Vitamin D is a steroid hormone that is created either endogenously by the skin's response to UV radiation or exogenously through food or dietary supplements. Vitamin D deficiency is a global public health issue that affects over a billion individuals at all stages of life. Several studies over the last decade have found a relation between vitamin D deficiency and a variety of disorders, including systemic illness. Vitamin D deficiency affects immunological activities because it has an immunomodulatory effect, enhancing innate immunity through the production of antiviral peptides, and so improving mucosal defenses. 

Low levels of serum vitamin D have been linked to acute respiratory tract infections such as epidemic influenza in clinical investigations. Subjects with a blood vitamin D concentration of less than 50 nmol/l, had a 64 percent greater risk of community-acquired pneumonia, according to a recent meta-analysis integrating data from eight observational studies.

Vitamin D deficiency, according to several recent reviews, may impair respiratory immune function, increasing the risk of COVID-19 severity and death. There have also been some retrospective investigations that have found a link between vitamin D levels and the severity of COVID-19 and death.

Can Vitamin D protect against contracting Covid-19?

COVID-19’s outbreak and rapid spread has posed a serious global health risk with uncertain variations. Vitamin D has recently been shown to have antiviral properties, as well as anti-inflammatory and immunomodulatory properties. The infection had appeared to predominantly exploit immune evasion during infection, which is followed by hyperreaction and cytokine storm in some patients, as a known pathogenic pathway in the development of acute respiratory disease syndrome (ARDS).

SARS-CoV-2 enters alveolar and intestinal epithelial cells via using angiotensin-converting enzyme 2 as a host receptor. The renin–angiotensin system may then be dysregulated, resulting in excessive cytokine production and potentially deadly ARDS. Given the disparities in COVID-19 severity and fatality across the globe, it's critical to comprehend the reasons for this. A significant factor could be the improvement of immunity through better nutrition. Vitamin D, for example, plays an important role in immunological function. However, very little is known about vitamin D's involvement in preventing COVID-19 infection and death. According to a study published in the Journal of Infection and Public Health, using data from the COVID-19 pandemic data site for 20 May 2020, this study looked at the relationship between vitamin D levels and COVID-19 cases and deaths per million people in 20 European nations (most countries after peak).

Vitamin D supplementation has been shown to protect against respiratory tract infections in randomised trials and meta-analyses; therefore, people who are at higher risk of vitamin D deficiency during this global pandemic receive advise on taking vitamin D supplements to keep their circulating 25(OH)D at optimal levels (75–125 nmol/L). Some retrospective investigations identified a link between vitamin D and COVID-19 instances and outcomes, whereas others showed no link when confounding variables were taken into account. There is, however, inadequate evidence to link vitamin D levels to COVID-19 severity and death.

To test this idea, specliasts concure that randomised controlled trials and large-scale cohort studies are required.

At a time of prolonged uncertainty, the prospect of revived medical travel in Asia is dividing opinion.

In a recent Omnia Health survey of 1,600 healthcare respondents worldwide, the Voice of the Healthcare Industry Market Outlook 2021, confidence in medical tourism returning over the next 12 months is shown to be weaker in Asia (18 percent) compared to any other region worldwide.

By contrast, 2021 research from Polaris Market Research shows that Asia-Pacific, which had generated the highest revenue in the medical tourism market in 2019, is expected to be the leading region globally. This is attributed to increased demand, accessibility of healthcare facilities, and an increased number of medical facilities for international patients.

Omnia Health Insights caught up with Datuk Dr Kuljit Singh, President, Association of Private Hospitals of Malaysia for clarity, and specifically an update on the medical travel situation in Malaysia, a key market for medical tourism in Southeast Asia.

In June 2020, Dr Kuljit revealed that medical tourism in Malaysia had been reduced to zero because of the pandemic. 12 months on the situation has little improved. Patients are beginning to seek treatment in their own country rather than travel overseas, with one exception: emergency medical evacuation, with patients arriving on chartered executive jets while still having to follow the mandatory quarantine of two weeks to 21 days.

Telemedicine is not a viable alternative to medical travel either: Dr Kuljit believes it is suitable only for maintaining communication between a physician and the patients, while medical tourism instead offers multiple advantages – examinations, imaging, monitoring and other benefits to the patient.   

The Malaysia Healthcare Travel Council (MHTC), a government office which promotes Malaysian healthcare globally, is looking therefore to identify opportunities to bring medical tourists back to Malaysia, where borders remain closed to visitors.

This is likely to remain challenging owing to the high number of COVID-19 cases in Malaysia – at the time of writing they are numbering more than 7,000 daily, having rocketed since April 2021. Vaccinations are however being ramped up in the country through mega vaccination centres (“PPV”) and private hospitals, while there are also discussions regarding introducing drive-throughs and mobile vaccination units to rural parts.

Approximately 3.5 million doses have been administered to date (as of 5 June), including first and second, and assuming that there are no new variants, the Malaysian government is targeting to complete the vaccination programme across the nation by October 2021 at the earliest.

Vaccine passports

With herd immunity worldwide likely to take “years”, Dr Kuljit suggested that the only credible solution for the reopening of international borders and resumption of tourism is the digital ‘vaccine passport’, or mobile health pass, that would in theory allow vaccinated travellers entry into Malaysia.

Yet a digital passport is not without its challenges.

A proper vaccine passport will require extensive verification through blockchain technology or similar, unequivocally proving that the holder has been vaccinated against COVID-19, as fraud in test results is rampant in many parts of the world. This is on top of what a conventional passport offers, that is verifying the nationality of the holder for international travel. Any failure will invite problems.

Another issue is that, with the recent resurgence of COVID-19 in Malaysia, decision-makers are now firmly focused on the nationwide vaccine rollout, resulting in discussions on vaccine passports falling by the wayside.

Third, not all vaccines are recognised equally - though there is some encouragement for ASEAN countries. Sinovac, a Chinese vaccine now approved by the WHO, is administered in Thailand and Indonesia, and will also be provided in Malaysia alongside Pfizer-BioNTech and AstraZeneca.

Post-pandemic medical travel

Looking further ahead to a time when the pandemic is brought under control worldwide, within the next two years in Dr Kuljit’s estimation, some caution will likely remain both on the part of the caregiver and patient.

Hospitals may have to adopt concrete steps to reassure patients that they are safe and will furthermore have to ready themselves – along with the wider system - for the emergence of any other pandemic.

On the part of patients, there will be subtle lifestyle changes – mask-wearing and regular handwashing for example are likely to continue in some form.

Despite this, international patients will be eager to return to Malaysia, owing to the country’s long track record in medical tourism and positive perceptions around value and quality.

If anything, patients and tourists alike may rush in at once, Dr Kuljit added, pointing to the surge of domestic visitors to popular tourism destinations Langkawi and Penang in the month or two after the first COVID-19 wave in Malaysia when cases had come down initially. This is something that the industry would need to consider when welcoming a return to normal.

The silence surrounding IBD has been plaguing patients who suffer from Colitis and Crohn’s disease. Symptoms are not only discomforting, but they are lifelong with complexities which have physical, psychological, and sociological impact. The result of an accelerated inflammatory immune response, the causes of IBD are still being studied with the current consensus of bacteria in the gut changing its morphology being a probable cause. According to experts, to treat IBD, complementary and alternative medicine therapies can be vital in creating a holistic approach to managing the condition in conjunction with conventional treatments.

What causes IBD?

According to Dr. Malik, Senior Associate Consultant, Assistant Professor of Medicine-Gastroenterology at the Mayo Clinic, and Director of Inflammatory Bowel Diseases Gastroenterology and Hepatology Consultant Physician at Department of Medicine - Sheikh Shakhbout Medical City, Abu Dhabi, UAE, while the cause of inflammatory bowel disease (IBD) is unknown, IBD describes two disease entities, Crohn's disease (CD) and ulcerative colitis (UC). These result from an uncontrolled immune mediated inflammatory response in genetically predisposed individuals to a still unknown environmental trigger that interacts with the intestinal flora and primarily affects the gastrointestinal tract.

Based on North American data, there is no consistent significant difference observed in the prevalence or incidence of IBD between males and females. However, some cohorts have indicated a female predominance in Crohn’s disease and a male predominance in ulcerative colitis. However, according to Dr Malik, these findings are not consistent.

While there is variation in data, estimates for point prevalence of IBD, based on North American is between 25-300 persons per 100,000. While IBD can occur at any age, the peak age of onset for Crohn’s is considered to be between 20-30 years of age and for ulcerative colitis, it is between 30-40 years. There is then another peak, especially for UC between 60-70 years of age based on some European studies.

“There are several potential risk factors for the development of IBD. These include peculiar environmental triggers, intestinal immune mechanisms, heritable factors, gut flora, diet, mesenteric fat, certain medications, nicotine (tobacco smoking), infectious agents, stress as well as lifestyle,” he explains.

Source: SSMC, https://ssmc.ae/

Holistic approach

Numerous cases of patients across Middle East and Africa have described having IBD as inconvenient, painful, and embarrassing, with 84 per cent of adults living with ulcerative colitis saying the condition is mentally exhausting. Whereas 30 per cent of patients relayed that there was a gap in communication between physicians and patient in discussing how the IBD impacts their mental health.

“It’s a vicious cycle,” says Dr Malik, “from epidemiological data, people with genetic predisposition to IBD or people with higher stress levels in their life were more prone to being diagnosed with Crohn’s and Colitis. These pain inducing conditions can cause patients to feel stressed, anxious, and even suffer from depression. Specialists can attend to your colon health but that may still leave psychological needs unaddressed. As physicians, it is crucial for us to not only focus on the physical aspect but play close attention to emotional health as well. We need to focus on patient metrics which are based on patients continuing their lives without hindrances caused by the condition. Through a holistic, multidisciplinary approach we have witnessed success in IBD treatment. However, to successfully ensure patient treatment and care is improving at large, our vision should have the best-practice treatment for IBD.”

Break the silence

In a virtual round table held by Pfizer to ‘break the silence’ on World IBD day by raising awareness, renowned specialists spoke about the impact of the condition. “Considering the implication of gut health on the brain, linked as they are through a complex system of nerves and biochemical signals, it is not only the social implications of the disease that impact mental well-being. In recognition of this fact, we want to encourage patients to break the silence, speak with their doctors and ask them for their support. By asking for help, doctors can connect patients with advocacy and patient support groups, which are an ideal forum for sharing experiences and helping patients alleviate the psychological burden of IBD and reducing feelings of isolation. These can be vital to the creation of a roadmap to get back a sense of emotional well-being after suffering from a chronic disease such as IBD,” says Dr. Cecilio R. Azar, Clinical Associate, Division of Gastroenterology, Clemenceau Medical Center (CMC), Consultant Gastroenterology and Hepatology, Middle East Institute of Health (M.E.I.H), Lebanon.

“As a chronic disease impacting both physical and psychological well-being, patients with IBD can face a lifetime of challenges impacting both work productivity and relationships if not properly managed. The invisibility of the disease can make it particularly challenging for patients to communicate the negative impact that IBD can have on their day-to-day lives,” comments Yasser El Dershaby, Vice President of Pfizer and Medical Affairs Lead for Africa and Middle East Region.

Future of IBD patient care in the UAE

 

Sheikh Shakhbout Medical City, one of the UAE’s largest hospitals for serious and complex care, and a joint-venture partnership between Abu Dhabi Health Services Company (SEHA) and Mayo Clinic, launched a comprehensive centre for inflammatory bowel disease in Abu Dhabi. The centre would offer dedicated, multidisciplinary services inclusive of biological medicines, minimally invasive robotic surgery, and as part of its set of services the SSMC IBD Center has onboarded a new dedicated, multidisciplinary team of experts that will be delivering surgical, endoscopic, nutritional, radiological, pharmaceutical, and eventually behavioural health services, amongst others.

“The close cooperation between gastroenterology and colorectal surgery specialists is an essential aspect of the comprehensive and patient centred care. IBD is a unique and challenging disease. Patients benefit the most when they are seen and managed by a collaborative team of specialists from the outset to select the most appropriate treatment plan for every individual patient,” says Dr. Faek El Jamali, division chair of Colorectal Surgery, SSMC.

“IBD patients are at significantly greater risk of pre-cancerous lesions of the colon which are typically difficult to see and remove. Therefore, employing advanced methods of detection such as chromoendscopy (both digital and blue dye) and the removal of these through endoscopes as opposed to surgery,” adds Dr. Michael Wallace, Gastroenterology and Hepatology consultant and division chair, SSMC.

Chromo colonoscopy, or chromoendoscopy, is an adjunctive procedure which refers to the application of topical dying or digital optical filters during an endoscopy in order to identify otherwise difficult to see abnormalities. A rare procedure at UAE facilities, it is being offered by SSMC IBD Centre.

To further improve understanding and publish sound epidemiological data for IBD in the UAE, SSMC is actively seeking to create the first IBD consortium in Abu Dhabi. “This registry will encompass every IBD patient in the emirate and will enable us to conduct robust observational research and put into place a clinical trials infrastructure that directly aims to address the needs of our local IBD patients,” concludes Dr Malik.

This article appears in the latest issue of Omnia Health Magazine. Read the full issue online today.  

Laboratory device advancements are having a significant impact on the quality of work performed in clinical chemistry laboratories around the world. Clinical labs can now obtain data more quickly, more accurately, and consistently based on the progression of new instruments. In some cases, new devices are delivering scientific data that was previously unavailable. For pathologists, these progressions are providing invaluable means of obtaining breakthroughs; And for clinicians, substantially more trustworthy laboratory data, which is crucial in the diagnosis and treatment of disease.

Conventional analytical labs and clinical chemistry labs use similar devices such as colourimeters, spectrophotometers, flame photometers, fluorometers, pH meters, gas chromatographs, radiation counters. However, due to the recent digital disruption in healthcare, a need for devices and methods specifically catered for the clinical laboratory has led to diversification.

In the next decades, an enormous change is predicted to evolve the practice of clinical microbiology due to the maturation of sequencing and digital imaging tools. “Both of these applications require Big Data solutions, such as machine learning applications. In the 1900s, our understanding of the world was only bound by how much data we could obtain. However, we need tools like data reduction strategies, or data enhancement tools to help identify vital information in the sea of data and machine learning can help us with that,” says Dr Daniel Rhodes, section head for microbiology at the Cleveland Clinic.

Lab automation

Automation in bioanalytical laboratories enhances sample throughput and data integrity, reduces method development time, and speeds up sample data turnaround time, according to industry consensus. The degree of automation is determined by the laboratory's needs and resources, and the reasons for using automation differ depending on the application. Staff manipulation of biological samples is reduced with automation, particularly in sample transport, subsampling, analytical processes, and waste management. Furthermore, the automatic storage space protects sample integrity and is adequately guarded against unwanted access.

AI’s impact on healthcare has been transformative, and within clinical microbiology, it is predicted to accelerate diagnostics, with integration in total lab automation and machine learning. “One of the key diagnostic issues we have in microbiology is the time consumption. Most investigations can take hours or days, however, there has been a revolution in microbial identification in the last 10 years due to lab automation,” explains Dr Dietrich Mack, Microbiologist at Bioscientia.

Lab automation was adopted by Bioscientia in 2015, overhauling their approach to microbiology. “There was something new and important, a bi-directional interface between the laboratory automation and our laboratory information system was created, installed and tested. Finally, we were live in November 2017 and then the microbiology department transferred on a rolling track bench by bench over a period of five weeks, and that worked very well," says Dr Dietrich.

Regarding laboratory-testing capacity and methodologies, laboratory professionals have reported that existing methods were revalidated, with a 36.5 per cent relaying that new instruments were required in the wake of COVID-19 testing, according to Initial Clinical Laboratory Response to COVID-19: A Survey of Medical Laboratory Professionals, published in oxford academic. A variety of testing options were developed, which require results sourced from laboratories within a short span of time, showcasing the need to deliver quality results rapidly.

Atif Al Braiki, the Chief Executive Officer of Abu Dhabi Health Data Services, the operator of Malaffi, said: “Technology is revolutionising healthcare delivery globally, and innovative solutions like HIEs, which allow the exchange of real-time, meaningful information, support safer, more efficient and more effective healthcare delivery. Privacy and security of patients go hand in hand with their care and ensuring effective safety measures are in place to protect data is critical. We are in a unique position of trust, so in addition to compliance with all Emirate-wide and federal health privacy laws and data standards, we strive to adhere to global best practice. Prioritising security has always been at the heart of Malaffi’s journey, as we have aligned with the highest standards, continuously assessed, and addressed potential risks and worked to improve our data security capabilities. Recognition from the ISO and EHNAC reaffirms our successful commitment to the integrity of patient security.”

Speaking about this important achievement for Malaffi, Abdulla Bader Al Sayari, Chief Information Security Officer at DoH said: “Recognition from independent, international bodies is extremely important for our healthcare system. In a short space of time, we have built a health infrastructure that is on a par with some of the most advanced in the world. Always at the heart of this ambitious journey, is the safety of our patients and the security of their health information. By looking to global benchmarks and organisations like ISO and EHNAC, whose sole ambition is to improve data standards, we can ensure that Malaffi adheres to the highest criteria and enables the Department of Health to offer high quality healthcare services.” 

EHNAC Executive Director and CEO, Lee Barrett said: “The EHNAC was established to promote accreditation within the healthcare industry, to help our partners achieve the highest standards of confidentiality, integrity, quality and accountability in all they do. With the implementation of such innovative technology for the first time in Abu Dhabi, instilling a sense of stakeholder-trust is vitally important.  As the leading accreditation authority for HIEs, EHNAC recognises the efforts made by Malaffi and the Department of Health-Abu Dhabi to continuously promote standards that support compliance, interoperability, trust, quality, innovation and regulatory compliance at all times, and congratulates Malaffi on being the first recipient of the accreditation outside of the US.”

For more information, please visit https://malaffi.ae/

Double masking is an essential part of practising preventative measures when it comes to staying safe during the pandemic. Ensure that you've performed hand hygiene before and after handling your masks.

There are two types of masks, the N-95 and the surgical mask, and there are specific steps that need to be followed to extend the life of each mask and maximise their level of protection.

To learn more, watch the video below on how to practice double masking.

 

Within healthcare, adaptation and innovation have played a pivotal role in continuing to provide and improve patient care during the pandemic. As the UAE telehealth market is expected to grow at a CAGR of 25 percent per year from 2020 to an estimated* US$536.5 million (AED19.7 billion) by 2025, telehealth may become the next frontier to cope with public health crisis and a key pillar of post Covid-19 patient care. 

Alvarez & Marsal’s study analysed the pandemic’s role in accelerating a surge towards a smarter healthcare ecosystem and examined the trends and challenges which payers and providers can encounter. The study also reviewed significant health care model disruptors, evolving market opportunities, and policy/regulatory developments to discover that innovation and collaboration will drive future development.  

Co- authored by Karim Benhameurlaine, Managing Director and Head of Healthcare and Life Sciences Middle East with Alvarez & Marsal’s strategy and performance improvement, and Dr. Sara Alom Ruiz, Senior Director Healthcare and Life Sciences Middle East with Alvarez & Marsal Strategy and Performance Improvement group in Dubai; Despite several, simultaneous transformations in service delivery, healthcare organisations demonstrated resilience in enhancing their existing operating models, seeking digital health solutions, as well as provider consolidation, to generate economies of scale and vertical and horizontal development, according to the report.

Source: Alvarez & Marsal, https://www.alvarezandmarsal.com/

1. Do you predict Covid-19 to leave a lasting impact on the telehealth market in the UAE?

COVID-19 has impacted industries at large. Pre pandemic, about only 5% of full-time office employees worked remotely and post pandemic, that percentage is expected to rise to about 20 to 30%. Reflecting on how we've been able to adapt to working remotely, it segways seamlessly into healthcare. If we look at the healthcare landscape pre pandemic, the use of telehealth was at its infancy, for a number of reasons, but the pandemic accelerated the use of telehealth out of need and necessity.

The regulatory frameworks have been supportive of that, as well as providers and reimbursements policy makers responding to that shift and need promptly. Currently, 91 percent of UAE insurers reported that their policyholders recently used some form of telehealth services, as opposed to 31 percent pre-pandemic, representing an increase of 60 percent as a result of the pandemic.

Now, post pandemic, some predict that the pendulum will swing back to more in person visits, but it definitely won't swing back to where it was pre pandemic. Patients have adapted to a new experience and healthcare providers have integrated telehealth. So will that go away? We don't think so, what we think is that hybrid models are likely to predominate the future of both telehealth and traditional healthcare models, with the choice ultimately with the patients.

2. How will telehealth shed its reputation of being an important tool used to cope with a public health crisis? 

Primary care typically lends itself well to telehealth along with chronic disease management. Over 50 percent of expats in the UAE are likely to use telehealth for primary care, 14 percent more than global averages. In instance of patients seeking primary care, they receive the same level of care remotely, which may be a convenient option for them to consider. Within primary care, there is a broad range of specialties such as family medicine, internal medicine, pediatrics, psychiatry which have demonstrated effective care via virtual means.

Patients who suffer from chronic disease require regular follow up visits with their healthcare practitioner. In addition, remote care monitoring is also a key facet of patient care which aligns well with the telehealth. For chronic disease management, patients can be served for multiple needs such as endocrinology, gastroenterology, geriatric care, and pain management to name a few.  

Most importantly, we've seen a big improvement in patients receiving diagnostic services remotely which may be required within a typical consultation. The first consultation would be virtual and then subsequently, electronic prescriptions would be prescribed for delivery. In addition, phlebotomists and other healthcare professionals can visit patients to collect blood samples.

3. Will telehealth be embraced as a regular pillar of healthcare?

Pre-pandemic we witnessed that telehealth was not widespread in the market, COVID-19 shifted virtual health into a higher gear. However, there are key aspects which determine its long-term viability. Quality and patient experience of the telehealth service rival in-person care. We discovered during tele consults that patients report the face-to-face factor as vital, to help establish empathy and trust similar to that achieved at the bedside.   

In a telehealth setting, a chronic disease patient who is accustomed to virtual consultations with their entrusted physician with knowledge of their case, would most likely continue rather than physically visit the facility every month. From a continuity of care perspective, if the quality of treatment and monitoring is akin to physical consults, it creates convenience for patients. However, we are in a progression period where solutions are being perfected to ensure that the patient experience is seamless. Therefore, factors such as integration of medical records, documentation of clinical services is crucial and ensures physician access to medical history, improving patient outcomes and safety.

One of the big aspects of telehealth is convenience, whether you save travel time or receive treatment at the comfort of your home. Training professionals to use evolving interfaces routinely is critical. Operations teams needs to be seamless with scheduling and embedding appointments in systems to ensure the time of a physician is adequately allocated between virtual and in person consults. All these factors play an important role in where telehealth becomes ‘commoditised’.

4. What digital advancements are forecasted to grow in the UAE?

Within digital health we are seeing a wide stream adoption of different applications of AI from chat bots to appointments or scheduling, and even supplying medical information. Clinical applications that support clinical care have existed in the market and are advancing rapidly, particularly within imaging and robotics.   

Big data and predictive analytics are growing as well. With algorithms in place and complex analytics that help predict and warn patients and physicians of potential health risks and serious complications, is where the future of health care and not sick care, is heading towards. Other advancements, such as genome sequencing and precision medicine are paving the way to shift care towards more personalised and precise care. All these technological advancements are continuing to disrupt the way healthcare is rendered.

5. How will these innovations impact the healthcare industry’s growth in the UAE? 

The number of hospitals in the UAE has been steadily growing year-on-year, at a rate of 6.2 percent per annum, leading to an increasingly competitive healthcare provider market. With the continued advancements of healthcare innovation, organizations that disrupt their existing healthcare offering will capitalise on diversifying from traditional revenue sources. Moreover, the interdependencies between all health sector stakeholders are continuously getting stronger, and along with the advancement of technologies to enable better care, ultimately poses a very positive future for patients and improved outcomes.