Asia’s first valve implant without surgery

Star: KUALA LUMPUR: The National Heart Institute (IJN) achieved another milestone by performing the first heart valve implant in Asia without the need for open heart surgery.
The procedure has a 99% success rate.
Known as trans-catheter aortic valve implantation (Tavi), the procedure allows for problematic valves in the aorta to be replaced with an artificial one by using a catheter, a tube that is 6mm in diameter.
The tube is inserted either in the thigh or below the left collar bone and then slid through arteries to the heart.
“Patients, who have gone through Tavi, will be able to move around on the third day after the implantation but they will be required to lie down during the first 24 hours,” said IJN medical director Datuk Seri Dr Robaayah Zambahari during a press conference yesterday.
The procedure, which uses a device called CoreValve, causes less trauma to body tissues and enables a faster recovery compared to the conventional open heart surgery as only incisions are made at certain areas to insert the tube.
Dr Robaayah was part of the team of IJN consultants which performed the procedure on two patients on Nov 25; a 73-year-old man and a 77-year-old man, both of whom had severe narrowing of heart valves.
The third patient is National Laureate Datuk Shahnon Ahmad, 76, who was treated the next day.
Other team members were cardiologists Datuk Dr Rosli Mohd Ali, Dr Shaiful Azmi and cardiothoracic surgeons Datuk Dr Mohd Azhari Yakub, Dr Jeswant Dillon and anaesthesiologists Datuk Dr Mohamed Hassan Ariff and Dr Sharifah Suraya.
The procedure was assisted by Dr Ganesh Manoharan, a consultant interventional cardiologist from Ireland, who will oversee the operations of the next 12 to 15 patients currently on the waiting list.
The CoreValve device costs RM112,000 while another RM10,000 is needed for other operation costs.
Dr Robaayah hoped that the Health Ministry would support and subsidise the procedures for the public in future. The current ones were borne by the institute.
Dr Robaayah said there had yet to be any case of a patient rejecting the artificial valve, which is made out of a type of metal called Nitinol.
The procedure takes between 45 minutes and one-and-a-half hours.
“We took about two-and-a-half hours for the first patient because we were still learning about the procedure and wanted to be careful,” she said, adding that the method was only performed on high-risk patients such as the elderly.
Dr Ganesh said local anaesthesia was applied to the patients and they remained conscious during the procedure.
“It is not surprising to see patients smiling as we conduct the procedure on them,” he said.
Dr Ganesh said about 50 centres worldwide were using the technology, adding that it was suitable for Asians as their blood vessels were generally smaller.

90% don’t use condoms

Star: GEORGE TOWN: Some 90% of drug users do not use condoms and this is a source of worry because it can contribute to the rise of HIV/AIDS cases, said social activist Datin Paduka Marina Mahathir.
Marina, an Asia Pacific Leadership Forum on HIV/AIDS steering committee member, said drug users continued to neglect the use of condoms despite the contraceptives being distributed for free by some non-governmental organisations (NGOs).
“Condoms are 98% safe and it can present an affordable way to combat the spread of the disease,” she told reporters yesterday after the opening of the World HIV/AIDS Day national conference.
The two-day conference was launched by Health Minister Datuk Seri Liow Tiong Lai.
Marina said 24-hour convenience stores should be allowed to sell condoms off-the-shelf although some state governments were against it.
Malaysian AIDS Council vice-president Datuk Zaman Khan said the distribution of free condoms did not mean that NGOs were encouraging free sex.
In his speech, Liow said the country was on track towards achieving the United Nations Millennium Development Goal of halting and reversing the spread of HIV by 2015.
He said the disease remained a potent threat because of the increasing infection through sex and more women were becoming infected.
Liow said the notification rate of HIV/AIDS in the country had continued to fall each year after it peaked at 6,978 cases or 28.5% per 100,000 population in 2002.
Last year, it was 13.3% per 100,000 population and this year indication shows that it may drop to 11% per 100,000.
“I am optimistic that the country can arrest the spread of HIV/AIDS by 2015 based on current trends,” he said.

Brace for rise in H1N1 cases

Star: GEORGE TOWN: The recent increase of Influenza A(H1N1) cases in the northern hemisphere serves as a reminder for countries to be alert for a possible second wave of the flu.
Health Minister Datuk Seri Liow Tiong Lai said 95% of countries in the northern hemisphere had recorded a rise in new cases.
The ministry, he said, had stepped up efforts to ensure the second wave was kept at bay in Malaysia. He added that the country must remain vigilant as the outbreak was still at Level Six, the highest of the World Health Organisation’s pandemic alert scale.
‘‘We cannot take this lightly although the H1N1 outbreak has stabilised in the country.
“We must ensure, where possible, that a second wave does not hit us,” he told reporters yesterday after launching the World HIV/AIDS Day national conference.
As of yesterday, the death toll still stood at 77 out of 12,210 confirmed cases while four patients remained in critical condition. For the week ended on Nov 28, a total of 589 cases were reported for flu-like illnesses, of which 573 have been discharged, said Liow.
To prepare for the second wave, he said the ministry had vaccinated 6,617 frontliners.
He said the ministry had also upgraded its surveillance system by improving early detection in all states including having the main command centre operating around-the-clock, and stock-piling anti-viral drugs at its pharmacies.
He advised people, especially those travelling during the school holidays, to take extra precautions. Meanwhile, Health director-general Tan Sri Dr Ismail Merican said 10 patients tested positive for the A(H1N1) flu last week.

WHO: More women getting HIV from their husbands

Star: KUALA LUMPUR: About 30% of all new HIV cases in Malaysia are women, a 400% increase compared with five years ago.
“It is an alarming figure. This finding has changed the previous perception that homosexuals and drug users are more vulnerable to HIV/AIDS.
“It has brought a new set of issues that we need to deal with and it is becoming more complex now,” said the United Nations Resident Coor­dinator Kamal Malhotra at the launch of The Red Carnival in conjunction with World AIDS Day at Sungei Wang Plaza yesterday.
Organised by PT Foundation for the 11th year, the two-day event has brought people from all walks of life especially youths in efforts to boost awareness on HIV/AIDS.
The findings, revealed by a World Health Organisation study on women’s health around the world last month, necessitated a new approach in dealing with HIV/AIDS.
“It should be dealt with as more than a health issue, but with the religious and legal aspects as well,” he said.
As of today, there are 33.4 million people around the world who are infected and living with HIV.
There were nearly three million new cases last year.
In Malaysia, 85,000 people have been infected with the disease, with about 15 new cases daily.
Up to June, a total of 1,497 people were infected.
A total of 315 Malaysians have died from AIDS.
PT Foundation chairman Hisham Hussein said many women and children had been infected with HIV/AIDS in the last few years.
He said most of these women did not see themselves as the vulnerable group that could get infected.
“They believe that they would not get infected because they are not drug users nor do they have multiple sexual partners.
“Yet they get it from their husband,” he said.
Hisham had urged the public to change their attitude about HIV/AIDS and to reduce stigma and discrimination against those who are infected with the ailment.

Health Ministry issues nationwide dengue alert

Star: PETALING JAYA: The Health Ministry has announced a nationwide dengue alert following an increase of 99 reported dengue cases within a week with two deaths in Malacca and one in Penang.
Deputy health director-general Datuk Dr Hasan Abdul Rahman said that 819 cases were reported last week (Nov 15 to 21) compared with 720 the week before (Nov 8 to 14).
“We have issued a dengue alert to state health directors and doctors to keep a look out for the cases,” he said.
The total number of reported cases for this year until last week was 36,514 with 78 deaths compared with 41,034 and 90 deaths last year.
Dr Hasan said if the public did not take the necessary action to remove aedes breeding sites, the number of cases could double next month.
Explaning that the drastic increase in dengue cases was due to the rainy season, he said: “Despite our awareness programme, the response from the public has not been encouraging.”
Speaking at a dialogue session on 1Malaysia Fight Against Dengue yesterday, Dr Hasan said the ministry had carried out surveys and found that people were aware of where and how aedes breeds in the house and outside but most of them neglected to check on those areas.
“They tend to think that it’s the Government’s responsibility, but we need cooperation from the people,” he said.
In the last three months, Sarawak recorded the highest number of increase with 331 cases last week, making it a total of 2,847 cases this year.
In total, Selangor recorded the highest number of cases in the country at 16,984.
Dr Hasan said that the World Health Organisation (WHO) had also placed the country on avian influenza alert following some reported cases in neighbouring countries.
There were no cases recorded in Malaysia and the Veterinary Services Department was monitoring the situation throughout the country while the ministry exchanged information with other countries in Asean as well as with the WHO.
Universiti Malaya medical microbiology department professor Dr S. Shamala Devi, who also spoke at the dialogue, said that people might get both Influenza A(H1N1) and avian influenza at the same time if their immune system was weakened.

In Kota Kinabalu, Deputy Health Minister Datuk Rosnah Abdul Rashid Shirlin said there were 199 cholera cases as of yesterday in the two affected states – Terengganu (185) and Kelantan (14).
She said health officials were now using different antibiotics to treat patients following the detection of a new strain of cholera in Thailand.
“The two states are close to Thailand. We believe that it is due to water contamination,” she said, adding that the 17 cholera cases detected in Sabah earlier this month was due to the “usual” strain found in the country.
Rosnah said that the cholera patients in Terengganu and Kelantan were not from relief centres but other areas.
“Our officers are closely monitoring the health situation at the flood relief centres,” she said.
The first case of cholera was detected in Terengganu earlier this month.
One person has died from it.

Ensuring cheaper private healthcare

Star: PUTRAJAYA: The public can soon seek medical treatment at private clinics and not worry too much about high costs.
This is because the Government is considering paying a portion of the bill for treatment at private clinics under a proposed healthcare reform plan which is expected to be ready next year.
Health Minister Datuk Seri Liow Tiong Lai said the details and quantum of payment have not been worked out but the plan would ensure that the public could get quality medical service at their convenience.
“The plan is to pay a portion of the bill but there is a cap to the amount,” he told reporters yesterday after a courtesy call from World Health Organisation (WHO) director-general Dr Margaret Chan and Chinese deputy health minister Wang Guoqiang at his office here,
“The public will pay the remaining amount,” said Liow, adding that WHO had offered their expertise and advice.
Liow said the proposed healthcare reform would also see the Government introducing the national health financing scheme.
He said the ministry was studying several models implemented in other countries such as paying medical bills through deduction from the Employees Provident Fund or a tri-parte payment scheme were medical cost would be borne by the patient, his employer and the government.

Improve quality of care for post-partum period, docs urged

Star: PETALING JAYA: Doctors need to improve the quality of care for the post-partum period, said Health director-general Tan Sri Dr Ismail Merican.
He said 60% of the deaths occurred during post-natal period and the rate was higher among women over 40 and those who had given birth more than five times, he said.
“Patient factors such as unbooked cases (where mothers did not receive antenatal care and did not register with a health facility for child delivery) and non-compliance to doctors’ advice, admission and therapy were identified as contributory factors to maternal deaths.”
Common remediable clinical factors included failure in communication and lack of technical knowledge and skill that resulted in failure to recognise early warnings, he added.
Dr Ismail said for every maternal death there were many “near misses” and this might provide doctors with more information on areas for improvement than mortality figures.
The implementation of inquiry recommendations and guidelines had shown to improve maternal health policies, procedures and practices and save the lives of mothers and their babies, he said.
He pointed out there was a steep rise in Caesarean section rates over the world with patients not fully understanding the risks involved. Since they might suffer complicated subsequent operative procedures, he urged senior doctors to be more actively involved in the management of high risk cases.
He added that the risks involved must be discussed and informed consent obtained and documented.

Health Ministry to take over new centre

Star: KUCHING: The Federal Government has agreed to take over the newly completed Sarawak International Medical Centre (SIMC) in Samarahan, near here.
Deputy Chief Minister Tan Sri Dr George Chan Hong Nam said the Health Ministry was now evaluating the centre’s buildings and facilities.
“An occupation permit has been obtained, and all the essential facilities are available to start operations.
“I will ensure that the Health Ministry will be able to operate the SIMC as a general hospital for the benefit of the people within the shortest possible time,” he added.

New strain of cholera found

Star: PUTRAJAYA: Those in Terengannu suffering from diarrhoea or vomiting should seek immediate medical attention, said Health Minister Datuk Seri Liow Tiong Lai.
This, he added, was because of the outbreak in the state of a new strain of cholera that has already caused one death.
He said severe dehydration from vomiting or diarrhoea would affect vital organs, especially the kidneys and if help was not sought quickly enough, the patient could die from organ failure.
“The current outbreak in Terengganu is caused by a new strain that is resistant to the antibiotics usually used to treat cholera.
“Although we can still treat it, we want those suffering from such symptoms to go to the nearest medical facility quickly to ensure early diagnosis,” Liow told a press conference after attending the National Food Safety and Dietary Council meeting and launching the Infants and Children’s feeding guidelines here yesterday.
Liow said there have been 174 confirmed cholera cases in the state since the outbreak on Nov 11 and it was suspected to have been due to food, especially ice-cubes, that was not hygienically prepared.
He said all those confirmed suffering from cholera were warded in hospitals and only allowed to return home if there was no trace of the bacteria in their faeces for three consecutive days. Hospitals in the state have so far discharged 33 of the patients.
“We have already dispatched a surveillance team to start conducting checks to identify the source of the problem and expect it to complete the task soon.
“We want to advise the people to observe good hygiene in food preparation, eat cooked food and avoid eating in shops where the cleanliness is questionable,” he said.
Liow also said the outbreak in Terengganu was not caused by the recent floods and did not involve any of those placed in various flood relief centres.