
a pharmaceutical preparation by • To combine several medications
a licensed pharmacist to meet the the patient is taking to increase
unique needs of an individual patient. compliance.
Dr Michael Over recent decades, technology
advancements in both equipment and Benefits of
Gamlen excipients have allowed pharmacists to compounding tablets
customise medication in tablet form. MAINTAINING DRUG SUPPLY
CEO at Gamlen Tableting In the future, compounding could When drug manufacturers discontinue
Ltd are world leading offer suppliers a key advantage in the the production of certain drugs,
powder compaction and drug supply chain. there may still be patients who need
material characterisation these medications. With this in mind,
specialists offering R&D Compounding tablets compounding pharmacists ensure
services and instruments to The United States Pharmacopeial patients continue to receive the care
industry and academia. Convention (USP) formally defines they require by manufacturing small
compounding as “the preparation, quantities of discontinued drugs
CONTACT: sales@ mixing, assembling, altering, packaging, for prescription.
gamlentableting.com and labelling of a drug, drug-delivery Compounding pharmacies have
device, or device in accordance with access to the highest quality
INSTRUMENTS: a licensed practitioner’s prescription, pharmaceutical ingredients and can
gamlentableting.com medication order, or initiative based fill prescriptions using the latest
on the practitioner/patient/pharmacist/ tableting equipment.

such as beyond-use date and stability,
and provides criteria for compounding
pharmacists to follow.
USP General Chapter 800 is a new
standard establishes practice and
quality standards of hazardous drugs
to minimise the exposure to hazardous
drugs within health care settings.
The aim is to promote worker safety
(pharmacists, pharmacy technicians),
patient safety, and environmental
protection. This standard was published
in 2016 but will not be officially
implemented until 1 July 2018.
RISING GERIATRIC POPULATION

The Middle East has a relatively young
population in comparison with Europe.
However, the region faces a rising
geriatric population. From 1965 to
2010 average life expectancy increased
from 48.7 years to 70.4 years, and is
expected to rise to 76.9 years by 2045-
2050. According to these predictions,
17.2% of the population will be over
60 by 2050.
SHIFTING EPIDEMIOLOGY
Many countries in the Middle East
are also experiencing a shift from
communicable to non-communicable
diseases, the latter being associated with
IMPROVING DOSE ACCURACY PRIORITISING PATIENT NEEDS obesity-related complications such as
Some medications may require patients Compounding supports a unique, diabetes and cardiovascular disease.
to take partial doses of commercially patient-centric approach – whether that However, the ageing population
prepared tablets. This is achieved by is to reduce side effects of medication, is expected to have a positive effect
breaking the tablet in half or into avoid allergens, or simply improve on market growth for compounding
quarters, which reults in variable compliance, compounding offers a pharmacies as compounded medications
doses. However, a compounding unique opportunity for pharmacists to allow for superior management of
pharmacist can custom manufacture the use their extensive knowledge to help disease conditions that are age related.
prescription. This is especially beneficial create unique treatment plans.
as improved dosage compliance can COMPLEX TECHNOLOGY AND
reduce associated healthcare costs such Market challenges SCARCITY OF QUALIFIED PHARMACISTS
as hospitalisation. REGULATORY EFFECTS Traditionally, tableting equipment
Compliance with USP guidelines is is highly complex. This coupled
REMOVING KNOWN ALLERGENS considered the minimum standard with a regional shortage of qualified
Allergies and intolerances to medication of practice in pharmacy, and legal pharmacists presents a challenge for the
constituents can result in unwanted permission to compound medicines production of compounded drugs in the
reactions. Commercially available must be sought from the relevant Middle East.
medications may contain preservatives government authorities.
that cannot be tolerated by the patient. USP General Chapter 795 provides Market opportunities
A compounding pharmacist can make a guidance for non-sterile preparations THE COMPOUNDING PHARMACIES
formula excluding certain ingredients so that are compounded in health care Market was valued at more than $8bn in
that a patient can continue using settings. The chapter describes the 2017 and is expected to grow at a rate of
the medication most appropriate for categories of compounding (simple, 5% CAGR by 2024.
their needs. moderate, complex), defines concepts In many countries throughout the

Pharmacology
Middle East, medications are classified

as ‘prescription’ drugs but are often
available for sale in pharmacies
without a prescription. Where legal
and authorised, this practice provides
an opportunity for compounding
pharmacists to enhance the level of care
provided to patients.
For children and the elderly,
compounding offers alternative drug
forms and doses. This is particularly
interesting for patients who cannot
tolerate intravenous administration and
would prefer taking medication orally..
Opportunities for compounding
tablets lie in those areas where tailoring
treatments can alleviate side effects,
such as hormone replacement therapy,
where compounded medications can be
Gamlen Instruments M series
tailored to the patient rather than
using commercially available ‘one-size-
fits-all’ products.
Compounding also improves dose pharmacists to weigh out and mix the Tableting (UK) M series small-scale
accuracy, with studies showing this to required ingredients before compressing tablet manufacturing instrument allows
be preferable over patients manually them into tablet form. The tablets are users to create, test, and manufacture
dividing tablets. Compounding is then tested for factors such as hardness tablets. The M series instrument is
particularly useful concerning drugs and their ability to disintegrate. a simple plug-in-and-go system that
such as the anticoagulant Warfarin, Formulations for compounding requires no assembly and no training.
the dosage of which has to be tablets are available from sources such Most importantly, each tablet made is
individualised for each patient. Warfarin as Compounding Today, an online quality controlled by compaction force
is administered orally in 5mg tablets. resource of the International Journal and weight.
At present patients have to manually of Compounding. Compounded tablets Using minimal material, the M series
divide their tablets which can result in are usually intended for swallowing but can be used in an isolator and can
inaccurate dosing resulting chewable and soluble effervescent tablets produce 100-180 tablets an hour. The
in hospitalisation. can also be made using small-scale isolator provides two important benefits
Some compounding pharmacists tablet presses. - protecting the operator from exposure
are now able to compress tablets on a to the product (which may be harmful)
small scale for their patients; a change A small-scale tablet as well as protecting the product
supported by the availability of single- manufacturing system from contamination.
punch tableting machines. Affordable, high quality tableting The isolator is a standalone unit
Pre-blended excipient powders are equipment is now available for that can be placed in a hospital
available to enable compounding compounding pharmacists. The Gamlen dispensary which operates the correct
manufacturing control system.
The M series manufacturing
instrument has been developed by
Gamlen Tableting Limited; recognised
worldwide as experts in powder
compaction and tableting science.
In addition to supplying tableting
and powder compaction analyser
instruments, Gamlen Tableting also
provides tableting training courses and
formulation development services from
its laboratory in London.
The Gamlen Tableting (UK) M series small-scale tablet manufacturing instrument allows users to create, FOR FURTHER INFORMATION PLEASE
test, and manufacture tablets. Using minimal material, the M series can be used in an isolator and can
produce 100-180 tablets an hour. VISIT gamlentableting.com

Infectuous disease
Middle East Respiratory

System Coronavirus
Latest Update
Lauren Bolton provides details about this infectuous disease
On the 26 January 2018, the control further outbreaks within

global count of confirmed humans. The advised measures to the
human cases of MERS-CoV health care sector include isolation
(Middle East Respiratory System for all confirmed cases; enforcement
Coronavirus) was 2,143, including 705 of strict adherence to environmental
deaths. The infection was recognised disinfection and making sure
for the first time in 2012 in Saudi infection prevention supplies are
Arabia as a primitive source of renal readily available; and ensuring the
failure and severe respiratory sickness. 24/7 availability of a trained nurse
Findings suggest that humans first for early detection of patients with
contracted the virus from camels, respiratory symptoms. Health care
through consuming contaminated workers have been advised to apply
camel product, and that camels standard precautions consistently with
contracted the virus through bats, Lauren Bolton all patients, regardless of if they’re
seen through antibodies found in symptomatic of MERS or not.
is Knowlex’s Research
both animals. Other animals such In community settings, the
Specialist. Her role includes
as goats, cows, and sheep have been Ministry of Health have been
close communication
tested for antibodies but none have promoting awareness of the virus to
with infection prevention
been detected. In humans, MERS-CoV reduce household and community
and control experts from
causes severe infections with a high transmission of MERS-CoV. The
bodies such as Public
mortality rate. Significant peaks of the Ministry have also advised against
Health England and NHS
infection were detected in the spring drinking unboiled camel milk and
Improvement in the United
of each year, however in June 2017, 3 eating undercooked meat, as well as
Kingdom, and the Ministry
hospital outbreaks were reported from avoiding close contact with animals.
of Health and the National
Riyadh. The infection was highlighted They have also published precautions
Guard in the Kingdom of
in Saudi Arabia in the Western (40.8%) for the general public to follow,
Saudi Arabia.
and Central (31.9%) regions, followed including frequent washing of hands,
by the Eastern region (20%), although thoroughly washing produce before
other cases have been linked to 7 consumption, avoiding contact with
countries in or near the Arabian Peninsula. sick people, avoiding frequent touching of the eyes and nose,
MERS-CoV is able to spread within humans via contact avoiding crowded places, eating well, sleeping well, and
or respiratory droplets, however human transmission is drinking lots of fluids. Parents should keep children home if
most prevalent in health care settings. 44% of those who they are showing signs of MERS-CoV, and teachers should
contracted the disease were exposed in the hospital, 33% were be trained to recognise the signs and send children home
professional caregivers, and 13% were health care workers. if necessary.
In health care facilities it is essential to implement the Saudi At the time of writing the most recent Hajj took place
Arabian Ministry of Health infection control measures to between 30 August and 4 September 2017 with no increase

in travel related incidents of MERS-CoV. However, it was People most at risk to the infection are those with diabetes,
reported that cases of MERS-CoV occurred in countries renal failure, chronic lung disease, and those who are
outside of Saudi Arabia following Umrah. Therefore, as long as immunocompromised. People with these conditions should
the public follow the recommendations made by the Ministry avoid close contact with any animal, regardless of health;
of Health, embarking on the Hajj this year should be fine. practice good general hygiene, such as washing hands before
However, the Ministry of Health have strongly recommended and after touching animals; and avoid close contact with
that people older than 65; those with chronic diseases or poorly suspected or confirmed human cases of the illness. Most
functioning immune systems; pregnant women; and children of those who have died from the illness have had other
under 12 years of age should postpone embarking on Hajj and medical conditions.
Umrah for their own safety. People planning on going on the The most common symptoms of MERS-CoV are fever,
Hajj with any medical issues should consult a doctor before cough, and shortness of breath. Associated symptoms may
they go to make sure they get any required vaccinations. Once include chills, chest pain, headache, diarrhoea, nausea, and
returning from Hajj, if people have any respiratory symptoms vomiting. Serious complications include kidney failure and
or a fever, they should see a doctor as soon as possible. pneumonia. Early reports of the virus described symptoms as
similar to those of SARS. Many individuals with MERS may
have a mild respiratory illness or no symptoms, but others will
have severe respiratory distress, and they may need to spend a
long time in the hospital with mechanical ventilation. There is
no medication that is known to treat MERS, all treatment is
supportive, much like SARS.
FOR FURTHER INFORMATION ABOUT KNOWLEX, PLEASE
VISIT knowlex.co.uk
Referencs for this aticle are available at:

Findings suggest that humans first contracted the virus from camels, MiddleEastMedicalPortal.com/references
through consuming contaminated camel product.

Is the Middle
East prepared
for Influenza?
Dr Hina Naveed investigates influenza across the Middle East and highlights
the benefits of healthcare professionals being vaccinated against the virus.

Medical conditions
Dr Hina
Naveed
Is an experienced
Pharamcist, writer,
and speaker. She
lives in the United
Arab Emirates.
Influenza viruses are divided scientifically into three

types, designated A, B, and C. Influenza types A and
B are responsible for epidemics of respiratory illness
that occur almost every winter. Influenza type C usually
causes either a very mild respiratory illness or no symptoms
at all; it does not cause epidemics and does not have the
severe public-health impact of influenza types A and B. Type medical visits and lost work days for the hospital and has the
A viruses are divided into subtypes and are named based on potential to spread flu to staff members and patients, including
differences in two viral surface proteins called hemagglutinin those with chronic medical conditions, pregnant women,
(H) and neuraminidase (N). There are sixteen known H young children, and older people at higher risk of serious flu
subtypes and nine known N subtypes. Hemagglutinin (HA) is complications. Flu vaccination of healthcare professionals
an antigenic glycoprotein found on the surface of the influenza has been shown to reduce the risk of flu and absenteeism in
viruses. It is responsible for binding the virus to the cell that is hospitals and reduce the risk of respiratory illness and deaths
being infected. of patients. The Advisory Committee on Immunization
Influenza pandemics can occur without warning and the Practices (ACIP) recommends that all hospital staff receive an
Middle East and North African region is critical to monitor annual flu vaccination.
as it is in the middle of the flight pathways of migrating birds. Each year, composition of the influenza viruses change,
The four main paths of birds are central Asia, East Africa, making the vaccine used in previous years ineffective. Each year,
West Asia, Black Sea–Mediterranean, a new vaccine must be prepared that will
and East Atlantic routes. All these cross be effective against the types of influenza
over in the Middle East and North Africa.
Egypt, Jordan, Saudi Arabia, Oman, the
‘Young virus that are expected to circulate in the
upcoming flu season. These are known as
United Arab Emirates, Iraq, and Iran face children and seasonal flu vaccines. The reason for the
the threat of influenza from migratory
birds to cross infect native birds as the
the elderly are differences in circulating strains of the
flu virus is that the virus can mutate (or
birds stop over mid migration. The Iranian at higher risk change its structure) rapidly, leading to new
Veterinary Organisation says that the
current H5N8 influenza infection, which
of serious flu subtypes of the virus. The key is to be able
to predict which influenza viruses are going
has led to the mass culling of more than complications’ to cause infection and to prepare a vaccine
18 million poultry, is believed to be caused against those viruses. Usually, scientists can
by migratory birds, and is could spill over predict accurately which types of influenza
to neighbouring countries. According to WHO, the influenza virus will cause infections and prepare an appropriate vaccine.
A virus H5N8 has not yet been transmitted to human beings, Typically, the viruses that are used to prepare flu vaccine are
although this possibility cannot be excluded since another grown in eggs, but a newer, egg-free version of the vaccine
clade of avian influenza A virus—A(H5N6)—has infected has been developed. This is particularly important for people
human beings before. Early intervention for influenza A virus with an egg allergy. The vaccine is generally effective against
infections, including antiviral treatment and surveillance, is the influenza virus within two weeks of administration. The
crucial. Early intervention is especially important in the Middle vaccine is only effective against the strains of the virus that
East and north African region, with countries there being some match the vaccine. These strains vary from flu season to flu
of the largest poultry and egg producers. season each year. This is the reason that revaccination is
How many healthcare professionals in the Middle east get required annually with the vaccine that matches the strains of
the flu jab? Influenza among healthcare personnel can result in influenza that are currently prevalent.

Medical conditions
The two different types of

flu vaccines, trivalent and
quadrivalent
• Trivalent vaccines protect against two influenza A
viruses (an H1N1 and an H3N2) and an influenza B
virus. Trivalent vaccines are available in:
• Standard-dose trivalent shots Quadrivalent vaccines protect
• Inactivated Influenza Vaccine 3 (IIV3), approved against two influenza A viruses
for use in people six months and older. (Most flu
shots are given with a needle. One flu vaccine also and two influenza B viruses.
can be given with a jet injector, for persons 18 These vaccines are approved for
through 64 years old).
• High dose trivalent shot approved for people 65 different age groups, and include:
years or older. • An intradermal quadrivalent flu shot, which is
• Recombinant trivalent shot that is egg-free, injected into the skin instead of the muscle and
approved for people 18 years or older. uses a much smaller needle than the regular flu
• A trivalent flu shot made with adjuvant (an shot. It is approved for people 18 through 64 years
ingredient of a vaccine that helps create a of age.
stronger immune response in the patient’s body), • A quadrivalent flu shot containing virus grown in
approved for people 65 years of age and older cell culture, which is approved for people 4 years
(new this season). of age and older (new this season).

Medical conditions
A breakthrough in
managing diabetic
foot ulcers
Diabetic foot ulcers are a major issue by Dominiek Voane
The Middle East has healthcare facilities urges governments

witnessed a spike in the to rethink their strategies on hard to
occurrence of diabetes over heal wounds. Regulatory and clinical
the last ten years. The Gulf region market evolution is towards objective
has experienced an especially marked diagnostics of the wound and peri-
and sudden increase in rates of wound areas, proven functional
diabetes where countries like Kuwait, assessment of wound dressings and
Saudi Arabia, and Bahrain now rank towards rapid evaluation of applied
among the top ten countries with therapies for wound closure. It is
highest incidence of type 2 diabetes clear there is a need for effective,
worldwide. Additionally, children
have also experienced a dramatic
Dominiek Viaene easy-to-use, cheaper, and fast
solutions in the field of wound care
increase in rates of type 1 as well as CEO at Protex Healthcare for complex wounds such as diabetic
type 2 diabetes in this region. Diabetic Ltd a manufacturing and foot ulcers. Diabetic patients with
foot ulcers (DFUs) are a major issue development company diabetic foot complications have an
as infection remains a common and for advanced wound care excess mortality rate when compared
serious complication in managing dressings, including Vacutex. with diabetic counterparts without
DFUs in countries with poor access foot complications and the general
to specialist diabetic care. The population. Early interventions to
consequence is that 85% of all amputations are caused by a prevent foot ulceration and consequent LEA as well as all the
foot ulcer and every 20 seconds a lower limb is amputated due measurements for reducing the prevalence of microvascular
to diabetes. and macrovascular complications should be considered.
Other hard to heal wounds, next to DFUs (which are
estimated to be at 42,5 million people worldwide in 2009 and
growing to 65 million people worldwide in 2030), are pressure
ulcers (estimated to be between 4.4 and 6.8% of all hospital
admissions in the UK in 2001) and venous leg ulcers (estimated
between 1 and 2 % of total population worldwide) 2. In
total, haBreard to heal wounds are estimated to be worldwide
1.35% up to 2.3% of the world population, often leading to
amputation when wounds do not heal quickly enough.
The shortage of wound specialists and nurses, the cost
of hospital beds and often the lack of essential primary

Breakthrough in the management
of DFUs
Vacutex, a powerful rapid micro-capillary action dressing
for the management of oxygen and edema in and around the
diabetic foot wound
How does Vacutex work into the

wound and peri-wound area? Rapid capillary action dressing
New clinical insights have started to prove the importance of for chronic wounds
good oxygen management and the major impact of reducing
oedema in and around the wound to achieve quick/good
wound healing. Chronic oedema was recently recognised to be
a major – so far non-addressed – factor in a lot of hard to heal
Locks and
wounds. re-distributes
In DFUs, oxygen and oedema management had until fluid(s) within a
central layer.
recently not been one of the key parameters of wound healing
therapies. Patient observation studies of oxygen and oedema
levels in the first clinical centres in Germany (Reutlingen,
Dessau) and Belgium (Chimay) with the TIVITA camera have
shown that these parameters play a much more important
role in the process of closing these hard to heal wounds than
previously expected, and show that the management of oxygen
Accelerated
and oedema levels can be very well done by means of this rapid capillary action
capillary action dressing, Vacutex. Clinical practice has proven “pulls” interstital
fluid(s) from the
repetitively in several international settings that this particular wound bed.
dressing can even help to prevent amputations when the wound Contact layer prevents
exudate from “spreading”
bed oxygen levels can be reactivated and the oedema can be across the wound site and
removed from those wounds. avoids maceration. Third layer of
dressing remains
dry until saturation
Mechanism of action of occurs within
Vacutex in DFU’s central layer.
Unlike any other kind of wound dressings on the market,

Vacutex has proven to be very effective in improving superficial
and deeper oxygen in the wound, as well as in reduction of
oedema in wounds and the peri-wound areas. In case of the
treatment of venous leg ulcers, Vacutex can also be used
under compression. Vacutex is not an anti-microbial dressing
but allows combination with several known anti-microbial
dressings on the world market.
Exudate “wicks” layerally

For further information visit throughout the central layer
protexhealthcare.co.uk until saturated.

Medical conditions
Multifaceted
approach
to diabetes
Diabetes is on the increase in the Middle East due to changing eating patterns.
Alyson Smith explores a multifacted approach to tackling this disease
Medical research from the the onset of diabetes is becoming a

A healthy
World Health Organisation major concern? balanced diet
contains fresh
(WHO) suggests that nearly The evolving eating patterns of the vegetabes
five per cent of the world’s population Middle East may be creating confusion
have diabetes. This global health issue with respect to what constitutes a
is increasingly affecting many regions healthy diet and therefore compound
of the world including the Middle East. the issue. Evidence based studies provide
According to the International Diabetes guidance on what is considered to be an
Federation, without lifestyle changes, a appropriate diet for both treatment and
quarter of the Middle East’s population prevention of diabetes. However, it is
will be affected by 2035. important to provide this information to
Rapid urbanisation and the the general public in a suitable way.
introduction of the western diet Using the noun ‘diet’ can be
across the Middle East; energy-dense counterproductive as for most people
food and refined carbohydrates are this implies special meals that one eats
having a negative impact on the health in order to be healthy or to lose weight.
of the population. In addition, the Messages such as ‘cut out meat’ and ‘eat
fat-saturated food and increasingly meals low in trans fats, salt and sugar’
sedentary lives of both adults and may present a problem for families who diabetic foods can place an extra burden
children continues to compound the have developed their eating habits over on diabetics and their family, thereby
issue. With this deadly combination generations. In addition to using the encouraging inappropriate luxury foods
of overeating, junk food, and low word ‘diet’, promotional information to be eaten. There is no evidence to
levels of activity, is it any wonder that with respect to purchasing specific suggest that these foods are of benefit
and in some cases such foods can have a
laxative effect.
Alyson Smith, BSc Health is a positive balance between
body and mind. In terms of prevention
Worked as an NHS nurse for over 40 and treatment; a healthy well balanced
years, including ten years as a Diabetes diet is recommended for everyone.
specialist. She is passionate about Avoiding over processed foods and foods
teaching people about living healthy with hidden sugars can be achieved by
lifestyles as preventative measures using natural ingredients and preparing
against disease. and cooking for oneself and family.
A healthy meal plan for people with

diabetes is the same as a healthy meal diabetics, both young and old can go of living with a life-long condition such
plan for all. Portion size, eating at into a state of denial of their condition, as diabetes.
regular intervals, and drinking sugar resulting in poor diabetic control and a A discussion around mental health
free drinks is the simple message to high-risk of complications. within a diabetes-specific consultation
get across without over complicating Mental health issues can make it should be part of diabetes management.
the message. more difficult for diabetes sufferers Very often though not always, a patient
This proposed epidemic has the to comply with alterations to their builds trust with their diabetic specialist
potential to impact on economics and diet. A depressed person is also less provider, therefore, enabling a frank
bankrupt healthcare systems. This is just likely to adhere to their medication or and open discussion around their own
taking into account the cost of providing monitoring regimes which are necessary mental health.
a full range of health care for both pre- for effective diabetes management Providing the opportunity for
diabetics and diagnosed diabetics with and prevention of complications. counselling with an appropriate
type 1 and type 2 diabetes. Symptoms of phobia or anxieties related professional following a diagnosis of a
We talk of providing holistic care for to self-administration of insulin and potential mental health issue can make
the diabetic population, which in fact self-monitoring of a huge difference to
means much more than dealing with the blood glucose levels the outcome. High
physical manifestations. Consideration
of the mental health of diabetic patients
can reinforce the
emotional distress.
‘Mental health quality cognitive
behavioural therapy
is an integral part of on-going diabetes Not only can poor issues can (CBT) can be
care. Further economic issues related
to the cost of mental health care and
blood glucose levels
lead to long-term
make it more a valuable tool
providing effective
loss of earnings may well impact on the complications, difficult for mental health
overall cost to the healthcare budget of
the Middle East.
but also to
distressing short-
diabetes intervention. Online
CBT mirrors face-
A study compiled by Iesco Digital term symptoms of sufferers’ to-face therapy
Health, the UK’s largest provider of hypoglycaemia as and involves real-
online therapy highlights the scale of well as the risks of time personalised
mental health problems affecting those diabetic ketoacidosis. communication between therapist a
living with diabetes. A multi-faceted approach to include nd patient.
The study highlighted the health a comprehensive assessment for mental The Middle East is facing a whole
beliefs of young adults (16-34) who felt health problems should be considered host of issues related to urbanisation
that their mental health was negatively as an integral part of on-going diabetes and the emergence of a diabetes
affected by their diabetes. care. Educating patients to be alert to epidemic. By adopting a holistic
Mental health issues linked to diabetes their changing mental health state and approach to the condition and early
include feelings of loss, stress, anger, to recognise the early warning signs of intervention including assessment of
panic attacks, depression, anxiety, and anxiety and stress will help to address mental health, the increased burden on
eating disorders. Some newly diagnosed the emotional and behavioural aspects healthcare systems can be managed.

Medical conditions
Non-alcoholic
fatty liver disease
Does genetics have a role?
Dr Ravi Kanth explores the role genetics have in this disease
Non-alcoholic fatty liver disease (NAFLD) describes

a range of conditions in the liver beginning with fatty
NAFLD, is it Genetic?
The risk of developing a disease is determined by the genetic
liver (accumulation of fat), that may progress to
susceptibility an individual carries. However, not all individuals
non-alcoholic steatohepatitis (NASH – fat accumulation along
with genetic susceptibility in the form of variants manifest
with inflammation and scarring), cirrhosis (hepatic cells are
with the disease suggesting that the phenotype (disease) is a
replaced by scar tissue) and finally to Hepatocellular carcinoma
result of complex interactions between genes and environment.
(HCC). While conditions up to NASH are reversible, disease
Most of the modern day diseases including cardiovascular
progression beyond NASH are irreversible. Therefore the
disease, diabetes, obesity, NAFLD are typically inherited in a
emphasis is on early identification of at-risk individuals for
multifactorial mode, that is a complex pattern of inheritance,
fatty infiltration, so that appropriate interventions can be
where a combination of both genetic and environmental risk
planned to avoid/delay progression.
factors are involved. Multifactorial complex conditions do not
always manifest with the disease despite the fact that the
Prevalence and heritability individual carries the genetic susceptibility putting the
Although the global prevalence of the disease is estimated to be
emphasis on the interacting environmental risks. However, it is
around 25%, the highest rates are reported from South
important to identify genetic susceptibility as it confers a
America (31%), followed by the Middle East (32%), Asia
higher risk of developing the disease in an individual.
(27%), USA (24%) and Europe (23%). Familial aggregation,
Candidate gene studies employing case-control approach
interethnic differences in susceptibility and twin studies
have identified genes that are modifiers of insulin sensitivity/
identified the contribution of genetics to susceptibility and
resistance (IRS-1, ENPP1, GCKR, PPARG, TCF7L2, SLC2A1),
variation of NAFLD progression. A prospective twin study
modifiers of fatty acid reflux and triglyceride levels (SLC27A5,
reported the heritability of hepatic fibrosis and steatosis to be
LIPN1, MTTP, PEMT, ADIPOQ, APOC3, TCF7L2, APOE3,
0.52 (95%CI 0.31-0.72) and 0.50 (95%CI 0.28-0.72) respectively.
NR1/2, PXR, PPARA, FADS1), modifiers of oxidative stress
Identifying genetic variants has been the major focus of
(HFE, SOD2, GCLC, MRP2 (ABCC2), MTHFR), modifiers of
research world over, although modifying lifestyles and changing
endotoxin response (TLR4, CD14), modifiers of cytokine
dietary habits are known to benefit patients with NAFLD.
activity (TNF, sTNFr-2, FDFT1, IL6) and finally modifiers of
fibrogenesis (AGT, ATGR1, KLF6, TGFb1, COL13A1,
CDKN1A). With advances in genomic technologies (next
Dr Ravi Kanth generation sequencing, microarrays) it is now possible to look
at variants at a whole genome level to unravel causative
is the Group Leader of variants associated with the disease in an unbiased manner.
genetics at the Asian The first genome wide association study performed by Romeo
Institute of Gastroenterology et al. for NAFLD included a custom chip of approximately
located at Hyderabad, 9,000 non-synonymous variants across the genome. A variant
Telangana, India. (rs738409; c.444C>G; p.I148M) in PNPLA3 gene was identified
to be associated with increased liver fat across the ethnicities

Image shows
a fatty liver on
background with
micrograph of
liver steatosis
that were studied (European, Hispanic and is now known that the gene is a regulator of
African-American). Carrier of the minor
allele “G” conferred a twofold increase in
‘Multifactorial liver fat metabolism influencing triglyceride
secretion and hepatic lipid droplet content.
hepatic triglyceride content (HTGC). complex There is convincing evidence not only on
PNPLA3 gene exhibits lipase activity
against triglycerides in hepatocytes and this
conditions do the role of the variants but also the function
of the genes namely PNPLA3 and TM6SF2 in
missense variant (I148M) results in loss of not always conferring higher risk of NAFLD. Further,
function promoting hepatic steatosis by
limiting triglyceride hydrolysis.
manifest with variant in PNPLA3 is also associated with
higher levels of ALT, histologic NAFLD,
Subsequently the variant is now replicated the disease’ steatosis and hepatocellular carcinoma.
for its association with NAFLD across Therefore it would be appropriate to
ethnicities. A whole exome association genotype these variants as part of the
study identified that a variant (rs58542926; c.499 A>G; diagnostic workup for NAFLD to assess the predisposing risk of
Glu167Lys) in TM6SF2 gene is associated with NAFLD. an individual. This would aid in identifying variant carriers who
During the same time another study identified that this variant are at an enhanced risk for the NAFLD spectrum so that
is also know to influence total cholesterol content and appropriate lifestyle based recommendations to the individual can
myocardial infarction risk. The variant (rs58542926) is an be suggested including weight reduction, nutrition changes to
adenine to guanine substitution in the coding nucleotide 499, minimise the risk of the disease and/or progression.
replacing the amino acid glutamate with lysine at position 167
and is associated with HTGC. It is also suggested that the Referencs for this aticle are available at:
variant carriers have elevated mean and median HTGC. MiddleEastMedicalPortal.com/references
Functional studies have established the role of this gene and it

Life of an expat in the
Middle East…
Paramedic
‘I had an incredible and life changing experience whilst being apart of the medical
world in the Middle East. I am delighted to be able to share my experiences via this
new series, the life of an expat in the Middle East. I aim to portray the various aspects
involved in relocating to the ME for work and the many benefits.’
PART 1: The journey begins

Rachel It was 2015, I was working in the UK and I felt
McDonald unmotivated. I needed a new challenge, so, I decided
to apply to become a hospital-based paramedic in
Rachel McDonald is Saudi Arabia.
a British paramedic The first challenge was undertaking all of the health
who spent two-years screening and recruitment process. Via the NHS, I had to battle
working at one of the with GP receptionists, hospital appointments, and lengthy
biggest hospitals in forms, but eventually I completed everything.
Riyadh, Saudi Arabia. I have to admit that I felt terrified when my father dropped
Whilst working as an me off at the railway station so I could travel to the airport. I
EMT, she was hugged him goodbye and suddenly felt like I never wanted to
headhunted and let him go (I did eventually). Once on the airplane, I started
honoured to provide thinking of friends and loved ones who I had left behind,
medical support for my thoughts were aided by two lucky charm bracelets gifted
a royal family whilst from friends. I began to feel less terrified and became excited
they travelled. thinking about what might be in store for me during this new
adventure. I had previously prepared for my migration to Saudi

Expat life
Arabia by studying the religious and cultural climate so that I carbonate. These are common practice in most areas of the
could be respectful to my new host country. Whilst on-board, USA, so in comparison to my American colleagues I felt
I made a mental checklist ensuring that I had everything, somewhat behind. I was lucky enough to have been the only
including my abaya (a simple loose over-garment, essentially a new employee at that time, which meant that my training was
robe-like dress). one-to-one with Linda. A typical training session
I arrived on a Thursday evening and would involve discussion of a topic, some further
I was met in customs, then rushed reading for me and then a practical run through
through the queues (like a VIP). I felt and assessment. It was testing at the time, but
tense and guarded, however, I was put at in hindsight, I appreciate her hard work and
ease when lots of kind local men at the dedication.
airport started helping me retrieve my On top of all the normal aspects of learning
bags from the conveyer belt. An American a new role, I also had to learn the layout of the
female colleague collected me and took huge hospital. Shame I couldn’t just learn to
me to my new home. She told me a few locate my office and relax, I had four training
valuable pieces of information in-order for weeks to grasp where each department was
me to be safe whilst in The Kingdom. When so that I could correctly locate and move
we arrived at my accommodation, a box patients around once solo… this was a
of groceries welcomed me into my (shared) Rachel wearing
mission as the hospital was massive.
apartment and a sign showed me to my her abaya It was fascinating to be working with an
bedroom. I distinctly remember thinking, international team. One day, I was working
‘well this ain’t too shabby!’ with healthcare professionals from the
The next morning, I met my Australian ‘I needed Czech Republic, Tunisia, Syria, Kashmir,
roommate, she showed me around the Canada, USA, and of course Saudi Arabia.
social areas of the hospital and I got to a new It felt mad and exhilarating all at once.
meet her friends. Within Saudi Arabia, challenge, so, In the evenings I spent my time revising by
the weekend runs from Friday to Saturday, the swimming pool at my apartment and
Sunday is the first day of the week (it takes I became a occasionally did some baking to unwind.
some time getting used to for sure!) paramedic in I took the baked goods into the office as a
On the Sunday morning I met with my ploy to ‘break the ice’ and let people know
clinical supervisor, Linda. Little did I know Saudi Arabia’ that, ‘I am alright’. They were gratefully
that I would be spending a lot of time with received as everyone takes
her over the next four-weeks and I had to Charm bracletes kindly to food and I think this
hit the ground running with the amount new information truly helped me to connect to
given to me. At that time, I held seven years’ experience my new colleagues.
working within emergency care and as a mentor. I However, what I didn’t realise
felt confident within my trade, however, this old dog during those primal stages was
was about to learn some new tricks. Only problem is, that I would have contact with
when a certain way of patient care, algorithms, policy, some really challenging cases. It
procedure, and societal health-norms are drummed meant that I had to work on my
into you, those ‘new tricks’, know confidence and leadership skills.
how to catch you out. Linda liked A cardiac arrest scenario is a
The pool
to take the approach of, ‘no one pretty standard situation for any
knows anything’. She was used paramedic, however, when working with
to training international medics an international team there can be some
with varying degrees of training language barriers. I was also involved in
and experience and therefore her the transport or critically unwell neonate
approach was justified, everyone patients, maintenance of safe infusion of
started from a blank sheet. blood products and would have to ensure
New skills included the use of the stability of cadavers destined for
infusion pumps, machines that allow organ harvesting.
for a constant or timed administration
of a medication, also cardioversion and pacing, which are I’ll explain the highs and lows involved in these
interventions that convert the heart rate to a slower rate trials in my next article, thanks for reading this far
or ensure a faster rate. I also had to get my head around and please join me next time.
a comparatively more in-depth use of ventilators and the
sedation of patients and the use of some new drugs such as;
dopamine, fentanyl, midazolam, magnesium, and calcium

Medical books
Current Surgical Guidelines Fragile lives:

Oxford University Press specialist A Heart Surgeon’s Stories of Life
handbooks in surgery and Death on the Operating Table
ABDULLAH JIBAWI, MOHAMED BAGUNEID, AND ARNAB PROFESSOR STEPHEN WESTABY, HARPERCOLLINS,
BHOWMICK ISBN: 9780198794769 ISBN: 9780008196769
Back for a second edition, An incredible memoir from one

Current Surgical Guidelines has of the world’s most eminent
been fully updated to reflect heart surgeons, Stephen Westaby
changes in guidelines across the who is a consultant cardiac
surgical sub-specialities since surgeon at the Oxford Heart
its first publication. Drawing Centre, John Radcliffe Hospital.
together printed and digital In this medical biography
guidelines from the Scottish he recalls some of the most
Intercollegiate Guidelines remarkable and poignant cases
Network (SIGN), the National he’s worked on.
Institute for Health and Clinical Professor Stephen Westaby
Excellence (NICE), and relevant took chances and pushed the
US guidelines, this book acts boundaries of heart surgery. He
as a valuable complete and saved hundreds of lives over the
comprehensive reference for course of a thirty-five year career
those embarking on their surgical training, revising for exams, and now, in his astounding memoir, Westaby details some of
or for senior staff as an aide-memoire. his most remarkable and poignant cases – such as the baby
Guidelines have been distilled into summary tables, and who had suffered multiple heart attacks by six months old, a
topics are formulated to answer most real-life clinical practice woman who lived the nightmare of locked-in syndrome, and a
questions with contemporary facts figures. man whose life was powered by a battery for eight years.
Sympathy for the Devil: Depression and Type 2 Diabetes

The Definitive True Story of Oxford University Press
Cancer Biotechnology and specialist handbook
Its Battle Against Disease, EDITED BY KHALIDA ISMAIL, ANDREAS BARTHEL, STEFAN R.
BORNSTEIN, AND JULIO LICINIO ISBN: 9780198789284
Death and Destruction
Type 2 diabetes is a major
DR GARY ACTON, MATADOR, ISBN: 978-1780885117
global health concern,
Gary Acton is a London and is predicted to affect
oncologist and his book between 10% to 25% of
offers a unique insight into the world’s population
the chaotically unpredictable in the next 20 years. This
world of cancer medicine and epidemic is mostly attributed
the biotechnology industry. to ageing populations and
Sympathy For The Devil is unhealthy lifestyles. Thusly,
the account of one company understanding how the mind
struggling to survive, as all their interacts with the body is
experimental cancer drugs fail. essential in unlocking the
Now they only have one left. psychological, biological, and
Battling for their existence turns sociocultural processes that
into a race against time, in an increase the risk of type 2
adventure taking them from diabetes and make it such a
New York to New Delhi. This is difficult condition to treat. Depression is a common co-morbid
a tragicomic true story, frequently bordering on the surreal. It condition and when both conditions are present, this poses
reveals, for the first time, the extraordinary world inhabited by a significant challenge to patients, clinicians, and health care
the people involved in cancer drug development. systems globally.

Middle East Jobs Portal
MANAGEMENT & DIRECTORS JOBS

Director of Nursing - Director of Nursing,
Standards of Care and Quality Neonatal Services
King Abdulaziz Medical City National Guard Health Affairs
(NGHA), Saudi Arabia Hospital, Saudi Arabia
BENEFITS BENEFITS
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English Language Skills: Level l-Skilled
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Case Manager King Saud University Hospital, Saudi Arabia

BENEFITS EXPERIENCE • Knowledge of Hospital
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NURSING JOBS
Nurse Educator Registered Nurse, Burns Unit
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Events
16th International Conference on Annual Conference on Bacterial, Viral

Gastroenterology and Digestive and Infectious Diseases
Disorders August 06-07 at Abu Dhabi August 06-08 in Abu Dhabi, UAE.
Further details at: Further details at:
gastroenterology.astroconferences.com bacterialdiseases.infectiousconferences.com
28th International Conference on Clinical Neuroscience and

Cardiology and Healthcare Neurogenetics Conference
August 09-11, 2018 Abu Dhabi, UAE August 13-14, 2018 in Dubai, UAE
Further details at: Further details at:
healthcare.cardiologymeeting.com neurogenetics.neuroconferences.com

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MIDDLE

Vision 2030 New UAE visa

2 July 2018 MiddleEastMedicalPortal.com

MiddleEastMedicalPortal.com July 2018 3

4 July 2018 MiddleEastMedicalPortal.com

The purpose of MEMP is to be the premier

MiddleEastMedicalPortal.com July 2018 5

Al Jalila Children’s Kuwait’s polio laboratory Bahrain to commence

6 July 2018 MiddleEastMedicalPortal.com

Al-Balsam International Organisation conducts 93 Jordan Government

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Doctors Without Borders

Al Moadamya primary health care centre in rural

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Gold Certification for Excellence in person-centred

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Beatle’s poison may be a

Professor Sinan Anla

Hala Zayed appointed as Minister of Health

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Award-winning Doctor returns to help

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Blockchain, AI, and

I should have taken heed of

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14 July 2018 MiddleEastMedicalPortal.com

‘Doctor’ Whether the label ‘Doctor’ remains in

Who will will take (it will be on site at the

MiddleEastMedicalPortal.com July 2018 15

16 July 2018 MiddleEastMedicalPortal.com

humans.’ His response was that

MiddleEastMedicalPortal.com July 2018 17

The New Healthcare

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The big question

MiddleEastMedicalPortal.com July 2018 19

Aldara Hospital and

Aldara Hospital and Medical

20 July 2018 MiddleEastMedicalPortal.com

MiddleEastMedicalPortal.com July 2018 21

Hobbs and Black. It is a purpose-built Living at Aldara

22 July 2018 MiddleEastMedicalPortal.com

brought this dynamic network onto the platform, thereby

Dr Rizwan Qureshi MB, FCPS,

SURGINS is among the fastest growing stainless-steel

FOR FURTHER INFORMATION surgins.co.uk

MiddleEastMedicalPortal.com July 2018 23

The opportunities in healthcare

279 hospitals there are significant needs to be met. 600,000

24 July 2018 MiddleEastMedicalPortal.com

• Establish medical facilities;

MiddleEastMedicalPortal.com July 2018 25

Marwan Abdulaziz Janahi, Executive

MiddleEastMedicalPortal.com July 2018 29

Dubai Science • Warehouse space designed

MiddleEastMedicalPortal.com July 2018 31

Marwan Abdulaziz Janahi,

Put the building blocks

simulate long-ago you can create an earth-bound Second

MiddleEastMedicalPortal.com July 2018 33

“expectations or able to sustain itself.

individual’s inner living That is the challenge

34 July 2018 MiddleEastMedicalPortal.com