Chronic Kidney Failures & Treatments

THE signs aren’t obvious in the beginning. And that is why some call it a silent disease.

But it isn’t a time to keep quiet about chronic kidney disease (CKD), which strikes nine out of every 100 Malaysians.

The overall number of patients – from stage one to five – is currently between two and three million, but the numbers are expected to rise. Most patients in stage five, known as end stage renal disease or kidney failure, depend on dialysis to carry on with life.

But while there are 40,000 dialysis patients now, the number is projected to more than double to a whopping 106,249 in 2040 if no effective remedies are in place, based on a recent study.

The large number of dialysis patients has made Malaysia the top seventh country with the highest dialysis treatment rate in the world, based on the study titled “Forecasting the Incidence and Prevalence of Patients with End-Stage Renal Disease in Malaysia up to the Year 2040”.

However, many kidney patients in Malaysia are still hoping for the alternative solution – a kidney transplant.

In fact, most of the 20,000 people on the organ transplant waiting list are in need of kidneys.

The problem is that while organ pledges remain low, the number of medical professionals, including surgeons and supporting staff, that can conduct transplants are less than ideal.

Calling it the ideal solution for kidney patients, he says transplants are also cheaper in the long run compared to dialysis.

“The main challenge when it comes to transplants is the need to increase the number of specialists, including transplant surgeons, pathologists and other supporting medical professionals.

Malaysia is looking into roping in foreign and local experts to train more specialists in this area so that more transplants can be conducted and in a safe way too.

Dr Jeyaindran points out that while only 1% of the Malaysian population had pledged their organs after death, it was still the “greatest gift” a person can offer.

“As such, we need to strengthen the mechanism to support such a gift of life to another in need,” he adds.

One plan is to double the number of “organ retrieval” teams, or teams of medical staff in charge of retrieving organs from those who have pledged their organs upon death.Currently, Malaysia has only two dedicated teams – one from Hospital Kuala Lumpur (HKL) and another from Selayang Hospital.

Dr Jeyaindran explains that increasing the number of teams would help make the process of transplantation more efficient. He says the limited number of staff available to retrieve organs presents a challenge, especially when the deceased donor is located far away.

“We want to double the number of such teams so that they can reach more locations quickly and cover wider areas like Sabah and Sarawak,” Dr Jeyaindran says.

Transplants can also be done involving living donors, who are often family members of the patient.
But for cases where the organ is from an unrelated deceased donor or cadaveric donor, there is also another hurdle – whether or not the organ is compatible with the patient.

On dialysis treatment, Dr Jeyaindran says the ministry is focusing more on peritoneal dialysis, just like in Canada. The treatment involves the lining of the body’s abdomen and a solution to clean the patient’s blood.

In his Budget 2014 speech, Prime Minister Datuk Seri Najib Tun Razak had also announced the Government’s initiative in promoting peritoneal dialysis by providing free Continuous Ambulatory Peritoneal Dialysis (CAPD) kits costing RM19,000 per unit.

The initiative benefited over 1,000 patients who can use the kit at home.

Pointing out that Malaysia has room for improvement when it comes to transplants, Malaysian Society of Transplantation president Datuk Dr Ghazali Ahmad says the number of procedures done these days is a far cry from the past.

“In the 1990s, about 50 transplants were done in HKL itself. But last year, there were only 27 transplants from both living related donors and cadaveric donors in Malaysian public hospitals,” he says.

And only two Malaysian public hospitals performed such procedures last year, namely HKL and Selayang Hospital.

Although private hospitals only perform transplants involving living related donors, he notes that the total number of overall transplants is low and has been declining between 2009 and 2014.

“In 2009, a total of 141 transplants were conducted involving Malaysian patients in private, public and overseas hospitals. But this number steadily dipped over the years and in 2014, only 81 transplants were recorded,” says Dr Ghazali, who is a senior consultant nephrologist.

The dip is due to the overall drop in organ pledges, proliferation of dialysis centres and dwindling numbers of doctors qualified to carry out transplant procedures.

Malaysia is in critical need of more organ transplant surgeons but even if there were, there is a lack of medical teams to retrieve the organs from deceased donors.At present, the country has fewer than 10 such surgeons, said the Malaysian Society of Transplan­tation.

Dr Ghazali points out that Malaysia has a long way to go when it comes to organ pledges, compared to countries like Spain and Belgium.

In 2015, Spain recorded 39.7 actual deceased organ donors per one million population, compared to Malaysia which has about 0.6 per one million population.

Concurring that cases of CKD are on the rise, Malaysian Society of Nephrology council member Dr Lily Mushahar attributes the spike to the increase in elderly population in Malaysia.

“With better healthcare in Malaysia, the population now has a longer life expectancy. This leads to an increase in non-communicable diseases (NCDs) such as hypertension and diabetes that relate to long-term complications like kidney disease,” she says.

As such, the rise in NCDs over the last two decades, especially diabetes and hypertension, has led to the corresponding hike in kidney failure. “Sixty per cent of end stage renal disease in Malaysia is caused by diabetes. Unhealthy lifestyle and diet among Malaysians also give rise to obesity and NCDs,” Dr Lily says.

Another factor is the lack of awareness among Malaysians, as many do not go for regular medical screening.

While Malaysia has enough nephrologists – about 120 for the country’s population of 30 million – Dr Lily finds it worrying that there are so few dedicated transplant surgeons.

“Most transplants are being done by general surgeons who are also involved in other daily duties.

“Malaysia needs a dedicated transplant team that comprises dedicated transplant surgeons, anaesthetists, nephrologists, nurses, psychiatrists and nutritionists that do not juggle their work with other non-transplant duties,” she says.

The National Kidney Foundation is also doing its part to help kidney patients by developing centres in underserved areas, especially in East Malaysia, to provide treatment for poor patients.

“We are also introducing another programme to help those with early kidney disease from progressing to advanced kidney failure.  We hope to kick off this pilot project this year,” says its chairman Datuk Dr Zaki Morad.
/theSTAR 09-04-2017

Disclaimer: Views or opinions expressed are solely those of the Author and should be used with discretion. The Author shall not be held liable for any acts or omissions arising from the use of the information. The user will be personally liable for any damages or other liability arising hereof.

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Body Language in Communication

When it comes to communication, body language counts a lot more than speaking the right words.

An American psychology, Professor Albert Mehrabian, stated that 7% is from the actual word, 38% tone of voice and 55% body language.

This means that no matter how hard one tries to convince others about his ideas, with his words, he may not be able to. However, if the individual leverages his words with his body language, it can help him to level up for success.

Thus the following should be considered for the effective use of body language:

1) Maintain Eye Contact 2) Have a genuine smile  3) A firm hand shake  4) Not fidgeting eg hair twirling, stroking your tie

5) Manage facial expression  6) Good posture eg standing confidently by looking up and straightening up

7) Use effective hand gestures to support ideas. It is to convey clear thoughts and descriptions to the other party.


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Dengue Vaccine given conditional approval

The Malaysia Health Ministry has given conditional registration for the world’s first dengue vaccine to be used in Malaysia. Pharmaceutical products are approved for five years period.

Health Director General Datuk Dr Noor Hisham Abdullah said that the Ministry approved the vaccine in October last year. "We have made a stand that it will not be in our National Immunisation Programme. In other words, the immunisation will not be given free in government health facilities."

The Drug Control Authority (DCA) said the vaccine was approved for a post-registration (phase IV) clinical study for two years involving volunteers aged 9 to 45, which, means that only those who participate in the study will be able to obtain the vaccine, which will be made available within the next six months.

The DCA also said that those who got the vaccination, which consists of three injections six months apart, would have to pay for the vaccination.

The study is to assess the vaccine’s effectiveness and safety.

It will be conducted jointly by the vaccine’s producer, French pharmaceutical company Sanofi Pasteur, and the Health Ministry.

In a statement, Sanofi Pasteur Malaysia said it welcomed the ministry’s decision to approve conditional registration of the vaccine.

“With this approval, Malaysians across the country will now have access to an additional form of protection against this debilitating, and sometimes, deadly disease,” it added. The vaccine gives an overall average of 66% protection against dengue infection, 93% against severe dengue and 80% against hospitalisation for dengue, for those aged between 9 and 16.

This is according to a 2015 paper in the New England Journal of Medicine, which combined and analysed the results from phase III clinical trials in five South-East Asian countries, including Malaysia, and five Latin American countries.

The DCA said although the vaccine offered protection regardless of previous exposure to dengue, major studies reported that it conferred significantly better protection to those vaccinated who were infected before (81.9%), compared with those without previous infection (52.5%).

The agency was also concerned that the vaccine was less effective in reducing dengue incidence caused by DEN1 (58.4%) and DEN2 (47.1%), compared with other strains, DEN3 (73.6%) and DEN4 (83.2%).

According to the ministry, DEN1 and DEN2 are currently the most common dengue virus strains in Malaysia.

The DCA said if the Phase IV study failed to verify the clinical benefit of the vaccine or was not conducted with due diligence during the next two years, the approval for the vaccine could be withdrawn.

Sanofi Pasteur Malaysia said it would collaborate with relevant stakeholders to provide support in giving access to, educating about and monitoring the impact of dengue vaccination in the country.
This includes developing a nationwide immunisation registry and organising education-­cum-awareness programmes for the public and medical professionals. 

The dengue vaccine is currently approved in 14 other countries, including the Philippines, Indonesia, Thailand and Singapore. Mexico was the first country to approve the licensing of the vaccine, followed by the Philippines, both in December 2015.

According to the World Health Organisation, there are currently five other dengue vaccine candidates being researched in clinical trials. Two of these vaccine candidates, from Brazil’s Butantan Institute and Japan’s Takeda Pharmaceutical, are currently beginning phase III trials.
/theSTAR 07-04-2017

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Halal Products - Malaysia leads

Malaysia has carved a name globally as the expert in halal matters, is confident of remaining as the go-to authority with the drawing up of a National Halal Policy.
The Policy, which is being drafted, entails certification, standards, accreditation, laboratory, research and development, and the growth of the halal industry itself.
A paper was presented at the Halal Malaysia Council’s first meeting on 3rd March 2017, chaired by Deputy Prime Minister Datuk Seri Dr Ahmad Zahid Hamidi. This was the first time the Council had convened a meeting since it was set up in June 2016.
Dr Ahmad Zahid said with competition from Brunei, Indonesia and Thailand, effort must be undertaken to ensure Malaysia maintains its position as the leading authority on halal matters.
“Our know-how will not only open up opportunities for local entrepreneurs but will allow us to further promote moderation to every corner of the globe. That is why it is important for us to lead the way,” he said.
The meeting also heard of achievements made to promote the country under the Halal Malaysia banner, with countries such as Japan, Saudi Arabia and China showing keen interest in its expertise and services. China welcomed Malaysia in developing a halal laboratory and certification for Yunnan.
United Arab Emirates and Saudi Arabia were also keen to have tie-ups to develop a halal eco-system.
Malaysia has offered Japan to look into the preparation of halal meals for the Olympic and Paralympic Games to be held in Tokyo in 2020. 
Malaysia is on track to achieve global halal hub status by 2020, backed by a holistic ecosystem, according to International Trade and Industry Minister Datuk Seri Mustapa Mohamed.

/theSTAR 03-03-2017

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Halal Products

Malaysian companies that sell halal products and services can benefit from the lucrative market offered by China’s Belt and Road trade route, says Deputy Prime Minister Datuk Seri Dr Ahmad Zahid Hamidi. 
“We are seeking to tap the growth opportunities arising from the Belt and Road trade routes with China which has some 30 million Muslims with an annual halal market growth of 10%,” he said in his speech at the launch of the 14th Malaysia International Halal Showcase (Mihas) trade fair here yesterday.
Mihas is billed by Matrade, its organiser, as the world’s largest halal trade show. Malaysia intends to be a global Halal hub.
The event, first held in 2004, generated RM1.14bil in sales last year. Last year, Malaysia exported RM39.3bil worth of halal goods and services globally, with China, Singapore, the United States and Japan the four biggest importers.
The halal market is still under-served as the supply of halal products was not matching the growing demand.
“Only a few countries such as Malaysia, Thailand and Australia are exporting halal goods. Demand has overwhelmed supply. There is an urgent need to create more halal suppliers in these areas,” he added.
He said a challenge facing the industry was the lack of a single unified halal standard.
“There are now more than 200 bodies issuing their own halal certificates and logos. The countries involved should foster mutual recognition of each others’ certification to overcome the problem,” he added.
Jakim has recognised 67 certified bodies globally from 40 countries.
Asean members should develop the halal industry by creating structured programmes, and an efficient and seamless global supply chain in order to move halal from a niche to a mainstream industry.
                                                                                                                                                                               /theSTAR 06-04-2017
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