80% of women diagnosed have advanced breast cancer

Eight out of 10 women who attend the breast cancer clinic at Dubai Hospital for the first time are diagnosed with advanced disease, which although curable, adversely impacts on their survival, one of the clinic’s doctors has warned.

Hospital data shows that approximately 60% of all those who attend the Department of Medical Oncology at Dubai Hospital have breast cancer, from where they are referred to the specialist clinic.

Of these, 80% are found to have stage two or three disease, a stark contrast to countries with comprehensive screening programmes, where a greater percentage of women present with pre-invasive or stage one disease, according to Dr Shaheenah Dawood, a senior specialist registrar in the Oncology Department at Dubai Hospital.

“The earlier you are diagnosed the better the outcome. In countries with screening programmes the majority of women present with pre-invasive disease, or stage one. But here most of the women present with advanced stage disease, which is still curable, but has a poorer overall prognosis compared with earlier stage disease,” Dr Dawood said.

The late diagnosis situation has prompted healthcare professionals at the hospital to start drawing up plans for a sustainable breast cancer awareness campaign, which will be rolled out across the emirate in the coming year.

Preliminary proposals include integrating breast cancer services in Dubai, educating women in breast self-examination, and creating a breast screening programme for both nationals and non-nationals.

Guidelines for screening, which will include mammography and genetic testing for high-risk patients, are currently being developed by the hospital’s multi-disciplinary Breast Cancer Awareness Committee, which was established in May this year.

Arab women fail to seek medical advice for breast lumps because of a widespread cultural fear of cancer, Dr Dawood, a UAE national, revealed. She added that women often delay action because they are embarrassed to reveal intimate medical problems to male relatives.

“In the Arabic population, the word cancer is taboo, and there is not enough awareness in the society as a whole of the disease. But, that attitude is changing among the younger generation,” she explained.

“This year we want to promote breast self-examination and educate women about it. We want to encourage women to come to the clinic as soon as they have a problem, so that they can get maximum benefit from some of the very effective treatments now available,” she added.

Turkey’s Acibadem provides training for Iraqi doctors

Turkey-based Acibadem Healthcare Group has provided a group of Iraqi doctors and nurses a training course to enable them to train their colleagues about the latest treatment options for diabetes.

Acibadem provides premium healthcare services through nine general hospitals and eight out-patient medical centres across Turkey.

Nesrir Majid Bahram, a diabetes nurse who attended the course, said: “The most critical step in the treatment of diabetes disease is the efficient training of the patients on how to take care of themselves.”

Dr Anwer Kakl, who works at a private diabetes centre in Arbil, Iraq, said the incidence of diabetes in Iraq has increased significantly due to a number of factors including poor nutrition and inadequate healthcare because of the war.

“The war changed the lives of our people. And the troubles continue even after the war has finished. Heightened trauma and stress in the community have also played a role in increasing the incidence of diabetes in all age groups,” he said.

“In the two-week course, Acibadem staff shared with us the most recent developments on diabetes and treatment approaches.

AHD opens specialist foetal maternal medicine unit

The American Hospital Dubai (AHD) has opened what it claims is the region’s first Fetal & Maternal Medicine Unit to manage high risk pregnancies associated with age and medical conditions such as diabetes.

The unit offers counselling to the parents and acts as a hub linking obstetrics and the other specialties for multidisciplinary care.

AHD says progress in obstetric ultrasound scanning has greatly increased the ability to identify and diagnose at an early stage babies with congenital anomalies, genetic syndromes and babies who fail to thrive in utero. The advanced training and skills needed to deal with these cases has led to the creation of a subspecialty in obstetrics called ‘foetal/ maternal medicine’ in UK, and ‘perinatology’ in the US.

Dr George Michailidis, Head of the new Fetal & Maternal Medicine Unit at the American Hospital Dubai, explains: “Changes in lifestyle and culture – as well as developments in assisted reproductive techniques - have led to more mothers deferring their pregnancies until their late 30s or even early 40s. This in turn has resulted in an amplification of medical problems in pregnancy and complications associated with advanced maternal age.

“With the help of advanced foetal scanning technology and dedicated specialists, we can now examine the foetus at a very early stage and identify possible problems. By diagnosing these problems in the first trimester the parents have the opportunity to decide how to continue the pregnancy with the expert guidance and support of our foetal medicine team.”

The American Hospital Dubai delivers around 2,000 babies every year and has one of the largest private obstetric units in Dubai.

Lebanon’s AUB & CMC sign collaboration MoU

The American University of Beirut Medical Center (AUBMC) and Clemenceau Medical Center, affiliated with Johns Hopkins International (CMC), in Lebanon, signed a memorandum of understanding (MOU) 6 July, to establish a new collaborative effort that will focus on specific areas of clinical and academic medicine. The two institutions will team up on several levels, including the creation of centres of excellence and the development of quality standards in healthcare.

“Excellence and relentless commitment to high quality patient care are deeply instilled in the institutional cultures of both AUB and CMC, and this is personified in the physicians, nurses and staff,” said Dr Mounes Kalaawi, CEO of CMC. “With this collaboration, the two institutions will enhance the work for their strategic plan to be at the forefront of medicine and deliver the highest quality health care.”

Dr Mohamed Sayegh, the new Vice President for Medical Affairs and Dean of the Faculty of Medicine and Medical Center of the American University of Beirut, said it was an historic occasion that “sets the stage for future collaboration between AUBMC and academic institutions in Lebanon and the region”.

He said the MoU will facilitate the development of “synergies among physicians and staff that will promote the advancement of medical knowledge through research, and provide the best in medical training for students and residents”.

Egypt moves to prevent bubonic plague outbreak

In July IRIN reported that the Egyptian authorities were taking measures to prevent a bubonic plague outbreak in neighbouring Libya from reaching Egypt.

At the time (6 July) WHO reported one person dead from the septicaemic plague and five others infected with bubonic and septicaemic plague in the eastern Libyan town of Tubruq, some 150km from the Egyptian border.

Dr John Jabbour, emerging diseases specialist at the WHO office in Cairo, said the WHO expert in Libya had made recommendations to the Libyan authorities on how to educate communities about the disease and its modes of transmission and how to improve surveillance systems in infected areas.

He said the situation was under control.

In the same report, IRIN said a London-based newspaper Al-Quds Al-‘Arabi, reported 50 cases of bubonic plague and two deaths in Algeria.

WHO said people infected with bubonic plague usually start with “flu-like” symptoms after an incubation period of 3-7 days. Patients typically experience the sudden onset of fever, chills, head and body-aches, and weakness, vomiting and nausea. The organisation stressed that rapid diagnosis and treatment is essential to reduce complications.

According to WHO clinical plague infection manifests itself in three forms depending on the route of infection: bubonic, septicaemic and pneumonic.

Plague is a bacterial disease caused by Yersinia pestis, which primarily affects wild rodents or rats. It is then spread from rat to rat by fleas. If a human is bitten by an infected flea, he or she would usually develop a bubonic form of plague (a form that enters via the skin), characterised by a swelling of the nearest nymph node to the bite. If diagnosed early, bubonic plague can be successfully treated with antibiotics. It has a case-fatality ratio of 30- 60% if left untreated.

The rare pneumonic form of plague is the most virulent as it can be transmitted from human to human via aerosolised infective droplets without the involvement of fleas or animals.

According to WHO, plague is endemic in many countries in Africa, in the former Soviet Union, the Americas and Asia. In 2003, nine countries reported 2,118 cases and 182 deaths – most in Africa.

Al Mousawi appointed president of RCSI Bahrain

The Royal College of Surgeons in Ireland (RCSI) and the Royal College of Surgeons Medical University of Bahrain (RCSI Bahrain) has appointed Dr Faisal Al Mousawi president of the university. Dr Al Mousawi, who has been chairman of the RCSI Bahrain Board of Governors, was due to take up the position on 1 September.

In a statement, the university said Dr Al Mousawi, as a surgeon and Fellow of the Royal College of Surgeons in Ireland, has played a crucial part in developing the close relationship between the Kingdom of Bahrain and RCSI for over a quarter of a century, particularly in the areas of medical education and training, culminating in the establishment of the Medical University of Bahrain in 2004.

H1N1 WHO patient care checklist

A new Patient Care Checklist for Influenza A (H1N1) has been developed by WHO for use by hospitals worldwide for the treatment of suspected or confirmed cases of this new virus. You can download via this link.


All hospitals are being encouraged to use the checklist and, where appropriate, to modify it to suit their local practice.

Kuwait to build 8 new hospitals

Arabian Business reports that Kuwait is to spend to US$3.1 billion on building eight new hospitals by 2016.

Dr Fadhel Safar, the Minister of Public Works and Minister of State for Municipal Affairs was quoted as saying the construction would take place in three stages, beginning with Al- Jahra hospital which will include maternity facilities.

Middle East Doctor

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Tawam marks anniversary of patient safety programme

In June staff at Tawam Hospital in Al Ain, UAE, celebrated the first anniversary of the Comprehensive Unit-based Safety Patient (CUSP) programme, an initiative designed to help ensure patient safety.

The programme allows frontline caregivers to identify and address hazards through steps such as measuring the safety-related culture of the unit, leveraging the wisdom of frontline personnel about the dangers facing patients, and opening the lines of communication between caregivers, managers and executives.

The CUSP programme, developed by Johns Hopkins physicians in 2001, is a mission-tested approach that has elevated safety consciousness across clinical units at the Johns Hopkins Hospital and numerous facilities outside the United States. It has helped to significantly reduce the incidence of surgical-site infections, ventilator-associated pneumonia, bloodstream infections, and wrong-site surgeries.

Abu Dhabi’s UE Medical signs MOU with top New York hospital

United Eastern Medical (UEMedical), a leading healthcare investment and development company in Abu Dhabi, has signed a Memorandum of Understanding with the world renowned Hospital for Special Surgery (HSS) in New York. The agreement aims to establish a regional Centre of Excellence for Orthopedics and Rheumatology in Abu Dhabi.

HSS’s areas of expertise include joint replacement, spine surgery, sports medicine, orthopedic trauma, hand surgery, foot and ankle surgery and rheumatology.

Warning issued against use of unlicensed herbal medication

Dr Abdullah Al-Baddah, Executive Director of the Saudi Arabian National Center for Alternative and Holistic Medicine in the Ministry of Health issued a warning to Saudis against using herbal preparations not licensed by the Saudi Food and Drug Authority. He issued the warning after several recent deaths were attributed to unlicensed herbal preparations. He was quoted as saying in the Saudi Gazette that more people were turning to herbal medicine because of the failure of modern medicine to treat some diseases, particularly chronic diseases. He pointed out that some people also had a fear of the side-effects of modern medicine, which prompted them to look for alternative medication.

Kidney centre in Jeddah to house 140 dialysis machines

The Saudi Gazette reported in late June that King Fahad Hospital in Jeddah will build and house what is claimed to be the world's largest kidney dialysis centre at a cost of SR60 million (US$16m). The unit will take about 18 months to complete.

The Prince Abdul-Majeed Bin Abdul Aziz Center for Kidneys will have 140 dialysis machines and serve more than 800 renal failure patients. The unit will employ 17 consultants, 34 resident-physicians and specialists and 280 nurses.

Meanwhile, the kingdom’s largest heart centre, being built in Madina at a cost of SR120 million, is scheduled to be completed by January next year, according a report in the Saudi Gazette.

● See Saudi Report pg 60.

Umrah pilgrim dies of H1N1 influenza

An Egyptian woman died 19 July of the new H1N1 flu virus after falling ill while on Umrah pilgrimage to Saudi Arabia, an Egyptian health ministry official told journalists. The official said the woman, who suffered from a pre-existing heart ailment due to rheumatic fever, had travelled to Saudi Arabia for the minor pilgrimage in early July, and developed flu symptoms on 11 July. She was treated in Saudi Arabia but did not respond to treatment, and returned to Egypt at the request of her husband. She was in her twenties.

● See H1N1 Update pg 24.

American Hospital Dubai installs PET-CT scanner

Dubai’s first operational PETCT scanner has been unveiled at the American Hospital Dubai, following the licensing of the hospital to provide PET/CT scanner services to patients. The Siemens 64- slice PET-CT scanner provides accurate diagnosis, treatment and management of diseases such as cancers and neurological conditions such as Alzheimer’s.

The scanner can detect cancers in their earliest stages by imaging metabolic activity in the body and can show tumour pathology before anatomical or structural changes are evident on conventional imaging. Clinical studies show that PET/CT indicates metabolic changes in the brain at a very early stage and helps diagnose Alzheimer’s disease two years before obvious clinical signs have developed.

150 Iranians suffer from anthrax infection

There are 150 people in the Islamic Republic infected with anthrax, an official of the Iranian health ministry announced 11 August 2009. “We have managed to control the spread of the disease throughout the country during recent years,” Mohammad- Reza Shirzadi was quoted in the Tehran Times as saying. He added “there is no concern in this regard”. Fortunately, there are vaccines effective against anthrax, and some forms of the disease respond well to antibiotic treatment, he noted.

A note by ProMED-mail (www.promedmail.org) rapporteur Susan Baekeland points out that “150 human cases in (presumably) 2008 is not a small number. In 2002 Iran reported 269 human cases to OIE (World Organisation for Animal Health); 250 in 2003; 155 (and 1 death) in 2005; and 165 cases (and 1 death) in 2007. Thus it is a constant human threat in the country.”

UNODC and Iran agree Afghan refugees HIV measures

The Executive Director of the United Nations Office on Drugs and Crime (UNODC), Antonio Maria Costa, and the Deputy Secretary General of the Islamic Republic of Iran's Drug Control Headquarters, Taha Taheri signed, earlier this year, two projects to provide HIV prevention and care services to Afghan refugees and female drug users in Iran. These projects will be launched thanks to funding from the Government of the Netherlands.

The HIV prevention and care services to Afghan refugees in Iran is part of a sub-regional project also targeting Afghan drugdependent refugees in Pakistan as well as those who have returned to Afghanistan. According to the latest information, there are more than 900,000 Afghan refugees in Iran, down from a peak of 2 million in 2002/03.

The second project targets another vulnerable group; Iranian women who are either drug dependent and/or affected by HIV. The aim of the project is to increase access to quality services tailored to the specific needs of these women, including in prison settings. This will complement the significant resources that the Government of Iran already devotes to prevention and treatment of HIV as well as drug demand reduction measures.

“These agreements are further evidence of UNODC's pro-health approach to drugs, and to a deepening of our partnership with the Islamic Republic of Iran,” said Costa. “UNODC is grateful for the financial assistance from the Netherlands.” He urged other funding partners to follow suit and reduce the vulnerability of women and Afghan refugees in Iran to drugs and HIV. “This is an often neglected and humanitarian side of drug control,” said the head of UNODC. 


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