Egypt’s HCV infection rate highest in world
Egypt has the highest rates of new hepatitis C virus (HCV) infection in the world, according to a new study published 9 August 2010 in the Proceedings of the National Academy of Sciences. The study estimates that more than 500,000 new HCV infections occur in Egypt every year, likely signalling an epidemic in a country of more than 77 million people. The authors suggest this high rate of HCV transmission may be due to the lack of sufficient standard safety precautions in medical and dental facilities.
“Nearly 7 out of every 1,000 Egyptians acquire HCV infections every year, suggesting intense ongoing transmission. This is the highest level of HCV transmission ever recorded at a national level for a blood borne infectious disease transmitted parenterally, that is, by use of non-sterile medical instruments,” said Dr F. DeWolfe Miller, lead author of this study and professor of epidemiology at the Department of Tropical Medicine and Medical Microbiology and Pharmacology at the University of Hawaii.
Although the high prevalence of hepatitis C in Egypt has been well established for many years, and linked in part to limited safety measures during antibilharzia campaigns, published estimates of prevalence from different Egyptian communities failed to provide a nationwide picture of the magnitude of ongoing HCV infection transmission. To estimate the rate of new HCV cases of infection in Egypt, the authors of the study performed epidemiologic modelling of data from a range of studies, including a 2008 national HCV survey with a representative sample and well-documented study design.
“The study opened our eyes to a disease burden similar in scale and challenge to the HIV problem in sub-Saharan Africa: Millions of cases of an infection for which there is no vaccine, no effective treatment, and where case management is so expensive that it is beyond the reach of most patients,” said Dr Laith J. Abu-Raddad, coauthor of the study and assistant professor of public health at the Infectious Disease Epidemiology Group at the Weill Cornell Medical College–Qatar.
The study necessitates not only further analysis of HCV transmission in Egypt, but also justifies the immediate increase of resources to strengthen public health measures aimed at reducing the transmission of HCV in clinical and non-clinical settings, according to the authors. Failure to address this problem will result in a massive disease burden in the nation in terms of HCV infection complications, including active liver disease, liver failure, or liver cancer.
“There is only one way to deal with the HCV challenge in this country: HCV prevention,” warned Dr Miller. “Effective and stronger HCV prevention programmes are urgently needed in Egypt. Failure to act could swamp the public health system over the coming decades with millions of cases of HCV disease complications with an economic and social cost that this nation does not have the means to confront.”
Key scientific findings of the study
• Nearly 7 out of each 1,000 Egyptians acquire HCV infection every year for a total of 537,000 new HCV infections every year. This is by far the largest ever recorded rate of occurrence of HCV at a national level of all countries in the world.
• One in every 10 Egyptians is a carrier of the HCV infection, which means that there are at least 4,459,000 persons infected with HCV who are infectious to others. This is the largest reservoir of HCV infection in the world.
• Contrary to the widely-held perception that this rate of occurrence reflects merely the limited safety measures during anti-bilharzia campaigns, HCV incidence likely continues at alarming levels due to limitations in the implementation and enforcement of stringent standard precautions in public and private medical and dental facilities.
Dengue kills dozens in Yemen
IRIN reports 14 July that outbreaks of mosquito-borne dengue fever in Yemen’s southern and eastern governorates of Hadhramaut, Taiz, Aden and Abyan have left dozens dead in the past few months, and are claiming an increasing number of lives.
The report quotes Rabea al-Abd Ba- Musa, head of the Ministry of Public Health & Population's office in Hadhramaut Governorate, as saying that dengue was spreading rapidly in various districts of the provincial capital, Mukalla.
Twelve people had died since April and 1,442 people had been infected in Mukalla city, Ba-Musa said. He complained of lack of funds to combat the disease.
Abdulbari Dughaish, a member of parliament from Aden Governorate, said dozens of slum residents in the governorate had died from dengue over the past few months and more than 150 had been infected. He said many people died at home as they were unable to cover the cost of treatment in hospitals.
According to a November 2009 survey by the Central Lab of the Republican Hospital in Taiz Governorate, 490,000 people (82% of the governorate’s estimated 597,000 urban population) were living in environments that exposed them to dengue infection. The survey said 2,000 people had been infected.
It was also reported on Al-Sahwa.net that hundreds of dengue-infected cases had been discovered in recent weeks in the southern governorate of Abyan; it was suspected that hundreds of other cases had gone undiagnosed.
Shawqi al-Qadhi, a member of parliament from Taiz governorate criticised the Public Health Ministry for being unable to curb the epidemic.
“The cost of an early diagnosis system is US$9,000-10,000. It's shameful of the government and its ministry to postpone the provision of such systems from one year to another,” he was quoted as saying. Lakhdhar Lasour, head of Aden’s Public Health Ministry office, said his department had carried out a massive pesticide spraying campaign last month in the governorate’s slums.
Attacking the sites of mosquito reproduction was the best way to fight the disease as there was no effective medicine to treat infected people, he told IRIN. “A patient is given only painkillers and fluids until he or she recovers.” However, Aden Minister of Parliament Dughaish, who is also a member of the parliamentary health committee, said spraying campaigns were inadequate. “It’s possible for spraying to kill flying vectors in the air, but not the Aedes mosquitoes [which causes dengue] in drinking water or inside abandoned vehicle tyres,” he said.
American Hospital Dubai starts using new 7-floor in-patient tower
The American Hospital Dubai (AHD) has begun using its new In-patient Bed Tower, with the opening of the first of the facilities to be located there. The 7-storey, 240 patient bed facility is now home to the newly designed and refurbished Total Joint Replacement Regional Center of Excellence on the fifth floor.
A new 20-bed maternity unit (labour and delivery) will open shortly, with its eight delivery suites, two c-section rooms, 10-bed neonatal ICU (intensive care unit) and a well-baby nursery. AHD says the new facility will be fully occupied and operational before the end of 2010.
The in-patient bed tower is the latest in a series of developments being undertaken by the hospital and follows the opening of a new outpatient clinic building, which resulted in a doubling of the medical staff at the hospital.
The JCI-accredited hospital is undergoing several other renovation projects including seven new Emergency Department treatment exam rooms which will constitute a new ‘Urgent Care Service’.
35th person dies in Egypt from Bird Flu
Another person has died in Egypt from A(H5N1) avian influenza infection. The case is a 20 year-old female from Shobra Elkhima district, Qliubia Governorate. She was admitted to hospital on 21 July 2010, placed on a ventilator, and received oseltamivir treatment. She died on 27 July 2010. Investigations into the source of infection indicated that the patient had exposure to sick and dead poultry.
The MoH also said a 2-year-old girl was infected with H5N1 in Elsalam district, Cairo, in early August. She was receiving oseltamivir treatment in hospital. Of the 111 laboratory confirmed cases of Avian influenza A(H5N1) reported in Egypt, 35 have been fatal.
Abu Dhabi’s Mafraq Hospital starts clean hands campaign
Abu Dhabi’s Mafraq Hospital has launched a year-long hand hygiene awareness campaign entitled ‘Clean Hands Save Lives’. The campaign targets Mafraq Hospital staff, patients, and the Abu Dhabi community, especially children. The educational initiative reinforces the importance of one of the simplest methods of preventing infection – hand washing. A range of activities are planned to coincide with Global Hand Washing Day on 15 October 2010.
“The Clean Hands Save Lives campaign is a crucial part of patient safety at Mafraq Hospital,” said John Nickens, CEO, Mafraq Hospital, which is owned and operated by the Abu Dhabi Health Services Company (SEHA). “To really drive the message home, we have focused on creating a programme that is cheerful, lighthearted, colourful and also educational to raise overall awareness of the benefits of hand washing.
“We are starting at the base, right here in the hospital, but also branching out into the wider community. The aim is to transform hand washing with soap from an abstract ‘good idea’ into an automatic behaviour performed in homes, schools, and across communities in the UAE.”
Mafraq Hospital starts 24-hour a day Thrombolysis Service
for acute stroke
Mafraq Hospital has become the first hospital in Abu Dhabi to provide a dedicated 24 hour Thrombolysis Service for acute stroke patients. The Neurology Department has established an efficient Triage system with the Emergency Department, Internal Medicine and Radiology to ensure a ‘Door-to-Needle’ time of 60 minutes at any time of day, any day of the week.
Mafraq Hospital is owned and operated by the Abu Dhabi Health Services Company (SEHA) and managed by Bumrungrad International.
Dr Ajith Goonetilleke MBBS (Lond) FRCP (UK), Chief of Neurology said: “The use of intravenous thrombolytic agents as a clot-dissolving therapy has been established to be the most effective treatment available for patients with an acute stroke – we can save one patient from becoming severely disabled for every 9 patients we treat with thrombolysis. In comparison, we need to treat 100 stroke patients with Aspirin in order to save one severely disabled patient. We can only administer thrombolytic therapy within 4 ½ hours of a stroke, and the earlier the treatment is given the better the potential outcome for the patient.”
WHO inaugurates building in Tunis
The WHO has opened a building in Tunis, Tunisia, to house a representative office and the WHO Mediterranean Centre for Health Risk Reduction. The opening was inaugurated on 12 July by Mondher Zenaidi, minister of public health in Tunisia in the presence of Dr Margaret Chan, WHO director-general, Dr Ibrahim Mohamed Abdel Rahim, WHO Representative in Tunisia, and Dr Hussein A. Gezairy, regional director, WHO Eastern Mediterranean.
The building has an information centre and a large conference hall to accommodate various WHO meetings. It will also be used as a headquarters to implement public health related activities in Tunisia.
Tawam introduces Neurally Adjusted Ventilatory Assist
system to NICU
Tawam Hospital, in Al Ain, in affiliation with Johns Hopkins Medicine, is the first hospital in the UAE to introduce the pioneering Neurally Adjusted Ventilatory Assist (NAVA) system to its Neonatal Intensive Care Unit (NICU).
NAVA is a new mode of assisted mechanical ventilation that enables the brain of the patient, in this case a premature baby, to control the mechanical ventilator. NAVA technology uses electrical diaphragmatic activity (EDA) to adjust ventilator support according to a patient’s needs by reading the electrical signal transmitted from the brain to the diaphragm. By synchronising the ventilator and diaphragm movement patient discomfort is minimised as is the need for sedatives.
EDA is considered to be “the new vital sign” in critical care medicine as it provides a unique means for physicians to diagnose and monitor various types of breathing disorders encountered in the intensive care unit. NAVA technology is provided by MAQUET.
Egyptian actor Waked named UNAIDS ambassador for MENA
Renowned Egyptian actor Amr Waked has been named Regional Goodwill Ambassador for the Joint United Nations Programme on HIV/AIDS (UNAIDS) in the Middle East and North Africa (MENA). Waked is a popular star and an influential figure with teenagers as well as adults across the region.
“I will work with all partners to raise awareness about the disease, reduce stigma, discrimination and fear, and deliver correct messages to people who don’t know about AIDS and who keep judging others without knowing about their lives and circumstances,” he said.
“People living with HIV have to get the support they need. It is not the disease that kills you; it is the people around you who refuse to understand and help you, who kill you.”
Endoscopic first at Mafraq Hospital
Mafraq Hospital in Abu Dhabi recently heralded a medical first in the UAE after a successful endoscopic surgery to excise cancer from the stomach of an Emirati patient.
The surgery was conducted using an endoscope inserted through the mouth of the 70-year-old patient who was under a local sedation. There were no skin incisions. The tumour was removed using Endoscopic Submucosal Dissection (ESD), a relatively new procedure that first separates the tumour from underlying tissue by injecting fluid and then using endoscopic surgery to excise the tumour. The procedure is fairly new and only a few centres in the US are known to perform it, according to a statement released by Mafraq Hospital.
Enhanced External Counter Pulsation therapy for
cardiac patients in Dubai
A new treatment technique for cardiac patients – Enhanced External Counter Pulsation (EECP) therapy – is being used at the Dubai-based American British Surgical and Medical Centre (ABSAMC). Dr M. H. Khan, medical director of ABSAMC, says: “EECP has transformed the lives of patients with cardiac disease in the United Kingdom, United States and Australia, where it has been successfully used for several years.” He added that EECP is non-invasive and patients can complete the procedure in an hour.
EECP uses four cuffs that are placed around the lower limbs. These cuffs inflate and deflate in time with the patient’s heart beat, taking their cue from electrodes placed on the patient’s chest that are linked to a cardiac monitor.
The EECP cuffs are timed to inflate when the heart has emptied its main chambers of blood and is in its relaxation phase,” explained Dr Khan. “The inflation compresses the legs’ vessels and forces blood back into the heart, which – after a series of sessions – improves the organ’s ability to contract. It also forges new circulation paths in the heart muscle itself which is extremely beneficial for patients’ whose hearts have been damaged following a heart attack,” he added. He said patients usually start to feel improvements after 10 sessions.
Sultan Qaboos University Hospital adopts First DataBank system
First DataBank, a leading global provider of drug databases and clinical decision support, in July this year announced their new partnership with Sultan Qaboos University Hospital, a 500-bed university hospital located in Muscat, Oman. In the new partnership, First DataBank’s clinical decision support and drug database is integrated with the hospital’s InterSystems TrakCare connected health information system as part of its patient safety and graduate learning initiatives.
According to First DataBanks’, its drug database will support medical staff by enabling them to access detailed drug information electronically.
A clinical decision support will provide clinicians with tailored warning messages on potential drug-drug interactions, as well as allergens and duplicate therapies during the prescribing and dispensing process.
Dr Ahmed Al Mandhary, director general of the Sultan Qaboos University Hospital said: “Academic health science centres are recognised for their innovation at an international level. We hope to engender best practice within our graduates and improve patient safety at the same time”.
DHCC’s City Hospital obtains JCI accreditation
The City Hospital in Dubai Healthcare City has been granted Joint Commission International (JCI) accreditation.
JCI is the leading industry benchmark for measuring the delivery of quality healthcare.
The City Hospital, a strategic part of the EHL Management Services portfolio – a joint venture between the South African private hospital group Medi-Clinic, the Dubai-based Varkey Group and General Electric – has earned the distinction within 18 months of its opening.
All hospitals within DHCC are mandated by the free zone’s Centre for Healthcare Planning and Quality (CPQ) to obtain JCI accreditation within two years of starting operations.
“This accomplishment, together with receiving one of the most prestigious accreditations in the world from the College of American Pathologists in October last year, underlines our commitment to the continuous delivery of quality healthcare to the people of Dubai and the region,” remarked Dr Pietie Loubser, Chief Clinical Officer, EHL Management Services.
The 210-bed City Hospital is a state-ofthe- art, fully equipped, multi-disciplinary modern hospital.
Welcare Hospital granted JCI accreditation
Dubai-based Welcare Hospital has been granted Joint Commission International (JCI) accreditation.
The checklist for accreditation includes more than 350 factors, ranging from surgical hygiene and anaesthesia procedures to the quality of medical staff and nurses.
“We are thrilled to receive this accreditation and will continue to strive to provide our patients with the best services possible,” commented Sakkie van der vyver, hospital director, Welcare Hospital.
Patients can now be assured that the hospital is complying with international standards in areas such as: access and continuity of care, patient and family rights, medication management and use, quality improvement and patient safety, prevention and control of infections, facility management & safety and staff qualifications & education.
Region’s first dedicated long-term care facility to open in Abu Dhabi
The region’s first long-term care and rehabilitation facility will officially open its doors in Abu Dhabi in September 2010. Pro Vita Abu Dhabi is the first facility of its kind in the MENA to offer state of the art long-term care for ventilated patients in a non-hospital setting.
With a capacity of 42 beds, more than 100 employees provide round the clock medical care. The facility will have 24 hour physician coverage staffed by German physicians and has a formal affiliation with the University of Munich. Pro Vita is an internationally leading, fully accredited and highly specialised provider of care in Germany and the original founder and managing partner of the German operation has relocated as founder and general manager of Pro Vita Abu Dhabi.
Currently only hospital beds exist for ventilator supported care across the GCC, meaning that approximately 200 hospital ICU beds are used for long-term care ventilator patients.
High rates of vehicle accidents and congenital disease factors in the region contribute to an environment where longterm ventilator care and rehabilitation services are in high demand across the GCC. Pro Vita is expected to significantly improve the quality of life for patients who need such treatment, allowing them the opportunity to receive care at a specialised facility in their home country as opposed to similar facilities abroad or ICU beds at local hospitals. It will also alleviate financial and logistical pressure on oversubscribed hospital ICU units in Abu Dhabi and the GCC.
Christina Shawky-Bohme, founder of Pro Vita and general manager of Pro Vita Abu Dhabi, said: “In Germany, Pro Vita has been providing care since 1996 and has seen over 500 patients, including several dozen from the Middle East region. Modern medical possibilities and increasing life expectancy have led to increased cost consciousness in healthcare, meaning greater demand for out-of-hospital intensive care. This need is not currently being met in the MENA.
“For us the person requiring care is seen not only as a patient with medical treatment needs, but as a human being with dreams, hopes and expectations. When dealing with family members, hospitals and financial sponsors we also attach significance to a person-centred, goal-oriented approach. In terms of daily patient care this means that we efficiently and effectively conserve all resources.”
There is a significant need for several dozen facilities across the GCC and MENA and Pro Vita plans to expand its offering with additional locations in the UAE as well as other countries in the region.
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