Prof. Dr. Mohamed Meshref, Medical Director at Boehringer Ingelheim IMETA
Prof. Dr. Mohamed Meshref, Medical Director at Boehringer Ingelheim IMETA
The road ahead for a more stroke-ready region to improve patient outcomes
Prof Dr Mohamed Meshref, medical director at Boehringer Ingelheim IMETA, says there is a critical need to ensure everyone has access to modern stroke care centres
Ischemic stroke is a medical emergency and occurs when there is a blockage or clot in a blood vessel that supplies blood to the brain, leading to a lack of oxygen and nutrients to brain tissue. According to a recently published study, the incidence of stroke in the Middle East and North Africa region is estimated to be over 1,500 per 100,000 people, making it a significant health concern.
The burden of ischemic stroke is expected to increase in the future due to ageing populations and the increasing prevalence of risk factors in the region. Risk factors for stroke include hypertension, diabetes, obesity, smoking, and physical inactivity.
For strokes to be managed effectively, three key factors need to be considered. Firstly, the symptoms and signs of stroke need to be recognised by the individual or close ones. Second, it is of utmost importance to address the situation as quickly as possible. The time between a stroke occurring and receiving treatment is critical and the window for receiving effective treatment is limited to 4.5 hours. Third, those who experience a stroke need to be taken to a facility that is equipped to handle stroke cases and is staffed by healthcare professionals trained in stroke management.
The evolution of stroke management
Stroke management has evolved significantly over the years, moving from a time when stroke was not treated as a medical emergency and there were no specialised units or protocols in place to a modern approach that focuses on rapid assessment and treatment.
In the past, patients affected by stroke were often treated on general medical wards without the benefit of specialised equipment or expertise. This could lead to delayed diagnosis and treatment, resulting in higher rates of disability and death. With the recognition of the importance of early intervention, stroke management has shifted towards a more specialised approach.
Key to this is specialised stroke units that are equipped with the necessary equipment and staff to provide comprehensive care to stroke patients. The development of life-saving stroke codes, such as the FAST assessment, has helped healthcare providers quickly identify stroke symptoms and begin treatment as soon as possible. This includes the use of treatments such as thrombectomy therapy to physically remove clots, dissolve blood clots and restore blood flow to the brain.
Studies have shown that these interventions – specifically administering treatment within 3 to 4.5 hours of the onset of symptoms – have had a positive impact on stroke outcomes, including lower death rates and reduced irreparable brain damage.
What makes a hospital acute-stroke emergency ready?
To be acute-stroke emergency ready, a hospital should have the necessary equipment, staff, and protocols in place to provide rapid and effective care to stroke patients. Key elements include:
· Having a dedicated stroke unit or stroke beds and staff – including a neurologist – trained in stroke assessment, diagnosis, and treatment.
· Using rapid assessment protocols or stroke ‘codes’ such as the FAST protocol to help healthcare providers quickly identify stroke symptoms and begin treatment as soon as possible. FAST stands for Face, Arm, Speech, and Time and involves looking for signs of drooping of the face, weakness or numbness on one side of the body, or slurred speech.
· Emergency medical service staff alert the hospital prior to arrival to activate the stroke code, so the hospital is ready to receive the patient and refer for immediate imaging.
· Point-of-care testing and advanced imaging capabilities such as a CAT scanner.
· The ability to administer thrombolytic ‘clot busting’ therapy within a short window of time.
· Having access to rehabilitation services to help patients regain their abilities and prevent future strokes.
· Implementing a systematic approach to quality monitoring of stroke management in a hospital-based or international registry. This has been shown to lead to improvement in performance and stroke care delivery.
The role of awareness in reducing the ill-effects of stroke
Preventative programmes should be implemented with a focus on metabolic risk factors. There is an ongoing need across the region for sustained joint efforts between health authorities, pharma and the medical community towards raising awareness on the prevalence of stroke, its risk factors and best practices for prevention. Investing in awareness campaigns, screening programmes, and lifestyle interventions has the potential to make a real difference in the number and outcome of strokes annually.
A key element of public education efforts must focus on how to act when detecting signs of stroke and being aware that stroke is an emergency and must be treated fast at an appropriate hospital. Healthcare professional education is important too, and Boehringer Ingelheim is active in this area, particularly in supporting healthcare professionals to develop their stroke awareness.
The need for standardised care and innovation
Regulatory bodies play an important role in standardising care for stroke management. This includes committing to evidence-based guidelines set out by the European Stroke Organisation that support physicians in making clinical decisions with regard to intravenous thrombolysis for acute ischemic strokes.
Moreover, the adoption of telehealth and mobile stroke units has become more prevalent with the aim of improving outcomes for those living outside urban centres.
Conclusion
While there have been great advances in stroke management in recent years, there is a critical need to ensure everyone has access to a modern stroke care facility. By having the necessary equipment, staff, protocols, and trained emergency medical services in place, hospitals can provide the highest level of care to stroke patients and improve their outcomes. Public education about stroke prevention and recognition of symptoms is also essential in saving as many lives as possible. Through these necessary interventions, we can evoke new hope for the 1,500 per 100,000 people in the Mena region experiencing a stroke each year.
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Mercer, the investment consulting arm of US services company Marsh & McLennan, expects its wealth division to at least double its assets under management (AUM) in the Middle East as wealth in the region continues to grow despite economic headwinds, a company official said.
Mercer Wealth, which globally has $160 billion in AUM, plans to boost its AUM in the region to $2-$3bn in the next 2-3 years from the present $1bn, said Yasir AbuShaban, a Dubai-based principal with Mercer Wealth.
“Within the next two to three years, we are looking at reaching $2 to $3 billion as a conservative estimate and we do see an opportunity to do so,” said Mr AbuShaban.
Mercer does not directly make investments, but allocates clients’ money they have discretion to, to professional asset managers. They also provide advice to clients.
“We have buying power. We can negotiate on their (client’s) behalf with asset managers to provide them lower fees than they otherwise would have to get on their own,” he added.
Mercer Wealth’s clients include sovereign wealth funds, family offices, and insurance companies among others.
From its office in Dubai, Mercer also looks after Africa, India and Turkey, where they also see opportunity for growth.
Wealth creation in Middle East and Africa (MEA) grew 8.5 per cent to $8.1 trillion last year from $7.5tn in 2015, higher than last year’s global average of 6 per cent and the second-highest growth in a region after Asia-Pacific which grew 9.9 per cent, according to consultancy Boston Consulting Group (BCG). In the region, where wealth grew just 1.9 per cent in 2015 compared with 2014, a pickup in oil prices has helped in wealth generation.
BCG is forecasting MEA wealth will rise to $12tn by 2021, growing at an annual average of 8 per cent.
Drivers of wealth generation in the region will be split evenly between new wealth creation and growth of performance of existing assets, according to BCG.
Another general trend in the region is clients’ looking for a comprehensive approach to investing, according to Mr AbuShaban.
“Institutional investors or some of the families are seeing a slowdown in the available capital they have to invest and in that sense they are looking at optimizing the way they manage their portfolios and making sure they are not investing haphazardly and different parts of their investment are working together,” said Mr AbuShaban.
Some clients also have a higher appetite for risk, given the low interest-rate environment that does not provide enough yield for some institutional investors. These clients are keen to invest in illiquid assets, such as private equity and infrastructure.
“What we have seen is a desire for higher returns in what has been a low-return environment specifically in various fixed income or bonds,” he said.
“In this environment, we have seen a de facto increase in the risk that clients are taking in things like illiquid investments, private equity investments, infrastructure and private debt, those kind of investments were higher illiquidity results in incrementally higher returns.”
The Abu Dhabi Investment Authority, one of the largest sovereign wealth funds, said in its 2016 report that has gradually increased its exposure in direct private equity and private credit transactions, mainly in Asian markets and especially in China and India. The authority’s private equity department focused on structured equities owing to “their defensive characteristics.”
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The Baha'i faith was made known in Yemen in the 19th century, first introduced by an Iranian man named Ali Muhammad Al Shirazi, considered the Herald of the Baha'i faith in 1844.
The Baha'i faith has had a growing number of followers in recent years despite persecution in Yemen and Iran.
Today, some 2,000 Baha'is reside in Yemen, according to Insaf.
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