wrote:
Hi Salwa;
Hope you are fine.
Inspite i am not in Egypt at the moment- as you know- i am still trying to follow most of the Egyptian media as much as possible, and really feel so sorry for these news , and i am sure you share this feelings with me, you know why these mortalities happened offcourse. Neglicance, lack of responsiblity, bad medical services, CORRUPTION.
I was astonished when i knew that the members of democracy group party were the first to recieve H1N1 Vaccine and you know the number of imported vaccine stock in Egypt is not that much and even our unlucky kids will not be vaccinated , also when i knew that some mortality among young kids happened because of shortage of the Osletamivir and day and night the minister of health keep talking to the media and saying the same words ( we have more than enough stock of medications ).
By the way the WHO recently recomend starting therapy without waiting throat and nasal swab results.
Back to Mr Ordogan he is offcourse free to decide not to recieve the vaccine.
I believe we should explain to our CKD patients that they are at high risk to catck H1N1 and there is still a small risk from the vaccine - as professor Steve elaborated- and let them decide .
Again Eid Mubareek for you and all my colleagues
Alaa Dr . Alaa Sabry
Assistant professor of Nephrology
Mansoura University , Egypt
Research fellow , Sheffield Kidney Institute, UK
From: salwaibrahim@hotmail.com
To: nephrol@mailman.srv.ualberta.ca
Subject: RE: [Nephrol] H1N1 vaccination in HD patients
Date: Thu, 12 Nov 2009 20:53:13 +0000
OK Alaa, Now they are six, the one you mentioned was a pregnant lady with prosthetic M+A valves and she developed bronchopneumonia after a short stay in Italy.
But that doesn't change much the stable course of this stain with a current mortality rate of 0.3%. One RTA claims more lives daily, air pollution, water contamination, social injustice do more harm, but don't cause such panic I am seeing around with daily press release counting the number of new cases and making headlines of TV news and local newspapers.
I think we should not allow brain washing and scare politics to override our ability to think reasonably, rate the risks we face and act accordingly.
Regarding vaccination, it was produced in short time, and there is no much data on its effectiveness or side effects. People are requested to sign a consent they are taking it on their own risk,so everyone has to decide for him/herself.
By the way, one of the key leaders in the region, Mr Erdogan,the PM of Turkey, has refused to get it, and you can't accuse him of thinking like the Public of Course, do you?
Best!
Salwa Ibrahim, MD MRCP (London)
Professor of Medicine and Nephrology
Cairo University, Egypt
P Think green before printing this e-mail
From: asabry2040@hotmail.com
To: nephrol@mailman.srv.ualberta.ca
Subject: FW: [Nephrol] H1N1 vaccination in HD patients
Date: Thu, 12 Nov 2009 09:38:58 +0200
Dear Salwa;
Hope you are fine and thanks for the delicate response. I will just add some comments on your e.mail and hope it will not bother u .
1-I just came from the ER in our hospital, I saw lots of patients who have chronic liver and/or kidney disease, these two are our own real problems,thousands are dying daily here because of hepatic/renal and HR failure. 100% you are right as an Egyptian from the Delta reigon i know how much our poor people are suffering from renal and hepatic problems.
2-We discussed swine flu in our journal Club, I understood from the presentation and discussions that Swine flu is the commonest cause of flu in the northern hemisphere while in the southern parts like ours the seasonal flu is still prevalent. According to the speaker, CDC guidelines suggest not to do testing for every case, but to segregate those with severe co-morbidities or those at high risk and treat them with Tamiflu. Do not worry the second wave will be coming soon and the southern parts of the world will be attacked soon , 6th case a female Egyptian patients passed out yesterday, do you agree that prevention is better than cure?
3-My point of view is that we have to keep our minds free from media control, so we can see our own problems, set our priorities and assign our health budget accordingly. Ironically, the government of Iraq, where every one chance of getting exploded is 100%, has assigned millions of dollars to buy vaccines and Tamiflu to Combat H1N1 virus! . First time to hear about this but i agree with you looks so funny.
NB. I personally believe in every word said by the Finnish ex-minister of health because I see on the TV the millions who have been killed in the elective wars conducted in the region. As i told you before can not trust this source
Have a nice weekend.
Alaa
Dr . Alaa Sabry
Assistant professor of Nephrology
Mansoura University , Egypt
Research fellow , Sheffield Kidney Institute, UK
From: salwaibrahim@hotmail.com
To: nephrol@mailman.srv.ualberta.ca
Subject: RE: [Nephrol] H1N1 vaccination in HD patients
Date: Wed, 11 Nov 2009 21:22:33 +0000
Dear Alaa,
I just came from the ER in our hospital, I saw lots of patients who have chronic liver and/or kidney disease, these two are our own real problems,thousands are dying daily here because of hepatic/renal and HR failure.
We discussed swine flu in our journal Club, I understood from the presentation and discussions that Swine flu is the commonest cause of flu in the northern hemisphere while in the southern parts like ours the seasonal flu is still prevalent. According to the speaker, CDC guidelines suggest not to do testing for every case, but to segregate those with severe co-morbidities or those at high risk and treat them with Tamiflu.
My point of view is that we have to keep our minds free from media control, so we can see our own problems, set our priorities and assign our health budget accordingly. Ironically, the government of Iraq, where every one chance of getting exploded is 100%, has assigned millions of dollars to buy vaccines and Tamiflu to Combat H1N1 virus!
NB. I personally believe in every word said by the Finnish ex-minister of health because I see on the TV the millions who have been killed in the elective wars conducted in the region.
Best!
Salwa Ibrahim, MD MRCP (London)
Professor of Medicine and Nephrology
Cairo University, Egypt
P Think green before printing this e-mail
From: asabry2040@hotmail.com
To: nephrol@mailman.srv.ualberta.ca
Subject: RE: [Nephrol] H1N1 vaccination in HD patients
Date: Wed, 11 Nov 2009 09:12:08 +0200
Dear Salwa:
Hope you are fine and thanks for your reply which i totally disagree with you.
First: How can we say we should talk about our own problems in the middle east and stop following those made up stories, do you think swine flu is not our problem as well? it is just because only 5 mortalities so it is not a problem any more? i know most cases can recover without therapy but even if this is the case it still be a worlwide and nationwide problem.
Second : About this video you sent , really i hardly inforced myself to listen to the full video ,my personel point of view we should not pay any attension to such media conflict, how can we believe this fabricated storry , they wann to decrease popualtion, they are attacking children and pregnant women, they wann to eliminate the new generations, they wann to poison and kill us, really i feel so sorry to listen to the X- prime minister of health... if we trust this source so what the public will do , i believe we should trust WHO and CDC recommendations and what is reported and published in the literature , that is what we learned from our professors.
Third; I do agree and believe that the vaccine is not risk free , there are side effects and with time we will know more about this and also there is still risk from vaccinationa and noone can expect what is the risk will be but we should weight the risk against benifit.
Fourth : just to remind you the first persons who were vaccinated in Egypt and KSA , both were ministers of health .
Have and nice day
Alaa
Dr . Alaa Sabry
Assistant professor of Nephrology
Mansoura University , Egypt
Research fellow , Sheffield Kidney Institute, UK
From: Ryutaro.Hirose@ucsfmedctr.org
To: salwaibrahim@yahoo.co.uk ; salwaibrahim@yahoo.co.uk ; nephrol@mailman.srv.ualberta.ca
Date: Tue, 10 Nov 2009 16:22:34 -0800
Subject: RE: [Nephrol] H1N1 vaccination in HD patients
CC:
I was thinking the link provided is better suited for Kim’s humor day?
I am sure I will be accused of making argumentum ad hominem, but in this case, I think perhaps justified.
Not that I can personally vouch for much beyond the rants I have heard this woman give on other available videos regarding UFO’s and mind control, but from other sources:
Rauni-Leena Luukanen-Kilde was a provincial medical officer in Finnish Lapland Province with a doctorate in medicine from 1975 until a car accident in 1986, which took away her ability to continue her work and career. Since then she has been best known for her UFO contacts and related thoughts. She likes to advertise her former title, but often she rather calls herself a former Chief Medical Officer of Finland and uses other questionable titles as well. Luukanen-Kilde has written UFO related books, which have been published inside and outside Finland. She has spoken openly about the hiding of the UFO evidence and other conspiracy theories. It is claimed she has taken part in numerous UFO conferences, but such a claim has been refuted in the past.[1] According to Kilde, the United States and other nations have been involved in covert "microchip mind control" research.
I may be mistaken, but I believe that she claims that aliens helped her survive her car accident.
On a more serious note, her assertions that the vaccines that have helped prevent deaths are actually designed by American companies to kill off certain populations of people would truly be laughable if it weren’t taken seriously by some of the lay public.
Ryutaro Hirose, M.D.
Associate Professor in Clinical Surgery
Department of Surgery
Division of Transplantation
Associate Director, Surgical Residency Program
University of California, San Francisco
(415) 353 8783
Fax: 415 353 9874
Ryutaro.Hirose@ucsfmedctr.org
Mailing Address:
505 Parnassus Avenue
Box 0780
Room M-884
San Francisco, CA 94143-0780
From: nephrol-bounces@mailman.srv.ualberta.ca [mailto:nephrol-bounces@mailman.srv.ualberta.ca] On Behalf Of Salwa Ibrahim
Sent: Tuesday, November 10, 2009 2:41 PM
To: nephro group
Subject: RE: [Nephrol] H1N1 vaccination in HD patients
Every time I hear about H1N1, I wonder why we are not taking care of our own problems in the middle east and stop following those made up stories. We have only five deaths from swine flu so far in Egypt, our minister of health is saying everyday that 99.7% of cases have completely recovered, sometimes without therapy. It is interesting to listen to the Finnish ex-minister of Health point of view on that topic.
Talk with the ex-minister of health of Finland
about swine flu
La Dra Rauni Kilde habla sobre la Conspiración de la Gripe Porcina
http://www.youtube.com/watch?v=nTgyakGAddM
Salwa Ibrahim, MD MRCP (London)
Professor of Medicine and Nephrology
Cairo University, Egypt
P Think green before printing this e-mail
From: thimam@hotmail.com
To: nephrol@mailman.srv.ualberta.ca
Subject: RE: [Nephrol] FW: H1N1 vaccination in HD patients
Date: Tue, 10 Nov 2009 10:10:22 -0800
"i have a case with proved infection and sucessfully treated with Oseltamivir............................."
=================================================================
Dear Dr Sabry,
We have had a few culture proven cases here also. We have also used it in few but the point I am trying to make is that you cannot be confident that the Oseltamivir you gave was successful, since the majority improve without it !!
Best regards
Talha H Imam, MD
Department of Nephrology
Kaiser Permanente
Fontana, California.
From: asabry2040@hotmail.com
To: nephrol@mailman.srv.ualberta.ca
Date: Tue, 10 Nov 2009 06:30:10 +0200
Subject: [Nephrol] FW: H1N1 vaccination in HD patients
Dear Nephrols;
A recent paper - Marcelli et al NDT 2009- about Influenza A ( H1N1) pandemic in dialysis patients - attached, the results shows a prevalence of
3.4% in 85 clinics, , mortalty rate 5% of all patients and recommnded vaccination for HD patients .
I would like to ask the group members openion : Are you vaccinating your HD patients ?
Second i have a case with proved infection and sucessfully treated with Oseltamivir and i think we will have many cases in the future- Hopefully not-. What is your experience in treating such patients?
If any of my colleagues in the Middle east is interested we can collect and published our caese , just contact me on my e.mail
Thanks.
KR
Alaa
Dr . Alaa Sabry
Assistant professor of Nephrology
Mansoura University , Egypt
Research fellow , Sheffield Kidney Institute, UK
From: asabry2040@hotmail.com
To: nephrol@mailman.srv.ualberta.ca
Subject: RE: [Nephrol] HBV seroconversion in HD patient
Date: Fri, 6 Nov 2009 18:15:32 +0200
tahnks but i did not mean this, what i mean in my particular case , this patients seroconverted from HBsAg -ve to negative and HBV DNA negative ,as you advised - if HBV-DNA is negative for more than 2 times and patient is antiHBe positive then he does not need isolation- what is the duration between these 2 assays ??
and after holding isolation what are the frequency of testing for HCV and HBV? should we treat him as HCV -ve and HBV -ve patients - checking his virological status every 6 months- or should we tested him more frequently?
Regards
Alaa
Dr . Alaa Sabry
Assistant professor of Nephrology
Mansoura University , Egypt
Research fellow , Sheffield Kidney Institute, UK
Date: Fri, 6 Nov 2009 17:44:30 +0530
From: skagarwal58@yahoo.co.in
Subject: RE: [Nephrol] HBV seroconversion in HD patient
To: nephrol@mailman.srv.ualberta.ca
Any patient with raised ALT but anti-HCV or HBsAg is negative, we do molecular test.
Any patient being assessed for treatment, we do molecular test.
20-25% anti-HCV negative have HCV-RNA positivity.
Rarely HBsAg negative has HBV-DNA positivity.
Otheriwse routine testing is by anti-HCV and HBsAg only.
I hope this is helpful.
regard
Dr. Sanjay K. Agarwal
Professor and Head
Department of Nephrology
MD, FRCP(Edin), FASN, FAMS
Commonwealth Fellow UK (Manchester)
AIIMS, New Delhi-110029, INDIA
Off: 00-91-11- 26594911, 26593292
Fax: 00-91-11-26588663, 26588641
--- On Fri, 6/11/09, Alaa sabry wrote: From: Alaa sabry
Subject: RE: [Nephrol] HBV seroconversion in HD patient
To: "nephrol@mailman.srv.ualberta.ca"
Date: Friday, 6 November, 2009, 3:27 PM Professor Agarwl;
Thanks for these informations really so helpfull.
What are the frequency of HCV and HBV DNA testing ? will you do the test annually or biannually ?
Regards
Alaa
Dr . Alaa Sabry
Assistant professor of Nephrology
Mansoura University , Egypt
Research fellow , Sheffield Kidney Institute, UK
Date: Thu, 5 Nov 2009 14:09:14 +0530
From: skagarwal58@yahoo.co.in
Subject: Re: [Nephrol] HBV seroconversion in HD patient
To: nephrol@mailman.srv.ualberta.ca
These issue we deal almost daily as HCV infection in our transplant recipient is significant. (NOT from our own unit but acquired in other unit but transplant is being planned with us)
If while on treatment for HCV with peg-INF, if consecutive three HCV RNA are negative then we are shifting the patient to normal room- means STOP isolation.
For HBV also, same if HBV-DNA is negative for more than 2 times and patient is antiHBe positive then he does not need isolation.
If patient has combined infection, then both criteria should be satisfied before we STOP isolation.
I hope this will be helpful.
rgds
Dr. Sanjay K. Agarwal
Professor and Head
Department of Nephrology
MD, FRCP(Edin), FASN, FAMS
Commonwealth Fellow UK (Manchester)
AIIMS, New Delhi-110029, INDIA
Off: 00-91-11- 26594911, 26593292
Fax: 00-91-11-26588663, 26588641
--- On Thu, 5/11/09, Alaa sabry wrote: From: Alaa sabry
Subject: [Nephrol] HBV seroconversion in HD patient
To: "nephrol@mailman.srv.ualberta.ca"
Date: Thursday, 5 November, 2009, 1:46 PM Dear Colleagues;
Your openion and suggestions are highly appreciated.
Forty- five year -old male patient with ESRD on HD since 5 years , with a history of transplant from LURD 15 years ago with CAN and graft failure 10 years after ,by the way we are isolating our patients according to their serology, this patients has HBV and HCV infection, the patient recieved IFN course before, was NSR , recieved a second combination( Riba+Peg-IFN ) course , he is on Lamivudine since 2 years , currently his HBSag is negative, HBV-DNA is negative. Regarding HCV the patients is PVR - did not complete the second course-.
The question is can we transfere him to HCV seronverted - HBV negative dilaysis machine? any possiblity that HBV may be occult -in the liver or bone marrow-or should we order for other HBV markers ?
Regards
Alaa.
Dr . Alaa Sabry
Assistant professor of Nephrology
Mansoura University , Egypt
Research fellow , Sheffield Kidney Institute, UK
From: dgo@teleglobal.ca
To: nephrol@mailman.srv.ualberta.ca
Subject: RE: [Nephrol] Peritonitis in Emergency Departament
Date: Mon, 2 Nov 2009 17:00:21 -0500
Having just come back from the ASN conference I am very busy and I did not have time to comment on these e mails, but I could not leave Dr Roman’s suggestion unanswered because of the risks involved with such a suggestion. Adding Iodine in the peritoneal cavity has been used as a model to develop encapsulating peritoneal sclerosis as two references I show below.
Please do not add iodine in the peritoneal solution .It is risky.
Dimitrios Oreopoulos
J Lab Clin Med. 1988 Sep;112(3):363-71.
Sclerosing encapsulating peritonitis in rats induced by long-term intraperitoneal administration of antiseptics. Mackow RCet al
Aust N Z J Surg. 1997 Oct;67(10):742-4.
Sclerosing encapsulating peritonitis after intraperitoneal use of povidone iodine.Keating JP, et al
_________________________________
D G Oreopoulos MD PhD FRCPC FACP
Professor of Medicine
Toronto Western Hospital
399 Bathurst St. Toronto ON, M5T 2S8 Canada
Email: dgo@teleglobal.ca
Telephone: 416-603-7974
Fax: 416-603-8127
Come to Toronto on September 25-26, 2009 for the 8th Annual Conference on PREVENTION in RENAL DISEASE. For program details, our outstanding faculty and On-Line Registration please visit: www.nephroprevention.com
From: nephrol-bounces@mailman.srv.ualberta.ca [mailto:nephrol-bounces@mailman.srv.ualberta.ca] On Behalf Of Jorge Roman
Sent: November 2, 2009 4:40 PM
To: Nephrol
Subject: RE: [Nephrol] Peritonitis in Emergency Departament
Have not done PD for many years but remember a technique called "Saline iodine flush " I think from Dr. Kolff himself .
It was fashionable as an analgesic measure, seemed to work .
It was using isotonic saline with a dab of tincture of iodine, no glucose as in & out flushes.
Any one still using it?
Jorge Roman-Latorre Dallas TX formerly from Roanoke VA where this was used
To: nephrol@mailman.srv.ualberta.ca
Subject: Re: [Nephrol] Peritonitis in Emergency Departament
Date: Mon, 2 Nov 2009 16:29:50 -0500
From: shelman100@aol.com
Dear Friends:
I second Dr Tucker's approach. I try to do everything I can to keep patients out of the ER for usual reasons but also because in my neck of the woods, if they go to the ER they get admitted
(for peritonitis per se, even without nausea and vomiting) to any of several hospitals without a PD nurse, that is ill equipped for a PD patient and bad things can happen.
My patients are trained to drain out and save their solution and to begin oral antibiotics (ours are not trained to administer IP antibiotics). They are then told to stay
dry until the next day (or Monday, if on the weekend), and to bring their bag in to the out pt CAPD nurse for culture, and to resume PD with IP antibiotics.
(this is for peritonitis at night or on the weekend; during the day, they come into the office)
The purpose of stay ing dr y i s t his: removing 2 plus liters of pus seems to really help with pain and n/v and if you hold restarting for one to two days after
the antibiotics kick in, there's a good chance (for routine staph peritonitis) that you can prevent an admission for n/v/pain (all said,admittedly, in anecdotal fashion)
They go to the ER if pain/n/v persists after draining dry.
I vaguely remember (someone will surely know) a paper from several years ago, possibly from Japan, in which peritionits was successfully treated with going dry, and
WITHOUT antibiotics. The idea was that 2 liters of dextrose fueled bacteria and hindered treatment. Obviously, the patients need dialysis at some point and you
can't do this for long, but this may be a curious (if unproven) additional benefit of holding PD for a day or two (I don't know of anyone who would have the temerity
to withhold antibiotics).
I'm no CAPD maven. Perhaps our experts can comment further
Shel don HIr sch, MD< BR>Chicago, Il
-----Original Message-----
From: Steven Tucker
To: nephrol@mailman.srv.ualberta.ca
Sent: Sun, Nov 1, 2009 7:01 pm
Subject: Re: [Nephrol] Peritonitis in Emergency Departament We generally don't face this problem.
All our patients are trained how to recognize or suspect peritonitis and how to administer their antibiotics with which they're supplied at home.
So, if they note cloudy dialysate, abdominal pain and/or fever they immediately save current drain, notify on call nurse, administer their antibiotics and then take their bag to the lab for culture which the PD nurses birddog for results. We have a standard algorithm which they follow.
Should the patient go to the ER, it's almost always because they need admit--- N/V severe pain etc. There we also have standard protocol to follow. We still generally use IP antibiotics which our pharmacists mix up.
Steve
On Nov 1, 2009, at 9:21 AM, Rafal Dudek wrote:
Dear Nephrolers:
I would appreciate any comments how the peritonitis in peritoneal dialysis patients is managed in ED's in hospitals, especially after bussiness hours.
1. ED physician orders IV antibiotics? Patient is drawing the PD fluid sample?
2. The ED staff waits till dialysis nurse arrive to get PD fluid sample and
a/ PD nurse gives antibiotics IP
b/ ED MD writes for antibiotisc IV
3. ED staff waits till nephrologists sees the patient?
4. Do you experience ED stuff comfortable/licenced to draw PD fluid sample and premix/administer IP antibiotics?
Or any other scenarios?
What I am curious about is there any delay in the treatmend depending from approach.
Thanks,
R. Richard Dudek, MD
SCPMG Sunse t, LA, CA , U SA
Bing brings you maps, menus, and reviews organized in one place. Try it now. _______________________________________________
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Steven B.Tucker, MD FACP
Director Nephrology Services PAMC
3300 Providence Dr # 304
Anchorage, Alaska 99508
sbtucker@alaska.net
907-261-4840 (ph)
907-261-4820 (f)
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