BackgroundLupus nephritis (LN) is a serious manifestation of systemic lupus erythematosus that can be fatal if left untreated. The causes and prognostic predictors of mortality in LN have been well studied in developed countries but evidence is lacking for developing countries. The objective of this study was to investigate the causes and predictors of mortality in a cohort of Malaysian patients with biopsy-proven LN.MethodsWe retrospectively studied all patients with biopsy-proven LN treated in Sarawak General Hospital during the period of 2000–15. Demographic data, clinical features and outcomes were collected. Cox regression analysis was carried out to determine the independent predictors of mortality.ResultsThere was a total of 250 patients with 259 renal biopsies available for our analysis. Our patients were of multi-ethnic origins with a female predominance (90%). Their mean ± standard deviation age was 37.7 ± 12.8 years. The patients had a mean disease duration of 135.6 ± 81.9 months. Nephrotic syndrome was the most common presentation (29.6%) and acute renal failure was evident at initial presentation in 16% of patients. Class IV LN was the predominant biopsy class within the cohort (66.8%). The majority of patients achieved remission (81.2%) and had normal renal function (83.9%) at the last follow-up. The 5-, 10-, 15- and 20-year survival rates for our cohort were 93%, 88%, 82% and 77%, respectively. There were 37 deaths (14.8%), of which the main causes were: infection and flare (52.7%), infection alone (25.0%) and other causes (22.3%). Independent predictors of mortality in our cohort of LN patients were: the presence of acute kidney injury at presentation [hazard ratio (HR) 3.41; confidence interval (CI) 1.50–7.76], failure to achieve remission at 1-year post-induction therapy (HR 2.99; CI 1.35–6.65) and non-compliance with treatment (HR 1.89; CI 1.22–2.96). Age, ethnicity, class of LN and type of immunosuppressant used were not predictive of mortality.ConclusionsSurvival and renal outcomes in our LN cohort were comparable to most LN studies reported worldwide. Both flare and infection remained the main causes of death. The presence of acute renal failure at presentation, failure to achieve remission at 1 year post-treatment and non-compliance with treatment were independent prognostic predictors of mortality in LN.

Despite a majority of patients having <60% TTR, there were low incidences of bleeding and stroke events in this center. There were no factors found to be associated with INR control in this study.

Djenkol beans or jering (Pithecellobium jeringa) is a traditional delicacy consumed by the local population in Malaysia. Jering poisoning or djenkolism is characterized by spasmodic pain, urinary obstruction and acute renal failure. The underlying pathology is an obstructive nephropathy, which is usually responsive to aggressive hydration and diuretic therapy. We present a case of djenkolism following ingestion of jering. The patient required urgent bilateral ureteric stenting following the failure of conservative therapy. Healthcare providers need to recognize djenkolism as a cause of acute renal failure and the public educated on this potential health hazard.

Paraquat poisoning resulted in multiorgan failure and is associated with high mortality. We audited 83 historical cases of paraquat poisoning in past 2 years treated with conventional decontamination and supportive treatment, followed by enrolling 85 patients over a 2 year period into additional immunosuppression with intravenous (i.v.) methylprednisolone and i.v. cyclophosphamide.Our results showed that age, poor renal function and leucocytosis are the main predictors of fatal outcome. Immunosuppression regime rendered higher survival (6 out of 17 patients (35.3%)) versus historical control (1 out of 18 patients (5.6%)) (p = 0.041) in the cohort with admission eGFR < 50 ml/min/1.73 m2 and WBC count > 11,000/μL.In contrast, there was no difference in survival with immunosuppression regime (38 out of 64 patients (59.4%)) compared to historical control (30 out of 52 patients (57.7%)) (p = 0.885) in those with eGFR > 50 ml/min/1.73 m2 or WBC < 11,000/μL at presentation.Multivariable logistic regression showed survival probability = exp(logit)/(1 + exp(logit)), in which logit = 13.962 − (0.233 × ln(age (year))) − (1.344 × ln(creatinine (μmol/L))) − (1.602 × ln(rise in creatinine (μmol/day))) – (0.614 × ln(WBC (,000/μL))) + (2.021 × immunosuppression) and immunosuppression = 1 if given and 0 if not. Immunosuppression therapy yielded odds ratio of 0.132 (95% confidential interval: 0.029–0.603, p = 0.009).In conclusion, immunosuppression therapy with intravenous methylprednisolone and cyclophosphamide may counteract immune mediated inflammation after paraquat poisoning and improve survival of patients with admission eGFR < 50 ml/min/1.73 m2 and WBC count > 11,000/μL.

No abstract

No abstract

Background Delays in producing discharge prescriptions have hindered the provision of bedside dispensing services (BEDISC) that enable medication reconciliation and pharmaceutical intervention, which is an important element in transitional care medication safety. We aimed to assess the impact of early medication discharge planning on the delivery of BEDISC in terms of the rate of bedside dispensing, medication errors, and cost-saving from medication reconciliation by reusing patient’s own medicines (POMs). Methods A pre–post intervention study was conducted at medical wards in a public tertiary hospital. During the intervention phase, a structured bedside dispensing process was delineated and conveyed to the doctors, nurses, and pharmacists. Regular verbal reminders were given to the doctors to prioritize discharge patients by producing the prescriptions once discharge decisions had been made and nurses to hand the prescriptions to ward pharmacists and not patients. Throughout the study, ward pharmacists were involved in medication reconciliation via screening of discharge prescriptions and reusing POMs, performed pharmaceutical interventions for any medication errors detected, and provided bedside dispensing with discharge counseling. Comparisons were made between bedside versus counter-dispensing at pre–post intervention phases using the chi-square test. Results A total of 1097 and 817 discharge prescriptions were dispensed in the pre-intervention and post-intervention phases, respectively. The bedside dispensing rate increased by 13.5% following remedial actions (p < 0.001). The number of prescriptions intervened due to detection of medication errors increased by 13.4% for bedside dispensing (p < 0.001) versus 4.7% for counter-dispensing (p = 0.002), post-intervention. Most medication errors fell under the category of inappropriate drug (44.5%), followed by inappropriate dose (12.8%). Reusing POMs resulted in cost-saving of MYR6,851.66 at pre-intervention and MYR7,032.98 at the post-intervention phase. Overall, the cost-saving from reusing POMs in both intervention phases was 52.7% (MYR13,884.64 out of the total MYR26.367.47), with the majority contributed by respiratory medications (40.2%) followed by cardiovascular (18%) and vitamins/minerals (17.5%). Conclusion Pharmacist-coordinated early medication discharge planning has improved the delivery of bedside dispensing services, enhanced medication safety, and reduced medication costs.

respiratory, cutaneous/ limb and urinary tract (41.7%, 26.4% and 20.8% respectively). Positivity of blood cultures were 43.1%. A total of 66 subjects (91.7%) were mechanically ventilated (median duration 5 days), while 59 (81.9%) required inotropic support (median duration 3 days). Modalities for RRT were haemodialysis (HD) in 84.7% of cohort (n ¼ 61), peritoneal dialysis (PD) in 4.2% of cohort (n ¼ 3), or a combined modality of HD and PD in 11.1% of cohort (n ¼ 8). Median HD catheter days and PD catheter days were 4 days (IQR 3 days) and 2 days (IQR 3 days) respectively. Percentages of subjects receiving 1, 2, 3 and > 4 sessions of HD were 44.1%, 26.5%, 8.8% and 20.6% respectively. Median length of hospitalisation was 14 days (IQR 16 days) with in-hospital mortality of 54.2% (n¼ 39). Causes of death attributed directly to index infection, nosocomial infection and noninfectious causes were 74.4%, 10.3% and 15.4% respectively. Among survivors, 11 (34.4%) were functionally dependent at discharge. Predictors of mortality were use of mechanical ventilation, inotrope use, younger patients, and cutaneous/ limb infection. Comorbidities, CKD status, CCI, positivity of blood culture and SOFA score did not predict mortality. Conclusion: Mortality and morbidity remain high for patients with SA-AKI requiring RRT, primarily driven by the index infection.