Public Health

SPECIAL SUPPLEMENT TUESDAY 28 NOVEMBER 2017

SPONSORS

MAIN SPONSOR

ACTING MANAGING EDITORMohammed Salim Mohamed

SUPPLEMENT COORDINATORAhmed Eltigani Idris

CHAIRMANSheikh Thani bin Abdullah Al Thani

EDITOR-IN-CHIEFDr. Khalid Al-Shafi

IMAGE PROCESSINGMohd Sajad Sahir

DESIGNAbraham Augusthy

PRODUCTIONSebastian TK

PAGE | 4-5 PAGE | 7

What yourfeet say about your health

Al-Ahli Hospital’s Endocrinology and

Diabetes Center offers expert care

Following the PHCC’s Interna-tional Primary Health Care Conference last week, PHCC has released recommenda-tions derived from the

sessions, discussions and workshops where globally healthcare minds came together to address challenges in healthcare. It was established that there is a required shift towards collaborative, educational, family–centered care.

Recommendations set out included state-level efforts to empower the Role of Primary Care in Health through fur-ther investment in Primary Care Research and Solutions and work col-laboratively in coordination with Ministry of Education, Academic bod-ies and Health Sector regulators to identify and monitor health labour market needs enabling students equiv-alently to enroll according to the required majors.

The drive towards a patient-cen-tered care was also a priority, recommending a model of care ori-ented toward the patient and the community, identifying that bringing the services to the community should be the approach going forward. This follows on from the role of family med-icine model to encourage prevention by promoting a healthy lifestyle in the community. Underlining that to reduce the burden of communicable disease

and non-chronic disease; primary care professional team should be the first point of contact to individuals and fam-ilies. To position the family medicine model as an essential and a key invest-ment at Health System level to ensure cost efficiency, funds saving and good accessibility to patients. Further to this, for family medicine professionals to be granted similar packages as other spe-cialists or consultants to attract more specialized workforce covering the sec-tor and population needs.

Recommendations presented also drew on the significance of capacity building, Training & continuous med-ical education, professional development and research, highlight-ing that a culture where educational and team building is a focus will drive a transformation in primary care sys-tems. As well as ensuring that quality assurance & accreditation is at the the heart of health care provider’s objectives.

Information Technology was also

recommended as mandatory to serv-ice improvement; new initiatives will ensure system efficiency i.e. E-Health, Teleconsultation, etc.

Lastly, it was recommended that annual reporting at ministry level should have data across all providers that should allow for proper and con-tinuous monitoring, data would also lead to proper planning outlining the main focus. I.e. collecting data from identified data. The above recommen-dations that emerged from the conference constitute an opportunity for the advancements of healthcare; it involves the healthcare experts at com-munity, national, regional, local and global levels.

PHCC shares recommendations following International Primary Health Care Conference

There is a required shift towards collaborative, educational and family–centered care.

it was recommended that annual reporting at Ministry level should have data across all providers that should allow for proper and continuous monitoring, data would also lead to proper planning outlining the main focus.

Public Health

TUESDAY 28 NOVEMBER 2017

2

Professor Maureen Topps is presently the Senior Associate Dean Education at the Cumming School of Medicine (CSM), Univer-

sity of Calgary, Canada. She was appointed to this role in 2017 and is responsible for the medical educa-tion continuum from undergraduate to continuing education, the non-medical undergraduate and graduate programs of the CSM, the Office of Health and Medical Edu-cation Scholarship and the Advanced Technical Simulation Skills Labora-tory. Professor Topps was previously the Associate Dean Postgraduate Medical Education at both the North-ern Ontario School of Medicine in Canada and at the CSM. She has also served as the Executive Director of the Alberta International Medical Graduate Program on behalf of the Government of Alberta.

As a clinician, she practices Family Medicine and currently works at the Sheldon Chumir Cen-tre in Calgary. She has had a broad and varied clinical career spanning rural, urban and academic prac-tices. With a strong interest in life-long learning, Professor Topps completed an executive MBA in 2014. Her research interests focus on social accountability, distrib-uted medical education and assessment of learners.

You are one of the keynote speakers in the International PHCC Primary Halth Care confer-ence; Can you talk to us a little but about what you will cover?

My keynote will focus on the importance of primary care as a phi-losophy and the benefits it provides for health care systems generally. There will be a review of how Fam-ily Practice as a discipline is an integral component of primary care; a discussion of the concepts which exemplify effective provision of pri-mary care; and thoughts around building capacity in Family Practice.

Has there been collaborations efforts in Primary Care between the two countries previously?

The University of Calgary has a strong relationship with Qatar through its School of Nursing

which has a campus in Doha. This was opened in 2007 and offers both Bachelor of Nursing and Master of Nursing training, both of which are accredited by the Canadian Associ-ation of Schools of Nursing.

What is the significance of country collaboration for the devel-opment of primary healthcare?

International collaboration has many benefits: Each country can learn from the best practices of the other; capacity for education and health care service provision can be enhanced with a focus on achieving and maintaining high standards of patient care through quality improvement practices; and expe-riences with diverse situations and environments can broaden the skills of our practitioners, educators and leaders.

What are the benefits that you are hoping to realize from this conference?

I am hopeful that my presence in Doha will further the relationship that the University of Calgary has with Qatar and that there are many oppor-tunities for networking and discussion of possible collaborations. I also look forward to learning sig-nificantly more about Primary Care in Qatar to extend my understand-ing of how this is evolving as the foundation of health care services in the country.

Any final comments. I extend my gratitude to the con-

ference organizers for inviting me to participate and my good wishes for a very successful event.

A short interview with Prof. Maureen Topps

International Primary Health Care Conference

I am hopeful that my presence in Doha will further the relationship that the University of Calgary has with Qatar and that there are many opportunities for networking and discussion of possible collaborations. I also look forward to learning significantly more about Primary Care in Qatar to extend my understanding of how this is evolving as the foundation of health care services in the country.

There will be a review of how Family Practice as a discipline is an integral component of primary care; a discussion of the concepts which exemplify effective provision of primary care; and thoughts around building capacity in Family Practice.

Public Health

TUESDAY 28 NOVEMBER 2017

3

��������

����� �

�����51 625

���������������

StreetZone

478

http://eservices.phcc.qa/location

In order to provide the best possible healthcare for you and for your family. Register your address at your health center now.

Speak to a member of Hayyak or a Receptionist for assistance

��������

����� �

�����51 625

���������������

StreetZone

478

���Zone

�� ����������������

�������������� ������ �������!" ���

����Street

#��� $�%�� �&'!

Or you can simply complete an online application on our PHCC website

IS YOUR ADDRESS REGISTERED CORRECTLY WITH US?

y

‘Screen For Life’, Qatar’s National Breast and Bowel Cancer Screening program, led by the Primary Health Care Corpora-tion (PHCC), has launched

amonth-long campaign across social media and radio,in line with the global Movember movement which highlights men’s health issues, to raise awareness of the program and encourage people to undergo screen-ing forbowel cancer.

The campaign, titled ‘During Movember, don’t forget to screen for bowel cancer,’ see the ‘Screen For Life’ team engage with com-munities, citizens and residents across Qatar through the media campaign and aware-ness lectures emphasizing the program’s goal and stressing the benefits of screening in the early detection of cancer. The campaign encourages men and women 50-74 years old to undergo screening for bowel cancer at one of the three dedicated ‘Screen For Life’ facilities at Al Wakra, Leabaib and Rawdat Al Khail Health Centers.

This latest awareness drive follows the hugely successful Breast Cancer Awareness campaign held throughout October, during which the ‘Screen For Life’ delivered a total of 15 awareness lectures and partnered with more than 30 public and private sector enti-ties to enhance knowledge levels of the ‘Screen For Life’ program.

“Movember is an important global initi-ative to raise awareness of men’s health issues and it represents an essential

opportunity to reach out to the community to continue raising awareness of bowel can-cer screening,” said Dr. Shaikha Abu Shaikha, Cancer Program Manager, PHCC.

“We were hugely encouraged by the response to the October campaign and are confident to keep on raising awareness of the importance of both breast and bowel cancer screening will have similar effects,” Dr. Abu Shaikha, said. “We want people to know we are there for them, and it is important that they take a proactive approach with their health by calling the call center and booking an appointment at one of our facilities,” Dr. Abu Shaikha added.

For more information call the ‘Screen For Life’ call center on 8001112 or visit the web-site www.screenforlife.qa

About the Breast and Bowel Cancer Screening Program

The Breast and Bowel Screening Program is a life-saving, population-based initiative

that aims to promote education, awareness and early detection of breast and bowel can-cer in Qatar. Titled ‘Screen for Life’, it is being conducted under Qatar’s National Cancer Pro-gram and in accordance with the country’s National Health Strategy 2011-2016, which represents a shift towards preventive and community-based care. The National Can-cer Strategy’s key recommendation 5.2 states the need for a population-based cancer screening program in Qatar.

The Primary Health Care Corporation, a provider of a wide range of primary health-care services across Qatar, has been given the authority to lead the program. To ensure its effective and efficient implementation, PHCC has tapped the expertise of an inter-national consortium of companies: Fujifilm from Japan, which supplies medical equip-ment and information solutions; RadNet from the US, which performs clinical and opera-tional services; and, Specialized Medical Solutions, which provides on-the-ground administrative support in Doha.

‘Screen For Life’ marked global Movember initiative for men’s health issuesOnline awareness campaign and lectures engage with community, increase knowledge of the program and encourage people of Qatar to undergo bowel cancer screening.

“Movember is an important global initiative to raise awareness of men’s health issues and it represents an essential opportunity to reach out to the community to continue raising awareness of bowel cancer screening,” said Dr. Shaikha Abu Shaikha, Cancer Program Manager, PHCC.

Public Health

TUESDAY 28 NOVEMBER 2017

4Public Health

TUESDAY 28 NOVEMBER 2017

5

Al-Ahli Hospital Doha-Qatar

- Cardiology & Cardiac Surgery - Dental center

- Chiropractic - Pediatrics

- Obstetrics & Gynecology - Neurology

- Internal medicine - Physiotherapy and Rehabilitation

- Endocrinology - Ophthalmology

-Anesthesiology- General Surgery - Dermatology - Travel Clinic - Emergency - Rheumatology- Coronary Care Unit (CCU) - Intensive Care Unit (ICU) - Neonatal Care Unit (NICU) - Gastroenterology - Speech Therapy - Pulmonary & chest - Dietary- Nephrology - Psychiatry- Hearing & Balance - Urology- ENT surgery - Orthopedic and Traumatology

For more information please call:0097444898000 -0097444898888

Accredited byACHS International until May 2018

Al-Ahli Hospital’s Endocrinology and Diabetes Center offers expert care

Dr Maher Ahmed IrshaidConsultant Endocrinologist and Head of Department

Assma AlsamailDietitian

Nidaa HamzaGeneral Manager of Iris Trading

Al-Ahli Hospital in partnership with Iris Trading has introduced a state-of-the-art biomechanical assessment tool which detects anomalies and provides customised special orthotics for foot problems. The service is available at Al-Ahli Hospital’s Foot Care Clinic.

Diabetes can lead to many different types of foot complications. People with type 1 diabetes for at least five years should have their feet examined at least once a year. People with type 2 diabetes should have their feet examined once per year.

Al-Ahli Hospital’s Endocrinology and Dia-betes Center offers expert care for various metabolic, pituitary, thyroid and diabe-tes-related conditions.

The team consists of three consult-ants committed in delivering compassionate care, educating and spreading awareness, diagnosing and treating endocrine and diabetes disorders.

In endocrinology and diabetes clinic, experts care about everything related to increase the awareness of the guests and treating their disorders.

In Qatar, prevalence of diabetes is 17 percent, and 11-23 percent has pre-diabetes and approximately 23 percent of pregnant women have Gestational Dia-betes. It is also estimated that one third of diabetics are not aware of their disease.

Dr Maher Ahmed Irshaid, Consultant Endocrinol-ogist and Head of Department says: “Diabetes is very common, it is a global burden. In our region also a big percentage of people have diabetes. In Qatar there are about 17 percent of people with diabetes and there are another big number of people with undiagnosed diabetes. This is why screening is important. People with a family history of diabetes or with risk factors should do frequent screenings.”

People with diabetes have an increased risk of developing a number of serious health problems. Con-sistently high blood glucose levels can lead to serious diseases affecting the heart and blood vessels, eyes, kidneys, nerves and teeth. Diabetes dramatically

increases the risk of various cardiovascular prob-lems, including coronary artery disease with chest pain (angina), heart attack, stroke and narrowing of arteries (atherosclerosis). A person with diabetesis more likely to have heart disease or stroke.

“In treating diabetes, our main aim is to prevent complications, as its better than treatment. Diabetes can cause many complications. The body can be affected from the head to the toe by diabetes: every part of the body can be affected. The most important thing is to educate people as many lack education. We are treating people to prevent complications,” says Dr Irshaid.

Al-Ahli Hospital’s Endocrinology and Diabetes Center is also staffed with qualified nurses and edu-cators. At least 20 patients are seen by each consultant per day at the clinic and half of them are treated for diabetes. Also people with risk factors for diabetes and pre-diabetes conditions are referred to the clinic.

“We are a unique Center; we have qualified nurses and diabetes educators. We don’t just give medicine, we teach patients how to stay healthy and have a quality life. We advise and guide the patient to pre-vent complications. We insist and advice patients to adopt healthy life style and control the disease,” said Dr Irshaid.

As healthy diet can help control diabetes, a spe-cialized dietitian at the Al-Ahli Hospital’s Endocrinology and Diabetes clinic guide patients on diet plans. A diabetes diet is a healthy-eating

plan that’s naturally rich in nutrients and low in fat and calories. Key elements are fruits, vegeta-bles and whole grains. However, a diet plan will differ from one person to another, says Assma Alsa-mail, Dietitian at the clinic.

“It is important for people with diabetes to seek professional help in planning their diet. Our task is to provide a diet plan for patients. We are also pro-viding complete education to avoid complications from diabetes. We collect complete information from patients such as their food habits, medical history

and plan their diet. We also provide instructions like how to prevent hypoglycemia , also avoid the fluc-tuation between hypoglycemia and hyperglycemia. We also guide people to reduce weight with a diet plan and adopting healthy lifestyle by doing physi-cal activities, ” says Alsamail.

The condition of high blood sugar or hyperglyc-emia occurs whenever the glucose (sugar) level in a person’s blood rises high temporarily, this condition is known as hyperglycemia. The opposite condition, low blood sugar, is called hypoglycemia.

“Some patients are unaware of the symptoms of hypoglycemia. Some others make the mistake of not following the correct diet. There are many myths also around hyperglycemia. Some feel that taking more fruits will control hyperglycemia but it will increase the carbohydrates. In case of hypoglycemia, some immediately take any type of a sweet like chocolate or cake. But such sweets with fat will not increase the glucose levels in blood. But simple sugar, honey or juiceis the best to take at a time of hypoglycemia,” said Alsamail.

Treating for hypoglycemia is usually recom-mended when a person’s blood glucose level is 70 mg/dl or less. The ‘rule of 15’ is commonly used as a guideline for treatment: After checking blood glu-cose level with the meter and seeing that the level is under 70 mg/dl, a person should consume 15 grams of sugar, honey or half cup of juice, wait about 15 minutes, then recheck the blood glucose level. If your blood glucose is still low, one should consume another 15 grams of sweet and recheck 15 minutes later. Since blood glucose levels may begin to drop again about 40-60 minutes after treatment, it is a good idea to recheck your blood glucose approximately one hour after treating a low. Although the ‘rule of 15’ is an accepted method for treating hypoglycemia, it should not replace the advice of the diabetes care team. Among, several other complications, foot problems are common in people with diabetes. It can even lead to a condition of losing a toe, foot, or leg but patients can lower the chances of having diabetes-related foot problems by taking care of feet every day.

Diabetes can lead to many different types of foot complications, including athlete’s foot (a fungal infec-tion), calluses, bunions and other foot deformities, or ulcers that can range from a surface wound to a deep infection. People with type 1 diabetes for at least five years should have their feet examined at least once a year. People with type 2 diabetes should have their feet examined once per year.

During a foot exam, a health care provider checks for poor circulation, nerve damage, skin changes, and deformities. Patients should mention any prob-lems they have noticed in their feet. An exam may reveal decreased or absent reflexes or decreased abil-ity to sense pressure, vibration, pin pricks, and changes in temperature.

Special devices, including a monofilament or tun-ing fork, can help determine the extent of nerve damage. A monofilament is a very thin, flexible thread

that is used to determine if a patient can sense pres-sure in various areas of the foot. A tuning fork is used to determine if a patient can sense vibration in var-ious areas, especially the foot and toe joints.

Al-Ahli Hospital in partnership with Iris Trad-ing has introduced a state-of-the-art biomechanical assessment tool which detects anomalies and pro-vides customised special orthotics for foot problems. The service is available at Al Ahli Hos-pital’s Foot Care Clinic.

Nidaa Hamza, General Managerof Iris Trading. says that special insole for diabetic patients can avoid or postpone the complications. The customer-made soles works on distributing the foot pressure points in a way that prevents any ulcers and dermatology from happening, as treatment for these cases are con-sidered hard at an advanced stage.

Public Health

TUESDAY 28 NOVEMBER 2017

6

A sinus is a hollow, air-filled cavity that are in the skull and connected to the nasal airway by a narrow hole in the bone (ostium). Normally

all sinuses are open to the nasal airway through an ostium. Humans have four pair of these cavities each referred to as the:

frontal sinus (in forehead),maxillary sinus (behind cheeks),ethmoid sinuses (between the eyes),

andsphenoid sinus (deep behind the

ethmoids).The four pair of sinuses are often

described as a unit and termed the "paranasal sinuses". The cells of the inner lining of each sinus are mucus-secreting cells, epithelial cells and some cells that are part of the immune sys-tem (macrophages, lymphocytes, and eosinophils).

Functions of the sinuses include humidifying and warming inspired air, insulation of surrounding structures (eyes, nerves), increasing voice reso-nance, and as buffers against facial trauma. The sinuses decrease the weight of the skull. If the inflammation hinders the clearance of mucous or blocks the natural ostium, the inflammation may progress into a bacterial infection.

Signs and symptoms of sinus infection or sinusitis

There are many signs and symptoms of sinusitis and sinus infections. The fol-lowing is a summary of predominant ones that may occur. Most patients have several signs and symptoms at the same time. Others may have some symptoms that are intermittent; most do not have all symptoms at once. The signs and symptoms of a sinus infection or sinusi-tis include the following:

� Headache due to pressure in par-tially or completely blocked sinuses. The pain may increase when the person bends down.

� Facial tenderness and/or swelling when facial areas over sinus areas are touched.

� Pressure or pain due to mucus pressing on sinus tissue or inflamma-tion of sinuses.

� Fever due to inflammation of sinus tissues and infection.

� A cloudy, discoloured nasal drain-age is often seen in bacterial sinus infections.

� Congestion is a feeling of nasal stuffiness, and occurs with both infec-tious and non-infectious sinusitis.

� Post-nasal drip is mucus overpro-duction from sinusitis that flows to the throat and irritates throat tissue.

� Sore throat is inflammation of throat tissue by post nasal drip.

� Cough is a response to post nasal drip and body's attempt to clear out throat tissue irritants.

� Tooth pain caused by pressure on surrounding nerves and tissues

� Ear pain caused by pressure on surrounding nerves and tissues

� Eye pain caused by pressure on surrounding nerves and tissues

� Fatigue due to fever, immune response and/or coughing

� Bad breath usually is due to bac-terial infections

� Itching/sneezing — In noninfec-tious sinusitis, other associated allergy

symptoms of itching eyes and sneezing may be common, but may include some of the symptoms listed above for infec-tious sinusitis.

�Nasal drainage usually is clear or whitish-colored in people with nonin-fectious sinusitis.

� Ulceration can occur with rare ful-minant fungal infections with sharply defined edges and a black, necrotic center in the nasal area. Some fungal infections cause dark, black-appearing exudates. This requires immediate med-ical evaluation.

� Multiple chronic (over 1-3 months) symptoms usually are a sign of suba-cute or chronic sinusitis

What is a sinus infection or sinusitis?

Inflammation of the air cavities within the passages of the nose (para-nasal sinuses) is referred to as sinusitis. Sinusitis can be caused by infection (sinus infection), but also can be caused by allergy and chemical irritation of the sinuses. A sinus infection (infectious sinusitis) occurs when a virus, bacte-rium, or a fungus grows within a sinus.

Sinusitis is one of the more common conditions that can afflict people throughout their lives. Sinusitis com-monly occurs when environmental pollens irritate the nasal passages, such as with hay fever. Sinusitis can also result from irritants, such as chemicals or the use and/or abuse of over-the-counter (OTC) nasal sprays, and illegal substances that may be snorted or inhaled through the nose. About 30 mil-lion adults have "sinusitis". Colds differ from sinusitis and are only caused by viruses and last about 7-10 days while sinusitis may have many different causes (infectious and non-infectious), and usu-ally last longer with more pronounced and variable symptoms.

What causes sinus infections or sinusitis?

Sinus infections or sinusitis may be caused by anything that interferes with airflow into the sinuses and the

drainage of mucus out of the sinuses. The sinus openings (ostea) may be blocked by swelling of the tissue lining and adjacent nasal passage tissue, for example with common colds, allergies, and tissue irritants such as OTC nasal sprays, and cigarette smoke. Tumors or growths also can block the sinuses if they are near the sinus openings.

Dehydration, disease, drying med-ications, and lack of sufficient humidity can cause sinusitis or sinus infection.The drainage of mucous from the sinuses can also be impaired by thick-ening of the mucous secretions, by decrease in hydration (water content) of the mucous brought on by disease (for example, cystic fibrosis), drying medications, and lack of sufficient humidity in the air. The epithelial cells have small hair-like fibers, called cilia, which move back and forth to help the mucus move out of the sinuses. These small cilia may be damaged by many irritants, especially smoke. This can pre-vent them from assisting the mucus in draining from the sinuses, and thus results in sinus infections or sinusitis.

Stagnated mucus provides an envi-ronment for bacteria, viruses and in some circumstances, fungus, to grow within the sinus cavities. In addition, the microbes themselves can initiate and exacerbate sinus blockage. The most commonly infected sinuses are the max-illary and ethmoid sinuses.

Rarely, immunodepressed or vic-tims of multiple traumas in disasters such as tsunamis, hurricanes, earth-quakes, or tornadoes may breathe in fungi from the soil or water. Eventually, in a few days to over a week, the fungi can grow and cut off blood supply to almost any type of tissue, especially in the nose and eyes. These infections, although rare, are serious and can be deadly and require immediate medical and surgical care. Although the fungal infection may resemble common bac-terial sinusitis initially, it is a disease t e r m e d z y g o m y c o s i s o r mucormycosis.

What are the types of sinusi-tis and sinus infections?

Sinusitis may be classified in sev-eral ways, based on its duration (acute, subacute, or chronic) and the type of inflammation (either infectious or non-infectious). The term rhinosinusitis is also used to imply that both the nose and sinuses are involved.

� Acute sinus infection (also termed acute sinusitis caused by infection or acute bacterial rhinosinusitis) is usually defined as being of less than 30 day duration.

� Subacute sinus infection as being over 1 month but less than 3 months.

� Chronic sinus infection as being greater than a 3 month duration. Chronic sinusitis may be further sub-classified into chronic sinusitis with or without nasal polyps, or allergic fungal sinusitis.

� Recurrent sinusitis is when a per-son has several attacks per year

There is no medical consensus on the above time periods. Infected sinusi-tis usually is caused by uncomplicated virus infection. Less frequently, bacte-rial growth causes sinus infection and fungal sinus infection is very infrequent. Subacute and chronic forms of sinus infection usually are the result of incom-plete treatment of an acute sinus infection.

Non-infectious sinusitis is caused by irritants and allergic conditions and follows the same general time line for acute, subacute and chronic as infec-tious sinusitis.

How is sinus infection or sinusitis diagnosed?

Sinus infection is most often diag-nosed based on the history and examination of a doctor. Most sinus infections are initially diagnosed and treated based on clinical findings on examination. These physical findings may include:

� redness and swelling of the nasal passages,

� purulent (pus like) drainage from the nasal passages (the symptom most likely to clinically diagnose a sinus infection),

� tenderness to percussion (tapping) over the cheeks or forehead region of the sinuses, and

� swelling about the eyes and cheeks.

Occasionally, nasal secretions are examined for secreted cells that may help differentiate between infectious and allergic sinusitis. Infectious sinusi-tis may show specialised cells of infection (polymorphonuclear cells) while allergic sinusitis may show spe-cialized white blood cells of allergy (eosinophils). Physicians prescribe anti-biotics if bacterial infection is suspected. Antibiotics are not effective against viral infections.

If sinus infection fails to respond to the initial treatment prescribed, then more in-depth studies such as CT or MRI scans may be performed. Ultrasound has been used to diagnose sinus infec-tions in pregnant women, but is not as accurate as CT or MRI. Rhinoscopy or endoscopy, a procedure for directly looking in the back of the nasal passages with a small flexible fiber optic tube, may be used to directly look at the sinus openings and check for blockage of

these openings by either swelling or growths.

Many sinus infections can be treated by your primary care physician or an Internal Medicine doctor. However, it is not unusual to consult an ENT (Eye, Ears, Nose and Throat) specialist, Infec-tious disease specialist, Allergist or Immunologist. With some complex sinus infections, a surgeon who specializes in sinus surgery may be necessary to consult.

What home remedies help soothe sinus infection or sinusitis symptoms?

Sinus infections caused by viruses can use home (over-the-counter, OTC) treatments such as pain and fever med-ications, decongestants, and mucolytics. In addition, some health-care profes-sionals suggest nasal irrigation or a sinus rinse solution to help relieve symptoms of sinus infections, even chronic sinusi-tis symptoms. Bacterial and fungal sinus infections usually require antibiotic or antifungal therapy so home treatments without them are often not successful. However, some suggest home treat-ments may reduce symptoms after medical therapy has begun; some health-care professionals recommend nasal irrigation after sinus surgery.

What are complications of sinus infection or sinusitis?

While serious complications do not occur frequently, it is possible for sinus infection to cause a direct extension of infection into the brain through a sinus wall, creating a life-threatening emer-gency (for example, meningitis or brain abscess). In addition, other adjacent structures can become infected and develop problems, such as osteomyeli-tis of bones in the skull and infection around the eye (orbital cellulitis). Rarely, these infections (mainly bacterial and fungal organisms) may cause death. The most susceptible individuals to compli-cations are patients with suppressed immune systems, diabetes, and rela-tively rarely from multiple trauma injuries that may occur in natural disasters.

Can sinus infection or sinusitis be prevented?

Currently, there are no vaccines designed specifically against infectious sinusitis or sinus infections. However, there are vaccines against viruses (influ-enza) and bacteria (pneumococci) that may cause some infectious sinusitis. Vaccination against pathogens known to cause infectious sinusitis may indi-rectly reduce or prevent the chance of getting the disease but there are no spe-cific studies to support this assumption.There are no fungal vaccines against sinusitis.

If a person is prone to recurrent bouts of "yearly sinus infection" it may be important to consider allergy testing to see if this is the underlying cause of the recurring problem. Treatment of the allergy may prevent secondary bacte-rial sinus infections. In addition, sinus infections may be due to other prob-lems such as nasal polyps, tumors or diseases that obstruct normal mucus flow. Treatment of these underlying causes may prevent recurrent sinus infections.

www.medicinenet.com

Sinus Infection (Sinusitis)

Public Health

TUESDAY 28 NOVEMBER 2017

7

COLD FEET, MANY CUL-PRITS: Are your feet and toes often cold? Poor blood circulation, known as peripheral arterial disease

(PAD), may be the reason. PAD is often the result of an underlying disease, such as high blood pressure, heart disease, diabetes, hypothyroidism, hyper-cho-lesterol, and anemia. Smoking is also strongly linked to PAD. Peripheral neu-ropathy may also make your feet feel cold. Common in fair-skinned females, Raynaud's disease makes hands and feet appear blotchy and bluish in cold weather. This may be associated with rheumatoid arthritis, 'Sjögren's disease, or lupus, and is known as Raynaud's phenomenon. Your doctor can check and see if you may have one of these underlying conditions or if you just have cold feet.

FOOT PAIN: It may not just be your shoes causing your feet to hurt. Although four out of five women complain of foot pain from their shoes, there may be an underlying condition causing the prob-lem. High heels or poorly fitting shoes can exacerbate common foot conditions such as bunions, neuromas, hammer-toes, and ingrown toenails. Postmenopausal women can suffer from osteoporosis, which puts them at a higher risk for a stress fracture, a small crack in the bone.

RED, WHITE, AND BLUE TOES: If your toes turn white, then blue, and red again with a blotchy appearance, you may have Raynaud's disease. Exposing your feet to cold temperatures or emo-tional stress triggers vasospasms that cause a sudden narrowing of the small arteries to the skin of the feet and toes, resulting in Raynaud's disease. Chronic smokers may also have an appearance of blotchiness and changing colour of their feet due to peripheral arterial dis-ease (PAD).

HEEL PAIN: Plantar fasciitis is the most common cause of heel pain. The plantar fascia is a large, broad ligament at the bottom of the foot that attaches to the heel and can become inflamed. This causes a sharp pain in the heel, which may be most pronounced when taking your first steps in the morning or after sitting. Other causes of heel pain are bone spurring, pump bump, stress fractures, bone tumors, infections, bur-sitis, neuritis, and arthritis. An examination by your physician, as well as X-rays, can rule out many of these conditions.

DRAGGING YOUR FEET: A change in the way you walk may be the first sign of an underlying medical condition. It may manifest itself as a slower or wider gait, imbalance, foot dragging, and trip-ping. One common cause is peripheral neuropathy, which is a slow loss of sen-sation that causes numbness and sometimes a burning sensation of the feet. Peripheral neuropathy is most commonly seen in diabetics but may

also be a consequence of infection, vita-min deficiency, lower back nerve impingement, or exposure to heavy metals.

CLUBBED TOES: Clubbing of the toes refers to the structural shape of the toes. Clubbing may also occur in the fin-gers. The nails are curved and rounded at the top, somewhat like an upside-down spoon. There may be a bulbous appearance of the tip of the toes. The most common underlying cause is lung disease or lung cancer. Other causes are heart defects present at birth, cystic fibrosis, celiac disease, liver disease, thy-roid disease, and Hodgkin's lymphoma. In some cases, clubbing of the toes and/or fingers may just be a family trait where no underlying disease exists.

SWOLLEN FEET: Swelling of the feet may be temporary from prolonged standing or sitting in one position. This is particularly common during preg-nancy and is usually benign. In contrast, persistent swelling of the feet and legs maybe an indication of a serious under-lying medical condition, including cardiovascular problems such as con-gestive heart failure, poor blood circulation, or venous insufficiency. It may also be a problem with one's lym-phatic system. Other causes of swelling are infections, kidney or thyroid disor-ders, and even a blood clot in the leg. Consult your doctor if you have persist-ent swelling of the feet.

BURNING FEET: The most common cause of a burning foot sensation is peripheral neuropathy, of which the most common cause is diabetes. Other neuropathies that cause peripheral nerve damage can be from vitamin B deficiency or exposure to some indus-trial chemicals. Burning feet may also

be a symptom of chronic kidney dis-ease, poor circulation, athlete's foot, allergic reaction, or thyroid disease.

SORES THAT DON'T HEAL: Sores on the feet that don't heal are a major concern. The three main causes are infection, repetitive abnormal pressure (from bone deformity or ill-fitting shoes), and poor circulation (PAD). Dia-betics are particularly vulnerable to nonhealing wounds of the feet because of their diminished sensation, circula-tion, and healing capabilities. Diabetics should check their feet daily for any areas of pressure or signs of a develop-ing wound. In some cases, nonhealing wounds are due to a foreign body or even a type of skin cancer (malignant melanoma). Nonhealing wounds of the feet should be evaluated and treated promptly by a doctor.

PAIN IN THE BIG TOE: The sudden onset of redness, pain, and swelling of the big toe joint is a classic example of gout. However, other conditions may also present in this way. They include osteoarthritis of the big toe joint, bun-ion deformity, an inflammation of the small bones associated with the big toe joint, fracture, infection of the joint, or even an ingrown toenail. Turf toe, com-monly seen in athletes where there is a demand for rapid push-off on the ball of the foot, may also appear with pain and swelling at the big toe joint caused by a straining and tearing of the soft tis-sues and ligaments.

PAIN IN THE SMALLER TOES: A pain in the ball of the foot that is sharp, burning, numbing, and/or tingling with radiation into the toes may be from a neuroma. Neuromas develop from

irritation and inflammation around the nerve, causing the surrounding tissue to thicken and scar. It most commonly occurs between the third and fourth toes of the foot. Symptoms can be intermit-tent and range from subtle numbness to extreme pain. Narrow shoes may be a causative factor and aggravate the condition. It is eight to 10 times more common in women than men.

ITCHY FEET: The most common cause of itchy feet is athlete's foot. This is a fungal infection. It may appear as a scaling red rash at the bottom of the feet and/or painful cracks in the skin between the toes. Contact dermatitis is another common cause of itchy feet. It is caused by a reaction from chemicals, soaps, creams, or even the materials of socks and shoes. Another potential cause for itchy feet is psoriasis, which may be due to an overreactive immune system. In most cases, obtaining the proper diag-nosis and applying the appropriate topical creams can be effective in reliev-ing the itch.

CLAW TOE: A claw toe deformity is a curling of the lesser toe joints. It is very similar to a hammertoe deformity but involves all three joints of the toe rather than two. It is caused from muscle and tendon imbalances of the foot and ankle. These imbalances can be from a number of conditions, particularly neuropathies such as diabetic neuropathy or another underlying neurologic disorder. Treat-ments for this condition include stretching exercises of the toes, func-tional custom orthotics, extra depth wide toe box shoes, and palliation. In some cases, surgical correction is recommended.

FOOT SPASMS: That sudden, sharp pain in the foot causing your toes to con-tract or spread may just be a foot spasm. Foot spasms can be caused from a vari-ety of conditions, most commonly from overuse and fatigue of the foot muscles as well as dehydration. Other causes may be imbalances of electrolytes in your system or deficiencies of magne-sium, calcium, potassium, or vitamin D. Conditions that can affect hormone lev-els, such as pregnancy and thyroid disease, also may be the cause of foot spasms. Keeping hydrated and wearing proper shoes, particularly for athletic activities, can be helpful. Strengthening of the foot's intrinsic musculature by walking barefoot on natural surfaces, such as sand or grass, can also be helpful.

DARK SPOT ON THE FOOT: Although we commonly associate skin cancer with areas that are more exposed to the sun, they can occur on the feet. Melanomas, the most dangerous skin cancer, can be found on any area of the foot, even between the toes and under the toenails. Dark spots under the toe-nails are often blood accumulated under the nail, however, a melanoma can appear very similar.

YELLOW TOENAILS: This is a fun-gal infection of the nails that causes discoloration and thickening of the toe-nails. Other causes of yellow toenails can be diseases such as lymphedema, arthritic conditions, lung disease, or even repetitive trauma to the nails from tight shoe gear and stop-start athletic activities.

SPOON-SHAPED TOENAILS: This can have many causes. One of the more common is iron-deficiency anemia. Exposure to industrial solvents and chemicals may also cause the toenails to grow upward in a spoon shape.

WHITE NAILS: Many conditions can cause white nails. One of the more com-mon is psoriasis, which can affect the appearance and texture of the nails. Yeast and fungal infections may also cause the nails to appear white. Trauma to the nail from an injury or ill-fitting shoes can sometimes lead to an accumulation of fluid that lifts the nail and gives it a more white appearance. In some cases, white nails may be indicative of a more seri-ous underlying condition, such as liver disease, diabetes, or congestive heart fail-ure. Consult your doctor if your nails appear abnormally white.

PITTING OF THE NAILS: Nail pit-ting is most commonly seen in people who suffer from psoriasis. Approximately 50% of people who suffer from psoria-sis will have pitting of the nails. Trauma to the nail growth plate or nail bed can also cause a pitted appearance with ridges. Bacterial and/or fungal infections may also cause pitting of the toenails. www.medicinenet.com

What your feet say about your health

Plantar fasciitis is the most common cause of heel pain. The plantar fascia is a large, broad ligament at the bottom of the foot that attaches to the heel and can become inflamed.

Public Health

TUESDAY 28 NOVEMBER 2017

8

Obesity and

diabetes

Fazeena Saleem The Peninsula

It is a well-known fact that being overweight or obese, puts a per-son into the greater risk of developing Type 2 diabetes, par-ticularly having excess weight

around the abdomen. Being overweight or obese increases

the chances of developing the common type of diabetes — Type 2 diabetes. In this disease, the body makes enough insulin but the cells in the body have become resistant to the salutary action of insulin.

In obese individuals, the amount of nonesterified fatty acids, glycerol, hor-mones, cytokines, pro-inflammatory markers, and other substances that are involved in the development of insulin resistance, is increased, says experts.

Although the exact causes of diabe-tes are still not fully understood, it is known different factors including obes-ity, up the risk of developing different types of diabetes mellitus.

Obesity is believed to account for 80-85 percent of the risk of developing Type 2 diabetes, while some research suggests that obese people are up to 80 times more likely to develop Type 2 dia-betes than those with a Body Mass Index of less than 22.

In Qatar, more than more than 70 percent of Qatar’s population are either overweight or obese and nearly half of all men (48 percent) are found obese, shows the Qatar Biobank report 2016. The report shows 16 percent of the pop-ulation has diabetes.

With the high prevalence of obes-ity, over weight and diabetes several awareness activities being organized across the country, with the aim to pre-vent and control the diseases. These activities coincide with World Diabe-tes Day (WDD) on November 14 as well as the World Anti-Obesity Day marked on November 26. Also the Hamad Med-ical Corporation (HMC) provides unique services to prevent, treat as well as

control obesity and diabetes. Due to the connection between obesity and diabe-tes, certain services are integrated and others are specific to the respective disease.

Obesity is a chronic disease, accord-ing to the World Health Organization and several other international associ-ations concerned with obesity management.

“Obesity can occur due to both genetic and environmental causes and it is a major risk for developing serious diseases, including coronary heart dis-ease, Type 2 diabetes, hypertension, hyperlipidemia, and infertility,” says Dr Mohamed El Sherif, Bariatric Endo-crinologist at Bariatric Surgery Department at HMC.

However, obesity is known as mostly preventable through a combination of social changes and personal choices. Anti-Obesity Day awareness events by HMC focus on providing information about obesity and its prevention. Its aim-ing to increase public awareness about obesity, obesity-related co-morbidities, risk factors, prevention, and supportive services available to patients.

The National Obesity Center, which sits under HMC’s Qatar Metabolic Insti-tute, was opened in October for the prevention of weight-related diseases as outlined in the National Health Strat-egy. Also in bariatric (weight loss) surgery service has been expanded from the Hamad General hospital to the Al Wakrah Hospital and to the Cuban Hospital.

Dr Mohammed Rizwan, Bariatric and Metabolic Surgery Consultant at Al Wakra Hospital, stresses that bariatric surgeries are now considered to be one of the most successful ways of treating morbid obesity. “Many metabolic dis-eases like Type 2 diabetes can be corrected by bariatric surgeries and can be cured completely post-surgery in some cases. It is important for patients to continue with their follow up after surgery and maintain a healthy lifestyle to avoid weight regain,” he said.

While, with the high prevalence of diabetes, HMC’s specialised diabetes clinics across its network of hospitals treat at least 3,000 patients each month and provide multi disciplinary care.

“These facilities serve as one-stop shops in which patients can speak with specialist doctors, renew prescriptions and learn self-care skills related to blood glucose monitoring, healthy eating, and physical activity,” said Professor Abdul-Badi Abou-Samra, Chairman of Internal Medicine at HMC and Director of the Qatar Metabolic Institute.

HMC looks beyond the care provided in the hospital setting and is working to promote the benefits of a healthy life-style as a strategy for disease prevention.

“Education is an essential element of the diabetes care plan at HMC. Edu-cation empowers not only patients but also members of the public to make the behavioural changes needed to protect their health. We work with patients with diabetes to help them understand the importance of controlling their blood glucose levels; and we work with patients who have been diagnosed as pre-diabetic, or who are at risk for dia-betes, to help them understand the significance of making the lifestyle and behavioural changes needed to reduce their chance of developing the condi-

tion,” says Professor Abou-Samra. Pre-diabetes happens when one’s

blood glucose level (blood sugar level) is higher than normal but not high enough to be called diabetes. It is effec-tively a warning sign and an indication that an individual could develop Type 2 diabetes. Research studies have found that moderate weight loss and exercise can prevent or delay Type 2 diabetes among those at high risk of developing the disease.

Further, more than 30,000 patients received diabetes education at HMC between January 2016 and September 2017. Education provided to patients is individualised and focuses on daily care as well as handling emergency situations.

“Once an individual has been diagnosed with diabetes, they need to start treatment immediately. This means meeting with our team of dia-betes specialists, which includes doctors, dietitians, nurses, health edu-cators, and other members of our clinical team. Together, working with the patient, we set a treatment plan that addresses medication, diet, and exercise,” says Manal Othman, Direc-tor of Diabetes Education at HMC.

Depending on the type and sever-ity of their disease, patients may need to take insulin or other diabetes

medication. Learning about diabetes medication and other treatment options can be overwhelming for many newly diagnosed patients.

“In addition to diet, Type 1 diabet-ics are treated with insulin injections, while most Type 2 diabetics are treated through diet and lifestyle modifications. However, some Type 2 diabetics and those with gestational diabetes may require oral drugs or insulin. Learning how to use medica-tion and how to manage blood sugar levels can seem complex at first, so we work with the patient and their family. For patients who require insu-lin, we teach them how to inject themselves, how to store their med-ication, and how to dispose of needles,” said Othman.

The diabetes care team works closely with patients to set goals for maintaining their blood sugar level and teach patients how to manage diabetic emergencies and avoid complications.

“Although our priority is stabilis-ing blood sugar levels and providing the support needed to manage the con-dition daily, we also talk about complications and diabetic emergen-cies. Chronic complications of diabetes can include heart attack, stroke, loss of sight, kidney failure, and amputa-tion. The care we provide is supportive, but we are firm with our patients. We encourage them to make healthy life-style choices, such as quitting smoking and maintaining a healthy weight,” said Othman.

The recently opened National Obesity Treatment Center, co-locates clinics previously situated at other facilities in one location, providing a unique multi-disciplinary service that integrates patient care. Located in Building 311 in Hamad Bin Khalifa Medical City, the Center is delivering holistic, multi-disciplinary care for obsessed and diabetic patients in need of medical management, lifestyle mod-ifications, bariatric and endoscopic procedures.

Obesity is believed to account for 80-85 percent of the risk of developing Type 2 diabetes, while some research suggests that obese people are up to 80 times more likely to develop Type 2 diabetes than those with a Body Mass Index of less than 22.

The National Diabetes Center at Hamad General Hospital was opened in 2013 and as of now it receives 2,000 patients each month. The National Diabetes Center at Al Wakrah Hospital opened a year later and cares for around 400 patients each month and the Diabetes in Pregnancy Clinic at Women’s Hospital receives around 600 patients per month.

HMC looks beyond the care provided in the hospital setting and is working to promote the benefits of a healthy lifestyle as a strategy for disease prevention.

Further, more than 30,000 patients received diabetes education at HMC between January 2016 and September 2017. Education provided to patients is individualised and focuses on daily care as well as handling emergency situations.