Liow: St John’s does not have enough docs

Hemananthani Sivanandam, posted

 on 19 June 2012 - 05:29am

newsdesk@thesundaily.com 

http://www.newspapersites.net/Newspaper/sun2surf.asp

KUALA LUMPUR (June 18, 2012): The government has brushed off claims that it has imposed unreasonable requirements with the enforcement of the Private Healthcare Facilities and Services Act 2008.

Health Minister Datuk Seri Liow Tiong Lai said it was the St John Ambulance Malaysia (SJAM) which has not fulfilled the need for having ample doctors and visiting nephrologists.

“We have been asking them for years, to make up the ratio but they have not complied,” Liow said.

He stressed that the ministry stresses on the quality of service, adding that safety of patients is the ministry’s utmost priority.

The Selangor government organ, Selangor Times, recently reported that SJAM has threatened to surrender all their dialysis centres to the government after unreasonable requirements were imposed with enforcement of the act.

The requirements include compelling private haemodialysis centres to have at least 4.5 sq metre of space for each patient.

In addition, a dialysis centre’s water treatment room, reprocessing room and storeroom are required to be located separately from the dialysis room.

SJAM commander-in-chief Datuk Dr Low Bin Tick was quoted as saying it was unreasonable for the government to impose such requirements as its centres have limited space compared to private hospitals.

SJAM has 14 dialysis centres nationwide with some 500 patients.

Apart from the requirements, it was reported that SJAM has yet to receive the ministry’s approval to begin operations of their three new dialysis centres despite waiting for nearly a year.

The ministry reportedly has refused to issue an operating licence to SJAM’s fully furnished dialysis centres due to their failure to comply with the space requirements.

To this, Liow said that it was “not a problem”.

“They can (operate the centres) as long as they apply and fulfil the requirements, especially on the (number of) nurses because we need a (certain) number of nurses over the patients.

“(Also) every centre must have one doctor responsible for the patient. The (SJAM) centres don’t have visiting nephrologists,” said Liow.

Treating Hypertension With Renal Nerve Ablation


Renal denervation therapy shows promise in treating persistent hypertension

By: 

 Dave Fornell
Diagnostic and Interventional Cardiology


Submitted by Mr Soong CS

For patients with severe hypertension that remains uncontrolled despite medical therapy, radiofrequency (RF) energy can be used in the renal vessels to block nerves involved with the sympathetic nervous system. Researchers believe this has the potential to impact the mechanical and hormonal activities of the kidneys and may eliminate the need for medical therapy.

 Symplicity Catheter System, manufactured by Ardian Inc., delivers RF energy from within the renal artery to block conduction in the surrounding renal nerves. This counteracts chronic activation of the sympathetic nervous system. In addition to blood pressure reduction, this treatment shows promising results for chronic kidney disease, heart failure and metabolic syndrome. The treatment is performed in the cath lab using routine interventional techniques similar to those used in renal stent procedures. The 40-minute treatment is minimally invasive and does not involve a permanent implant.

The Symplicity Catheter System already has CE mark approval in Europe and is in trials in the United States.

Device Effectiveness

An initial study of the device in Australia, the Symplicity I trial, showed promising results. “We saw a drop of 27 mm of mercury and the one-year followup showed the effect on blood pressure was durable,” said Krishna Rocha-Singh, M.D., director of Prairie Vascular Institute, Springfield, Ill. He was involved with Symplicity I and in the planning for the U.S. pivotal trial. He has already used the device in numerous patients. “This treatment may help people who have the worst of the worst disease — who have hypertension that medications just can’t control and who are most likely to suffer from stroke and heart disease.”

Symplicity I showed 89 percent of patients saw their blood pressure drop dramatically. At 12 months, the average decline in systolic blood pressure was 27 points and the decrease in diastolic pressure was 13 points. There was no evidence the procedure harmed vessels or kidney function.

During the European Society of Hypertension meeting this summer, Dr. Markus Schlaich, Neurovascular Hypertension and Kidney Disease Laboratory, Alfred and Baker Hypertension Network, Melbourne, Australia, explained the two-year results of the therapy on the initial cohort of 153 patients. He said there were significant reductions in blood pressure in patients with multidrug-resistant hypertension and the effect has been sustained through at least 24 months. Data also show no significant decline in renal function.

Schlaich added there were no RF treatment-related vascular complications.

Read full text here

This procedure is available at Putra Specialist Hospital Melaka, anyone interested?

Survival analysis and causes of mortality in patients with lupus nephritis

1. Desmond Y.H. Yap, 
 
2. Colin S.O. Tang, 
 
3. Maggie K.M. Ma, 
 
4. Man Fai Lam and 
 
5. Tak Mao Chan

1. Division of Nephrology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China

1. http://ndt.oxfordjournals.org/content/early/2012/05/24/ndt.gfs073.short?rss=1

Abstract

Background. This study aimed to define the causes and associated risks of death compared with the local general population in Chinese patients with lupus nephritis in the recent era.

Methods. The records of all lupus nephritis patients followed in a single centre during 1968–2008 were reviewed. The causes of death were identified, the survival curves constructed and the standardized mortality ratios (SMRs) of potential risk factors were calculated with reference to the local general population.

Results. Two hundred and thirty systemic lupus erythematosus patients with history of renal involvement (predominantly Class III/IV lupus nephritis with or without membranous features) were included. The follow-up was 4076.6 person-years (mean 17.7 ± 8.9 years). Twenty-four patients (10.4%) died, and 85% of the deaths occurred after 10 years of follow-up. The 5-, 10-, and 20-year survival rates were 98.6, 98.2 and 90.5%, respectively. The leading causes of death were infection (50.0%), cardiovascular disease (20.8%) and malignancy (12.5%). The renal survival rates at 5, 10 and 20 years were 99.5, 98.0 and 89.7%, respectively. The SMR in patients with renal involvement, end-stage renal disease (ESRD), malignancy or cardiovascular disease was 5.9, 26.1, 12.9 and 13.6, respectively.

Conclusions. Lupus nephritis is associated with a 6-fold increase in mortality compared with the general population. Lupus patients who develop ESRD have a 26-fold excess in the risk of death, which is more than twice the risk associated with malignancy or cardiovascular disease in these patients

Dialysis Access Dysfunction

Alexander Yevzlin,¹ Arif Asif,² and Anil K. Agarwal³

¹Interventional Nephrology and Vascular Access Program, University of Wisconsin, 5148 MFCB 1685 Highland Avenue Madison, WI 53705, USA
²University of Miami, Coral Gables, FL 33146, USA
³Ohio State University, Columbus, OH 43210, USA

International Journal of Nephrology
Volume 2012 (2012), Article ID 612025, 2 pages
doi:10.1155/2012/612025

Vascular access failure (VAF) is the most common reason for hospitalization among hemodialysis (HD) patients. The economic burden of VAF is estimated to be greater than 1 billion dollars per year and continues to grow. The purpose of this special issue is to focus on recent advances in our understanding of dialysis access dysfunction.

Thanks in part to several national initiatives, the rate of arteriovenous fistula (AVF) placement continues to rise in the United States. AVF failure remains a major concern. Although the detection of early stenosis with preemptive correction prior to thrombosis seems to be a plausible option to prevent access failure, there is much debate, on the basis of of surveillance studies, as to whether early surveillance actually improves the longevity of an access system.

Evaluating the available information for surveillance, specifically the data for AVF stenosis and survival, is necessary to determine if surveillance is of any benefit. In an attempt to clarify ambiguities, one of the articles in this issue attempts to review the question: Does regular surveillance improve the long-term survival of arteriovenous fistulas?

Similarly, L. Kumbar et al., have contributed to this special issue with an evaluation of access surveillance outcomes. They state that although different techniques and methods are available for identifying access dysfunction, the scientific evidence for the optimal methodology is lacking. A small number of randomized controlled trials have evaluated the role of different surveillance techniques. The authors conclude that the limited randomized studies especially involving fistulae and small sample size of the published studies with conflicting results highlight the need for a larger multicentered randomized study with hard clinical end points to evaluate the optimal surveillance strategy for both fistulas and grafts.

Another important contribution is made by M. L. Zadeh et al. in this special issue. The authors observe that while native AVF is the recommended vascular access for HD, its failure to mature remains a major problem. The aim of their study was to determine the correlation between diameter and maturation of vessels in radiocephalic AVF. The authors performed a prospective cross-sectional study carried out during 2006-2007 on 96 hemodialysis patients from Hasheminejad Kidney Center. The maturation of fistula showed correlation with vein diameter, but no correlation was seen with the diameter of the arteries.

Inflammation is a problem for dialysis access as well as for ESRD patients’ cardiovascular health. The contribution of the dialysis vascular access type to inflammation, however, remains largely undefined. This special issue contains a paper describing a prospective observational study in an incident HD population. C-reactive protein (CRP), interleukin-6 (IL-6), and interferon-γ-induced protein (IP-10) were measured before and at 6-time points after access placement for 1 year. A mixed effects model was performed to adjust for age, sex, race, coronary artery disease, diabetes mellitus, infections, access thrombosis, initiation of HD, and days after access surgery. In comparison to AVFs, the presence of a tunneled catheter (TC) was associated with significantly higher levels of CRP. Patients who initiate HD with a TC or an AVG have a heightened state of inflammation, which may contribute to the excess 90-day mortality after HD initiation.