Financing water infrastructure: waqf as a solution

The WEF’s Global Risks 2015 report stated that global water crises are the biggest threat facing the planet over the next decade. Currently, 1.6 billion people live in countries with water scarcity and expected to rise to 2.8 billion people by 2025. Despite this, a staggering 32 billion cubic meters of treated water is lost around the world, costing US$14 billion due to aging pipelines that distribute drinking water. There are 42,977 km of asbestos-cement (AC) pipes in Malaysia that are over 60 years old that need to be replaced to reduce leakages. The study found that the AC pipes can be replaced within 20 years and 3.8 billion cubic meters of water, worth RM 4.5 billion can be saved from leakage. The paper also looks at financing of water infrastructure from Islamic history and proposes a decentralized approach that allows the community to be directly involved in ensuring water security for themselves

Extracorporeal Membrane Oxygenation and Continuous Renal Replacement Therapy

Extracorporeal membrane oxygenation (ECMO) is a supportive therapy, which provides cardiopulmonary and end-organ support in critically ill patients when other measures fail. These patients receive large amounts of fluid for volume resuscitation, blood products and caloric intake, which results in fluid overload and which in turn is associated with impairment of oxygen transport and increased incidence of multiple organ failure especially heart, lungs and brain. It is common to see a decrease in urine output during ECMO that may be associated with acute renal failure. The acute renal failure is a manifestation of multiple organ system failure due to acute decompensated heart failure, sepsis, hemolysis, use of vasopressors/inotropes, nephrotoxic medications, and activation of complement system during ECMO support. It is associated with poor prognosis and higher mortality in ECMO patients. Continuous renal replacement therapy (CRRT) in patients on ECMO provides an efficient and potentially beneficial method of fluid overload and acute kidney injury management. In addition, recent data suggest that the use of CRRT may remove inflammatory cytokine released as a result of circulation of blood across synthetic surfaces during ECMO. The two most common methods to provide CRRT are through the use of an inline hemofilter or through a traditional CRRT device connected to the extracorporeal circuit. The primary objective of this chapter is to discuss current state and role of renal replacement therapy in patients on ECMO and address the controversies and challenges about its application

Trastuzumab and Docetaxel Combination Therapy Compared to Docetaxel Monotherapy in HER2-Positive Stage IV Metastatic Breast Cancer: An Open Labelled Randomized Study

BACKGROUND: Pre-clinical and clinical studies indicate that a combination of docetaxel and trastuzumab may effectively treat patients with human epidermal growth factor receptor-2 (HER-2) overexpressing metastatic breast cancer. Therefore, this study was designed to compare the efficacy, safety and tolerability of trastuzumab plus docetaxel and docetaxel monotherapy in HER-2 Positive Metastatic Breast Cancer patients. METHODS: A total of 40 patients were randomly assigned to two groups. Twenty patients (Group 1) were assigned into six cycles of docetaxel 75 mg/m2 every 21 days with trastuzumab 8 mg/kg loading dose followed by 6 mg/kg weekly and Group 2, twenty patients were assigned into six cycles of docetaxel 75 mg/m2 every 21 days. RESULTS: Objective responses of Trastuzumab with docetaxel combination and docetaxel monotherapy were found to be similar without any significant difference between the study groups. Subjective responses after sixth cycle were found to be similar in both the groups. Side-effects were similar in both the study groups. The most common haematological toxicity was leukopenia. Non-Haematological toxicities reported were alopecia, peripheral neuropathy, myalgia/arthralgia and nail discolouration and they were almost equal in both the study groups. CONCLUSION: Trastuzumab with docetaxel combination was certainly a promising combination for metastatic breast cancer in patients with HER-2-overexpression. Further long term studies regarding overall survival, overall response rate and time to progression would be needed to confirm the effectiveness of this combination over docetaxel monotherapy in the metastatic setting

Assessment of knowledge about post exposure prophylaxis of HIV among medical, nursing and paramedical students in hospital and laboratory practice

Background: India has 2.1 million of people living with HIV, and places in third-largest population of people infected with the HIV after South Africa and Nigeria. It is thus important for health care providers including medical, nursing and paramedical students to have adequate knowledge on PEP for HIV to protect themselves prior to starting their life long career.Methods: Cross-sectional study was conducted among 200 medical, nursing and paramedical students in Tirunelveli medical college from December 2016 to February 2017. A pre-designed questionnaire was used to collect data. Results were summarized in percentages and presented in tables.Results: A total of 96 (48%) males and 104 (52%) females responded in the study. Though many (87%) had heard about PEP, just 31 (15.5%) had received formal training on PEP for HIV. Only 81 (40.5%) knew the ideal PEP regimen and 88 (44%) knew the correct drug regimen. The majority 196 (98%) considered PEP was important and significant 178 (89%) considered themselves to be at risk of acquiring HIV at work, with 46 (23%) having experienced an exposure in the past. Of those exposed, only 21 (45.7%) received PEP.Conclusions: This study shows that knowledge, attitude and practice towards PEP for HIV is inadequate. A formal PEP training centre with proper guidelines is recommended for medical, nursing and paramedical students

Actualización en síndrome hemolítico urémico atípico: diagnóstico y tratamiento. Documento de consenso. Revisión

Podeu consultar la versió en castellà del document a: http://dx.doi.org/10.1016/j.nefro.2015.07.005Haemolytic uraemic syndrome (HUS) is a clinical entity defined as the triad of nonimmune haemolytic anaemia, thrombocytopenia, and acute renal failure, in which the underlying lesions are mediated by systemic thrombotic microangiopathy (TMA). Different causes can induce the TMA process that characterises HUS. In this document we consider atypical HUS (aHUS) a sub-type of HUS in which the TMA phenomena are the consequence of the endotelial damage in the microvasculature of the kidneys and other organs due to a disregulation of the activity of the complement system. In recent years, a variety of aHUs-related mutations have been identified in genes of the complement system, which can explain approximately 60% of the aHUS cases, and a number of mutations and polymorphisms have been functionally characterised. These findings have stablished that aHUS is a consequence of the insufficient regulation of the activation of the complement on cell surfaces, leading to endotelial damage mediated by C5 and the complement terminal pathway. Eculizumab is a monoclonal antibody that inhibits the activation of C5 and blocks the generation of the pro-inflammatory molecule C5a and the formation of the cell membrane attack complex. In prospective studies in patients with aHUS, the use of Eculizumab has shown a fast and sustained interruption of the TMA process and it has been associated with significative long-term improvements in renal function, the interruption of plasma therapy and important reductions in the need of dialysis. According to the existing literature and the accumulated clinical experience, the Spanish aHUS Group published a consensus document with recommendations for the treatment of aHUs (Nefrologia 2013;33[1]:27-45). In the current online version of this document, we update the aetiological classification of TMAs, the pathophysiology of aHUS, its differential diagnosis and its therapeutic management