Causative organisms and outcomes of peritoneal dialysis-related peritonitis in Sarawak General Hospital, Kuching, Malaysia: a 3-year analysis

Abstract Background Peritoneal dialysis peritonitis remains a significant cause of morbidity for peritoneal dialysis patients and the main reason for conversion from peritoneal dialysis to hemodialysis. As the characteristics of patients and microbial susceptibility vary from center to center, the aim of this study is to evaluate the microbiology and the clinical outcomes among continuous ambulatory peritoneal dialysis patients in Kuching, Malaysia. Methods This is a retrospective record review of 82 continuous ambulatory peritoneal dialysis patients who developed peritonitis during 2013 to 2015. Data examined included patients’ demographic data, causative organisms, and outcomes. Results A total of 124 episodes of peritonitis were recorded, and the overall peritonitis rate was 0.40 episodes per patient-year. There was an increasing incidence in continuous ambulatory peritoneal dialysis peritonitis over the 3-year study period (0.35 to 0.47 episodes per patient-year). The gram-negative peritonitis rate increased over the period until towards the end of the study period, when gram-positive and gram-negative organisms accounted for almost equal proportions of peritonitis. Streptococcus sp. was the most common organism among the gram-positive peritonitis while Pseudomonas sp. was the most common organism in gram-negative peritonitis. The culture-negative peritonitis rate was 25.8%. The peritoneal dialysis catheter was removed in 32 episodes (26.6%). The catheter loss rate was significantly higher in gram-negative peritonitis, as compared to gram-positive peritonitis (38.9 vs 16.7%, p = 0.027). Conclusions The increasing trend of peritonitis and high rates of culture negativity and peritoneal dialysis catheter removal are areas that need further evaluation and improvement in the future. Study on risk factors of continuous ambulatory peritoneal dialysis peritonitis, detailed microbiology, and antimicrobial treatment and response are warranted to further improve the outcomes of continuous ambulatory peritoneal dialysis patients

A cross-sectional study on the cardiovascular risk factors among residents aged 30 years and above at Rumah Jana and Rumah Runggai in Julau district from 4 September 2000 to 22 October 2000

A cross-sectional study on the cardiovascular risk factors was carried out among residents aged 30 and above at Rumah Jana and Rumah Runggai, Julau from September to October 2000 by fourth year medical students from Universiti Malaysia Sarawak. The cardiovascular risk factors studied were hypertension, smoking, hypercholesterolaemia, (high fasting blood cholesterol), diabetes mellitus (abnormal fasting blood glucose) and overweight. A total of 155 respondents were universally selected for the questionnaire interview and measurements of blood pressure, body mass index, fasting blood glucose and fasting total blood cholesterol. The prevalence of hypertension was found to be 37.4 %, prevalence of smoking was 21.3 %, prevalence of high fasting total blood cholesterol was 17.4 %, prevalence of abnormal fasting blood glucose was 4.5 % and the highest prevalence was of overweight which was found to be 38.7 %. Study on the association between prevalence of cardiovascular risk factors with sociodemographic data revealed four significant associations. The significant associations were male respondents were found to have higher prevalence of smoking than female respondents, prevalence of hypertension rose with the increase in the respondents age, the prevalence of overweight was higher among the lower age group and the prevalence of overweight were higher among respondents with formal education (p<0.05). Results revealed that 74.8% of the respondents have at least 1 cardiovascular risk factor and 31.6% have 2 or more cardiovascular risk factors. A significant association was found between prevalence of overweight and the prevalence of high fasting total blood cholesterol (p<0.05). Generally, the respondents have good knowledge on cardiovascular risk factors. The percentage of respondents with adequate knowledge of each of the studied cardiovascular risk factor ranged from 68.4% for hypertension to 72.9% for hypercholesterolaemia. Study on the association between knowledge on a particular cardiovascular risk factor and the prevalence of that particular cardiovascular risk factor revealed a significant association between knowledge on overweight with the prevalence of overweight (p<0.05). Results revealed that respondents have very good attitude towards cardiovascular risk factors, with the percentage of respondents with positive attitude towards each of the studied cardiovascular risk factor ranged from 80.0% to 93.5%. Significant associations were found between the attitude of respondents towards hypertension with the prevalence of hypertension and between the attitude of respondents towards smoking with the prevalence of smoking (p<0.05)

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially