ISSUE EIGHTJULY 2014

HiataL HerniaDiagnosis & treatment

Breast is BestWhy breastfeeding is important

Liver LifeHepatitis prevention & management

trUtH aBoUt triageEmergency educational video

Food, fitness & fasting

Ramadan Kareem

For A Healthy

Approach To Life

It is our pleasure to bring you the eighth issue of Tabibi, Mafraq Hospital’s health and lifestyle magazine that is published in-house and customised just for you. We have recently started using palm scanning to identify patients. This allows us to link the unique pattern of veins in your hands with your electronic files so that we can reduce waiting times and identify patients who arrive in the Emergency Department unconscious. We also introduced a video and some posters to raise awareness about our triage process. Watch our video to learn about how waiting in the Emergency Department ensures that doctors see the sickest patients first.

Najwa Bou Eid, Maternal and Child Health Services Department, tells you about the benefits of breastfeeding your baby in this issue. It truly is the best gift you can give your baby. The benefits last a lifetime and even reduce the risk of cancer for both you and your baby. Dr. Magdi Shehata, Consultant Surgeon, discusses hiatal hernia, a fairly common condition whereby part of the stomach moves up through the diaphragm. It is especially common in obese patients, and if you have heartburn or reflux, you should read this and ask your doctor about it. Dr. Karim Elmasry, Chair of Obstetrics and Gynaecology is always here to answer your questions. In this issue he explains ovarian cancer, a particularly dangerous disease that only affects women. Dr. Asim Malik, Consultant and Chief, Infectious Diseases, provides details about hygiene and explains the importance of hand washing to prevent sickness. Lastly, Dr. Ahmad Al-Rifai, Consultant Gastroenterologist and Hepatologist, describes liver disease.

Regarding Ramadan, we focus on healthy fasting, and give you advice for exercising and eating, with some tasty and healthy recipes to try for Iftar. Please feel free to contact us if you have any health-related questions and we hope that you enjoy this issue.

Wishing you good health

Ramadan Kareem

Marketing & CommunicationsMafraq Hospital

Contents10

11

8

13

DEAR READERSfor YoUr

famiLY’s HeaLtH04

Carer of ChoicePatient ID by palm scan

06Breast is Best

Najwa Bou Eid explains why

07Hiatal Hernia

Dr. Magdi Shehata on diagnosis and treatment

08Ovarian Cancer

Uncommon but dangerous

08Cancer Prevention

General lifestyle tips

09Ask the ExpertDr. Elmasry tells you

about ovarian cancer

10Good Health

is in Your HandsDr. Asim Malik

promotes hygiene

11Ramadan Kareem

A guide to healthy fasting by

Ahlam Al Hajeri

12Be Fit and Fast

Exercise while fasting

13Healthy Living

Ramadan recipes for your family

14Liver Life

Dr. Ahmad Al-Rifai discusses hepatitis

Mafraq Hospital was established in 1983 and is one of the largest tertiary hospitals in the UAE. Mafraq Hospital is part of the SEHA HealthSystem and is owned and operated by Abu Dhabi Health Services Company PJSC (SEHA) which is responsible for the curative activities of the public hospitals and clinics of the Emirate of Abu Dhabi. Visit www.mafraqhospital.ae for details of our services, specialties and clinics. © Copyright 2014. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means without permission in writing from Leading Brands.

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Cover image supplied by Ameera al AmeriCheck her Instagram account at Amerabinth

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ISSUE EIGHTJULY 2014

HIATAL HERNIADiagnosis & treatment

BREAST IS BESTWhy breastfeeding is important

LIVER LIFEHepatitis prevention & management

TRUTH ABOUT TRIAGEEmergency educational video

Food, fitness & fasting

Ramadan Kareem

For A Healthy

Approach To Life

Follow us on Twitter and Facebook for healthy lifestyle tips and health updates

Carer Of ChoiceUPDATES

The Latest Developments at Mafraq Hospital

Summertime Activitieslearning a sport, swimming or going to a summer camp are healthy activities. You can foster your child’s talents by having them join specialised clubs.

Share your suggestions with us on Mafraq Hospital’s Twitter and Facebook so that we can help young children enjoy interesting and enriching experiences this summer, away from tablets and TV screens.

Fadya Al Katheeri Marketing & Communications OfficerMafraq Hospital

Every summer, parents find it difficult to keep their children occupied with beneficial and interesting activities. It is not uncommon for children to protest against educational activities. They feel bored and mope until they eventually fall asleep during the daylight hours, only to wake up in the evening with renewed energy!

This is a wide-spread complaint among families in the UAE. It can be difficult to find solutions for our children and we need to inspire each other to try new activities. For example,

ASk A DoctoRWhy do I feel tired all the time, even after getting enough sleep? Is it related to vitamin B12 deficiency?

Dr. Hasna Alzubaidi, Consultant Haematologist, answered: No – only if B12 deficiency is associated with anaemia would you feel tired. You would also have shortness of breath and palpitation. Iron deficiency is a more common cause of tiredness. Vitamin B12 deficiency can cause nerve damage, which leads to sensations of numbness and tingling anywhere in the body, but most often in the hands and feet. Lack of sleep is the main cause of fatigue and no single condition is associated with fatigue. Most tiredness is linked with lifestyle factors, medical conditions or psychological problems. Caffeine, excess physical activity or inactivity, lack of sleep, cough medications and antihistamines, and unhealthy eating habits are some lifestyle factors that are associated with fatigue. Psychological conditions include anxiety, depression and stress. Lastly, medical conditions linked with fatigue include liver and kidney disease, iron deficiency, breathing problems, hormonal conditions, heart disease, overweight and obesity, diabetes and some medications for heart, blood pressure, pain and mental illness.

A SHOW OF HANDSSEHA recently introduced a new type of technology to identify patients at Mafraq Hospital. The Malaffi My Scan is a palm scanning system that links with electronic medical records to not only improve accuracy, but also to speed up patient registration. Near-infrared light, similar to the light used in night vision goggles and TV remotes, scans the palm to generate a detailed image of the blood vessels inside. The pattern of blood vessels within the body is unique to each individual; it even differs between identical twins. Palm scanning is currently used in Japan for banking customers.

Benefits of Malaffi My Scan• Patient safety: the right care is provided to the right patient• Record accuracy: eliminates duplicate and mixed medical records • ED trauma search: ability to identify a previously enrolled patient

that is unconscious• Enhanced patient experience: patients do not need to provide personal

information every time they visit the hospital, wait time is reduced and there are fewer administrative errors

Malaffi My Scan is now live at Mafraq Hospital. To register with the Malaffi My Scan system, you need to bring your valid Emirates ID, UAE Driver’s License or passport to registration and have your palm scanned twice. Once your palm is in the system you will not need to show your ID again. The system allows healthcare professionals to access your medical records, even if you arrive by ambulance due to an emergency and are not awake. This helps save vital time and allows doctors to give you the best treatment.

TRUTH ABOUT TRIAGEA video and several posters have been developed to increase awareness about the triage process in our Emergency Department. This campaign serves to inform you about how the urgency of medical emergencies is measured using the T1-T5 system and why you may need to wait while doctors tend to patients with life-threatening conditions first. The video features animated characters that arrive at Mafraq Hospital with conditions of varying severity and shows that the triage system ensures that the sickest patients are seen first. Check out the video and posters in the Emergency Department.

Best TeacherDr. Mondy Hammad, Chief of ENT, was recognised by the Gulf Medical University as being the best teacher at Mafraq Hospital. The decision was made by medical students who had entered clinical rounds at the hospital during the third phase of their second year in the MBBS programme. Congratulations to Dr. Hammad for his notable influence on our upcoming physicians in the region. Without teachers to pass on their expertise, there would be no future leaders!

DOCTORS ONLINEWe have a convenient online directory of all our consultants that is organised alphabetically by medical specialty. Simply visit www.mafraqhospital.ae and click “Services & Specialties” to see the alphabetical list of therapy areas. Choose a specialty to read an overview of the service and view details of affiliated physicians, including their areas of expertise and contact information such as their telephone numbers and email addresses.

Dr. Hasna AlzubaidiConsultant Haematologist

4 JULY 2014 www.mafraqhospital.ae 5

Lactation Consultants and nurses educate pregnant women in the Antenatal Clinic about breastfeeding. Immediately after birth, specialists help mothers stay in close contact with their new-borns, which helps develop close bonds, and mothers are assisted when breastfeeding for the first time. Infants are roomed with their mothers to further help bonding. Important information about correct positioning and attachment is provided and a follow up system is available for mothers to contact specialists by phone, email or by visiting the Lactation Clinic. Mothers can also join La Leche League Leaders for more breastfeeding information and support.

• Skin-to-skin contact for at least one hour immediately after birth

• Start breastfeeding as soon as possible after birth

• Keep your baby in your room as much as possible

• Have your baby next to you to make feeding easier

• Learn your baby’s feeding cues so that you know when to feed

• Empty one breast before switching; the last bit of milk has fat that helps your baby grow and helps you produce more milk

• Night time breastfeeding helps you produce more milk

• Use proper positioning and attachment to prevent problems

• Avoid giving your baby a pacifier if possible; they will feed less and grow slower; pacifiers can also carry germs

• Maintain a healthy diet and ask your doctor about medications if you take any

• Exercise for overall health benefits and practice good hygiene

Breastfeeding has significant health benefits for both mother and child. Breast milk is a free source of adequate nutrition for new-borns, supplying all the necessary nutrients for healthy development for the first six months of life. After six months, breast milk remains a healthy food source for two years or longer as babies are introduced to other foods. Your baby’s immune system is boosted by antibodies found in breast milk that prevent allergies, diarrhoea and pneumonia. Breastfeeding even reduces the risk of cancer. Adults who were breastfed as babies tend to have lower blood pressure and cholesterol levels, and are less likely to be obese or develop type 2 diabetes, Crohn’s disease and other digestive conditions.

A strong bond between you and your child is formed with prolonged skin-to-skin contact. This bond helps your child develop and function normally. Breastfeeding right after giving birth helps the uterus contract and stops bleeding. It also helps you return to your normal weight faster by burning calories and reduces the risk of ovarian and breast cancers.

Breastfeeding is the best gift you can give your baby, and it also helps you!

Breast is BestNajwa Bou Eid, Lactation Consultant, Baby Friendly Hospital Initiative Coordinator, Neonatal Screening Coordinator, Maternal and Child Health Services Department, explains why breastfeeding is so important

MAFRAq HOSPITAL HELPS YOU BREASTFEED

NursiNg Tips

Dr. Magdi ShehataConsultant Surgeon

The oesophagus is essentially a tube that connects your mouth with your stomach. It passes through an opening in the diaphragm called the hiatus to join with the stomach. A circular muscle called the lower oesophageal sphincter tightens the oesophagus where it meets the stomach to prevent food and acid from flowing back into the oesophagus.

Hiatal hernia is a condition whereby part of the stomach and the lower oesophagus move up through the hiatus.

• TypeI:Sliding.Mostcommon(morethan95%ofhiatalhernia)and occurs when the lower part of the oesophagus and the top of the stomach move slide up through the hiatus.

• TypeII:Rolling.Partofthestomachprotrudesthroughthehiatus but the lower part of the oesophagus remains where it normally is, below the diaphragm.

• TypeIII.AcombinationoftypeIandtypeII.• TypeIV.Otherabdominalstructures,suchasthebowelsare

present in the hernia

Lessthan10%ofpeopleyoungerthan40yearsofagehavehiatalhernia,whereasaround60%ofpeopleolderthan60yearshaveit.Some people with this condition have reflux, which is a backflow of stomach contents. They can experience heartburn, gas, and problems with swallowing or digesting food. If you have these symptoms,thenaskyourdoctorwhattodo.However,lessthan5%of people with this hernia have symptoms. The hole that part of thestomachmovesthroughtocausehernia(thehiatus)islargerin some people, making hiatal hernia more likely. Also, obesity and chronic cough increase the chance of developing this condition.

For diagnosis, doctors use x-ray imaging and a procedure to look down the throat using a tube, called endoscopy. Medications that reduce stomach acid can help, and people with sliding hernia do not need surgery. More severe cases may require surgery to wrap the top of the stomach around the oesophagus to stop reflux. As with most health conditions, lifestyle changes can also help.

HIATAL HerniaDr. Magdi Shehata, Consultant Surgeon, describes the symptoms, causes and treatment of hiatal hernia

If you are one of the few people to experience symptoms of hiatal hernia, you can help stop them by incorporating the following lifestyle behaviours:• Stop lifting heavy objects and

bending over. Sit up straight, exercise more often and lose weight if you are obese. Sleep with the head of your bed raised and try to stay standing after a meal.

• Avoid foods such as caffeine, chocolate, fried or fatty foods, peppermint, and don’t eat within 2-3 hours of bedtime. Also, try eating smaller meals more frequently.

• Most cases of hiatal hernia can be managed using medication. Ask your doctor what is best for you.

TIPS FOR TROUBLESOME HIATAL HERNIA

TYPES OF HIATAL HERNIA

NORMAL SLIDING

Diaphragm

Esophagus

Stomach

ROLLING

www.mafraqhospital.ae 76 JULY 2014

Ovarian CancerAlthough ovarian cancer is relatively uncommon, it is a particularly serious disease that is difficult to detect at early stages

Dr. Karim Elmasry, Chair of Obstetrics and Gynaecology, answers some of your questions about ovarian cancer

Ovaries are small, almond-sized organs in your pelvis that contain eggs and produce the female hormones, oestrogen and progesterone. Women have two ovaries, one on each side of the uterus. The uterus is also known as the womb and when an ovary releases an egg and it gets fertilised, the fertilised egg develops into a baby within the uterus. Ovaries are essentially small packages of eggs. An egg is released each month, which if fertilisation does not take place, is expelled by menstruation. When women go through menopause and they stop menstruating, the ovaries stop releasing eggs and make less hormones.

Ovarian cancer occurs when cells inside the ovaries become cancerous. Although generally uncommon, this type of cancer causes more deaths than most other cancers that develop in female reproductive organs. The problem is that most women have either no symptoms or very mild symptoms until the cancer advances. Advanced stage ovarian cancer is more difficult to treat. Ovarian cancer normally occurs in older women and fortunately, the rate of ovarian cancer has been slowly falling over the past several decades.

Women’s HealthAsk the Expert

Dr. Karim Elmasry Chair of Obstetrics and Gynaecology

Whether or not you’ve been diagnosed with cancer, healthy lifestyle plays an important part in both recovery and prevention of various illnesses. It is well-known that lifestyle choices that you make affect the chance of developing cancer. Some simple changes can make a big difference.

Using any type of tobacco significantly increases the chance of developing several different types of cancer. Even if you don’t smoke yourself, second-hand smoke may also increase the risk of cancer. Eating a healthy diet is also important. Try to eat plenty of fruits and vegetables, and limit sugar and fat. Obesity is associated with cancer, and therefore it is beneficial to maintain a healthy body weight. Physical activity is also linked with a lower risk of cancer. Try to spend at least two hours every week exercising at a moderate or high intensity and spend 30 minutes or more being active every day.

Other important ways of lowering the chance of getting cancer include protecting yourself from the sun and getting immunised against viruses, especially hepatitis B and human papillomavirus (HPV).Ingeneral,seeyourdoctorregularlyand ask them what you should be screened for. This way cancer can be detected early, when treatment is most effective.

See your doctor in the event that you experience any of the following symptoms:• Heavy feeling in the pelvic area• Pain in the lower abdomen• Vaginal bleeding not from menstruation• Weight gain or weight loss• Abnormal periods• Unexplained back pain that worsens• Gas, nausea or loss of appetite

Symptoms

Live WeLL

How common is ovarian cancer?Ovarian cancer is more common in Western countries, where it is the fifth most common type of cancer in women, after breast cancer, bowel cancer, lung cancer and cancer of the uterus.

What causes ovarian cancer?The risk of ovarian cancer is influenced by several factors. Older women who have never given birth and women who have a first or second degree relative with the disease have an increased risk. Certain genes can increase risk as well. Women who cannot get pregnant, have a disease called endometriosis and those who take oestrogen after menopause also have an increased risk of developing ovarian cancer.

What are the tests used to identify ovarian cancer?Early detection of ovarian cancer is uncommon due to unreliable screening tests and few symptoms. However, there are a few symptoms that are more frequent in diagnosed women. Ovarian cancer is rare in women under 40 years of age and women who have symptoms should see a doctor. It’s unlikely that symptoms are caused by a serious problem but it’s best to check.

If a doctor suspects ovarian cancer, there are a number of tests that can help decide whether symptoms are due to cancer or another cause. Blood tests and ultrasound are often performed. There isn’t a single test that can determine ovarian cancer and therefore doctors use multiple tests. If results suggest ovarian cancer, then the doctor will perform surgery, which is the only way to definitively diagnose ovarian cancer.

How is ovarian cancer treated?In general, people with cancer should be cared for by a team of specialists who work together. This multidisciplinary team usually consists of cancer surgeons, a medical oncologist and a radiation oncologist. Treatment is decided based on the stageofthecancer(howbigitisandhowfarithasspread),the general health status of the patient and whether fertility is an issue. Surgery and chemotherapy are usual treatments. The earlier ovarian cancer is treated, the better.

Can you prevent ovarian cancer?Oral contraceptives, also known as birth control pills, lower the risk of ovarian cancer. Women who use oral contraceptives for 10 years have half the risk of developing ovarian cancer as those who do not, and this protection lasts for 25 years. Women who undergo surgery to have their fallopian tubes closed or have a hysterectomy to remove the uterus have a decreased risk. Some women who have relatives with ovarian cancer, or who have inherited altered genes have their ovaries removed to prevent cancer.

Routine screening of women for ovarian cancer is not recommended because no research has shown improved survival for women that are screened. Cancer screening in general needs to be accurate and reliable. Tests must detect the disease and not give false positives in people who do not have cancer. As of yet, there is no evidence showing that screening tests of blood or ultrasound detect cancer any earlier in women with average risk.

www.mafraqhospital.ae 98 JULY 2014

Hygiene

Good Health is in Your HandsDr. Asim Malik, Consultant and Chief, Infectious Diseases, explains the importance of hygiene

Hygiene involves taking care of yourself in terms of maintaining a state of cleanliness to avoid germ growth. Germs are so small that you can’t see them without a microscope. They are organisms that spread or cause disease and inhabit skin and moist parts of your body, such as inside your nose. Germs easily spread when people contact a person who has poor hygiene. By maintaining good hygiene, we prevent colonisation of body surfaces with germs and therefore we are able to break the cycle of spreading sickness.

Clean Hands Save Lives

Your guide to healthy fasting during the holy month of Ramadan, by Ahlam Al Hajeri, Senior Clinical Dietitian

Eight hours after eating, the gut finishes absorbing nutrients from food and the body enters a fasting state. Stored sugar is used for energy and when the stored sugar has been used up, the body starts to use fat as fuel. After fasting for an extended period of many days to weeks, the body begins using protein for energy, which is unhealthy and is called starvation.

Considering that people only fast during daylight hours during Ramadan, there is plenty of time to get the required nourishment before dawn and after dusk, and the body

doesn’t have to break down muscle to use protein for energy. A well-balanced diet is important for healthy fasting during Ramadan. Do not skip breakfast because it’s the meal that will sustain you throughout the day. In addition, Ramadan is a great time to quit smoking.

If you are unwell during Ramadan you are exempted from fasting because taking medication is seen as breaking the fast. Talk to your doctor before Ramadan, as it is very important to keep taking your medication. Fasting is not recommended for pregnant women.

To Eat or Not to EatPut in extra effort to ensure that you eat a well-balanced diet during Ramadan

• Breads, cereals and grains• Fruit and vegetables• Meat, fish and poultry• Milk, cheese and yogurt• Limited fats and sugars

Complex carbohydrates are foods that your body will slowly use for energy, including wheat, oats, barley, millets, semolina, beans, lentils, wholemeal flour and basmati rice. Fibre-rich foods are also digested slowly. These include bran, cereals, whole wheat, grains and seeds, potatoes with skin, vegetables and fruit. Avoid processed and quickly-used foods that have sugar such as white flour, fatty foods, cakes, biscuits, chocolates and sweets. When cooking, try shallow frying, boiling, grilling or baking, and avoid deep frying and cooking with too much oil.

Washing your hands frequently is one of the best ways to prevent sickness. Germs accumulate on your hands as you touch people and objects throughout the day. You can then infect yourself by touching your eyes, nose or mouth. It’s impossible to keep your hands germ-free, and therefore washing your hands is very important. Ensure that your children do as well.

ExerciseFasting reduces the energy in your body and therefore intense exercise should be avoided. However, physical activity is still important and moderate daily exercise is recommended. If you are used to intense exercise, then go to the gym after Iftar. An evening walk for 30 minutes after Iftar can help.

Quick Tips• Eat nutritious foods at Suhur and Iftar• Avoid fat, salt and sugar• Eat plenty of fruit, vegetables, beans, lentils, rice and grains• Drink plenty of liquid, especially water• Avoid coffee, tea and soft drinks• Break your fast with a healthy snack, such as dates• Spicy foods can cause indigestion or heartburn• Continue to floss and brush your teeth several times per day• Talk to your doctor about fasting if you are on medication• Avoid excessive exercise while fasting• If you want to go to the gym, go after Iftar• quit smoking

Ramadan Kareem

Keeping your hands clean is the single most important factor that provides the most benefit in terms of limiting the spread of disease. Hand hygiene is critically important in hospitals. Alcohol based sanitisers are very useful and allow quick and effective elimination of germs in hospitals. Mafraq Hospital promotes hand hygiene among employees, guests and visitors through hand hygiene campaigns, mandatory training and by distributing flyers and electronic educational material. Everyone in our hospital adheres to the WHO’s “5 Moments of Hand Hygiene” by cleaning their hands before contacting a patient, before aseptic tasks, after body fluid exposure, and after contacting a patient or their surroundings.

Wash those hands!

When?•Before:cooking, eating, treating wounds and inserting or

removing contact lenses•After: preparing food, using the toilet, changing a diaper,

touching an animal, blowing your nose, coughing into your hands, treating wounds and handling garbage

Wet your hands with running water

Wash all surfaces of your hands

Apply soap and lather well

Rinse well and dry with something clean

Rub your hands vigorously for at least

20 seconds

1. 4.2. 5.3.

Dr. Asim Malik Consultant and Chief, Infectious Diseases

10 JULY 2014 www.mafraqhospital.ae 11

Wellbeing

Be Fit &

Fast Lentil SoupTotal time: 2 hours, 5 minutesPrep time: 20 minutesCook time: 1 hour, 45 minutes

2 onions, chopped2 cloves garlic, minced1 teaspoon grated fresh ginger6 cups water1 cup red lentils1 (15ounce)canchickpeas,drained1 (19ounce)canwhitekidneybeans1(14.5ounce)candicedtomatoes½ cup diced carrots½ cup chopped celery1 teaspoon garam masala1 ½ teaspoon ground cardamom½ teaspoon ground cayenne pepper½ teaspoon ground cumin1 tablespoon olive oil

•Sauté onions, garlic, ginger and olive oil in a large pot for 5 minutes

• Add water, lentils, chick peas, white kidney beans, diced tomatoes, carrots, celery, garam masala, cardamom, cayenne pepper and cumin; bring to boil for a few minutes and then simmer for 1 to 1 ½ hours or longer, until the lentils are soft

• Puree half the soup in a food processor/blender and return the pureed soup to the pot; stir and serve

Some simple meal ideas that avoid excess fat and sugar; remember to drink plenty of water, at least eight glasses in the evenings!

Healthy LivingEat well and live well – tasty Ramadan recipes that are good for you and the whole family

MashkoulTotal time: 47 minutesPrep time: 7 minutesCook time: 40 minutes

2 cups white basmati riceCold water½ tablespoon salt1 large onion, finely chopped¼ cupghee(orbutter)

Preheat oven to 350 °F. Wash rice with cold water until the water runs clear. Drain. Bring 6 cups of water to a boil in a large pot. Add rice and salt and

roasted Chicken al KabsaTotal time: 57 minutesPrep time: 7 minutesCook time: 50 minutes

1 whole baby chicken, cut into 43 tablespoons olive oil teaspoon turmeric½ teaspoon baharat spice mix1.2 teaspoon kabsa spice mix Pinch of salt3 Coriander sprigs

Preheat oven to 350 °F. De-skin the chicken. Season the chicken with spices and olive oil. Place the seasoned chicken in a roasting pan and into the oven for 40-50 minutes. Garnish with cilantro and serve with mashkoul(ricewithonions)andsteamed vegetables of your choice (broccoli,carrotsorcauliflower)orsalad(salata).

return to the boil, stirring occasionally to keep the grains separate. Boil for 8 minutes and strain in a large sieve. Heat ghee or butter in a heavy pan and add onion. Fry gently until transparent, increase heat and fry until crisp and light-coloured. Mix half of the onion with the rice in a baking pan using a fork. Sprinkle the rest of the onion on top of the rice, cover with aluminium foil and bake for 15 minutes. Fluff the rice and serve on a platter.

Fasting for 30 consecutive days without physical activity is associated with a loss of strength and fitness, especially for people who exercise regularly. Exercise should be continued throughout Ramadan, but with special considerations. If you suffer from a disease such as diabetes you should continue your exercise routine but at a moderate or low intensity for no more than 30 minutes. Intense exercise while fasting is not recommended. Moderate exercise can be done 30-90 minutes before Iftar, but be aware of how you feel and stop immediately if you feel dizzy or nauseous.

•Planwhentosleepandwakeup•Considertakingnapsbecauseyour

body can be fatigued when fasting•Exerciseaftereveningprayer•Avoidhighintensityphysicalactivity•Eat6-10gramsofcarbohydrates

per kg of body weight•Eat1.2gramsofproteinperkgof

body weight•20-30%ofyourtotalenergyintake

should come from healthy fats•Drinkalotofwater,atleasteight

glasses between Iftar and Suhur

www.mafraqhospital.ae 1312 JULY 2014

Liver LIFE

Hepatitis is swelling in the liver caused by injury. This swelling is called inflammation and results from a viral infection or exposure to toxic substances such as alcohol. Some types of hepatitis are short-lived and do not permanently damage the liver. Other types can last a long time and end up scarring the liver. Liver scarring is called cirrhosis. There are five types of viruses that cause hepatitis: A, B, C, D and E. D and E are rare.

Hepatitis aThe most common type of viral hepatitis, the hepatitis A virus usually infects people by contaminating water. It is passed from the faeces of someone who has hepatitis A. Infection lasts three months and treatment relieves symptoms.

Hepatitis BThe hepatitis B virus can be found in blood and some body fluids. It is transmitted when people contact body fluids. Most adults who get infected can get rid of it, though some people develop long-term hepatitis B.

Hepatitis CThe hepatitis C virus is found in blood, and is therefore transmitted through blood-to-blood contact. Infection rarely causes symptoms and typically is long-lived. Most people with this infection develop chronic liver disease.

Dr. Ahmad Al-Rifai, Consultant Gastroenterologist and Hepatologist, describes liver disease, focusing on viral hepatitis

Hepatitis causes cirrhosis, which is associated with a type of cancer called hepatocellular carcinoma (HCC). People with hepatitis B have a high risk of HCC, even without cirrhosis. HCC is the fourth most common cancer in the world, occurring in 30% of people with hepatitis C. Over two billion people are infected with a hepatitis virus worldwide, leading to one million deaths every year.

Hepatitis A and B rarely require treatment, but those with long-lasting hepatitis need treatment to help prevent cirrhosis and HCC. New treatments for both hepatitis B and C have a very high success rate and most often cure the infection.

Although no vaccine exists for hepatitis C, hepatitis A and B can be prevented by vaccination. Vaccination for hepatitis B requires three injections over a six-month period. The hepatitis A vaccine is recommended for children in high risk areas of the world and when children travel to high risk countries.

Good hygiene and common sense can help prevent hepatitis. Practice good hygiene by following the advice in Dr. Asim Malik’s article that appears on page 10 of this issue. Don’t drink tap water when visiting certain countries and don’t share personal items such as toothbrushes, razors and nail clippers with someone who is infected.

MAFRAq HOSPITAL SERVICES

Our hospital offers comprehensive services for patients afflicted with viral hepatitis. The Liver Clinic provides the latest advancements in medical therapies. Routine screening is offered for people at high risk of liver cancer and to those with cirrhosis. Patients are followed up regularly whether they are being actively treated or not to ensure that their hepatitis is controlled and complications are dealt with as early as possible.

Dr. Ahmad Al-Rifai Consultant Gastroenterologist and Hepatologist

14 JULY 2014