UHS Medical Times January 2017

UHS Medical Times 1

Newsletter | January 2017

Let’’’s fight it Together Cervical Health Awareness Month is observed all over the world every January. This aims to spread consciousness about Human Papilloma Virus (HPV) and Cervical Cancer through joint support, education and cooperation among healthcare professionals, stakeholders and patients.

Cervical Cancer is the seventh most common cancer world-wide World Cancer Research Fund International -

Newsletter from University Hospital Sharjah

Cervical Cancer is the 7th most common cancer for both genders and 4th among women worldwide. In UAE, 1.82 million women ages 15 years old and older are at risk of developing Cervical Cancer.

Present approximation suggest that every year, 93 women are diagnosed with Cervical Cancer and 28 deaths related from the disease. Cervical cancer ranks the 3rd most frequent cancer among women in UAE and the 3rd most common cancer amongst female between ages 15 to 44.

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CERVIX ANATOMY The cervix is a cylinder-shaped neck of tissue that connects the vagina and uterus. Located at the lowermost portion of the uterus, the cervix is composed primarily of ďŹ bromuscular tissue.

The two main portions of the cervix are the ectocervix and endocervix. Ectocervix which is covered in squamous cells is the part of the cervix that can be seen during the gynecological examination. There is an opening in the center of the ectocervix known as external os, which allow the passage between uterus and vagina. The Endocervix or also named as endocervical canal which is a subway through the cervix from the external os into the uterus. This part of the cervix is covered in glandular cells. These two parts of the cervix meet at a place called the transformation zone. The transformation zone changes as one female gets older and upon giving birth.

The cervical canal is lined with a single layer of column-shaped cells, while the ectocervix is covered with multiple layers of cells topped with at cells. The two types of epithelia meet the squamocolumnar junction. Infection with the human papillomavirus (HPV) can cause changes in the epithelium, which can lead to cancer of the cervix. Cervical cytology tests can often detect cervical cancer and its precursors, and enable early successful treatment. Ways to avoid HPV include avoiding sex, using condoms, and HPV vaccination. HPV vaccines, developed in the early 21st century, reduce the risk of cervical cancer by preventing infections from the main cancer-causing strains of HPV.

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Newsletter | January 2017

WHAT IS CERVICAL CANCER? Cervical Cancer happens when there is an abnormal growth of cells in the lower part of the uterus which is the cervix. Most cervical cancer starts in the transformation zone. The normal cells of the cervix initially develop in pre-cancerous changes that turn into cancer. While cervical cancer starts from cells with pre-cancerous changes, not all women progresses cancer. It usually takes more than a few years for cervical pre-cancer to change to cervical cancer however it can also happen in less than a year. When detected at an early stage, the 5-year survival rate for women with invasive cervical cancer is 92%.

TYPES OF CERVICAL CANCER The two most common type of Cervical Cancer is the Squamous Cell Carcinoma and the Adenocarcinoma. Although the mentioned types are the most common for Cervical Cancer, other types can also develop. These further categories like sarcoma, melanoma ad lymphoma take place more frequently in other parts of the body.

1. Squamous Cell Carcinomas – These cancers develop from the cells in the exocervix and mostly begin in the transformation zone of the cervix.

2. Adenocarcinomas – These are cancers that start from gland cells of the endocervix. Cervical adenocarcinomas have been found to occur more often in the past 20 years.

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Newsletter | January 2017

CAUSES OF CERVICAL CANCER: Most cervical cancer is caused by Human Papillomavirus or HPV. HPV is acquired through sexual contact with a person who has the virus. Not all type of HPV can develop cervical cancer, some of it can result to genital warts. Other types of HPV may not cause any symptoms at all.

RISK FACTORS FOR CERVICAL CANCER 1. Human Papilloma Virus (HPV) Infection – Exposure with HPV is the most vital risk factor for Cervical Cancer. HPV 16 and 18 are considered the high-risk strain that can cause cervical cancer. Other types of HPV will lead to papilloma or more commonly known as warts.

2. Smoking – The harmful substances obtained from cigarette smoke are absorbed through the lungs and carried in the bloodstream throughout the body. Studies have shown that cervical squamous cell carcinoma risk is 1.5 times higher in current smokers versus never-smokers.

3. Low Immune System – The immune system is important in eliminating cancer cells and slowing their progress and spread. A women who is immunocompromised, a cervical pre-cancerous might develop faster into an invasive cancer than it normally would.

4. Other Sexually Transmitted Infections like Chlamydia – Chlamydia like any other sexually transmitted disease can infect the reproductive system. These infections can cause pelvic inflammations leading to sterility.

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Newsletter | January 2017

5. Oral Contraceptives – The long-term use of oral contraceptives have been associated to cervical cancer.

6. Intrauterine Device – The use of IUD has been linked to cervical cancer according to some research.

7. Overweight – Adenocarcinoma of the cervix is more likely to develop in overweight women.

SIGNS AND SYMPTOMS OF CERVICAL CANCER Women in pre-cancerous stage or at an early stage of cervical cancer does not show any symptoms. Symptoms often begin when the cancer becomes invasive and affects nearby tissue.

The most commons symptoms are:

However, these signs may also indicate other gynecological condition other than cervical cancer. Overlooking these symptoms may allow cancer to grow more in an advanced stage.

It is best to see your doctor to eliminate doubts and higher your chance for effective management.

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Newsletter | January 2017

DIAGNOSTIC TEST TO DETECT CERVICAL CANCER

The initial step in finding cervical cancer is usually an abnormal Pap smear test. Pap Smear Test is a gynecological procedure which is usually than in the doctor’s clinic. The doctor will be using a vaginal speculum to open your cervix and from there the doctor by the use of a sterile swab test will scrape the lining of the cervix. It will be sent to the laboratory for examination. The preliminary result will be released in a day or two. An irregular result will lead to further tests which can diagnose cervical cancer like colposcopy and biopsy.

Pap smear test is recommended every 3 years for women ages between 21 and 65. Women who have a higher risk of cancer may need to do pap smear more often.

COLPOSCOPY AT UHS Colposcopy is an invasive procedure to closely visualize and examine your cervix, vagina and vulva for any abnormality using an instrument called colposcope. The main goal of colposcopy is to prevent cervical cancer by detecting precancerous lesions early and treating them.

Colposcopy is performed with the woman lying back, legs in stirrups, and buttocks at the lower edge of the table (a position known as the dorsal lithotomy position). A speculum is placed in the vagina after the vulva is examined for any suspicious lesions. The procedure normally takes 10 to 20 minutes depending on a patient’s case. If for instance, the doctor finds remarkable finding, your doctor might decide on cervical biopsy during the procedure.

PREPARATIONS FOR COLPOSCOPY

Before starting colposcopy, your physician will explain to you the procedure in details. You can freely ask any questions and doubts have in mind. A written consent should be signed by you that gives your permission to carry-on with the procedure.

Generally, there is no much preparation needed such as fasting or sedation. But based on your condition, your healthcare provider may request other preparation. Do not use tampons, vaginal creams or medications, douche and vaginal intercourse 24 hours before the test. If you are having your menstruation, your doctor might post-pone the procedure at least 1 week after your period.

Alert your gynecologist if you are pregnant, if you have allergies to any medications, latex, tape, iodine and anesthesia. Inform the doctor if you are taking any prescribed and over-the-counter medications, and having any history of bleeding disorders.

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Newsletter | January 2017

WHAT TO EXPECT AFTER COLPOSCOPY? After the procedure, you may take rest for a few minutes after before heading home. If you had colposcopy with biopsy, your recovery will differ. It will depend on the type of biopsy done and type of anesthesia used if any. It is normal to have mild uterine cramping, spotting and dark or black-colored vaginal discharge for several days if biopsy was done. It is because the dark discharge come from the medicine applied to the cervix to control bleeding. Also, do not douche, use tampons or have vaginal intercourse for 7 days after the procedure or as long as your healthcare provider allows you to. Avoid strenuous activity and lifting heavy things. Report to your doctor if you experienced bleeding, foul-smelling discharge from vagina, fever and pelvic or abdominal pain.

TREATMENT FOR CERVICAL CANCER Cervical Cancer if detected and managed early can be successfully treated. The choice of treatment is depending on the stage and type of cancer. Your doctor may require 1 or combined management depending on the severity of the disease.

Surgery

Radiation Therapy

Chemotherapy

Chemoradiation

1. Surgery – The procedure to remove part of the cervix is called Radical Trachelectomy. Other surgeries are called radical hysterectomy (surgery to remove the womb) and laparoscopic surgeries (less invasive technique to remove some parts of the cervix).

2. Radiation Therapy – This treatment involves high doses of radiation or implants in vaginal cavity to eliminate cancer cells. Usually, it is combined with surgery.

3. Chemotherapy – In order to kill cancer cells, chemo drugs will be administered in 6-8 sessions depending on the patient’s condition. This is used for more advanced cancer stage.

4. Chemoradiation – For early and late stage, combination of chemotherapy and radiation is being used.

WAY TO RECOVERY FROM CERVICAL CANCER Adopting to a life with cancer is stressful and tough. Being a survivor means that you are returning back to some accustomed things and adjusting to new choices and habits. You have to discuss with your physician about your recovery period, below are some required matters to talk over: Follow-up check-up Further tests if needed to be screened for other type of cancer Diet and physical activity

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Newsletter | January 2017

OBSTETRICS AND GYNECOLOGY TEAM AT UHS

QUALIFICATIONS Dr. Kauser Mansoor is a UK Board Certified Obstetrician and Gynecologist. She is a fellow of the Royal College of Obstetrician and Gynecology (FRCOG, London), a member of the Royal College of Obstetrician and Gynecologist (MRCOG, London) and also an affiliate of the British Society of Colposcopy and Pathology (Birmingham).

EXPERIENCE Dr. Kuaser Mansoor is a UK Board certified Consultant Obstetrician and Gynecologist with 32 years of clinical experience. Before relocating to UAE, she underwent extensive advance training in UK. She holds a remarkable distinction as an accredited colposcopist. Prior to joining UHS, Dr. Kauser has been working as a Consultant in Obstetrics and Gynaecology and Head of the Department for a government hospital in Sharjah. Dr. Kauser recently joined the admirable team of Obstetrician and Gynecologist in UHS as the department head.

Dr. Kauser Mansoor Baig MBBS, MRCOG (UK), FRCOG (UK) Consultant Obstetrician and Gynecologist

She has in-depth obstetrics and gynaecological knowledge including routine and high-risk antenatal care, all types of obstetric emergencies, complex obstetric situations such as pre-eclampsia, diabetes and VBAC, caesarean sections, cosmetic or reconstructive surgery of the vulval area (vagina and labia), operative Gynaecology such as hysterectomies, hysteroscopy and laparoscopic surgery, cervical screening, reproductive medicine and issues involving infertility, urogynaecology, oncology and menopause.

Apart from her clinical responsibilities, Dr. Kauser is academically associated to University of Sharjah MedicalSchool as senior faculty member.

Dr. Kuaser regularly participates as a speaker in local, regional and international conferences and publishes articles in peer reviewed scientific journals. She won several international prices, including the recipient of the award of excellence for best oral presentation in Kuwait during the 5th International Conference of Obstetrics and Gynecology held on October 2010 by the Royal College of Obstetrics and Gynecology.

SPECIAL INTEREST

High-risk Pregnancy Laparoscopic Surgery Obstetric and Gynecological Ultrasound Infertility Management

Colposcopy Labour Ward Management Patient Safety and Fetal Medicine Medical Innovation

LANGUAGE KNOWN Arabic, English, Hindi, Punjabi, Urdu

QUALIFICATIONS

SPECIAL INTEREST

Prof. Mohamed Zayed graduated from Cairo University, Egypt and went on to complete Master’s Degree and Doctorate Degree in Obstetrics and Gynecology from the same university.

He has acquired his advanced fellowship training in Gynecologic Oncology from at Vanderbilt University, USA.

High Risk Pregnancy Assisted Reproductive Technology Gynecologic Oncology Hysteroscopy Laparoscopy Pelviscopic Surgery

LANGUAGE KNOWN

EXPERIENCE Prof. Mohamed Zayed is a consultant in Obstetrics and Gynaecology with a particular interest in high-risk antenatal care, critical care in obstetrics and medical/surgical management of benign gynaecological conditions.

Arabic, English and French

Apart from his clinical exposure, he is academically associated as a professor of Obstetrics and Gynecology in Cairo University and University of Sharjah Medical School.

Prof. Mohamed Zayed Masters in Obstetrics & Gynecology, PhD in Obstetrics & Gynecology, Chairman of the Department of Obstetrics and Gynecology in University of Cairo (Egypt)

Prof. Zayed is a member of the American Society of Colposcopy and Cervical Pathology, International Society of Gynecologic Endoscopy, American Association of Gynecologic Laparoscopy and American Society of Reproductive Medicine.

He has made numerous research studies that were published and presented in both local and international journals and conferences.

Consultant Obstetrician and Gynecologist

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Newsletter | January 2017

OBSTETRICS AND GYNECOLOGY TEAM AT UHS

QUALIFICATIONS

SPECIAL INTEREST

Prof. Alaa El Din Naguib El Ebrashy graduated MBBCh with honors from Cairo University, Egypt and went on to complete his Masters of Science and Medical Degree in Obstetrics and Gynecology from the same university.

Ultrasound High-Risk Pregnancy Major Gynecologic Surgery Infertility

LANGUAGE KNOWN

EXPERIENCE

Arabic and English

Prof. Alaa El Din Naguib El Ebrashy is a German and UK trained Fetal Medicine physician. He has undergone advanced training courses from Munchen University, Birmingham Women’s Hospital and University College London.

He is an expert in ultrasonography for fetal anomalies and fetal medicine including invasive foetal medicine procedures.

His clinical interest includes routine scans and scans for high-risk women, fetal echocardiography and invasive procedures for the diagnosis of chromosomal and genetic disorders.

Prof. Alaa El Din Naguib El Ebrashy MBBCh, Master’s Degree and PhD in Obstetrics andGynecology, MD Obstetrics and Gynecology Consultant Fetal Medicine

He is a member of the Executive Committee of Mediterranean Association of Ultrasound in Obstetrics Gynecology (MEDUOG) and a reviewer for the Middle Fertility Journal, European Journal of Obstetrics Gynecology and Reproductive Biology.

the and East and

He had published over 20 research studies in local and international journals and conferences. He is also invited as speaker in many international conferences.

QUALIFICATIONS

SPECIAL INTEREST

Dr. V.L. Arathy is a Member of the Royal College of Obstetricians and Gynecologists (MRCOG), UK since 2000 and obtained her Diplomate of National Board (DNBOG) from New Delhi, India. Prior to that she completed her Master’s degree in Obstetrics and Gynecology from Dr. MGR Medical University in Chennai, India.

Maternal Fetal Medicine and High-risk Obstetrics

LANGUAGE KNOWN Arabic, English, Malayalam and Tamil

EXPERIENCE Dr. Arathy has 17 years of experience from hospitals in India and UAE. Before joining University Hospital Sharjah, she was working in Al Ain as Consultant Obstetrics and Gynaecology.

Dr. V.L. Arathy MD, DNB, MRCOG (UK), FRCOG Consultant Obstetrician and Gynecologist

She has in-depth obstetric and gynecological experience and expertise which includes routine and high-risk antenatal care, all obstetric emergencies, complex obstetric situations such as pre-eclampsia, diabetes and VBAC, reproductive medicine and issues involving infertility, urogynaecology, family planning and menopause, major obstetric and gynecological surgeries like emergency cervical cerclage, and total abdominal hysterectomy with bilateral salpingo-oophorectomy, ovarian cystectomy, myomectomy, vaginal hysterectomy, repair of uterine prolapse, and pelvic floor repairs.

She published reports of confidential reviews of maternal deaths in Kerala in collaboration with Nice International, UK. She is also a practical obstetric multiprofessional trainer.

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Newsletter | January 2017

OBSTETRICS AND GYNECOLOGY TEAM AT UHS

QUALIFICATIONS Dr. Hind Sabah studied medicine from Baghdad University and gained post graduate certification in Obstetrics and Gynecology from Iraqi Council for Medical Specialization.

She has also fellowship from Arab Board of Obstetrics and Gynecology and Diploma in Obstetrics and Gynecology.

EXPERIENCE Dr. Hind has 8 years of clinical experience as a Senior Specialist in Obstetrics and Gynecologist from hospitals in Iraq and UAE. She has high qualification from Iraqi and Arab Board for Medical Specialization.

Performing Cesarean Section Polycystic Ovary Syndrome and Infertility Family Planning and Contraception Abnormal Uterine Bleeding Obstetrics and Gynecology Ultrasound Vaginal Repair Surgery Major and Gynecological Surgeries like Total Abdominal Hysterectomy and Bilateral Salpingo-oophorectomy and Ovarian Cystectomy

LANGUAGE KNOWN Arabic and English

Academically she is associated as a lecturer of Obstetrics and Gynecology in the college of Medicine at University of Sharjah. Prior to that she was as an instructor for medical students in Baghdad University for 4 years.

Dr. Hind Sabah MBChB, Diploma in Obstetrics and Gynecology, Arab and Iraqian Board Certified Senior Specialist Obstetrician and Gynecologist

Her recent research study entitled “CA 19-9 versus CA 125 in Endometriosis� was published in International Organization of Scientific Research Journals on April 2014.

SPECIAL INTEREST

High Risk or Complicated Pregnancies Gestational Diabetes Mellitus Gestational Hypertension Pre-eclampsia

QUALIFICATIONS Dr. Ameenah Saadi, an Arab Board certified physician is also a holder of PhD in Obstetrics and Gynecology. She has certification from the Royal College of Obstetrics and Gynecology (MRCOG), London.

LANGUAGE KNOWN Arabic and English

EXPERIENCE Dr. Ameenah Saadi is a Senior Specialist Obstetrician and Gynecologist with 15 years of clinical experience in Obstetrics and Gynecology.

Before joining University Hospital Sharjah, she has worked and honed her skills in various government and private hospitals in Sharjah and Dubai.

Dr. Ameenah has attended various local and international courses and trainings pertaining to her field of expertise. She has research studies which were published in international journals and magazines.

SPECIAL INTEREST Dr. Ameenah Mohammad Saadi Arab Board Certified, PhD in Obstetrics and Gynecology, MRCOG Senior Specialist Obstetrician and Gynecologist

High Risk Pregnancy Infertility Treatment Treatment and Follow-up of Recurrent Miscarriage Menopause Female Adolescence General Gynaecology Polycystic Ovarian Syndrome (PCO) Screening and Follow-up for Cervical Anomalies

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Newsletter | January 2017

OBSTETRICS AND GYNECOLOGY TEAM AT UHS

QUALIFICATIONS Dr. Nariman gained her basic medical degree from Damascus University, Syria and went on complete her Master’s Degree in Obstetrics and Gynecology from the same university.

LANGUAGE KNOWN Arabic and English

EXPERIENCE Dr. Nariman Awad has over 16 years of medical experience from hospitals in Syria and UAE and over 11 years practicing Obstetrics and Gynecology ultrasound.

She has in-depth obstetrics and gynaecological knowledge including routine and high-risk antenatal care and has conducted more than 1,800 vaginal deliveries and more than 900 cesarean sections in her long clinical career.

SPECIAL INTEREST

Dr. Nariman Awad MBChB, Master’s Degree in Obstetrics and Gynecology Senior Specialist Obstetrician and Gynecologist

High Risk Pregnancies Infertility Careful Monitoring of Pregnancy Course Detection of Fetal Malformations Close Patient Follow-up Before Delivery Cesarean Section Gestational Diabetes Gestational Hypertension Polycystic Ovary Syndrome Abnormal Uterine Bleeding

QUALIFICATIONS

SPECIAL INTEREST

Dr. Nagla Abdalla graduated from University of Khartoum, Sudan and is currently a candidate for the certification program from the prestigious Royal College of Obstetricians and Gynecologist, UK.

EXPERIENCE Dr. Nagla Abdalla is a Senior Specialist Obstetrician and Gynecologist with 15 years of clinical experience. Before joining University Hospital Sharjah, she worked in hospitals in Saudi Arabia and Sudan.

High Risk Pregnancy Infertility Treatment Menopause Female Adolescence General Gynaecology

LANGUAGE KNOWN Arabic and English

Dr. Nagla believes in combining individual clinical expertise with best available research evidence so as to offer high standard of care to the patients.

Dr. Nagla Elhadi Abdalsamad Abdalla MBBS, Sudanese Board Certified

Aside from her clinical responsibilities, Dr. Nagla was active on the academic activities side, where she is licensed to teach Advance Life Support in Obstetrics provided by American Academy of Family Physicians (AAFP) to the medical students of the Universities of Sudan for over three years. She is at present a lecturer in the medical collegeof University of Sharjah.

Dr. Nagla has 3 research studies published in international magazines.

Senior Specialist Obstetrician and Gynecologist

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Newsletter | January 2017

SCOPE OF SERVICES AT UHS MEDICAL SERVICES

SURGICAL SERVICES

CARDIOLOGY

NEUROPHYSIOLOGY

Anesthesiology

Bariatric Surgery

24-Hour BP Monitoring

Electroencephalogram (EEG)

Aviation Medicine

Ears, Nose and Throat Surgery

24-Hour Holter Monitoring

Electromyography (EMG)

Cardiology

General Surgery

2D/3D Echo

Evoked Potential Test

Critical Care

Neurological Surgery

3D Transesophageal Echo

Brain Auditory Evoked Potential

Dermatology

Obstetrics and Gynecologic Surgery

CT coronary Angiography

(BAEP)

Emergency Medicine

Ophthalmic Surgery

Somato Sensory Evoked Potential

Endocrinology

Orthopedic Surgery

Dobutamine Stress Echo for Ischemia and Viability Studies

Family Medicine

Pediatric Surgery

Gastroenterology

Plastic and Reconstructive Surgery

Internal Medicine

Urologic Surgery

Medical Oncology

Vascular Surgery

Neonatology Nephrology Neurology Pediatrics Psychiatry Pulmonology Rheumatology MEDICAL DIAGNOSTICS IMAGING (MDI) 128 Channel CT Scan with Coronary and Cardiac Facility

PATHOLOGY & LABORATORY MEDICINE

Interventional Cardiology Stress Test

(SSEP) Visual Evoked Potential ( VEP) Nerve Conduction Studies (NCS)

Treadmill Stress Test

AUDIOLOGY

OTHER SPECIALTY SERVICES

Biochemistry

Acoustic Reflex Threshold

24/7 Emergency Services

Blood Transfusion Medicine

Auditory Brainstem Response

Ambulance

Cytology

Auditory Steady State Response

Hemodialysis

Hematology

Cochlear Implant Mapping

Physiotherapy

Histology

Electrocochleography

Pharmacy

Immunology

Free Field Audiometry

Sharjah Breast Centre

Microbiology

Hearing Aid Fitting and Programming

Phlebotomy

Newborn Hearing Screening

Bone Densitometry

Otoacoustic Emission

Digital X-Ray and Fluoroscopy

Pure Tone Audiometry (PTA)

Mammography and Guided Breast Intervention

Speech Audiometry

MRI 1.5 TESLA

Tinnitus Evaluation

Ultrasound

Tympanometry

Vascular Interventional Lab

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