Egypt is the most populous Arab country in the world and has a growing population rate. The demand for healthcare services is expected to grow continuously with Egypt requiring an additional 26,000 beds (at 1.5 beds / 1,000 population) with an investment of $6 billion to $9 billion. Dr Soliman highlights the healthcare investment opportunities.
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In the Middle East, the growth of palliative care is still in its early stages. Dr Lama El Zein discusses how providing palliative care has shown to have extensive benefits for patients with serious illnesses by improving quality of life, decreasing unnecessary cost and improving care throughout the illness.
Continue reading1. Kelley, A. S., & Morrison, R. S. (2015). Palliative Care for the Seriously Ill. New England Journal of Medicine, 373(8), 747–755. https://doi.org/10.1056/NEJMra1404684
2. WHO | WHO Definition of Palliative Care. (n.d.). Retrieved October 26, 2018, from WHO website: http://www.who.int/cancer/palliative/definition/en/
3. National Institute on Aging. What Are Palliative Care and Hospice Care? (n.d.). Retrieved April 25, 2019, from National Institute on Aging website: https://www.nia.nih.gov/health/what-are-palliative-care-and-hospice-care
4. Murray. S., Osman. H., WHO EMRO | Primary palliative care: the potential of primary care physicians as providers of palliative care in the community in the Eastern Mediterranean Region | Volume 18, issue 2 | EMHJ volume 18, 2012.. Retrieved October 28, 2018, from http://www.emro.who.int/emhj-volume-18-2012/issue-2/article-11.html
5. Zeinah, G. F. A., Al-Kindi, S. G., & Hassan, A. A. (2013). Middle East Experience in Palliative Care. American Journal of Hospice and Palliative Medicine®, 30(1), 94–99. https://doi.org/10.1177/1049909112439619
6. Shamieh, O., & Hui, D. (2015). A Comprehensive Palliative Care Program at a Tertiary Cancer Center in Jordan. American Journal of Hospice and Palliative Medicine®, 32(2), 238–242. https://doi.org/10.1177/1049909113513316
7. Wright, A. A., Zhang, B., Ray, A., Mack, J. W., Trice, E., Balboni, T., … Prigerson, H. G. (2008). Associations Between End-of-Life Discussions, Patient Mental Health, Medical Care Near Death, and Caregiver Bereavement Adjustment. JAMA, 300(14), 1665–1673. https://doi.org/10.1001/jama.300.14.1665
8. Temel, J. S., Greer, J. A., Muzikansky, A., Gallagher, E. R., Admane, S., Jackson, V. A., … Lynch, T. J. (2010). Early Palliative Care for Patients with Metastatic Non–Small-Cell Lung Cancer. New England Journal of Medicine, 363(8), 733–742. https://doi.org/10.1056/NEJMoa1000678
9. Meier, D. E., Back, A. L., Berman, A., Block, S. D., Corrigan, J. M., & Morrison, R. S. (2017). A National Strategy For Palliative Care. Health Affairs; Chevy Chase, 36(7), 1265–1273. http://dx.doi.org.ezproxy.cul.columbia.edu/10.1377/hlthaff.2017.0164
10. DiBello, K. M., & Coyne, N. M. (2014). Palliative Care Hits a Triple Win: Access, Quality, and Cost. Home Healthcare Nurse, 32(3), 183–190. https://doi.org/10.1097/NHH.0000000000000026
11. Johnson, D. (2018).Enhanced Physician Training And Support Are Needed To Improve End-Of-Life Care. Health Affairs Blog. August 2, 2018. Retrieved November 3, 2018, from https://www.healthaffairs.org/do/10.1377/hblog20180730.54577/full/
12. OHCHR | Right to pain relief: 5.5 billion people have no access to treatment, warn UN experts World Hospice and Palliative Care Day – Saturday 10 October 2015. Retrieved April 25, 2019, from https://www.ohchr.org/en/NewsEvents/Pages/DisplayNews.aspx?NewsID=16590&LangID=E
13. WHA67.19 – Strengthening of Palliative Care as a Component of Comprehensive Care Throughout the Life Course. WHA Resolution; Sixty-seventh World Health Assembly, 2014 . Retrieved October 30, 2018, from http://apps.who.int/medicinedocs/en/d/Js21454ar/
Professor Samar Ahmed highlights a stand-alone workplace culture crisis within Health Professions Schools. She discusses how faculty in these schools are burdened with the responsibility to build graduates who are willing to work under extreme stress and yet remain empathic and human. Dr Samar Ahmed provides a range of solutions to address the workplace culture crisis.
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A large majority of people will experience back pain at some point in their lives. It is estimated that 540 million people globally are affected by low back pain and it is the main cause of disability worldwide. A peer-reviewed research study concluded that the highest prevalence of low back pain is in Western Europe, followed by the MENA region
Continue reading2. Harvard men’s Health watch, Dec 2018
3. Pud med Mt Sinai J Med. 1991 May;58(3):217-20., Grichnik KP1, Ferrante FM.
Urine testing may be as effective as the smear test at preventing cervical cancer, according to a study published in the journal BMJ Open.
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The thalassemia syndromes are genetic disorders characterized by absent or deficient synthesis of one or more of the normal globin chains. Biotechnologist Osama Atif provides an overview of these gentic disorders.
Continue readingCappellini MD. The thalassemias. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 162.
Chapin J, Giardina PJ. Thalassemia syndromes. In: Hoffman R, Benz EJ, Silberstein LE, et al, eds. Hematology: Basic Principles and Practice. 7th ed. Philadelphia, PA: Elsevier; 2018:chap 40.
Weatherall, David J., and John B. Clegg. The thalassaemia syndromes. John Wiley & Sons, 2008.
Schrier, Stanley L. “Pathophysiology of thalassemia.” Current opinion in hematology 9.2 (2002): 123-126.
Chui DH, Waye JS. Hydrops fetalis caused by alpha-thalassemia: an emerging health care problem. Blood. 1998;91:2213–22.
Higgs DR, Bowden DK. Clinical and laboratory features of the alpha-thalassemia syndromes. In: Steinberg MH, Forget PG, Higgs DR, Nagel RL, eds. Disorders of Hemoglobin: Genetics, Pathophysiology, and Clinical Management. Cambridge, UK: Cambridge University Press; 2001:431-69.
Coelho A, Picanço I, Seuanes F, Seixas MT, Faustino P. Novel large deletions in the human alpha-globin gene cluster: Clarifying the HS-40 long-range regulatory role in the native chromosome environment. Blood Cells Mol Dis. 2010;45:147–53.
Chui DH: Alpha-thalassemia: Hb H disease and Hb Barts hydrops fetalis. Ann N Y Acad Sci. 2005, 1054: 25-32. 10.1196/annals.1345.004.
Ingram VM, Stretton AO: Genetic basis of the thalassaemia diseases. Nature. 1959, 184: 1903-1909. 10.1038/1841903a0.
Bernini L: Geographic distribution of alpha-thalassemia. Disorders of Hemoglobin. first edition. Edited by: Steinberg MH, Forget BG, Higgs DR, Nagel RL. Cambridge University Press; 2001:878-894.
Ko T, Hsieh FJ, Hsu PM, Lee TY. Molecular characterization of severe α-thalassemias causing hydrops fetalis in Taiwan. Am J Med Genet 1991; 39: 317–320.
Steensma DP, Viprakasit V, Hendrick A, Goff DK, Leach J, Gibbons RJ, Higgs DR. Deletion of the alpha-globin gene cluster as a cause of acquired alpha-thalassemia in myelodysplastic syndrome. Blood. 2004b;103:1518–20.
Galanello, Renzo, and Raffaella Origa. “Beta-thalassemia.” Orphanet journal of rare diseases 5.1 (2010): 11.
Weatherall DJ, Clegg JB. Inherited haemoglobin disorders: an increasing global health problem. Bull World Health Organ. 2001;79(8):704-712.
Weatherall DJ. Hemoglobinopathies worldwide: Present and future. Curr Mol Med. 2008;8:592–599
Steinberg MH, Forget BG, et al., editors. Disorders of hemoglobin: genetics, pathophysiology and clinical management. Cambridge University Press; 2001.
Verma S, Bhargava M, Mittal S, Gupta R. Homozygous delta-beta thalassemia in a child: a rare cause of elevated fetal hemoglobin. Iran J Ped Hematol Oncol. 2013;3:222–227.
Bollekens JA, Forget BG. Delta beta thalassemia and hereditary persistence of fetal hemoglobin. Hematol Oncol Clin North Am. 1991;5:399–422.
Forget, Bernard G. “Molecular basis of hereditary persistence of fetal hemoglobin.” Annals of the New York Academy of Sciences850.1 (1998): 38-44.
Bollekens, J. A. & B. G. Forget. 1991. δγ Thalassemia and hereditary persistence of fetal hemoglobin. Hematol. Oncol. Clin. North Am. 5: 399–422.
According to the paper now available online, TP53 is the most frequently mutated gene in triple negative breast cancer, meaning it is fuelling the growth of this aggressive form of breast cancer. However, the problem with trying to target mutated TP53, specifically, is that it is not a druggable target, because of its potential toxicity – or ability to kill – nearby healthy cells.
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Vasopressors are medications that causes vasoconstriction; some of them have additional inotropic effect. By maintaining end-organ perfusion; the role of vasopressors remains critical to prevent irreversible organ injury and failure, and their use is usually accompanied by fluid resuscitation for adequate patient outcomes. Vasopressor agents are used clinically in the treatment of arterial hypotension in shock states. Shock is best defined as inadequate blood flow to meet the metabolic needs of the tissues. The most common reasons for shock are the cardiac output is low relative to the global demand, despite increased O2 extraction by the tissues; or perfusion pressure is inadequate such that blood flow distribution to metabolically active tissues is inadequate, despite an otherwise adequate cardiac output.
Continue reading1. Jentzer JC, Coons JC, Link CB, Schmidhofer M. Pharmacotherapy update on the use of vasopressors and inotropes in the intensive care unit. Journal of cardiovascular pharmacology and therapeutics. 20(3):249-60. 2015.
2. Senz A, Nunnink L. Review article: inotrope and vasopressor use in the emergency department. Emerg Med Australas. 2009 Oct;21(5):342-51.
3. Bangash MN, Kong ML, Pearse RM. Use of inotropes and vasopressor agents in critically ill patients. Br J Pharmacol. 2012 Apr;165(7):2015-33.
4. Tisdale JE, Patel RV, Webb CR, Borzak S, Zarowitz BJ. Proarrhythmic effects of intravenous vasopressors. Ann Pharmacother. 1995 Mar. 29(3):269-81.
5. Hollenberg SM. Vasoactive drugs in circulatory shock. American journal of respiratory and critical care medicine. 183(7):847-55. 2011.
Deborah Kobewka, Managing Director of Healthcare UK, shares insights from the UK’s National Health Service, on how healthcare authorities and operators in the Gulf states can build, design, and operate the ‘Hospital of the Future’.
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Dr Ivonne Bedei, Dr Amelie Hofmann-Werther, and Dr Afshin Pour Mirza provide detailed information about the prenatal diagnosis of Turner syndrome.
Continue reading2. Sävendahl L, Davenport ML. Delayed diagnosis of Turner´s syndrome: proposed guidelines for change. J Pediatr. 2000;137(4):455-459).
3. Dondorp W, de Wert G, Bombard Y, et al. Non-invasive prenatal testing for aneuploidy and beyond: challenges of responsible innovation in prenatal screening. Eur J Hum Genet. 2015;23:1438-1450.
4. Schmid M, Klaritsch P, Arzt W, Burkhardt T, Duba H, Häusler M, et al. Cell-free DNA testing for fetal chromosomal anomalies in clinical practice: Austrian-German-Swiss recommendations for non-invasive prenatal tests (NIPT). Ultraschall Med – Eur J Ultrasound 2015;36:507–10).
5. Murdock DR, Donovan FX, Chandrasekharappa SC, Banks N, Bondy C, Muenke M, et al. Whole-exome Sequencing for Diagnosis of Turner syndrome: Towards Next Generation Sequencing and Newborn Screening. J Clin Endocrinol Metab. 2017
6. Hook EB, Warburton D. The distribution of chromosomal genotypes associated with Turner´s syndrome: livebirth prevalence rates and evidence for diminished fetal mortality and severity in genotypes associated with structural X abnormalities or mosaicism. Hum Genet. 1983;64:24-7
7. Alpman A, Cogulu O, Akgul M, Arikan EA, Durmaz B, Karaca E, Sadol S, Ozkinay C, Ozkinay F 2009 Prenatally diagnosed Turner syndrome and cystic hygroma: incidence and reasons for referrals. Fetal Diagn Ther 25:58-61)
8. Bondy C. Recent Developments in Diagnosis and Care for girls with Turner syndrome. Advances in Endocrinology Volume 2014, Article ID 231089.
9. Ibarra-Ramirez M, Martinez-de-Villareal LE. Clinical and genetic aspects of Turner´s syndrome. Medicina Universitaria. 2016;18(70):42-48).
10. Viuff MH, Stochholm K, Uldbjerg N, Nielsen BB, the Danish Fetal Medicine Study Group, and Gravholt CH. Only a minority of sex chromosome abnormalities are detected by a national prenatal sceening program for Down syndrome.Human Reproduction, Vol.30, No 10pp.2419-2426,2015).
11. Sybert VP, McCauley E. Turner´s Syndrome N Engl J Med 2004; 351:1227-1238,
12. Chang HJ, Clark RD, Bachman H. The Phenotype of 45,X/46,XY Mosaicism: An Analysis of 92 Prenatally Diagnosed Cases. Am. J. Genet. 46:156-167, 1990).
13. Gil MM, Accurti V, Santacruz B, Plana MN, Nicolaides KH. Analysis of cell-free DNA in maternal blood in screening for aneuploidies: updated meta-analysis. Ultrasound Obstet Gynecol 2017; 50:302-314).
14. Reiss RE, Discenza M, Foster J, Dobson L, Wilkins-Haug L. Sex chromosome aneuploidy detection by noninvasive prenatal testing: helpful or hazardous? Prenatal Diagnosis 2017, 37; 515-520
15. Grati FR, Bajaj K, Zanalfa V, Malvestiti F, Malvestiti B, Marcato L. Implications of fetoplacental mosaicism on cell-free DNA testing for sex chromosome aneuploidies. Prenatal Diagnosis 2017. 37. 1017-1027).
16. Malvestiti F, Agrati C, Grimi B, et al. Interpreting mosaicism in chorionic vili: results of a monocentric series of 1001 mosaics in chorionic villi with follow-up amniocentesis. Prenatal Diagnosis 2015, 35, 1117-1127)
17. Russell LM, Strike P, Browne CE, Jacobs PA. X Chromosome loss and aging. Cytogenet Genome Res 116:181-185(2007).
18. Zhang B, Lu B-Y, Zheng F-X, Zhou Q, Cheng Y-P, Zhang X-Q. Noninvasive prenatal screening for fetal common sex chromosome aneuploidies from maternal blood. J Med Res. 2017 Apr; 45(2): 621-630.
19. Bevilacqua E, Ordonez E, Hurtado I, Rueda L, Mazzone E, Cirigliano V, Jani JC. Screening for Sex Chromosome Aneuploidy by Cell-Free DNA Testing: Patient Choice and Performance. Fetal Diagn Ther DOI: 10.1159/000479507.
20. Chitty LS, Hudgins L, Norton ME. Current controversies in prenatal diagnosis 2: Cell-free DNA prenatal screening should be used to identify all chromosome abnormalities. Prenatal Diagnosis. 2018;38:160-165)
21. Samango-Sprouse C, Banjevic M, Ryan A, Sigurjonsson S, Zimmermann B, Hill M, Hall MP, Westmeyer M, Saucier J, Demko Z, Rabinowitz M. SNP-based non-invasive prenatal testing detects sex chromosome aneuploidies with high accuracy. Prenat Diagn. 2013 July; 33(7): 643-649.
22. Bronstein M, Zimmer EZ & Blazer S. A characteristic cluster of fetal sonographic markers that are predictive of fetal Turner syndrome in early pregnancy. American Journal of Obstetrics and Gynecology 2003 188 1016-1020.
23. Gravholt CH et al. Clinical practice guideline for the care of girls and women with Turner syndrome: proceedings from the 2016 Cincinnati International Turner syndrome Meeting. European Journal of Endocrinology 2017;177:3 G1-G70).
