against Diabetes program achieves Guinness World Record

5 ways to stop snoring

Coping with Colds and Flu

BOTOX.. NEW TREATMENT OF THE URINARY BLADDER OVERACTIVITY

10 habits for healthier children

Juices for optimal Health

Monthly magazine of Dubai Health Authority for health promotions in cooperation with Balsam For Health Promotion 2nd ISSUE, 15th Jan 2015

Initially, the Department of Health and Medical Services (DOHMS), which was created in 1973, was the functioning authority that almost exclusively focused on health service delivery.Therefore, the DHA was created, in June 2007, by Law 13 issued by His Highness Sheikh Mohammed bin Rashid Al Maktoum, Vice President and Prime Minister of the UAE, Ruler of Dubai, with an expanded vision to include strategic oversight for the complete health sector in Dubai and enhance private sector engagement.His Highness Sheikh Hamdan Bin Rashid Al Maktoum, Deputy Ruler of Dubai and UAE Minister of Finance is the President of the Dubai Health Authority. His Excellency Engineer Essa Al Haj Al Maidoor is the Director General of the DHA.The DHA’s aim in Dubai is to provide an accessible, effective and integrated healthcare system, protect public health and improve the quality of life within the Emirate. This is a direct translation of the objectives of the Dubai Strategic Plan 2015 launched by His Highness Sheikh Mohammed bin Rashid Al Maktoum. Keeping the strategic plan in mind, the DHA’s mission is to ensure access to health services, maintain and improve the quality of these services, improve the health status of nationals, residents and visitors and oversee a dynamic, efficient and innovative health sector.In addition to overseeing the health sector for the Emirate of Dubai, the DHA also focuses on providing services through DHA healthcare facilities including hospitals (Latifa, Dubai and Rashid), specialty centers (e.g. the Dubai Diabetes Center) and DHA primary health centers spread throughout the Emirate of Dubai.The main pillars of service delivery at DHA health facilities are quality, efficiency, patients and staff. It is our aim to maintain and improve the quality and efficiency of DHA health services. An important aspect of the service delivery strategy is to focus on patients, their needs and satisfaction as well as attract, retain, nurture and support outstanding staff.

Vision:

Healthy, Happy and Safe Community.

Mission:

Develop an integrated and sustainable healthcare system that ensures delivery of comprehensive and excellent services to achieve the highest international standards in health of individuals and community.

ValuesPeople First

Excellence in ServiceHonesty

Team SpiritEfficiency

Creativityand Innovation

6 – Dubai Health Sector has several options for international accreditations

8 – DUBAI against Diabetes program achieves Guinness World Record

12 – Warning Signs of a Heart Attack

16 – Coping with Colds and Flu

20 – BOTOX new treatment of the urinary bladder overactivity

28 – Attention Deficit Hyperactivity Disorder in Children and Adolescent

34 – Juices for Optimal Health

38 – Breathing & Relaxation

42 – 6 Creative ways to use twitter for healthcare marketing

44 – Irritable bowel syndrome

About us: Contents

Editor-in-chief

Ghanim Lootah

Managing Editor

Mahmoud Youssef Al Ali

Medical Media & Marketing Consultant

Bassam Darwish MD

Editorial board

Husni AlbalwnahTalal AlDebyiat Fadi Wannous

Kamakshi GuptaNancy Bhatia

Coordinator

Ashwaq Abdullah Hala Darwish

Art Director

Talah Abdullah Mohammed

Contact us

04 219706604 5531348

E-mail :ashwaq@dha .gov .ae

hala@balsam-group .com

Sehhaty ,The official monthly magazineof Dubai Health Authority, in cooperation

with Balsam For Health Promotion

SEHATY magazine aims to achieve the following: - Promote medical mourism in Dubai.- Enhance the communication between (DHA) and all beneficiaries of the healthcare system like investors, patients, medical service providers and others. - Promote the quality and safety concepts related with healthcare facilities.- Educate people by focusing on issues related to healthy life routine, chronic diseases and how they can handle it.- Spread health awareness amongst people, information about Medical practices, new developments in the healthcare sector and all the laws and legislations related to it.

In terms of the public sector,

the accreditation journey for the

DHA began in 2007 when

Dubai hospital, Latifa (previously

known as Al Wasl) and Rashid were

internationally accredited in

2007 and were reaccredited in

2010 and 2013 respectively.

D ubai recognizes more than 20 international accreditations for healthcare facilitates

giving the health sector in the emirate several options to seek international accreditations, said a Dubai top health official.Essa Al Maidoor, Director-General of Dubai Health Authority (DHA), said, " Dubai has a dynamic health sector and we recognize more than 20 international accreditations for health facilities, thus the health sector in Dubai have several options to choose from in terms of seeking international accreditations. In line with the DHA's health regulation mandate, all hospitals in Dubai must be internationally accredited and we are pleased to see that hospitals either already have the accreditation or are in process of obtaining it." He added that hospitals that are accredited, work towards reaccreditation on a regular basis, because of the DHA mandate, which helps Dubai sustain high quality of health services and ensures

patient-safety.Al Maidoor said: "Seeking international accreditations for the health sector of

Essa Al MaidoorDirector-General of Dubai Health Authority (DHA)

Dubai Health Sector has several options for international accreditations

6ISSUE (2) 15 Jan 2015

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News & Views

Dubai is in line with the vision of His Highness Sheikh Mohammed Bin Rashid Al Maktoum, Vice President and Prime Minister of the UAE and Ruler of Dubai and is in line with the Dubai Health Strategy 2013-2025. International accreditations are important to benchmark ourselves at an international level and accreditations are a tool to ensure delivery of safe and high-quality services for our population and visitors alike. Accreditations also provide a boost to the medical tourism." Al Maidoor said that Dubai has come a long way in terms of international accreditations since this program began in 2007 when only one private hospital was internationally accredited.Today, Dubai has 25 private hospitals, of which, two will be down-graded to day-care centres. Presently 18 hospitals are accredited and 5 are under process,

of which two are new hospitals, and will begin the accreditation process after being operational for 18 months.In terms of the public sector, the accreditation journey for the DHA began in 2007 when Dubai hospital, Latifa (previously known as Al Wasl) and Rashid were internationally accredited in 2007 and were reaccredited in 2010 and 2013 respectively. DHA's Thalassemia Center achieved an international accreditation in 2007 and was reaccredited in 2010 and 2013. Similarly, the Airport Medical Center achieved its accreditation for ambulatory care standards in 2010 and was reaccredited in 2013. The Dubai Blood Donation Centre (DBDC) achieved the AABB (American Association of Blood Banks) accreditation in 2012 by successfully meeting standards set by American Association of Blood Banks(AABB)

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U A E residents, as part of the Stay Strong Campaign, have set a Guinness World Record by lighting 11,022 bulbs, which

represent the number of Stay Strong app downloads in the UAE, on the 25th of December at the Burj Park, showing their support and raising awareness about diabetes.Undertaken by Benchmark Middle East, an award winning Healthcare communication agency, in partnership with the Dubai Health Authority (DHA), the event, entitled ‘Celebrating the Moment’, officially kicked off the Dubai Against Diabetes three year programme.It was a spectacular lighting ceremony initiated by 18 individuals, symbolising unity against diabetes.Speakers at the event included Stay Strong campaign ambassadors. Abdulla Al Hashidi, an Emarati with diabetes, gave attendees an inspirational story of how he overcame obstacles while living with diabetes, and Raha Moharrak, the first and youngest Saudi woman to climb Mount Everest. Fayez Al Saed, Emarati singer, also attended the event as a supporter and guest of honour.Speaking about the campaign, Mohamed Hammad, Founder and Chief Executive Officer, Benchmark Middle East, said, "We are extremely delighted and

proud that we were able to bring 11,022 UAE residents together to support DHA’s attempt to set a Guinness World Record in support of the Dubai Against Diabetes programme. It is time to revolutionise health education in the Middle East thereby preventing diseases from spreading, and minimising complications due to the lack of awareness and availability of resources for accurate information. We at Benchmark Middle East believe we need to communicate in an innovative way to the public, and adding more effort in educating the new generations for a better future." Attendees of the event included Dr. Fathia Al Awadi, Chairperson, Dubai Diabetes Control and Combat Committee at Dubai Health Authority, Dr. Abdelrahman Al Jasmi, Chief Executive Officer, Dubai Hospital, Dr. Jamal Al Saleh, Acting Director, Dubai Hospital, Dr. Mouza Sharhan, President of Emirates Medical Association, Ghanim Abdullah Lootah, Director of the Department of Institutional Marketing and Communication at Dubai Health Authority, Mohamed Hammad, Founder and Chief Executive Officer, Benchmark Middle East, Guinness World Records representatives, Haitham Al Sayed from Life Scan, Johnson and Johnson’s, Ahmed Abo Al Fadl and Ahmed Azhary from Merck Serono, and representatives from Novo Nordisk and Astrazeneca

News & Views

Against Diabetes Program

achieves Guinness World Record

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“Surgical site infections are one of the biggest complications acquired in the operating room,” said David Leaper, Professor of Clinical Sciences, University of Huddersfield, UK. “Because these infections are primarily preventable, it is really important to bring together the medical community, not only to raise awareness, but also to exchange information and best practices, and discuss ways to work together to prevent and optimally manage surgical site infections when they occur.”Surgical site infections, infections which occurs after a surgical procedure, have been shown to compose up to 20% of all of healthcare-associated infections, and patients who develop a surgical site infection are five times more likely to be re-admitted to the hospital after discharge. Surgical site infections can also extend hospitalization by an average of four to seven days with an increased risk of dying. A surgical site infection may range from a superficial infection occurring within seven to 10 days of an operation, to a life-threatening

post-operative complication (e.g. infection of the chest cavity after open heart surgery). Most surgical site infections are caused by contamination of an incision from microorganisms from the patient's own body during surgery.1 A four-city roadshow aims to drive dialogue amongst key healthcare leaders to improve patient care through the prevention and management of surgical site infections Surgical site infections, of which 40-60% may be preventable, have been shown to compose approximately 32% of all hospital-acquired infections and that figure is rising, not fallingGuidelines exist which recommend ways to prevent and manage these infections, including the use of anti-microbial sutures, to help reduce the burden on patients and the healthcare systemEthicon, a division of Johnson & Johnson, announced today the launch of a series of regional symposia which are focused on surgical site infections, a preventable

News & Views

Ethiconannounces a series of symposia to raise awareness of surgical site infections and help improve patient outcomes

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type of healthcare-associated infection which is associated with a significant personal and economic burden on patients and healthcare systems across the Middle East. Healthcare professionals across all disciplines are invited to participate in a discussion-based forum on how to reduce the occurrence of surgical site infections and improve the quality of patient care. With the help of Modern Pharmaceutical Company the Abu Dhabi symposium took place on Dec, 16th, with other cities to follow.Measures can be taken in the pre-, intra- and post-operative phases of surgery to reduce the risk of infection and International guidelines make recommendations for the prevention and management of surgical site infections based on the evaluation of available published evidence, (e.g., maintaining perioperative normothermia and the utilization of anti-microbial sutures.) Despite current preventive measures, surgical site infections account for one out of three (37%) of all hospital-acquired infections in surgical patients – highlighting that there is still more work to be done to reduce its risk.

“Ethicon is proud of its role in bringing together

noted healthcare leaders, as we recognize the value of collaboration and shared knowledge in our ongoing mission to minimize surgical site infections in patients,” said Jamie Phares, Business Unit Director of Ethicon Surgical Care Middle East. “As part of our commitment to improving patient outcomes and quality of care, we are delighted to launch this series of symposia, which will help the healthcare community gain valuable insights on how to best address this type of infection.”

Surgical Site Infection symposia will also be held this month in Jeddah, Riyadh, Abu Dhabi and Amman. Further symposia are planned for 2015

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S ome heart attacks are sudden and intense — the "movie heart attack," where no one doubts

what's happening. But most heart attacks start slowly, with mild pain or discomfort. Often people affected aren't sure what's wrong and wait too long before getting help. Here are signs that can mean a heart attack is happening:

Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back,

warning signs of

a Heart Attack

Your Health

12ISSUE (2) 15 Jan 2015

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neck, jaw or stomach.Shortness of breath with or without chest discomfort.Other signs may include breaking out in a cold sweat, nausea or lightheadedness.As with men, women's most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting, and back or jaw pain. Learn the signs, but remember this: Even if you're not sure it's a heart attack, have it checked out (tell a doctor about your symptoms). Minutes matter! Fast action can save lives — maybe your own. Don't wait more than five minutes to call 999 or your emergency response number. Calling 999 is almost always the fastest way to get lifesaving treatment.Emergency medical services (EMS) staff

can begin treatment when they arrive — up to an hour sooner than if someone gets to the hospital by car. EMS staff are also trained to revive someone whose heart has stopped. Patients with chest pain who arrive by ambulance usually receive faster treatment at the hospital, too. It is best to call EMS for rapid transport to the emergency room

Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach.

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T here's no miracle cure for snoring, but lifestyle changes, over-the-counter

remedies and medical treatments may help. As snoring is often related to lifestyle, there are some simple changes you can make to minimize it.Snoring self-help tips:Maintain a healthy weight and diet. Being overweight by just a few kilograms can lead to snoring. Fatty tissue around your neck squeezes the airway and prevents air from flowing in and out freely.Try to sleep on your side rather than your back. While sleeping on your back, your tongue, chin and any excess fatty tissue under your chin can relax and squash your airway. Sleeping on your side prevents this.Avoid alcohol before going to bed. Alcohol causes the muscles to relax more than usual during a normal night's sleep. This added relaxation of the muscles makes the

back of the throat collapse more readily, which then causes snoring.Quit or cut down on smoking. Cigarette smoke irritates the lining of the nasal cavity and throat, causing swelling and catarrh. If the nasal passages become congested, it's difficult to breathe through your nose because the airflow is decreased.

Keep your nasal passages clear, so that you

breathe in through your nose rather than

your mouth. If an allergy is blocking your

nose, try antihistamine tablets or a nasal

spray. Ask your pharmacist for advice, or

see your GP, if you're affected by an allergy

or any other condition that affects your

nose or breathing, such as sinusitis.When to seek medical adviceVisit your GP if you feel excessively tired during the day, as it may be caused by your snoring affecting your breathing while you sleep.The most common sign of excessive tiredness is when you find yourself falling

Try to sleep on your side rather than your back. While sleeping

on your back, your tongue, chin

and any excess fatty tissue under

your chin can relax and squash

your airway. Sleeping on your

side prevents this.

ways to stopsnoringThere's no miracle cure for snoring, but lifestyle changes, over-the-counter remedies and medical treatments may help.

5Your Health

14ISSUE (2) 15 Jan 2015

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asleep during the day.You should also see your GP if you suspect a lack of sleep is affecting your day-to-day activities and causing symptoms such as:poor memory and concentrationheadaches (particularly in the morning)irritability and a short temperanxiety depression lack of interest in sexAlso visit your GP if your snoring is causing relationship problems with your partner, such as keeping them awake at night or waking them up.Snoring in children should be investigated by a GP as it is often caused by an underlying problem with their airways, such as enlarged tonsils, which may require further investigation and treatment

Also visit your GP if your snoring is causing relationship problems with your partner, such as keeping them awake at night or waking them up.

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C olds and flu are caused by viruses. There are more than 200 common cold viruses and three types of flu virus, with many different strains, so they're hard to avoid.

These viruses can be spread through droplets that are coughed and sneezed out by an infected person. The viruses can also be transferred via a person's fingers or surfaces, such as door handles, if there are infected droplets on them.

Coping withcolds and flu

Your Health

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The virus enters the body via the nose or eyes. If you have infected droplets on your fingers and you touch your eyes or nose, the virus can enter your body. Cold symptomsThe main symptoms of winter cold and flu bugs are:coughingsneezingblocked nosesore throatheadachea slight temperatureIf these are the only symptoms you have, it’s unlikely that your GP will be able to do anything.You may want to visit your local pharmacy, where you can get advice on how to manage the symptoms and buy

over-the-counter medicine.Get rest and eat wellDr Rupal Shah, a GP in south London, has the following advice: “Try to rest, eat well, avoid stress and keep hydrated. If you have a fever, you may need extra fluids. You could also take paracetamol to treat fever and pain, or inhale steam with a decongestant in to help clear a blocked nose.”Pharmacists say cold and flu medicines are among their top sellers in the winter. Some of the remedies combine painkillers with decongestants, which can help to manage symptoms.“Painkillers – such as paracetamol, ibuprofen and aspirin – can really help if you have a cold,” says pharmacist Angela Chalmers. However, aspirin shouldn't be

Pharmacists say cold and flu medicines are among their top sellers in the winter. Some of the remedies combine painkillers with decongestants, which can help to manage symptoms

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given to children under 16 years of age. She adds that, “decongestants help to reduce the swelling inside your nose so you can breathe more easily”. In most cases, antibiotics (which are used to treat bacterial infections) aren’t necessary. “Colds and flu, and most coughs, are caused by viruses, so antibiotics can’t help. Minor bacterial infections will also be fought off by natural immunity,” explains Dr Shah.Children and coldsChildren can be treated using some

over-the-counter painkillers, to ease discomfort and help bring down a fever. Both paracetamol and ibuprofen are available as a liquid for children, and can be given from the age of about three months. Always check with your doctor if you aren’t sure which treatments you can give your child.There are some benefits, particularly for children, in catching a few coughs and colds. “Children tend to get a lot of colds because the body takes time to build up immunity. Your body learns to fight off

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a particular kind of virus every time you get an infection, which is why you get fewer colds as you get older," says Angela Chalmers. When to see a doctorWhile most bugs will run their course without doing any real harm, Dr Shah says there are certain cases when you or your child should see a GP. These include:if you or your child have a chronic condition – such as asthma, diabetes or heart diseaseif you have a very high temperature and feel ill – for example, if you also have an unusually severe headache or abdominal painif your child is vomiting but does not have diarrhoea, or has a rash in addition to the feverif your child stops drinking and is unusually lethargicif your child’s fever doesn’t respond to paracetamol or ibuprofenBabies, as well as older and frailer people, should get help if they're unwell.Always contact your GP, health visitor, practice nurse or nurse

practitioner if either:your child has other signs of illness, as well as a raised temperatureyour baby’s temperature is 38C (100.4F) or higher (if they’re under three months)your baby’s temperature is 39C (102.2F) or higher (if they’re three to six months)If you need to speak to someone outside of normal surgery hours, you can call your GP surgery’s out-of-hours service (if they have one) .Help stop germs spreadingCATCH IT Germs spread easily. Always carry tissues and use them to catch your cough or sneeze.BIN IT Germs can live for several hours on tissues. Dispose of your tissue as soon as possible.KILL IT Hands can transfer germs to every surface you touch. Clean your hands as soon as you can

If you need to speak to someone outside of normal surgery hours, you can call your GP surgery’s out-of-hours service (if they have one)

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On 14 December 1895 in Ellezelles, Belgium, three persons died after consuming smoked ham sausages. A student of Roberto Koch isolated the responsible organism and named Bacillus botulinum (1), today known as Clostridium botulinum.In 1946, Edward Schantz succeeded in extracting BoNT-A in crystal form. In the 1960s, Alan Scott and Schantz tested the possibility of treating strabismus in monkeys.Finally in 1978, after the American Federal Drug Agency (AFDA) permitted its use, Scott used BoNT-A injection successfully for treating strabismus in human. Carruthers in 1996 published the first paper about its use in cosmetic therapy .In the mid-1990s, it was applied by Naumman for the treatment of hyperhydrosis. After its successful application in patients with detrusor sphincter dyssynergia, the research team of Schurch in Zurich (1997) started to show promising results after having done their first injection of BoNT-A in the urinary bladder for treating neurogenic incontinence in patients with spinal cord injuries, and for patients suffering from idiopathic overactive bladder, respectively .

Mechanism of action in the Bladder wall and muscle:The pathophysiologic basis of Detrusor overactivity remains incompletely understood; indeed, it is probably a multifactorial problem, with a balance of predisposing and compensatory processes participating to elicit a fluctuating clinical picture.Furthermore, functional changes at several levels in the regulatory operations of the lower urinary tract (LUT) give rise to seemingly similar clinical features, perhaps as a consequence of limited repertoire of behavior which can be discerned clinically (Detrusor overactivity, urgency and

BOTOX.. NEW TREATMENT OF THE URINARYBLADDER OVERACTIVITY

Your Health

Prof. Dr. Med. SEMIR AHMED SALIM AL SAMARRAI

Director of Professor Al Samarrai Medical Center

20ISSUE (2) 15 Jan 2015

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incontinence).When recognizing the uncertainty as to precisely how botulinum-A-neurotoxin (BoNT-A) achieves its beneficial effect, it is important to consider that overactive urinary bladder is still enigmatic.The Neurogenic Hypothesis:Understanding of the reflex basis of the micturation cycle was elaborated in the later part of the 19th century by Barrington, who identified the pontine brainstem as the site of ultimate control. This insight indicated the importance of the “pontine micturation centre” (PMC) in regulating the state of the entire LUT, controlling the fundamental determining step of switching between the storing and voiding status.Consequently, brainstem-mediated inhibition of bladder at spinal and peripheral level, with excitation of the bladder outlet, was perceived to underpin LUT reservoir function, also the LUT-

Dysfunction is derived from CNS deficit, this is manifested by abnormal excitation or loss inhibition. Thus, the various strands by which the CNS could underpin overactivity with the bladder muscles were drawn together as “the neurogenic hypothesis”, this can be summarized as explaining overactive contractions by the emergence of abnormal reflex activity. Several processes within the CNS could lead to this. The physiological inhibition of lower centres by the brainstem is fundamental, and it is clear that any lesion affecting such inhibition would allow an abnormal level contractile activity to be expressed peripherally.Depending on the precise location of any deficit in the CNS, loss of bladder inhibition could allow bladder muscle overactivity to emerge in the bladder. Lesions in other locations could simultaneously affect outlet function, the latter either being reduced (predisposing

Understanding of the reflex basis of the micturation cycle was elaborated in the later part of the 19th century by Barrington, who identified the pontine brainstem as the site of ultimate control. This insight indicated the importance of the “pontine micturation centre” (PMC) in regulating the state of the entire LUT, controlling the fundamental determining step of switching between the storing and voiding status.

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to Detrusor Overactivity incontinence) or increased (causing Detrusor Overacitvity (DO) with an elevated postvoid residue volume). Theoretically, either abnormal excitation of the pontine micturation centre (PMC) by higher centres, or loss inhibition, could facilitate premature switching of the storage phase over to voiding. At any level of the CNS, reduced inhibition or increased excitation could result from reorganization of reflexes, exemplified by the emergence of C-fiber-mediated activity in spinal injury.The Myogenic Hypothesis: A radical departure from the neurogenic hegemony came with the recognition that similar bladder behavior to bladder muscle Detrusor Overactivity (DO) can arise with no efferent input, and that nonneurogenic processes can elicit the same widespread uninhibited detrusor contraction arising without volitional control. The initial review in which the myogenic hypothesis was fully elaborated still represents one of the clearest expositions of the fundamental considerations in overactive bladder disorder, which have to be explained to understand its mechanism basis. Of these, particular emphasis must be placed on increased peripheral excitability, exaggerated propagation and triggering.Increased excitability refers to the observation of higher levels of spontaneous contraction in detrusor muscle strips isolated from people with DO. The increased excitability could result from alterations in the resting cellular membrane potential, or changes in the cell-surface receptors (‘supersensitivity’).Certainly, various studies have shown a change in the sensitivity to standardized stimuli , although this is not invariably

the case. This supersensitivity could be a result of changes in intracellular pathways, or increased cell expression of surface proteins such as the muscarinic receptors.The ability of smooth muscle of the bladder to increase cell surface receptor expression is an important consideration, as it signifies the ability of smooth muscle to adapt to change in the paracellular environment. For example, denervation of smooth muscle leads to reduced cholinergic stimulation and elicits up-regulation of cell-surface-cholinergic receptors. Consequently, exogenous application of equivalent doses of cholinergic agonist elicits a more powerful contractile response in denervated muscle than muscle removed from an otherwise normal specimen. In principle, this might underlie loss of clinical efficacy in long-term use in people with DO who initially responded to anticholinergic drugs. In effect, sustained blockade of muscarinic receptors would produce loss of functional influence of the nerve endings on the muscle cells, leading to receptor up-regulation, which might eventually overcome the effect of the muscarinic antagonist. Subsequent discontinuation of anticholinergic drug would then lead to a ‘rebound’ exacerbation of symptoms. By itself, increased smooth muscle cell excitability of the bladder will not result in Detrusor Overactivity (DO), as spontaneous

Certainly, various studies have

shown a change in the sensitivity to

standardized stimuli , although this is not

invariably the case. This supersensitivity

could be a result of changes in

intracellular pathways, or

increased cell expression of surface

proteins such as the muscarinic

receptors.

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excitation is normally limited in extent by failure of excitation to spread more than a few millimeters (reflected in a short space constant) . Thereby, only a small proportion of the bladder wall would participate in any spontaneous contraction, insufficient to affect intravesical pressure. However, in people with DO, the propagation of spontaneous excitation appears to disperse over a more substantial proportion of the bladder wall, thereby carrying the potential to generate pressure change. This might be a result of the altered detrusor ultrastructures in DO, which includes increased expressional intracellular communication channels. Triggering refers to the fact that a pure increase in excitability at the cellular level will still not cause increased spontaneous activity unless something actually sets it off (the “trigger”).Given the response of DO to anticholinergics, acetylcholine (Ach) must be involved at some point, and it is in triggering that Ach is most likely involved in the myogenic hypothesis, where altered properties of smooth muscle are said to underpin DO, the inhibitory effect of BoNT-A on vesicular Ach release can be observed to be beneficial.Peripheral Cellular Physiology:For some time the bladder has been regarded as a relatively “simple organ” with the bladder wall muscle (Detrusor) and parasympathetic nerve endings seen as the only relevant bladder structures for the urination process. However, the recent past has seen a burgeoning recognition of the cellular complexity of the bladder wall. The urethelium is a remarkable example of the fundamental reappraisal that is occurring. The presumption that the urethelium is simply a watertight barrier between the stored urine and the bladder wall is now recognized substantially to underestimate its functional potential . Particularly intriguing is the ability of urethelial cells to release mediator substances, including Ach and ATP, and substances that might suppress smooth muscle contraction. The extent of mediator release appears to be influenced by distention, supporting a role in priming or facilitating the voiding contraction.

Clearly, the profile of receptor agonists and inhibitors in the vicinity of the smooth muscle cell will affect its behaviour. Thus, urothelial transmitter release is interesting in the pathophysiological understanding of normal and overactive bladder activity. More subtly, simple anatomical considerations show that the detrusor muscle is separated from the urothelium by a region containing a considerable density of nerve endings. Thus, the site of action of urothelial mediator release might be mediated by peripheral nerves, presumed to be afferents. Interest in putative role of the urothelium in DO is whetted by possibility of manipulating urothelial transmitter release, e.g. through their expression of several surface proteins, including vanilloid, nicotinic and muscarinic receptors .The presence of interstitial cells (ICs) is a further intriguing observation. Putatively the bladder ICs belong to a multipotent group of functional regulatory cells, some of which are capable of pacemaking (exemplified by the interstitial cells of Cajal in the gut) and propagation of excitation. The terminology of this cell class is often misapplied, but myofibroblasts are a specialized cell group which overlays with the ICs; some of the bladder ICs might be myofibroblasts, but not all are.Bladder ICs occur in the detrusor layer and the suburothelial region. In the detrusor muscle, they constitute a widespread ramifying network; they are recognized to precipitate calcium waves in the muscle bundle . In the suburothelial region, the ICs again provide a widespread communicating network

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. They have been proposed to constitute part of a “sensory transduction triad”; along with the urothelium and afferent nerves. The hypothesis suggests that the three cell types act in concert to drive a graded response to bladder filling whose sensitivity (gain) can be modulated as a result of IC contraction (effectively off-loading tension in the afferents). Subtypes of ICs express M3 receptors , vanilloid and related receptors, which might represent a locus for potential pharmacological manipulation. However, as a possible drug target, it must be remembered that ICs are also in the urethra .Thus, beneficial effects on urine storage, by influencing bladder ICs could be counteracted if urethral function is also affected by collateral effects on urethral ICs.Yet further the reappraisal relates to the peripheral innervations. Historically, the peripheral ganglia nerve consigned to the status of mere “relay” (a relay is an engineering concept, counteracting loss of electrical potential in long pathways by inserting an amplifier which essentially passes on an input unaltered, bar the restoration of potential difference). This dismissive attitude is inappropriate as the complexity of intrinsic wiring, range of inputs and outputs, and presence of neuronal subpopulations clearly indicates a potential for neuronal modulation in the signal distribution at the level of the intramural and perivesical ganglia.In addition, the recognition of nonandronergic, noncholinergic transmitter substances allowed investigators to suggest more functionally significant modulation of neuromuscular

transmission and possible relevance in the pathophysiology of DO. Furthermore, the transduction of stimuli into afferent information is more complex than previously recognized, both functionally and anatomically.Peripheral Integrative Physiology: the autonomous modules:The sheer scope of peripheral cellular complexity is somewhat confusing. Nonetheless, the cellular complexity does not necessarily alter the fundamental tenets as alluded to above, i.e. that higher CNS centres normally exert tonic inhibition of lower centres, and that spontaneous excitation is relatively infrequent and does not spread far enough to involve a significant proportion of the bladderwall. However, what it does do is provide additional peripheral elements that could have the same contribution to DO as the smooth muscle changes proposed in the myogenic hypothesis.Thus, exaggerated spontaneous activity could arise from changes in the ICs driving the detrusor (rather than from changes in detrusor cells as in the myogenic hypothesis). Propagation over abnormal distances could result from dissemination through the ramifying network of IC processes (rather than by direct muscle cell to muscle cell communication). Triggering could result from various sources, such as altered urethelial cell mediator release the peripheral innervations, or from the ICs. This is, in effect, the basis of the peripheral autonomy hypothesis as it relates to DO, which can be summarized as attributing to various

The specifity of BoNT-A for cholinergic neurons in vivo is due to the presence of specific membrane acceptors/receptors. The synaptic vesicle protein SV2 might be the binding site, hence BoNT-A might enter more active neurons preferentially.

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cellular elements (myogenic, neurogenic, ICs and the urethelium) the potential to be responsible for changes in normal physiology that give rise to the processes of triggering, exaggerated excitability and excessive propagation that underpin overactive detrusor contractions. The integrative (peripheral autonomy) hypothesis is thus derived from and closely allied to (indeed, incorporates) the myogenic hypothesis. However, it extends further, as it hypothesis that the complexity of cellular elements must function integratively for normal physiological function, relevant in generation of sensation during urine storage and in reducing the energy expenditure required for efficient emptying during voiding. It proposes that the ICs and peripheral innervation interact to form a “myovesical plexus”, which determines crucial physiological aspects of urine storage and voiding. Thereby, the theoretical scope for manipulating normal activity and overactive contractions is substantially broadened. The Effect of Botulinum-Toxin (BoNT-A) of Nerve endings: Having discussed the hypothetical origins of the Detrusor Overactivity of Bladderwall (DO), the cellular effects of BoNT-A must be understood before it is possible to gauge how it could influence DO.Exposure to BoNT-A results in cascade of processes;Binding to receptors on the membranes of specific nerve endingsInternalization via receptor-mediated endocytosispH-moderated translocation to the cystosolZinc-dependent endoprotease activity, cleaving, polypeptides essential for transmitter exocytosis.The specifity of BoNT-A for cholinergic neurons in vivo is due to the presence of specific membrane acceptors/receptors. The synaptic vesicle protein SV2 might be the binding site, hence BoNT-A might enter more active neurons preferentially.

Mechanisms of action of Botulinum Toxin in treating Bladder Overactivity:The cellular components in the physical sphere of diffusion after intravesical injection are now easy to ascertain. In fact, when describing intravesical injection, the term”intradetrusor” is exactly correct. All Endo-Urologists are truly able to stipulate the exact location of the injected agent at the time of the procedure. Accordingly, the specific term “intramural” signifies the certainty about the precise degree to which the intradetrusor and the suburethelial compartments are involved.The purified BoNT-A has a molecular mass of 150 kDa, the pharmaceutical products have a greater molecular mass. The size of the 900 kDa complex of one of the commercial BoNT-A products reduces diffusion of the toxin within the target muscle (48), along with systemic spread; this is relevant when considering the likely cellular targets for the treatment of Detrusor Overactivity (DO) of the urinary bladder. Numerous factors have to be weighed up including:Safety: a high dose may increase systemic dissemination.Efficacy: insufficient toxin may not diffuse sufficiently to address the clinical indication.Duration of response: administered dose affects duration in some context.Health economic considerations.There are various peripheral loci at which exocytotic transmitter release occurs in the LUT, which could

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potentially fall within the reach of peripherally injected toxin. These are:Release of neuromuscular transmitters from efferent nerve endings (efferent).Release of transmitters and modulatory substances from the presynaptic nerve terminals within the myovesical plexus (afferent).Release of active mediators from urothelium into the realm of the subjacent myovesical plexus structures (afferent).Interneuron activity in peripheral ganglia or the spinal cord (efferent and afferent).It is debatable to classify the above points into either “afferent” or “efferent”, given the propensity for fibres attributed to one or other class to express characteristics of the other (e.g. release of efferent transmitters by afferent nerve).The term “efferent”, simply stated, is based on influencing muscle contractility; given that BoNT-A causes muscle paralysis, reduced muscle contractility in detrusor muscle should reduce overactive contractions.“Afferent” suggests that reduced sensory information from the lower urinary tract will increase the reflex bladder volume associated with the switching of the pontine micturation center (PMC) from storage to voiding mode.Release of neuromuscular transmitters from Efferent Nerves:

The effects of botulinum exotoxaemia are largely a result of motor paralysis of skeletal muscle. After localized injection, axotomy-like changes in the motor neurons occur in a few weeks. BoNT-A also affects release in autonomic organs, including several transmitter substances from the bladder . Accordingly, it is logical to presume that the clinical use of intravesical BoNT-A in the setting of Detrusor.Overactivity induces a partial motor paralysis of the bladder. High enough doses would likely counteract voiding activity, assuming all neuromuscular transmitter release is inhibited, necessitating intermittent or indwelling catheterization. Peripheral Afferent MechanismsFor some people with idiopathic Bladder Overactivity to achieve the “ideal” of abolished symptoms and preservation of voiding, some other mechanism beyond partial detrusor paralysis is probably involved in the clinical response; because the quantity of sensory information reaching the CNS at any given bladder volume is reduced by the BoNT-A injections, such that a higher intravesical volume can be achieved before the PMC gauges the necessity to instigate switching from storage to voiding mode. It is plausible that fundamental alterations of lower urinary tract activity can arise without the detrusor itself being directly affected.The specificity of BoNT-A for cholinergic neurons is due the presence of specific proteins, such that absence of the relevant surface protein will prevent cellular sensitivity to the toxin.There is a background release of Ach in the bladder under conditions modeling the storage phase.ConclusionsOveractive urinary bladder is the clinical manifestation of multifactorial pathophysiological processes, reflecting complex CNS and peripheral cellular physiology. BoNT-A alters the release of Ach from cholinergic nerves, and this efferent block might explain the treatment response.

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Recently the Drugs regulator of the National Institute for Health and Clinical Excellence (NICE) has ruled that those with or without urge-incontinence should have access to the BoNT-A injections intravesically, if other anticholinergic treatment or other therapy methods of control prove ineffective.The Botox (BoNT-A) treatment might give dramatic improvements for many patients with DO and allows them to resume a normal lifestyle.The International Continence Society (ICS) has defined painful bladder syndrome as the complaint of suprapubic pain related to bladder filling accompanied by other symptoms such as daytime and night time voiding frequency in the absence of proven urinary infection or other obvious pathology . The European Society for the study of Interstitial Cystitis (ESSIC) in an attempt to use a consistent pain syndrome terminology has preferred the term bladder pain syndrome (BPS). BPS is defined as pelvic pain, pressure, or discomfort perceived to be related to the urinary bladder accompanied by at least one.other urinary symptom such as persistent urge to void or increased daytime and night time voiding frequency . The definition of interstitial cystitis (IC) should be restricted to cases that include typical cystoscopic and histological features . The etiology of BPS/IC is unknown. Therefore, BPS/IC management is directed to pain relief, as bladder pain is believed to drive both voiding frequency and nocturia. Botulinum toxin (BoNT-A) has been shown to decrease noxious input .The analgesic effect of BoNT-A presumably results from decreased neuropeptide release at peripheral extremities. In the first case, neurogenic inflammation is prevented, and in the second, nociceptive transmission becomes inhibited at the spinal cord.Most nociceptive bladder afferents are concentrated in the trigon. This may suggest that previous studies that injected the entire bladder of BPS/IC patients with BoNT-A placed most of the neurotoxins far from the

receptive fibers and increased the risk of decreasing detrusor contractility. The hazard of vesicoureteral reflux after trigonal BoNT-A is nonexistent. The treatment of the BPS/IC is to inject 10 sites in the trigone with 100 I.U. BoNT-A diluted with 10 mL saline. These trigonal injections improved BPS/IC symptoms without significant complications. Reinjections after 3 and 6 months remain effective, because BoNT-A prevents exocytosis of Acetylcholine (Ach) vesicles at the nerve terminal, thereby inhibiting neurotransmission and muscle contraction. The action of BoNT is not permanent because neuronal death does not occur and eventually the toxin is inactivated and removed. BoNT subtype A (BoNT-A) is the most relevant clinically. Onabotulinum toxin A (BoNT-ONA), abobotulinum toxin A, and incobotulinum toxin A are available BoNTAs. Recently, the use of BoNT-ONA in LUTS was comprehensively reviewed. Its efficacy in treatment of idiopathic Detrusor Overactivity was mentioned above. It seems that the dose of 100 i.U. may be the one that appropriately balances the symptoms benefits with the safety profile (67). Improvement of lower urinary tract symptoms associated with Benign Prostata Enlargement (BPE) has been reported with the use of intraprostatic injection of BoNT-ONA in clinical studies. Recently, intraprostatic injection of BoNT-ONA 100 I.U., 200 I.U., and 300 I.U. was tested versus placebo injection in a phase 2 dose ranging study. IPSS, Q-max and prostate volume significantly improved in all groups, owing to a large placebo effect from the injectable therapy. A post hoc analysis revealed a significant reduction with BoNT-ONA 100 I.U. in prior to α-blocker users at week 12, which will be explored in further studies

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Approximately 8 to 10 percent of children aged 4 to 17 years have ADHD, making it one of the most common disorders of childhood. It occurs two to four times more commonly among boys.Causes:Most experts agree that ADHD is a medical or neurodevelopmental disorder. Many experts believe there is an inherited

imbalance of chemicals in the brain. This is supported by the improvements often seen with the use of medications that affect these chemicals.Most experts do not feel that dietary factors (food additives, sugar, food sensitivity, mineral deficiency) cause ADHD. It is possible that some children have mild behavioral changes in response

Attention DeficitHyperactivityDisorder in Childrenand Adolescent

A ttention deficit hyperactivity disorder (ADHD) is a medical condition with symptoms of inattention , hyperactivity , and impulsivity. It is often first recognized in childhood. The symptoms affect a child's cognitive , academic

, behavioral , emotional , and social functioning , and the condition often continues into adulthood.

Child Health

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to certain foods or food additives. However, these changes do not meet the diagnostic criteria for ADHD. Symptoms:Attention deficit hyperactivity disorder (ADHD) is a condition that can cause three categories of symptoms: hyperactivity, impulsivity, and inattention. Children with ADHD may have one or more of these symptoms and the symptoms may change in frequency or pattern as the child develops.Hyperactivity: Hyperactive behavior is defined as excessive fidgetiness or talking, difficulty remaining seated when required to do so, difficulty playing quietly, and frequent restlessness.These symptoms are usually seen by the time a child is 4 years old and typically increase over the next three to four years. The symptoms may peak in severity

when the child is 7 to 8 years of age, after which they often begin to decline. By the adolescent years, the hyperactive symptoms may be less noticeable, although ADHD can continue to be present.Impulsivity: Impulsive behavior almost always occurs with hyperactivity in younger children. It can cause difficulty waiting turns, blurting out answers too quickly, disruptive classroom behavior, intruding or interrupting others' activities, rejection by classmates, and unintentional injury.Inattention: Inattention may take many forms, including forgetfulness, being easily distracted, losing or misplacing things, disorganization, underachievement in school, poor follow-through with assignments or tasks, poor concentration, and poor attention to detail.

Hyperactive behavior is defined as excessive fidgetiness or talking, difficulty remaining seated when required to do so, difficulty playing quietly, and frequent restlessness.

By: Dr Umair Sharih MD FAAP American Board Certified Pediatrician

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Because of the developmental demands on a child (eg, needing to pay attention, sit still), these problems may become more obvious in school when the child is 8 to 9 years old, although the child may have symptoms at a younger age when at home. Inattention is most likely to persist through adolescence and potentially into adulthood.Types of ADHD: Three subtypes of ADHD have been identified:• The predominantly inattentive type, previously known as attention deficit disorder• The predominantly hyperactive-impulsive type• The combined typeADHD EVALUATION AND DIAGNOSIS: Parents who are concerned their child may have attention deficit hyperactivity disorder (ADHD) should speak with the child's healthcare provider. Early recognition and treatment of ADHD are important to prevent or limit emotional, academic, and behavioral difficulties.There is no simple test to diagnose ADHD. In addition, many of the symptoms of ADHD are common among 4 to 6-year-old children, but tend to occur with less frequency and/or intensity than

in children with ADHD. Thus, it may be difficult for parents to tell if their young child has ADHD or is simply behaving as young children often do. However, studies that evaluate children over time have confirmed that most preschool children who meet all the criteria for ADHD will continue to do so as they get older.Diagnostic criteria: Criteria for the diagnosis of ADHD have been defined by the American Psychiatric Association. There are several important features of these criteria, including the following:• The symptoms must be present in more than one setting (eg, school and home).• The symptoms must persist for at least six months.• The symptoms must be present before the age of 12 years.• The symptoms must impair function in academic, social, or occupational activities.• The symptoms must be excessive for the age of the child.• Other mental disorders that could account for the symptoms must be excluded.There are a number of other medical

There are a number of other medical

and psychological conditions that have symptoms similar to

those of ADHD. A thorough medical,

developmental, educational, and

psychosocial evaluation is

necessary to confirm the diagnosis.

Several office visits, occasionally with

more than one healthcare provider,

may be necessary during the evaluation

process.

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and psychological conditions that have symptoms similar to those of ADHD. A thorough medical, developmental, educational, and psychosocial evaluation is necessary to confirm the diagnosis. Several office visits, occasionally with more than one healthcare provider, may be necessary during the evaluation process.Other psychological and developmental disorders exist in as many as one-half of children with attention deficit hyperactivity disorder (ADHD). These can be difficult to distinguish from ADHD because there are frequently overlapping symptoms. The most common coexisting disorders include learning disabilities, disruptive behavior disorders (oppositional defiant disorder and conduct disorder), anxiety, and mood disorders (depression or bipolar disorder). ADHD can also co-occur with autism spectrum disorder.Treatment for coexisting conditions may require medication. Behavioral or psychosocial treatments may also be recommended. A child with a coexisting condition usually requires the care of a specialist (eg, psychiatrist, child psychologist or developmental behavioral pediatrician, pediatric neuropsychologist, pediatric neurologist).When to seek Help : Parents who suspect that their child has attention deficit hyperactivity disorder (ADHD) should begin by talking to the child's teacher and/or school staff. This can help parents determine if the child has difficulties with behavior in more than one setting (eg, at home and at school).The next step is to make an appointment with the child's healthcare provider. The provider will evaluate the child

and determine if further testing or evaluation is needed, and if ADHD or another condition is a possible cause of symptoms. Bringing school records to the appointment may help the provider to have a clearer understanding of the child's situation.After the diagnosis is made and treatment begins, the parent, teacher, and healthcare provider will continue to monitor the child to ensure that treatment is effective and the diagnosis is correct. Referral to a developmental behavioral pediatrician or child psychiatrist may be recommended if improvements are not seen; further evaluation is sometimes required.TreatmentDOES MY CHILD NEED ADHD TREATMENT? — Some parents wonder if treatment for attention deficit hyperactivity disorder (ADHD) is necessary. Most experts agree that unrecognized and untreated ADHD can have serious consequences, including school failure and drop out, depression, poor behavior, failed relationships, poor performance in the workplace, and increased risk of accidents.

Treatment for coexisting conditions may require medication. Behavioral or psychosocial treatments may also be recommended. A child with a coexisting condition usually requires the care of a specialist (eg, psychiatrist, child psychologist or developmental behavioral pediatrician, pediatric neuropsychologist, pediatric neurologist).

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Treatment can help a child to:- Have better relationships with parents, teachers, siblings, or peers (eg, play without fighting at recess)- Perform better in school (eg, finish school work)- Follow rules (eg, not appear to be disobedient to the teacher)Treatment options : Behavioral treatments usually are recommended for preschool-age children. Medications are sometimes added if necessary. The most effective treatment for most school-aged children with ADHD is a stimulant medicine. Behavioral treatments and counseling are sometimes added if needed.Parents who prefer that their school-aged child avoid medicine should work closely with the child's doctor or nurse. While it is reasonable to consider using behavioral treatments alone, this may not work as well as medicine alone.Dubai Health Authority has licensed Atomoxetine (non stimulant) and methylphenidate.(stimulant)Stimulant medicines are the first-line attention deficit hyperactivity disorder (ADHD) treatment for school-aged children. However, there are criteria that must be met before medicine is considered. In addition, parents (and the child, when appropriate) should understand the need for close monitoring during treatment.Despite their name, stimulants do not cause a child with ADHD to become more stimulated, but instead improve communication between several areas of the brain. This helps to improve attention and concentration. However, medicines do not cure ADHD or teach the child to behave, work well with others, follow rules

in school, or be motivated. Behavioral treatments can be added to the medicine to address these issues.ADHD BEHAVIORAL TREATMENTS : Behavioral treatments for attention deficit hyperactivity disorder (ADHD) include changes in a child's environment, which are designed to help the child change his or her behavior. Behavioral treatments work to improve problems with:- Behavior and learning at school- Relationships with friends, parents, and siblings- Following through with adult requestsA professional training program is recommended for parents because it can be difficult to learn these techniques and use them effectively without support. Adults can help to shape the behavior of a child who has ADHD with the following techniques:- Follow a daily schedule- Keep distractions to a minimum- Provide specific and logical places for the child to keep schoolwork, toys, and clothes- Set small, reachable, and clear goals- Reward positive behavior (eg, a sticker chart with a bigger reward for a certain number of stickers)- Use charts and checklists to help the child stay "on task"- Suggest physical activity breaks during tasks that require attention- Limit choices- Find activities where the child can be successful (eg, hobbies, sports)- Use calm discipline (eg, time out, distraction, removing the child from the situation)COMPLEMENTARY

- Is it based on multiple studies

that have been published? To

confirm the safety and benefit of a

treatment, multiple clinical studies

should be published in mainstream

medical journals (www.pubmed.gov).

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AND ALTERNATIVE TREATMENTS: Complementary therapies are used along with mainstream medical therapies. They do not replace medical treatment, but are offered to support the patient and family. Examples include massage, support groups, vision training, special diets (eg, avoiding sugar, allergy triggers, or particular food additives), megavitamins, herbal, mineral supplements and biofeedback. However, studies have not confirmed the benefits of these treatments, and the risks are not well understood.If you are considering a complementary or alternative treatment for your child, ask the following questions:- Does it claim to cure ADHD and multiple other health problems? There is currently no known cure for ADHD, and no single treatment is likely to cure multiple health problems.- Does it claim to be harmless or natural? Natural does not necessarily mean safe.- Is it offered by only one individual or is it a secret that only certain people can share? Reputable treatments that work well should be available from any licensed healthcare professional.- Is it based on multiple studies that have been published? To confirm the safety and benefit of a treatment, multiple clinical studies should be published in mainstream medical journals (www.pubmed.gov).- Is it expensive? Spending a large amount of money on a treatment that is not proven is risky.- Is the group or person promoting the CAM treatment an expert in ADHD treatment? Verify the education and licensing of any person who claims to be an expert

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juicesfor Optimal

HealthFruits and vegetables are great

sources of the vitamins, minerals, and nutrients that can help you achieve optimal immune health. However,

some people may find it difficult to consume the recommended servings

of fruits and vegetables a day.

These quick, easy, and delicious juice recipes pack in a variety of fruits and vegetables to help your body fight off

the cold and flu this season.

Nutrition

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F ruit DelightThis juice will satisfy your flavor palette. Strawberries, mangoes,

and lime are also great sources of vitamin C and vitamin A. If you choose to include wheat germ, you will gain the added benefit of vitamin E. Vitamin E is an antioxidant and helps to protect immune cells from harmful oxidative damageCarrot Apple Pear JuiceCarrots are a great source of beta-carotene, a substance in plants that is converted into vitamin A in the body. Vitamin A plays an essential role in regulating the immune system and helps the body fight off infections, and helps keep enough T-cells, also known as fighter cells, in circulation. It also boosts the activity of white blood cells, which defend the body from foreign substances Tomato Garden DelightThis delightful combination of ingredients is a powerhouse of immune protecting properties. The tomato is a secret fruit (i.e., it’s not a vegetable—surprised?) and it’s also a great source of vitamin C and vitamin A, two vitamins that play an integral part in immune health.Orange Grapefruit JuiceOranges, grapefruits, and limes are citrus fruits that all contain a good source of

vitamin C.Vitamin C is an antioxidant and protects cells from substances that damage the body. Vitamin C promotes white blood cell and antibody production, which help fight off foreign invaders. A deficiency in vitamin C can lead to delayed wound healing, inability to properly fight infections, and impaired immune response. This juice is a vitamin C monster.Kool Kale JuiceKale has gained a great deal of popularity in the past few years. Not only is it a tasty and versatile vegetable, but it’s also loaded with numerous vitamins, minerals, and antioxidants. Kale is a great source of vitamin A, vitamin C, magnesium, vitamin B6, copper, and iron, which are all beneficial for immune health. This recipe also uses beets, which are a good source of folate, a vitamin that helps your body produce DNA and RNA, which are needed for the production of white blood cellsStay JuicedFruits and vegetables are great sources of the vitamins, minerals, and nutrients that can help you achieve optimal immune health. However, some people may find it difficult to consume the recommended servings of fruits and vegetables a day.These quick, easy, and delicious juice recipes pack in a variety of fruits and vegetables to help your body fight off the cold and flu this season. All you need is a juicer!

Carrots are a great source of beta-carotene, a substance in plants that is converted into vitamin A in the body. Vitamin A plays an essential role in regulating the immune system and helps the body fight off infections, and helps keep enough T-cells, also known as fighter cells, in circulation. It also boosts the activity of white blood cells, which defend the body from foreign substances

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Carrot Apple Pear JuiceCarrots are a great source of beta-carotene, a substance in plants that is converted into vitamin A in the body. Vitamin A plays an essential role in regulating the immune system and helps the body fight off infections, and helps keep enough T-cells, also known as fighter cells, in circulation. It also boosts the activity of white blood cells, which defend the body from foreign substances.

Orange Grapefruit JuiceOranges, grapefruits, and limes are citrus fruits that all contain a good source of vitamin C.Vitamin C is an antioxidant and protects cells from substances that damage the body. Vitamin C promotes white blood cell and antibody production, which help fight off foreign invaders. A deficiency in vitamin C can lead to delayed wound healing, inability to properly fight infections, and impaired immune response. This juice is a vitamin C monster.Kool Kale JuiceKale has gained a great deal of popularity in the past few years. Not only is it a tasty and versatile vegetable, but

it’s also loaded with numerous vitamins, minerals, and antioxidants. Kale is a great source of vitamin A, vitamin C, magnesium, vitamin B6, copper, and iron, which are all beneficial for immune health. This recipe also uses beets, which are a good source of folate, a vitamin that helps your body produce DNA and RNA, which are needed for the production of white blood cells.Tomato Garden DelightThis delightful combination of ingredients is a powerhouse of immune protecting properties. The tomato is a secret fruit (i.e., it’s not a vegetable-surprised?) and it’s also a great source of vitamin C and vitamin A, two vitamins that play an integral part in

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immune health. .Fruit DelightThis juice will satisfy your flavor palette. Strawberries, mangoes, and lime are also great sources of vitamin C and vitamin A. If you choose to include wheat germ, you will gain the added benefit of vitamin E. Vitamin E is an antioxidant and helps to protect immune cells from harmful oxidative damage. .Root JuiceThis juice is a combination of three root vegetables, which independently contain immune boosting properties. Celery

contains vitamin C, vitamin A and folate, but the true secret to this juice is in the leaves. Celery leaves are a wonderful source of vitamins A and E. Beet leaves contain an ample amount of vitamins C and A.Green PowerThis juice is a wonderful combination of healthy green leafy vegetables. Kale, spinach, and parsley provide a significant amount of nutrients including, magnesium, folate, and vitamin B6, which play important roles in optimal immune health. Vitamin B6 in particular plays an important role in immune cell proliferation and antibody productionKiwi Strawberry Juice

Strawberries and kiwis are sweet and tasty fruits that are filled with vitamin C. What makes this juice even better is the added benefit of mint. Mint is not only a great herb that gives this juice a fresh kick, but it’s a good source of folate, vitamin A, magnesium, and zinc. Insufficient magnesium intake may weaken the immune system and leave the body at risk for infection.Watermelon CoolerWatermelon is a great source of vitamin A, which helps the body fight off infection. Pineapple and oranges contain an ample amount of vitamin C

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Breathing & Relaxation Techniques To Beat Anxiety

P roper breathing soothes both your body and brain. This easy, one-minute controlled breathing technique helps you to focus entirely on your inhale and exhale phases, which in turn enhances your

concentration ,clears your mind, and reduces your anxiety. Practice this breathing exercise in the morning just after you’ve woken up before and experience the benefits of beginning your day with a clean slate.

Well being

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Breathing & Relaxation Techniques To Beat AnxietyDirections:Find a cool and quiet spot to sit or recline.Close your eyes.Take five long, deep, slow breaths for warm up.Inhale slowly for 5 seconds, hold your breath inside for another 5 seconds, and exhale slowly for 5 seconds.Repeat four times for a full minute of focused breathing.Note: Begin with 5 seconds per phase and slowly build up to 20 seconds per phase.Relaxation Techniques Ka pha body-mind types generally best release stress through aerobics and cardio. But regular aerobic activity can place an unhealthy strain on the muscles and joints – especially in increasing temperatures. We recommend alternating (and/or supplementing) aerobics with a deep breathing routine that will soothe stressed, restless nerves.Directions:– Find a cool and quiet spot to sit or recline.– Inhale slowly and deeply through the nose for a full count of 10. When inhaling, your stomach and abdomen should expand, but your chest should not rise.– Exhale through the nose, slowly and deeply, for a full count of 10. Concentrate on your breathing and the movements of your stomach and abdomen.– Repeat inhale-exhale cycle 5-10 times.Note: Deep breathing proves most

effective for stress release when practiced regularly. Find time in your day for at least five inhale-exhale repetitions, even on days when you do not feel affected by stress.

generally best release stress through aerobics and cardio. But regular aerobic activity can place an unhealthy strain on the Muscle building

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You probably spend more time at your desk than any place other than your bed. So when you’re sitting in front of it, it’s important to do it properly. Adjust your chair height so that your feet are flat on the floor and your knees and arms are at a 90-degree angle. Adjust your computer screen so that your eyes are even with the top edge. Angle the screen so it’s tilted slightly upward toward your eyes.

Poor Posture

An unkempt work area can cause stress and lead to inefficiency. Furthermore, your desk, phone, and computer are notorious for harboring germs. Once each week, clean your workspace with antibacterial wipes. Organize your desk in a way that minimizes strain on your body, and keep things in their place. If you need help, look around the office at coworkers’ desks, and ask them for tips.

Messy Desk

One of the most plentiful resources in the office is usually the one that gets ignored the most. Drinking water should be a constant part of your workday. Not only does it keep your body and mind working efficiently, it also curbs your appetite so you will be less likely to munch on unhealthy snacks. It’s tempting to seek an energy boost from soda, but if you need an afternoon pick-me-up, try a cup of tea.

Soda vs. Water

Occupational health

F or people who work in an office

e n v i r o n m e n t ,

sitting behind a desk and staring at a computer screen likely makes up the bulk of your day. The stress and demands of the job keep you focused only on your work and not on your physical well-being. This can lead to 40 hours of poor health habits each week. But with just a few adjustments,

you can break the bad routine and be healthy at work.

Unhealthy9Workplace Habits

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When you sit for an extended period of time, your body and mind will fall asleep, much like when you skip a meal. Once per hour, you should get up for a walk or a stretch. This will wake you up and get the blood flowing through your body (and your brain). Take every opportunity to get away from your desk. Instead of calling a coworker or sending an email, walk across the office to deliver the message in person.

Staying Put

Drama in the workplace not only hinders productivity, it can also affect office morale and cause stress and psychological problems for those involved. Try to avoid known gossips in the office, and if you do come across personal information about a coworker, keep it to yourself. If you are out with colleagues for a night on a town, keep any potentially embarrassing stories out of the work environment. What happens outside the office should stay out of the office.

Gossiping

We’ve encouraged you to be diligent about eating lunch and healthy snacks throughout the day, but you should not eat them at your desk. Lunchtime is a chance to give yourself a much needed mental break during the day. And if you don’t keep your workspace clean, you could be sharing your meal with the germs that collect on your computer keyboard and phone.

Eatingat Your Desk

Mid-morning and mid-afternoon snacks are encouraged to keep your mind sharp and energy high. They can also keep your appetite satisfied so you don’t overeat at lunch or dinner. But grabbing a bag of chips or raiding your neighbor’s candy stash does more harm than good. Instead, try a piece of fruit or handful of almonds in the morning. And when the sweet tooth calls in the afternoon, go for a low-sugar granola bar or a small piece of dark chocolate.

Unhealthy SnackingIt always feels like there aren’t enough hours in the day to get your work done. But a healthy work-life balance is essential to keep you energized and productive. Try to limit your work hours to a manageable number, and do your best to set boundaries between home and the office. Don’t take work calls after hours, and make your evenings fun and fulfilling enough to take your mind off your busy day.

Long Work Days

While snacking on junk food is discouraged, skipping lunch altogether is just as bad. Don’t let the hustle and bustle of work keep you from breaking up the day with a healthy meal. Not only can this affect your energy levels and your ability to think and focus, you will be more likely to overeat at dinnertime.

Skipping Lunch

41ISSUE (2) 15 Jan 2015

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Social Media

Creative ways to useTwitterfor healthcare marketing

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42ISSUE (2) 15 Jan 2015

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V ideo can make a major impact and leave a lasting impression. When that power is paired with the strength of social media,

the results can be truly remarkable. Now, that mighty marketing combination is available via Vine, the mobile app from Twitter that can be used to record and share brief videos. Despite its six-second limit, content creators are already getting creative and producing video snippets that inspire, promote, educate, and entertain. In fact, their brief length makes people more likely to watch them since they know they’ll be short and sweet. To help healthcare marketers create the most compelling and beneficial videos,WordViewEditing.com offered the following savvy suggestions.1. Spotlight Your Supporters – Satisfied patients and passionate employees can be a powerful form of advertising, so let these advocates sing the praises of your brand on video. Help each of them create a personal video and attach it to the brand’s #hashtag for the world to see and share.2. Exhibit New Technology – Give the facility a competitive advantage by highlighting new medical equipment via video. Show how the facility prides itself on having the latest advances in treatment and testing, and then briefly show how it works—and works wonders.3. Celebrate Special Occasions – There are an abundance of special days, weeks, and months devoted to different health issues and Vine is a great way to show the organization’s support for these occasions. Healthcare videos can feature inspiring messages to encourage support, personal stories of hope and survival" \t "_blank" videos can feature inspiring messages to encourage support, personal stories of hope and survival,

and interesting facts that grab attention.4. Hype Up the Hospital – If the organization is about to unveil a new building or a renovated area, create a teaser video as a way to promote the debut and spark buzz about the event.5. Offer a Virtual Tour – Introduce potential patients to your facility by offering a virtual video tour. Show off the high-tech features and beautiful surroundings, as well as the friendly faces that staff the facility to leave a likeable and lasting impression.6. Promote Upcoming Events – Spread the word about fundraising, health classes, blood drives, and other events by creating brief teaser videos. Make the videos upbeat and promote the benefits of the event to encourage attendance.Vine is an outstanding way to leverage video and social media all at once. It offers enormous potential to healthcare marketers as they strive to connect with consumers in the most convenient and contemporary ways.

43ISSUE (2) 15 Jan 2015

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Ask your doctor

Question: Is This irritable bowel syndrome (IBS)? What Else Could It Be?

Answer:If you are experiencing unpleasant digestive symptoms, you might be wondering if you have irritable bowel syndrome (IBS) or some other medical problem. Several other digestive disorders do share some of the same symptoms as IBS. Here are the symptoms of IBS: Diarrhea، Constipation، Abdominal discomfort and/or pain، Bloating and intestinal gas.Because other health problems share some of the same symptoms, it is essential that you see your doctor for an accurate diagnosis. Keep in mind that it is possible (although certainly unfair!) to suffer from more than one health condition at a time.IBSIBS is a digestive disorder in which a person experiences bouts of abdominal pain and a significant and chronic change in the frequency and appearance of their bowel movements. IBS is diagnosed when specific criteria known as the Rome III criteria for IBS are met. Other Digestive Health ProblemsThe following disorders are some other possibilities as to what might be causing your symptoms:1. Celiac Disease: Celiac disease is a condition in which eating foods that contain gluten results in a problematic autoimmune response. 2. Colon CancerIBS patients frequently worry that they might have colon cancer and that they have been misdiagnosed. In order to put this worry to rest, you should talk to your doctor about your concerns and educate yourself about the

symptoms of colon cancer.3. Food AllergyA food allergy is when your body’s immune system responds to certain chemicals in particular foods by releasing allergic antibodies. 4. Food Intolerance A food intolerance differs from a food allergy in that the problem occurs at the level of the digestive system as opposed to an immune system response. 5. Inflammatory Bowel Disease Inflammatory bowel disease is a general term for Crohn’s disease and ulcerative colitis. Symptoms may be similar to IBS, but may also include bloody diarrhea, weight loss and fevers. Both conditions differ from IBS in that visible signs of inflammation are seen in the digestive tract during a colonoscopy

irritable bowel syndrome

44ISSUE (2) 15 Jan 2015

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Pulses

I f we ask any person working in the healthcare finances, what causes budget depletion in the system? The obvious answer will be high treatment costs and low prevention expenditures. Thus we all have to keep in mind that A stitch in time

saves nine.According to studies, about 60% of the healthcare expenditures are related to treatment of preventable diseases like diabetes, cardiovascular diseases, and obesity. All these three severe clinical conditions are a result of poor and unhealthy lifestyle. These clinical conditions are preventable; however we tend to neglect it until we ourselves affect our health with either one of them.Important here is to ask ourselves, who will pay the bills and tax for the treatment? How can we decrease those financial burdens for the healthcare sector? How can we give the patient a chance to contribute in costs savings?Disease costs associated with lifestyle related preventable yet sever clinical conditions like diabetes, cardiovascular disease, obesity etc impose a great challenge in the healthcare sector worldwide. Not only this, the number of cases reported for such diseases is increasing day by day further increasing the healthcare expenditures. Such diseases not only affect the patients financially but it also affects his/her social life with a negative impact on physical and mental health. For example: a report from American Diabetes Association suggests that the healthcare expenditures in treating Diabetes saw a rise from $174 billion in 2007 to $245 in 2012. This is a huge increase of 41% in just 5 years.The report suggests that about $174 billion from the total cost ($245 billion) have been spent for treatment and $69 billion were considered as loss due to disability for diabetes patients.In UAE, about 67% of deaths occurred due to severe diseases, and 20% of the people have diabetes. 1 out of every 4 people have a chance to get diabetes or already have diabetes, so that means the diabetes can drain the budget of healthcare by 22%.According to report by World Health Organization, severe diseases put a pressure on countries economics and delay the developments. Worldwide health economics suggests that an increase in the number of sick people in any country by 10% will decrease the economic development of that country by 5%Best solution is to focus on “prevention and health promotion” through provision of health knowledge sources in simple way, which can be applied by all people, thus everyone in the society can manage their life and health easily

Dr. Bassam DarwishMedical Media & Marketing Consultant

Disease cost: The biggest concern in healthcare