Atrial Fibrillation (AFib) is a common heart condition that causes an irregular heart rhythm (arrhythmia). The currently estimated global prevalence of AFib in adults is between 2 and 4 per cent.

AFib can induce the formation of blood clots and is therefore associated with a high number of complications. Among these, what is defined as an embolic stroke, a type of stroke that occurs when a blood clot forms elsewhere in the body breaks loose and travels to the brain via the bloodstream, is undoubtedly the main one.

The risk of stroke increases by almost five-fold in patients suffering from AFib. Clinicians often think of AFib as a silent condition, as it has no symptoms to alert patients of its presence. As a result, this dangerous condition often goes unnoticed, remaining undiagnosed and untreated.

Treatment options to prevent stroke

Prevention is at the heart of reducing the risk of stroke in AFib patients. Today, there are different treatments available to reduce stroke risk in patients with AFib that is not caused by a heart valve problem, also known as non-valvular AFib. The most common treatment prescribed by doctors is anticoagulants, which are medications that prevent blood clots from forming, potentially leading to a stroke.

Adopting a healthy lifestyle also plays a crucial role in reducing the risk for stroke in AFib patients – namely being physically active, making healthy food choices, avoiding smoking, and generally keeping blood pressure and cholesterol levels in check.

Being ranked as the second leading cause of death worldwide, with an annual mortality rate of about 5.5 million, stroke is a condition with severe economic and social implications.

The public health burden of stroke is set to rise further in the coming years. Furthermore, unlike with diabetes and hypertension, there is a general tendency to be less aware of AFib and its increased risk of stroke. Therefore, it is crucial to keep raising awareness about this condition and highlighting the importance of a regular pulse rhythm check. People must visit their doctors for regular check-ups to agree on the best treatment option for their respective situation.

To remain on the frontline of halting the increased risk of strokes in AFib patients, pharmaceutical companies have to keep partnering with patient groups, hospitals, and health organizations across the region to keep raising awareness and running screening and counselling programs. The ultimate goal is to empower people by arming them with the necessary knowledge to safeguard and manage their health in the best way possible.

References available on request.

More than 125 million psoriasis patients worldwide can now keep their autoimmune skin disease under control, thanks to rapid advancements in medical treatments, says an expert from Cleveland Clinic.

Dr Anthony Fernandez, M.D., Ph.D., Director of Medical and Inpatient Dermatology at Cleveland Clinic said: “Psoriasis is one of the more common but misunderstood autoimmune diseases. While the skin disorder is not contagious, moderate to severe cases are associated with systemic inflammation that can trigger major damage to internal organs, joints, and decrease lifespan if left untreated. However, with recent advancements, almost all patients can now keep their psoriasis under control – from topical ointments on fingers to biologic therapies for full-body psoriasis.”

What is psoriasis?

Psoriasis is a commonplace skin disorder of thick and itchy patches and plaques of skin with silvery scales, afflicting more than 8 million Americans, according to the National Psoriasis Foundation, and 125 million people worldwide, according to the International Federation of Psoriasis Associations.

There is no one way to prevent psoriasis – the causes are likely genetic with an external trigger such as cuts, stress, strep infections, or medications for blood pressure or anti-malarials. Still, experts advise patients to maintain a healthy lifestyle and to avoid risk factors such as smoking or obesity.

“Psoriasis is a disease of chronic inflammation, which can also have effects throughout the entire vascular system potentially leading to cardiovascular disease, inflammatory bowel disease, and inflammatory arthritis,” added Dr. Fernandez. “While people in their 20s are the most common age group for psoriasis, seniors should be on the lookout for rashes and joint pain that could be symptoms of psoriasis or psoriatic arthritis. One-third of psoriasis patients will eventually develop psoriatic arthritis -- which could permanent destroy joints if not treated properly.”

Many patients may have only mild disease, which can often be treated by seeing a dermatologist who can recommend topical medications such as steroids, moisturizers, or coal tar.

However, at Cleveland Clinic, a large percentage of their psoriasis patients have moderate to severe psoriasis – defined as more than “three palms” of the scaly rash.

Treatment methods

Moderate to severe psoriasis can be treated with phototherapy using ultraviolet light B (UVB), Vitamin A-related drugs called retinoids, methotrexate that can also treat arthritis, and the immunosuppressant cyclosporine. Cleveland Clinic physicians are seeing most moderate to severe cases come under adequate control within three months – and significantly improving quality of life for patients.

Breakthrough advancements in medical research have driven the development of new treatments such as TNF inhibitors, other injectable biologic therapies, and small molecule immune-modulating pills.

“Biologic medications have revolutionized our ability to adequately control moderate to severe psoriasis.  Currently, medical researchers are trying to identify blood markers that could predict the likelihood that patients with psoriasis will develop psoriatic arthritis and identifying the immunologic cells of origin in psoriasis whose destruction could one day lead to a cure for psoriasis,” concluded Dr. Fernandez. “While we’re in the very early stages of this research, I’m hopeful that further advancements will lead to even better treatments, and possibly a cure in the coming decades.”

Having worked in market research for over 20 years, Guillaume Corpart, Founder & CEO, Global Health Intelligence, strives to help clients identify target markets, opportunities, and see where they can get growth and how to achieve it. He founded Global Health Intelligence, a market research and intelligence firm in 2014 that focuses on the healthcare space in emerging markets. The company started by creating a database of all the hospitals in Brazil, and then gradually expanded to Mexico, Colombia, Argentina, and Chile, among others. It now covers 18 countries in Latin America and is also expanding to Asia and the Middle East.

As a moderator at the upcoming Omnia Health Live Americas, Corpart will be discussing the impact of COVID-19 on healthcare systems in Latin America and the major trends this will drive moving forward, particularly pertaining to technology penetration and adoption. In an interview with Omnia Health Magazine, he said that COVID-19 has had a polarising effect on healthcare systems.

Corpart expressed that COVID-19 has crippled healthcare systems globally and Latin America was no exception. Moreover, the region was ill-prepared to face the pandemic. He said: “The economic impact of COVID-19 is something that's going to be around us for the next two years. On the one hand, we have seen a rise in hospital admissions to treat urgent cases, which has resulted in a saturation of healthcare systems. While on the other hand, there has been a steep decline in doctor visits and non-emergency procedures as patients wanted to stay away from the hospital setting.”

Latin America is also characterised by having smaller hospital size than most other countries around the world. This, he explained, means that the region doesn't have access to the financial or infrastructure leveraging capabilities that are required to acquire more equipment.

Accelerated tech adoption

When asked if COVID-19 has had a positive impact on technology adoption such as artificial intelligence (AI), telemedicine, or remote patient monitoring, Corpart said that both technology and connectivity can play a strong role in shaping the future of healthcare. This can be achieved by reducing the number of touchpoints that a patient has with the institution as well as reducing the amount of time that a patient spends inside the institution.

Corpart emphasised: “Certainly telemedicine is a key component in that framework, notably for diagnosing patients and seeing if a hospital visit is really necessary. But connectivity can also help schedule appointments and keep everyone on time so that patients spend as little time as possible within a hospital. And finally, technology can also be used to deliver results, whether that be digital diagnostic images or a virtual consult to explain a situation.”

In terms of technology adoption, telemedicine has not been as prevalent in Latin America, as compared to other countries. Therefore, patients who might not have COVID-19 had to go into a hospital and be surrounded by people that might be contagious.

“At the onset of COVID-19, a lot of companies invested in AI tools,” he shared. “A laboratory in Mexico created an online screener to see if patients needed to get tested. Initially, there was a lot of confusion and patients didn't even know they needed to get tested. So, the laboratory was using online screeners and AI to model if patients actually needed that test or not.”

According to Corpart, technology adoption needs to be more ingrained in the culture because there are other threats that the region has to face besides the pandemic.

“Latin America is facing an ageing demographic, an obesity epidemic, and another pandemic might be around the corner. Therefore, we need to find tools that can scale to the occasion and increasing technology adoption is the only way to do it. In certain cases, COVID-19 did help accelerate the test penetration and technology adoption, with AI modelling being one of them. I'm just curious as to see if that impact will be sustained in the long term or if it was just a one-time investment,” he added.

Growth areas

Latin America saw a vast expansion of primary care equipment and devices used to detect, treat and support COVID-19 patients. This includes patient monitoring systems, infusion pumps, electrocardiograms, diagnostic equipment, blood analysis machinery, amongst others. However, the flip side, Corpart said, was the major contraction seen in equipment and devices used within surgical procedures such as plastic surgery devices and implants, orthopaedic devices, dental implants and orthodontics accessories, surgical staplers, haemostats and sealants, amongst others.

“In the next 18 to 24 months, we're going to see a slowdown in the purchase of high tech, high-quality capital equipment that's not related to pandemic detection,” he elaborated. “For instance, MRIs, robotic surgery systems etc., cost hundreds of thousands of dollars to acquire and require technical expertise. Hospitals, both on the public and private side have been heavily impacted financially by COVID-19. Therefore, all those huge investments will be postponed or put on hold temporarily.”

According to projections, lower-cost goods will have an advantage over the higher cost equipment and devices. So, investments in short to medium term will be related to the sub-premium market such as ventilators and patient monitoring system, and acute care patients will rise. “The ventilator availability in Latin America is below the standards of the U.S. or Europe. The ventilator installed base has dropped across the region in every single country for the past three years, except Brazil, which saw heavy investments in ventilators from 2018 to 2020,” he shared.

Changing the mindset

Understanding the needs of the market is more critical than ever, stressed Corpart, because the new normal is shifting all of the established parameters that had been set for the past two decades. Whether you're looking to sell technology or a capital good, or consumables, understanding what the market needs is essential.

For instance, for companies that sell high-tech equipment such as 3D modelling systems for surgeries or robotic surgery systems, they need to keep in mind factors such as which hospitals could potentially acquire it? Where are they located? What are their financial needs? What are their financial capabilities today, because those will be different than what they were six months or a year ago?

The same questions also apply to companies selling gloves or syringes. At the onset of COVID-19, there had been a 50 to 90 per cent drop in non-emergency procedures. “That's massive and has had a strong impact on the financials of businesses because maybe hospitals don't need as many syringes as they used to, as patients are not coming in or maybe they need more because they're catching up on procedures that had been postponed. So, understanding client needs is critical,” he added.

Furthermore, companies also need to be budget-conscious. From a technology standpoint, Corpart advises that it would be good to have a technology roadmap, be it on the supplier-vendor side, such as a supplier of technology or an adopter of technology, such as hospitals or clinics. The roadmap will ensure business acquire systems after fully understanding how and why they fit together. Scalability is also a critical factor, both for dealing with pandemics, and with the obesity epidemic and ageing population, and results in patient interoperability, with better integration of electronic health records, and understanding that “scale will win the game”.

On a parting note, he said that there needs to be a change in the mindset. “It's still too early to tell if COVID-19 has been able to change the mindset. Only the next couple of months will tell. Technology and connectivity are at the centre of business continuity. Overall, we will see budget reductions across the board for 2021. This will lead to the expansion of sub-premium products, both in the public and the private sector,” he concluded.

Corpart will be moderating the ‘Adoption and penetration of high-tech equipment in Latin America’ on Friday, November 6 at Omnia Health Live Americas

Hemophilia is a genetic disease that stems from the deficiency of a protein required for normal blood clotting – clotting factor VIII in hemophilia A or clotting factor IX in hemophilia B. As the level of factor VIII or IX in the blood usually stays the same throughout life, hemophilia is a lifelong disease. Hemophilia patients bleed excessively when injured, and those with more severe forms of the disease can even experience spontaneous bleeding around the joints or other areas that can be life-threatening.

Hemophilia is commonly treated using infusions to replace the missing clotting factor in the blood. These have been available since the late 1960s.

Gene therapy, a non-factor treatment currently in development, is starting to shift the treatment paradigm, as it addresses the root cause of the disease.

Hemophilia treatment advances were highlighted in the 11^th Global Hemophilia Summit organised by Pfizer in September. The summit connected 916 healthcare professionals from 60 countries in a four-day-virtual programme. Gene therapy is a specialised treatment that inserts the corrected gene into the patient’s cells to replace the defective one or modulate the expression of a targeted gene to correct the disease. Significant progress is made in the field since discovering novel adeno-assisted virus (AAV) vectors that are small viruses used to deliver genetic material to the cells. This discovery has been promising as AAV vectors can do the job without damaging the cells or permanently altering the genome in an unwanted way.

In hemophilia gene therapy, the gene introduced encodes for the clotting factor that the patient is lacking. Following the treatment, it is expected that the patient would not need continued prophylaxis or factor replacement following trauma or before surgery.

Hemophilia gene therapy brings hope to many patients, as it is a one-time fix that is also cost-effective in the long run. The first patient dosed in the longest-running factor IX trial has now passed the 8-year mark with steady levels of factor expression.

Furthermore, there were 31 clinical trials for hemophilia in one of the latest ClinicalTrials.gov report, and the last phase clinical trials for factor VIII and IX are now underway.

The results from these clinical trials confirm that the safety and efficacy of gene therapy for hemophilia are persuasive. When licensed, gene therapy is initially limited to adults with severe hemophilia and will exclude those with inhibitors. Moreover, to check eligibility for gene therapies with viral vectors, it is crucial to run an immunity check against viral vectors, and patients with significant liver dysfunction, those who are positive for Hepatitis B (through surface antigen detection test) or positive for Hepatitis C infection (through RNA detection test) will not be eligible.

In conclusion, gene therapy remains a complicated area, which is highly demanding in terms of material and human resources. In Africa and the Middle East region, adequate funding and strategic partnerships are essential to provide a base to facilitate meaningful progress.

This year two knowledge-sharing sessions were conducted with the UAE MOHAP and SFDA together with Pfizer. Pfizer will continue to partner with UAE and Saudi Arabia’s scientific and regulatory authorities for novel initiatives, and continuous medical education and training in gene therapy. In these partnerships, there is a plan for providing centres to conduct five gene therapy clinical trials in the Middle East.

As companies will need to prepare for current and future manufacturing demand with time, personnel, and capacity to ensure new robust quality systems, treatment innovation will be accompanied by both opportunities and challenges. However, the future for hemophilia is exciting, and patients, physicians, healthcare leaders must leverage the coming wave of innovation.

Mert Ceyhan

References available on request.

ASEAN and East Asia states have proved more successful in handling the global COVID-19 outbreak, demonstrating fewer new cases and better economic prospects compared to other regions worldwide.

Over three days at Medlab Asia & Asia Health virtual event, experts from Cambodia, Singapore, Taiwan, Thailand and Vietnam provided insight into many of the effective approaches deployed by administrations during the pandemic. 

Related: Asia’s largest healthcare and medical laboratory virtual event underway

Common strategies included early rapid response, strict quarantine measures, effective use of contact-tracing technology, public enforcement of mask-wearing and hand-washing, and clear communications from the top.

Cambodia: How did Cambodia contain COVID-19 with few resources?

Dr Lim Pich, Deputy Director, National Center for Health Promotion, Ministry of Health, Phnom Penh, commented on Cambodia's zero deaths despite having had fewer resources.

As of 6 September 2020, there were 275 cases, with 274 recoveries. Of this number, 111 were aged 20-29, the biggest cohort, with the majority male (101). 

Factors accounting for this success include the following:

• Cambodia's hot climate
• Cambodia's predominantly young population, making them less vulnerable
• A COVID-19 response that included focusing on high risk individuals; an extensive contact tracing strategy; empowerment at all levels, complemented by a mobile app; the creation of a new hotline by the Ministry of Health (115); and the creation of a new network of 2,900 healthcare workers
• Actions was taken from the beginning: authorities took the threat seriously by enforcing the wearing of masks, social distancing and frequent hand-washing
• Compliance through introducing "an authoritarian style" allowing containment measures to be quickly implemented
• Awareness campaigns for mask-wearing and self-quarantining

Singapore: Surveillance systems in a pandemic

Dr Indumathi Venkatachalam, Consultant, Infectious Diseases, Singapore General Hospital (SGH) explained how different surveillance systems were used for staff and patients.

The first COVID-19 patient was admitted to SGH on 23 January 2020. Since then, the number of SGH cases has risen to 1,729 (as of 19 October). 

Staff surveillance 

Nearly 6,000 SGH staff were screened for COVID-19, with 6 found positive with the virus. Acute Repiratory Illness (ARI) syndromic surveillance was set up for staff and patients, while SGH continued with routine surveillance of other diseases.

Dr Venkatachalam explained the syndromic surveillance system (SSS) as tracking discernable clinical features before COVID-19 diagnosis is confimed; monitoring patients from the onset of symptoms; observing changes in disease activity; fostering immediate decision-making; and better protecting patients and healthcare workers.

SGH built an SSS by utilising the EHR database. All at risk staff were mapped in time and location, and presented in a heat map for visualisation.

Baseline data was obtained for two weeks, and thereafter reviewed daily with a weekly aggregated output. A cluster of cases was defined as more than 50% the previous baseline. 

The adoption of a SSS may aid in infection prevention measures within institutions, Dr Venkatachalam commented, and may be useful to explore during the pandemic. Future steps include geospatial 3D mapping for better visualisation of data.

Taiwan: Taiwan’s successful measures in combating COVID-19

Dr Wui-Chang Lee, Taiwan, Director, Department of Medical Affairs and Planning, Taipei Veterans General Hospital, provided a thorough breakdown of how Taiwan responded so successfully to the pandemic. 

As of 20 September 2020, Taiwan ranked 182/188 countries worldwide for the number of confirmed cases per million people. Multiple sources, including OECD and national statistics agencies, show that Taiwan performed best worldwide in managing the economy as well as health in the pandemic in the second quarter of 2020.

Dr Lee attributed the island's success to factors that included lessons from SARS; proactive measures; effective rapid response; public engagement; a well-prepared healthcare system; effective use of civic technology; and transparency.

He added that Taiwan is still on guard, and is still maintaining a high degree of border control, quarantine, isolation, precision testing and tracking.

In addition Taiwan is collaborating internationally in vaccine and medicine R&D, and adopting big data analytics as a further measure.

Proactive measures launched after SARS

Taiwan prepared for 17 years for emerging communicable diseases after the SARS outbreak. Proactive measures were adopted after the SARS outbreak in 2003 when Taiwan was ranked second in the world for SARS cases, with 346 infected, including 105 staff, and 73 deaths (including 10 staff). 

These proactive measures included:

• Amending the Communicable Disease Control Act in 2004
• Strengthening Taiwan's CDC infrastructure, manpower and organisation efficiency
• Establishing a Central Epidemic Command Centre (CECC) for inter-ministry coordination
• Establishing a communicable disease control medical network
• Enhancing a communicable diseases survelliance and reporting system
• Ensuring enough medical capacity, manpower and proactive equipment stockpile
• Estabilshing testing laboratories, and vaccine research and mass-production

COVID-19 rapid response

Taiwan's rapid response was underway as early as 31 December 2019. A CDC task force was convened on 1 January, and a travel alert for Wuhan was issued on 7 January.

With the announcement by the WHO that COVID-19 was a human to human viral infection halfway through the month, Taiwan's government awarded the disease Communicable Disease (category 5) status.

A week later, Taiwan announced its first documented case from China, and the following day President Tsai convened a National Security Conference.

COVID-19 rapid response strategies: border control and quarantine

The most important COVID-19 strategy to date, Dr Lee emphasised, was maintaining tight border control that began with prohibiting China nationals from entering the island in early February to blocking airline passenger transits through Taiwan in late March. 

Added to this rigorous border control was a series of quarantine measures that included home quarantine for 14 days upon arrival in Taiwan - a requirement also for Taiwanese citizens.

Three days prior to arrival, travellers are required to produce a report showing that they are COVID-19 negative. 

PCR testing was conducted on those showing symptoms. Anyone with fever symptoms was transported to hospital in a specially designated taxi or ambulance.

Following the quarantine period, inbound visitors enter a phase of "self help management" for 7 days, where they may freely leave home but are required to call a local government hotline ahead of any hospital visit.

All quarantined arrivals are tracked by a Digital Fencing Tracking System. Anyone found by the GPS to have strayed beyond the permitted distance will receive a police visit to their home. If they are found to have broken the rules, they will receive a fine.

Government support is however available to quarantined individuals through, for example, garbage collection, meal delivery and reimbursement for the two weeks they are unable to work. 

Because of Taiwan's limited testing capacity, the island has had to undertake precision testing at a rate of 8,800 per day.

Tests were offered in the following locations (designated as levels): 1) airports and harbours; 2) primary care clinics (free and subsidised by the government); 3) destinated laboratory stations; and 4) certified labs at hospitals. 

COVID-19 rapid response strategies: self-discipline and PPE

Key to its control, Dr Lee explained, was a high level of public awareness and engagement. As Taiwan is not a WHO member, it must fight emerging epidemics "alone", yet its population maintains good hygiene habits, learned since elementary school.

Taiwan's self-disciplined citizens followed CECC's infection control guidance that include mask-wearing and maintaining social distance. 

To facilitate mask-wearing, Taiwan embarked on a Mask Rationing Plan from 24 January that included:

• banning mask and PPE exports
• launching domestic mask production, reaching 20 million masks a day
• setting the price of each mask at US$ 0.13

A name-based registration and purchasing system was additionally introduced allowing Taiwan's people to purchase masks not only from pharmacies, social welfare bureaus, public health bureaus and 7-11, but also through a mobile app. 

COVID-19 rapid response strategies: transparency

A daily press conference was held at 2pm by the CECC who provided details around each infected case. Dr Lee described this as a "very important" way to minimise public anxiety.

The government used digital media as well as traditional to communicate to younger generations in particular, that included WeChat, Line, Facebook, Instagram and Google.

Cell broadcasts meanwhile communicated messages to the public via their phone, especially during the peak of the outbreak in Apri and May.

Thailand: Lessons learned from successful management of COVID-19 in Thailand

Dr Tanarak Plipat, Deputy Director General, Department of Disease Control, Ministry of Public Health, Bangkok, revealed how Thailand responded effectively to the pandemic through a mixture of timeliness, decisive leadership, unified communication, a multi-sectoral approach and a strong health security system.

Thailand had already invested in health security over decades, he began. A field epidemiology training programme was in place since 1980, and access to healthcare has been free for Thai citizens since 2002, with a health security programme launched in the same year.

Five years later a public health emergy programme was initiated.

Dr Plipat revealed that a Johns Hopkins study in 2019 placed Thailand as the 6th best prepared country worldwide for a pandemic, awarding it a score of 73.2, and best overall in Asia. 

One month after the research was released, he added, news of a cluster of pneumonia cases in Wuhan was announced. 

From 31 December 2019, Thailand monitored closely the situation in China. 

Emergency operations

Emergency operations were activated on 3 January 2020 with the announcement of 44 new COVID-19 cases in China.

At that point, more than 2,000 Chinese nationals from Wuhan alone were streaming into Thailand daily, arriving at Bangkok, Chiang Mai and Phuket airports. 

On 8 January, the first case of pneumonia caused by the coronavirus surfaced in Thailand - a 61 year old female tourist who landed at Bangkok airport with mild respiratory symptoms. 

The case was reported to the WHO on 13 January and announced by the Ministry of Health.

Thailand changed its case definition from any traveller from China to any Thai national who had been in contact with a Chinese tourist.

By 31 January - one full month after the Wuhan outbreak was first reported - Thailand recorded its first human-to-human COVID-19 transmission, a taxi driver who had never been to China.

The cumulative number of cases topped 19, and one month later this had increased to 42. 

Following the first confirmed death in March and emergence of new COVID-19 clusters, the Thai PM launched the Centre for COVID-19 Situation Administration (CCSA).

This was followed by the closure of public places such as sports grounds, schools and entertainment places, while employers were asked to consider allowing staff to work from home.

COVID-19 cases peaked at 188 in March, and a state of emergency came into effect, restricting domestic travel between provinces and imposing a 14-day self-isolation on inter-province travellers, and requiring visitors from high-risk countries to quarantine for 14 days.

Thailand imposed stricter measures the following month. A curfew was introduced, all commercial flights into the country were banned, and all Songkran activities were banned.

The impact of all of this was the number of new daily infections were reduced to a single digit.

The beginning of a return to normal commenced in May, with Thailand opening up in phases, and by the end of the month the last confirmed case was reported - under the first wave.

Vietnam: Road to zero cases – Vietnam

Associate Professor Le Thi Anh Thu, President, Ho Chi Minh City Infection Control Society, revealed that of the 1,097 cases reported in Vietnam since the beginning of October, 1,022 have recovered. 

Since 7 September, only 47 cases were reported - a major fall from 636 registered over the 99 days prior - with zero community transmission.

She added that Vietnam is cited by global media as having one of the best-organised epidemic control programmes in the world.

"Fighting the pandemic is like fighting the enemy"

From the outset the pandemic was seen by Vietnam's government as akin to fighting a war, according to the speaker. As such, the government prioritised:

• starting prevention early and on a major scale. Any affected city or or region was immediately locked down - Da Nang for example was locked down within two days
• involving all government sectors including Army and police. The medical system in Vietnam - structured over central, provincial and district levels - answered to a national steering commitee set up by the Ministry of Health for responding to COVID-19
• applying strict isolation for any carrier of COVID-19 - individuals in close contact were tracked
• strengthening triage/screening process in hospitals
• contact tracing and isolating positive carriers in hospitals. More than 1 million tests have been performed to date.

Medlab Asia and Asia Health, a free-to-attend virtual event brought by Informa Markets and Impact Exhibition Management Co., kicked off Tuesday 20 October with a panel discussion on pandemic management.

This year’s event builds on the success of ASEAN’s biggest multi-disciplinary conference for the healthcare and medical laboratory industry. 

The three day virtual exhibition will bring together regional healthcare professionals to meet and do business online.

Participants may explore hundreds of innovative products from businesses seeking new dealers and distributors - including the latest from leading global players such as Abbott, Euroimmunn, LG, Randox and Snibe – and also set up virtual meetings to discuss new business opportunities. 

The event will also empower attendees with advanced knowledge and networking skills to improve patient service and care.

More than 50 healthcare, laboratory and business sessions will be available through keynotes, on-demand broadcasts and virtual panel discussions on topics that include COVID-19 Control & Treatment, Imaging, Doing Business in Thailand and Immunology.

Attendees will earn up to 21 CME, 15 CMTE and 7 CNEU points through hearing from more than 100 world renowned experts in healthcare. Speakers include

• Dr Tanarak Plipat, Deputy Director General, Department of Disease Control, Ministry of Public Health, Thailand;  
• Prof Heungsup Sung, Chairperson, COVID-19 Diagnosis Test Management Committee, Korea Centers for Disease Control and Prevention, South Korea;
• Dr Bayu Teja Muliawan, Head of Planning Republic of Indonesia, Ministry of Health, Indonesia; and
• Joseph Kalaivanar, CEO, GotMyCoach, Singapore. 

“We are excited to be introducing Medlab Asia & Asia Health this year as a virtual edition, enabling participants to interact and do business with the wider healthcare and medical laboratory community, while also learning through a compelling line-up of accredited webinars – all from the comfort of their own home or office,” says Tom Coleman, Exhibitions Director.  

For more information about the show, including details of how to register, visit https://www.medlabasia.com/asiahealth/en/home.html.

Certain aspects of our daily lives seem to be moving faster and faster. For example, we are not only used to software updates, we actually have come to expect a steady stream of regular improvements showing up on our phones, and in the digital tools, we use at work and at home.

Against that backdrop, what seems to remain stubbornly resistant to the same pattern of speed and improvement are advances in the treatment of cancer and certain diseases. Treating and curing cancer is not the same as binge-watching online, there is no debate there. But a key enabler of both—computation in the cloud–offers hope that we can crank up the speed with which we are able to deliver earlier and more accurate diagnosis, better therapies, and yes, even cures for cancers.

At its core, discovering new ways to detect and treat cancer is a computational problem. Here’s why.

Keys and locks

Think of a key as a drug, and the lock that fits that key as cancer. Researchers try to find the right key to fit a particular lock—a drug molecule that interacts with a particular cancer receptor. Now, imagine you have billions of keys and billions of locks. If we tried to manually match a key to a lock in the hopes of unlocking the desired lock, you can see how it could take forever.

Next, picture a massively powerful computer operating at incredible speed trying every key in every lock, almost simultaneously. What would that change? How fast could you find the right drug that unlocks the treatment for a disease?

A great example of this quantum leap in accelerating drug discovery is from one of our Amazon Web Services (AWS) partners: Numerate.

Numerate was looking for drug candidates to treat a particular heart condition. They had over 128 million drug molecules to choose from, and as you might imagine, it would have taken brilliant scientists five to seven years to narrow down the choice from millions of options down to a handful to take to clinical trials. This is the key/lock problem. But Numerate didn’t go that route, it used AWS compute instead.

Using thousands of machine learning models and massive computing in the cloud, Numerate was able to examine 128 million molecules, searching for the few that could help treat the heart condition they were studying. The models accounted for how the potential drug molecules would be absorbed in the body, distributed, metabolised, eliminated, and whether it fits into the right disease “lock.” Numerate applied the equivalent computing muscle of a single high-performance processor running continuously for 1,000 years in just 12 months and discovered 69 drug candidates that they were able to move forward to clinical trials. More recently, other AWS customers such as Abcellera have developed sophisticated cloud-based solutions that reduce the drug discovery process down to six weeks.

From five to seven years to less than two months—you can bet we’ll get faster. And that same massive compute plus machine learning approach is applicable to the discovery of treatments to fight cancer or any other disease.

A cure just for you

An increase in the speed with which candidate drugs can be discovered means more drugs enter the clinical trials pipeline. More clinical trials mean more hope and options for individuals who are looking for a treatment for their particular type of cancer. All of that leads us toward something the medical world has been working towards for decades—precision medicine. The ultimate goal of precision medicine isn’t to simply offer patients treatment for their type of cancer, but to offer a therapy tailor designed for their individual cancer.

A terrific example of using AWS computing power for precision medicine can be found in the born-in-the-cloud biotech company, Moderna. You have likely heard of Moderna in the news for its effort to find a vaccine for COVID 19. The same techniques that Moderna is using to examine the virus that has caused the pandemic is applied to other diseases including personalised cancer vaccines (often referred to as immunotherapies), and treatments for rare diseases. If you go to Moderna’s lab you see row after row of therapies being produced, what is stunning is that their shop isn't applying machine learning and compute to make a single drug for a billion people, they are making a single drug for a single person based on that patient’s unique genetic makeup. It’s like manufacturing a billion different drugs.

Harnessing compute doesn’t just speed the process up when looking for cures, it changes the economics of what drugs are even brought to market. In the manual and expensive traditional approach to drug discovery, companies needed blockbuster drugs to support the economic model of drug discovery. But when drug discovery becomes a team effort between gifted scientists, computing power, smart algorithms, and very smart models that simulate our biology and chemistry, the economics change. Organisations can find treatments and cures for diseases that afflict a relatively small number of people. They can find a cure just for you.

The next best thing to finding a cure

Clearly, a cure is the ideal cancer treatment outcome; however, short of a cure, treatment pathways that are tailored and personalised to the needs of an individual would still provide immense benefit to patients everywhere. BreastCancer.org is a great example of an organisation that uses AWS computing power to help personalise the patient health journey.

Breastcancer.org allows individuals with breast cancer to upload their pathology report to a private and secure personal account. Using AWS machine learning, BreastCancer.org analyses the patient’s pathology report and customises their digital properties to deliver personalised content to the patient. Just as biotech companies use the computing power to discover new drugs for cancer treatment, BreastCancer.org uses the power of computing and natural language processing understand the pathology report and create a very personalised experience for the patient.

If you carry this forward, it isn’t a huge leap to see how a person’s own medical information can help deeply personalise their health journey. Navigating Cancer is a start-up built on AWS that is working closely with cancer patients and their doctors to help patients self-manage their care journey. Navigating Cancer collects thousands of data points about a patient’s condition, and through sophisticated real-time compute-intensive analytics, helps clinicians create the ideal path towards recovery. Navigating Cancer doesn’t simply empower patients, they activate them to take charge of their lives on their road to recovery, alongside, and with the help of, friends and family.

And that, of course, is the whole point. During this Tech Day of Pink, throughout this entire Breast Cancer Awareness month—and every day—to spend our time as best we can, with the people we love.

Dr Shez Partovi

What are haemorrhoids?

The word ‘haemorrhoid’ derives from the Greek language and means ‘A flow of blood’ referring to the main symptom of the disease that is bleeding. In normal individuals, there are three main cushions of fibrovascular connective tissue in the anal canal that contribute to the anal continence at rest. These anal cushions are usually located in the 3,7,11 o’clock position, and their engorgement, stretching and prolapse will lead to hemorrhoidal disease. There are two types of haemorrhoids: internal and external. Internal haemorrhoids are located above the dentate line, while external haemorrhoids are below this line. There are some vascular communications between the two locations that when open, they will lead to a mixed type of disease (internal-external haemorrhoids).

How common are haemorrhoids?

Haemorrhoids are very common with 4-8 per cent of the population in the U.S. affected. Although the disease is reported in up to 40 per cent of endoscopic examinations, only half of the cases are symptomatic. Older age and obesity are main risk factors for hemorrhoidal disease. Haemorrhoids are more common in the Western countries probably because of a diet poor in fibres that will lead to constipation and straining on passing motions. The western sitting posture during defecation may place more strain on the anal canal compared to the squatting position used in African and Eastern countries. A general tissue laxity may be a contributing factor. Some studies have also reported an association with diarrhoea that may itself increase pressure on the anal canal as the patients will pass motions several times in a day.

How are haemorrhoids diagnosed?

A full history and accurate clinical examination are needed for the diagnosis of haemorrhoids. Prolapsing haemorrhoids can be obvious on examination or they may become apparent asking the patient to strain and stimulate a bowel movement. It is important not to assume that any rectal bleeding is due to haemorrhoids without completing a full work-up. Anoscopy and proctoscopy can be carried out in the outpatient department. Flexible sigmoidoscopy or colonoscopy can be performed in case a higher source of bleeding is suspected.

What are the symptoms of haemorrhoids?

Typically, haemorrhoids present with bleeding on defecation. The bleeding is bright red and drops on top of the stool and not mixed with it. Haemorrhoids can prolapse on defecation and may need to be pushed back in (Grade III). The prolapse can cause soiling, discharge of mucous and irritation of the anal and perianal skin with associated itching. In severe disease, haemorrhoids are permanently prolapsed and associated with fibrotic changes and skin tags (Grade IV). Painful haemorrhoids are often the result of complicated disease with thrombosis or strangulation. External haemorrhoids tend to be more painful as somatic innervation is present below the dentate line.

Do haemorrhoids always require surgery?

Minor grades of haemorrhoids are most of the times self-limiting and benefit from a conservative approach: increased intake of fluid and fibres, laxatives, toilet habits modification and regular exercise. Fibre supplements treatment has been reported to reduce rectal bleeding in 50 per cent of patients. Steroid and anaesthetic-based topical agents have not been shown to be of benefit. Phlebotonics that increase venous tone and lymphatic drainage have been found to improve bleeding, discharge and itching. When conservative treatment fails, surgery is required, and this can be performed in the office or in the operating theatre.

What are the latest options for painless surgery?

While symptomatic grade I and II haemorrhoids (non-prolapsing) can be treated with office-based techniques without the need of anaesthesia (rubber band ligation, sclerotherapy, infrared coagulation etc.), higher grades of haemorrhoids are more effectively treated in the operating theatre.

Traditional haemorrhoidectomy involving the surgical removal of haemorrhoids has been shown to achieve the best long-term results in terms of recurrence. However, the severe postoperative pain, the potential of injury to the anal sphincter complex and possibility of excessive scarring with stricture, usually related to poor technique, have encouraged the development and widespread use of alternative techniques.

In these new approaches, the haemorrhoids are not excised and there is no external wound to heal. The procedures are carried out above the dentate line avoiding the sharp pain from somatic innervation and producing only a dull postoperative discomfort that is well tolerated by the patients. Currently, the most commonly adopted new painless approaches are stapled hemorrhoidopexy, doppler-guided hemorrhoidal artery ligation and laser hemorrhoidoplasty.

Stapled hemorrhoidopexy allows to remove a cuff of rectal musosa above the haemorrhoids using a stapling device. The haemorrhoids are lifted up (pexy) and at the same time, their blood supply is interrupted. The stapled line should lie just above the sphincter complex to avoid muscle injury, postoperative pain and urgency. The main indication for stapled hemorrhoidopexy is Grade III circumferential haemorrhoids. The technique is fairly straightforward, but surgeons must have received specific training as rare but potentially serious complications have been reported: recto-vaginal fistula, stenosis, perforation.

Doppler-guided hemorrhoidal artery ligation is based on the concept that ligating all the branches of the superior rectal artery that supply the haemorrhoids will lead to their shrinkage. A dedicated proctoscope with a Doppler ultrasound probe is used to identify the vessels. Application of the redundant rectal mucosa is then made in case of associated prolapse.

Laser Hemorrhoidoplasty uses a laser probe that is introduced into the haemorrhoids and activated. This will produce immediate shrinkage of the haemorrhoids. Ice is applied after each application to reduce heat damage. A mucopexy is also performed to treat the mucosal prolapse with the secondary gain of interrupting the blood supply to the haemorrhoids and lift them up.

What is the best technique to use?

There is no best technique and treatment should be tailored to every single patient. Traditional haemorrhoidectomy in skilful hands may produce excellent long-term results with the downside of increased postoperative pain. The other techniques are very effective, greatly reduce pain and allow for shorter recovery and early return to work. A proctologist skilled in the various approaches and a full discussion with the patient is needed to achieve the best results.

Prof. Dr. Antonio Privitera is an Internationally renowned surgeon and speaker. He is the only surgeon with a Mayo Clinic Colorectal fellowship in the Middle East and Africa and the only one with both a Mayo Clinic and University of London colorectal fellowship in the world.