Category: English

Type 2 Diabetes is a metabolic disorder that occurs when the body has trouble using insulin, which helps cells take in glucose from the blood.  

Insulin is produced by beta cells in the pancreas. The inability to use insulin effectively leads to high blood sugar and other problems with metabolism, including: 

• Weight gain and obesity 
• Damage to organs, including the kidneys, eyes, heart, and nerves 
• Increased risk for heart disease and stroke 

What Causes Type 2 Diabetes? 

Type 2 Diabetes is caused by a combination of lifestyle choices and genetics. Some people are more susceptible to this disease than others because they have a family history of diabetes or obesity. Those who are overweight or obese are much more likely to develop Type 2 Diabetes than those who maintain an appropriate weight. 

Physically inactive individuals are also at higher risk for developing Type 2 Diabetes. Inactivity is one of the most significant contributors because it leads to poor circulation, reduces insulin sensitivity, and increases insulin resistance. 

Other lifestyle choices that can increase your chances of developing Type 2 Diabetes include eating high-fat foods and drinking too much alcohol. 

What are the Symptoms? 

The symptoms of Type 2 Diabetes can include: 

• Increased urination, which may result in increased thirst 
• Increased hunger, which may lead to weight loss and muscle wasting 
• Fatigue and weakness 
• Blurred vision 

What are the Risk Factors? 

There are several risk factors for developing type 2 Diabetes:  

Age. You’re more likely to develop type 2 Diabetes as you get older. This is because your body becomes less sensitive to insulin as you age, and it’s more difficult for the pancreas to produce enough insulin to keep up with your body’s needs.  

Family History. If your parents had type 2 Diabetes and were overweight at any point in their lives, you’re at increased risk for developing diabetes.  

Obesity or Being Overweight. A person’s weight may also directly affect the pancreas’ ability to produce insulin and insulin sensitivity. As blood sugar levels rise after eating, the pancreas pumps more insulin to back them down again. But if you have too much fat around your middle, it can be more difficult for the pancreas to produce enough insulin and maintain blood sugar levels. 

Gestational Diabetes. People who have had gestational diabetes (diabetes during pregnancy) or who delivered a baby weighing more than 9 pounds, those with high blood pressure or high cholesterol, physically inactive people 

How is Type 2 Diabetes Different from Type 1 Diabetes? 

It is a disease affecting many different body organs, including the brain and eyes. It is characterized by high blood glucose (sugar) levels caused by insulin resistance and a lack of insulin production. Type 1 Diabetes, on the other hand, is an autoimmune disease where the body’s immune system attacks and destroys its beta cells (which produce insulin). 

Can Type 2 Diabetes Be Prevented or Reversed? 

It is one of the most common chronic diseases in the world, affecting over 500 million people worldwide. It’s characterized by high blood sugar levels that can’t be controlled with diet and exercise alone. 

The good news is that there are several ways to prevent or even reverse the disease. Here are some of the best ways to help keep your blood sugar under control: 

1. Start exercising. 

2. Lose weight if you’re overweight or obese. 

3. Eat healthfully and limit sugary foods and drinks in your diet. 

What are the Complications of Having Type 2 Diabetes? 

The complications of having this form of diabetes are wide-ranging and can be life-threatening. The most common complications include the following: 

• Heart disease 
• Stroke 
• Eye problems 

• Kidney disease 
• Frequent infections 

How is Type 2 Diabetes Treated? 

This form of diabetes is treated with medication and lifestyle changes. Medications are used to lower blood glucose levels.  

Lifestyle changes include eating a healthy diet and exercising regularly, which helps you lose weight and reduce the risk of other health problems. 

Diabetes medications work by lowering blood glucose levels. Metformin is the most common type of diabetes medication, which helps your body use insulin better.  

Metformin lowers blood glucose levels by helping your liver release more of its stored sugar into your bloodstream, which reduces the amount of glucose in your blood. 

Other diabetes medications include sulfonylureas (such as glipizide), meglitinides (such as nateglinide), alpha-glucosidase inhibitors (such as acarbose), thiazolidinediones (such as pioglitazone or rosiglitazone), or DPP-4 inhibitors (such as sitagliptin).  

These medications work by increasing insulin production, slowing down the breakdown of carbohydrates in the stomach, or improving insulin sensitivity in muscle cells so that more glucose can be used for energy instead of being stored as fat. 

It’s important to know that there are treatment options available. Medeor Hospital is a leading provider of diabetes treatment in Dubai and Abu Dhabi. Our experts have the most up-to-date knowledge about the latest treatments and technologies available for diabetes. We use our expertise to deliver comprehensive care that improves your quality of life while lowering your risk of complications. We aim to help you manage your condition to live a healthy life. 

High blood sugar, also called hyperglycemia, is a condition in which your blood glucose (sugar) levels are too high. 

High blood sugar is caused by an imbalance between the amount of glucose in your body and the amount of insulin to move into your cells. When this happens, the glucose builds up and stays in your bloodstream instead of being taken up by cells throughout your body.  

This causes even more glucose to be released from the liver into the bloodstream to prevent dangerously low glucose levels in the body — causing even higher blood sugar levels. 

High blood sugar can be a severe health issue. If left untreated, it can lead to diabetes and other severe conditions. Here are some signs that you may have high blood sugar: 

Drinking More Fluid than Normal 

If you notice that you’re drinking more fluid than usual, it could show high blood sugar. The kidneys can lose the ability to reabsorb excess glucose from the body, which causes excess glucose to enter the urine.  

This causes increased urination and thirst, as well as weight loss. Increased urination also means you’re not getting enough fluids, which can lead to dehydration. 

Increased Hunger  

One of the most common symptoms of high blood sugar is increased hunger. Because your body can’t properly use glucose, it burns fat instead.  

This causes a decrease in insulin levels, which then triggers an increase in appetite. This can lead to a rise in snacking, often on unhealthy foods high in sugar and fat. 

Blurred Vision  

Blurred vision is a symptom of high blood sugar that various factors can cause. 

When you have high blood sugar, the glucose in your bloodstream can damage the small blood vessels that supply your eyes with oxygen. This damage causes blurred vision. 

If you have high blood sugar and blurred vision, you must see a doctor as soon as possible. 

Feeling Tired or Fatigued 

Tiredness is one of the first signs of high blood sugar. If you have diabetes, your body does not produce enough insulin or cannot use the insulin it produces efficiently.  

This causes glucose to build up in your blood instead of entering your cells, where it would be used for energy. Too much glucose stays in your bloodstream, and not enough is available to fuel vital organs such as your brain and kidneys. 

When there’s too much glucose in the bloodstream, cells become starved for energy and stop working properly. Your brain needs a constant supply of glucose to stay alert, so when there’s too much glucose in your bloodstream, you’ll start to feel fatigued. 

Needing to Pee More Than Usual  

If you’ve felt you have to pee more than usual, you may have high blood sugar. 

When your body breaks down food, it creates glucose as fuel for your body. Your liver uses some of this glucose to make glycogen. The rest is used as energy for your muscles and brain. 

If you have diabetes, your body doesn’t process glucose normally.  

Instead of using insulin to move glucose into cells where it can be used as energy, your body makes too much glucose and stores it in the form of glycogen. Glycogen is then turned into fat and stored in the liver and muscles. 

This excess glucose can build up in the bloodstream and spill over into the urine, causing more frequent urination. 

Slow Wound Healing  

Wound healing is the process of repairing damaged tissue. It involves growing new tissue to replace damaged, dead, or dying cells. 

High blood sugar can delay wound healing because it interferes with the formation of new blood vessels needed for this process. 

Infections like Thrush 

Infections like thrush can occur in people with high blood glucose levels. This can be caused by an overgrowth of candida, a fungus that normally lives in the mouth and vagina.  

High blood glucose levels can also cause an increase in the number of bacteria and fungi in the body, which makes it easier for infections to develop. 

Dry Mouth and Itchy Skin  

A dry mouth and itchy skin are two symptoms of high blood sugar. When your blood sugar is too high, you may experience a dry mouth.  

Your body uses sugar as fuel, so when you have too much sugar in your system, your body tries to eliminate it by making you thirsty and urinate. The dry mouth is a result of this excessive urination. 

Another symptom is itchiness. High blood sugar can cause the body’s cells to swell, irritating the skin’s surface.  

This irritation may cause you to itch all over your body, especially in areas where you sweat heavily or have lots of hair follicles.  

Weight Loss  

If your blood sugar is high, you may experience weight loss. This is because it causes your body to produce more insulin than it needs.  

And since insulin helps your body turn the food you eat into energy, when you have too much insulin, it doesn’t have enough energy to burn up all its calories.  

So instead of being stored as fat, they are burned up as heat—which can lead to weight loss. 

If you’re experiencing unexplained weight loss, checking your blood glucose levels is essential. This can help identify if there’s an underlying health issue or not. 

Mood Changes or Feeling Anxious or Depressed  

High blood sugar levels can cause your mood to change. It may make you feel anxious or depressed. You might also have trouble concentrating and remembering things. It can affect your body in various ways. See these symptoms and speak with your doctor if you have concerns.  

Medeor Hospital in Dubai and Abu Dhabi offers the best treatment and cares for patients with high blood sugar to help them better manage their diabetes and take control of their health.  

Our team of doctors, nurses, dietitians, and other health professionals is dedicated to helping people live healthier by reducing the effects of high blood sugar through comprehensive and personalized care, education, and support. 

The flu season is here, So we’re here to ensure you get the vaccine. And we want to make sure you and your family are prepared!

That’s why we’d like to recommend a Flu Shot for Kids, a great way to help protect your children from getting sick this winter.

The flu shot for kids is available at Medeor Hospital, Abu Dhabi, UAE. 

Flu Vaccination Package for Kids

Our Flu Shot package includes:

• Flu Shot
• Doctor Consultation
• Surprise Goodies for Kids

About flu or Influenza Virus

The flu is a contagious respiratory illness that affects the nose, throat, and lungs. The flu can be spread by coughing and sneezing, touching contaminated surfaces and then touching your mouth or nose, or having close contact with someone who has the flu.

Symptoms of the Flu

The most common symptoms of the flu include:

• Fever (may spike as high as 104°F)
• Cough (usually dry in adults, but may produce mucus in children)
• Sore throat
• Runny or stuffy nose
• Headaches (often severe)
• Muscle aches, body aches, and pains
• Fatigue (extreme exhaustion)

People Who are at High Risk for Flu Complications

People who are at high risk for flu complications include:

• Children
• Adults 65 years of age or older
• Pregnant women
• People with certain chronic medical conditions (such as heart disease, lung disease, kidney problems, cancer, and liver disease) and people with weakened immune systems (because of medicines they take or illness)

Difference Between Flu & Cold

Protecting Children from Flu & Steps to Protect Them Event After the Flu Vaccine

You can take several steps to protect your children from getting the flu.

• The first step is to make sure they get their annual flu shot. Every child aged six months or older should receive one. 
• Another critical step is to keep your child away from other children with colds or infections that can spread the flu. 
• If your child has symptoms of a cold or another infection, keep him at home until he is well again. 
• Teach them to wash their hands often with soap and water for at least 20 seconds. If they don’t have soap and water, they can use an alcohol-based hand sanitizer that contains at least 60% alcohol.
• Ask them to avoid touching the eyes, nose, or mouth. Germs spread this way.
• Teach them to cover while coughing and sneezing with a tissue or arm (not their hands). 

About Pediatric Flu Vaccine

Children should get the seasonal flu vaccine every year. It takes about two weeks after getting vaccinated for your child’s body to develop protection against the viruses that cause the flu. It’s important for all children six months and older to get a yearly flu shot so they can be protected throughout the season.

Getting a flu shot every year also helps protect your child from other illnesses caused by influenza viruses. Flu shots are safe, effective, and not harmful or painful when injected into your body.

Don’t Get Caught Off Guard. Get Your Child a Flu Vaccine Today

Flu season is here and that means the risk of spreading the flu is very real. When it comes to protecting your children against the flu, there’s no better way than a flu vaccine. The Pediatric Flu Vaccine is available at Medeor Hospital, Abu Dhabi, UAE.

What is a Stroke?

A stroke is a sudden, severe disruption of blood flow to part of the brain. Strokes can cause brain damage, ranging from mild to severe, depending on where they occur and how long they last.

What are the Types of Stroke?

There are two main types of stroke: ischemic and hemorrhagic.

Ischemic Strokes occur when a blood clot (thrombus) blocks the blood flow to the brain. Ischemic strokes can be further divided into two types: thrombotic and embolic.

• A thrombotic stroke occurs when a clot forms on top of another clot inside an artery in your brain.
• An embolic stroke occurs when a clot travels through your bloodstream from somewhere else or outside your body (such as from a piece of plaque).

Hemorrhagic Strokes occur when a weakened blood vessel ruptures and bleeds into the brain. Hemorrhagic strokes can also be divided into two types:

• Intracerebral Hemorrhage (ICH) occurs when a weakened blood vessel ruptures and bleeds into the brain tissue.
• Subarachnoid Hemorrhage (SAH) occurs when a weakened blood vessel ruptures and bleeds into the space between your brain and skull.

What are the Symptoms of Stroke?

Stroke symptoms vary among individuals and can also change throughout a stroke.

• Some of the most common symptoms include:
• Sudden numbness or weakness on one side of the body
• Pain in the shoulder, arm, or leg on one side of your body
• Dizziness and loss of balance
• Trouble speaking or understanding speech
• Vision changes such as blurring or double vision

What Causes Stroke?

A stroke occurs when blood flow to your brain is blocked by a clot or a blood vessel in your brain bursts. This causes brain cells to die, resulting in paralysis, speech problems, and thinking difficulties. Several factors can cause a stroke, including:

• Aneurysms: An aneurysm is a bulge in the wall of a blood vessel; when this bulge bursts, it can cause a stroke
• Arterial blockages: sometimes cholesterol can build up inside arteries and form plaques, which can block blood flow to parts of the body, including the brain
• Carotid artery disease: this occurs when plaque builds up on the carotid artery (the main artery in your neck), causing narrowing or blockage of blood flow
• High blood pressure: high blood pressure can cause arteries to enlarge and become weak; these weakened arteries are more likely to form clots that can cause stroke
• Brain tumors: these growths also increase your risk of having a stroke

What are the Five Stages of a Stroke?

The five stages of a stroke are:

• Flaccidity is where the muscle is not working correctly and cannot be moved.
• Spasticity appears when the affected muscle spasms and contracts, leading to severe pain.
• Increased Spasticity, where the spasms increase in frequency and intensity.
• Decreased Spasticity, where the spasms begin to decrease in frequency and intensity.
• Spasticity Disappears, and Coordination Reappears, where coordination returns and movements become more fluid again.

How are Stroke Diagnosed?

The most common way to diagnose stroke is through a CT scan, showing blocked blood vessels and bleeding. If an artery blockage causes the stroke, the CT scan can also show if there’s any bleeding in the brain. A second test that may be used to diagnose a stroke is an MRI, which uses magnetic waves instead of radiation as a CT scan does. The MRI can show bleeding in the brain or spinal cord.

What are the Risk Factors?

The risk factors of stroke are:

• Age: Risk increases with age. About 80% of all strokes occur in people over the age of 65. Stroke can occur in younger people, but it is less likely.
• Diabetes: People with diabetes are more likely to have a stroke than those without diabetes.
• Cardiovascular disease: People with cardiovascular diseases such as high blood pressure or high cholesterol are more likely to stroke than those without heart disease.
• Family history: If someone in the family has had a stroke, the risk of having one is higher than average.
• Smoking: Smokers are twice as likely to have a stroke as non-smokers. It also increases the chances of having a heart attack or heart disease by three times. Cigarette smoke can increase inflammation throughout the body, developing these conditions over time.

What Does the Treatment Involve?

A five-year study by the National Institute of Neurological Disorders and Stroke (NINDS) found that some stroke patients who received t-PA within four and half hours of the start of the symptoms were at least 30 percent more likely to recover with little or no disability after three months.

The treatment depends on which part of the brain has been damaged and how severe the damage is. Here are some common treatments:

• medications to help reduce swelling in the brain
• medicines to lower cholesterol levels and blood pressure
• medicines to thin the blood (also called blood thinner)
• surgery to remove part of the clot or repair an artery that is causing bleeding

What is the Role of Endovascular Intervention in Stroke?

The role of endovascular intervention in stroke is to treat it by opening up an artery that a blood clot has blocked. There are two types of endovascular interventions: thrombectomy and stent retrieval.

Thrombectomy is a procedure that removes the clot and restores blood flow through the affected artery. In this procedure, the clot is removed using a thin tube called a catheter inserted into the neck or groin area. A device called an aspiration catheter is then inserted through the catheter and used to suck out the clot. Once all of the clots have been removed, a stent (a small metal coil) may be inserted into the vessel to keep it open as it heals.

Stent Retrieval is similar to thrombectomy, except that instead of removing any clots, your doctor will remove all or part of a stent that was placed during prior stenting procedures to unblock the blood flow to your brain.

Do All Patients Need Rehab?

Rehabilitation is restoring an individual’s ability to perform daily activities and regain independence. It includes physical, occupational, speech, and other therapies to help improve mobility and function. It is a major cause of disability, and rehabilitation is essential to prevent long-term complications such as loss of mobility and cognitive impairment.

How Long Does it Take to Rehab After a Stroke?

Stroke rehabilitation is a long process, and it’s essential to understand that everyone is different.

Most people spend between 1 and 2 weeks in the hospital after having a stroke. During this time, the patient will receive medical care and begin to learn about how it affected their body. The patient may also be given physical or occupational therapy to help them regain strength, coordination, and motor skills.

After leaving the hospital, the patient will probably go through stroke rehabilitation at home or in a specialized facility for up to 6 months. The length of time it takes for someone’s brain function to fully return depends on several factors:

• The location and severity of the damage caused by the stroke
• How quickly treatment begins after a person experiences symptoms (this can mean being able to reach out for help before they become severe enough that they require emergency care)
• Their age at the time they had their stroke (the older someone is when they experience their first attack, the more likely it is that they will have lasting effects from it)

What Rehabilitation is Needed After a Stroke?

Stroke rehabilitation involves physical, occupational, and speech therapy to help you recover as much function as possible. The goal is to get you back on your feet as soon as possible so you can resume your life as normal.

Physical therapy focuses on building strength and flexibility in muscles affected by the stroke.

Occupational therapy helps people relearn everyday tasks like dressing and eating with proper technique or safety measures to prevent further injury. Speech therapy helps patients regain their ability to communicate verbally using a variety of modalities, including sign language for those who are deaf or hard of hearing.

How Can it be Prevented?

Because stroke causes permanent damage to the brain, it’s essential to do everything you can to prevent strokes from happening. Here are some tips for preventing it:

• Maintain a healthy weight
• Eat healthy foods
• Drink alcohol in moderation or not at all
• Avoid smoking or chewing tobacco
• Get regular exercise
• Quitting any medication that could increase the risk

When it Comes to Spotting a Stroke, BE FAST.

When it comes to spotting a stroke, BE FAST.

B-Balance: Is the person steady when they walk? Do they have a wide-based gait? (They may be at risk for falling.)

E-Eye: Is one eye drooping? Is the person having trouble reading or seeing out of one eye?

F-Face: Does the face look asymmetrical? Are the corners of the mouth drooping on one side? Or is their mouth twisted on one side?

A-Arms: Can they raise both arms and keep them there without help? Can they make a fist with either hand? Can they clench their fingers tightly in front of them? If not, they may have weakness in their arms or hands.

S-Speech: Are they slurring their words or speaking too fast or too slow? Does their speech sound normal or different than usual?

T-Time: It is a severe medical condition that requires immediate attention. If you or your loved ones have any warning signs of stroke, call 998 immediately and get to the hospital as soon as possible.

Medeor Hospital is dedicated to providing comprehensive patient care, including treatment, rehabilitation, and follow-up care. We have a team of expert Neurologists and multi-disciplinary specialists who work together to provide world-class medical care for our patients. We aim to ensure that every step of your recovery is handled with the utmost care and attention.

What is Multiple Sclerosis?

Multiple sclerosis is a neurological disease that affects the brain and spinal cord. It causes problems with muscle control, balance, vision, and other functions. It affects more than 2.3 million people worldwide.

In MS, the body’s immune system attacks the protective sheath around nerve fibers in the brain and spinal cord. This sheath is called myelin. When MS damages myelin, it cannot properly insulate the nerve fibers in the brain and spinal cord, which can cause problems with nerve impulses—how the brain sends messages through the body.

What are the Symptoms of Multiple Sclerosis?

The symptoms of multiple sclerosis can vary from person to person. The most common symptoms include:

• Tingling or numbness in the limbs
• Loss of balance, coordination, and strength
• Changes in sensation
• Impaired memory
• Tremors and muscle spasms in one part of the body that may spread to other parts (known as “spreading tremors”)
• Muscle weakness or paralysis
• Bladder problems, including urinary incontinence (inability to control urination) and bladder infections
• Fecal incontinence (inability to control bowel movements)
• Trouble swallowing food or liquids
• Vision problems, including double vision (diplopia) or blurred vision
• Sensitivity to heat, which makes symptoms worse

What are the Types of Multiple Sclerosis?

There are three main types of multiple sclerosis: relapsing-remitting, secondary progressive, and primary progressive.

• Relapsing-remitting MS is the most common form of the disease, and it’s characterized by periods of relapse (unpredictable attacks that can cause symptoms to worsen) followed by remission (when symptoms fade). This type is generally easier to manage than other types.
• Secondary progressive MS is less common than relapsing-remitting MS, but it’s more difficult to manage. With this form of MS, there are no remission periods; symptoms gradually worsen over time.
• Primary progressive MS is also less common than relapsing-remitting MS; however, it’s less manageable than secondary progressive MS because symptoms don’t get better or worse over time—they get worse as time goes on without any respite whatsoever.

What are the Tests Used to Diagnose MS?

Three main kinds of tests can be used to diagnose multiple sclerosis (MS):

• Magnetic Resonance Imaging (MRI) uses magnetic fields and radio waves to make detailed pictures of the brain and spinal cord. It is often used with a special dye called gadolinium, which helps doctors see areas of inflammation in the brain or spinal cord that aren’t visible on an MRI alone.
• Evoked Potentials (EP) measure how well the brain responds to electrical signals sent from the eyes, ears, muscles, and nerves by using electrodes placed on the scalp. At the same time, they are shown a series of flashing lights or sounds.
• Electromyogram (EMG) measures the electrical activity in certain muscles at rest or being moved by the brain or spinal cord nerves.
• CSF Analysis – Cerebrospinal fluid (CSF) is the clear fluid that surrounds and protects the brain and spinal cord. A lumbar puncture (also called a spinal tap) is a procedure in which a small amount of CSF is removed from around the spinal cord using a needle. Analysis of CSF can help determine if there’s inflammation in the central nervous system (CNS).
• Blood Tests – These tests check for antibodies associated with MS or other conditions that may cause similar symptoms.

What are the Treatments Available for Multiple Sclerosis?

Multiple sclerosis is a chronic and often disabling disease that involves the immune system and affects the central nervous system. There is no known cure for multiple sclerosis. However, treatments are available to help manage symptoms and slow down the progression of the disease. The primary goal of treatment is to reduce the frequency and severity of flare-ups (also known as “exacerbations”). Treatments may include:

• Disease-modifying drugs (also known as immunomodulatory drugs) can help reduce inflammation throughout the body. Still, they are not a cure for multiple sclerosis. They can be used alone or in combination with other therapies to manage symptoms and slow down the progression of the disease.
• Steroid medications are sometimes used to treat acute flare-ups or symptoms that are not controlled by other medications. These medications should only be taken under doctor supervision because they can cause serious side effects if not used correctly.
• Immune system suppressors may be prescribed if they have severe nerve damage from multiple sclerosis or have certain types of cancer associated with MS (such as lymphoma). These medications help control symptoms while reducing immune system activity.
• Physical therapy and rehabilitation play a crucial role in the management of MS.

Multiple Sclerosis and Pregnancy

Women with MS often experience flare-ups during pregnancy—sometimes even before they know they’re pregnant—though many women with MS can carry healthy pregnancies to term. Studies suggest that having MS does not increase the risk of pregnancy complications or miscarriage; however, it can cause the woman to experience short-term problems while pregnant. Before becoming pregnant, talk with a multiple sclerosis specialist about how best to manage the symptoms.

How to Reduce Flare-ups (Relapses)

In addition to disease-modifying therapies, which effectively reduce relapses, a healthy lifestyle is crucial. Eating a healthy balanced diet, quitting smoking, drinking plenty of water, and getting daily exercise to stay fit and active.

Patients with MS are advised to stay positive. Although not curative, available disease-modifying therapies can alter the negative impact of the disease. Most people with MS continue to have productive, active lives. Research is going on, and almost every year, a new MS drug is approved, giving hope to MS patients and their families. The expert Consultant Neurologist at Medeor Hospital, Dubai, have vast experience providing comprehensive care for MS patients.