Brachiobasilic versus brachiocephalic arteriovenous fistula: A prospective randomized study

BackgroundThe most recent Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines recommend that the order of preference for arteriovenous fistula (AVF) placement is the radial-cephalic primary AVF, followed by the secondary brachiocephalic (BC) and, if either of these is not viable, then brachiobasilic (BB) AVF should be fashioned. However, there is limited prospective data comparing technical and clinical outcomes of these two approaches. The purpose of our study was to compare outcome, patency, and complication rates in these two autogenous upper arm AV accesses.MethodsBetween December 2003 and and January 2007, patients (61 male, 39 female) who have lost more distal AVFs were enrolled in the study. After preoperative duplex mapping, patients with patent both basilic and cephalic veins greater than 3 mm of diameter were randomized into BCAVF and BBAVF groups, each group consisting of 50 patients. All procedures were performed under local anesthesia as one-stage procedures. Follow-up data were prospectively collected. Kaplan-Meier analysis was used to calculate primary and secondary patency rates. Univariate and multivariate Cox-regression analysis was used to find risks for the occurrence of thrombosis.ResultsBaseline demographics, clinical characteristics, and preoperative history dialysis access were comparable between groups with the exception of the fact that mean caliber of the basilic veins were larger (4.51 ± 0.93 mm vs 3.90 ± 0.1 mm; P = .002). The mean duration of operation was significantly shorter in the BC group compared with the BB group (P < .001). There was no significant difference in the thirty day mortality, wound complications, 24 hour thrombosis, postoperative hemorrhage, maturation, and time to maturation between the groups. Mean follow-up was 43.2 ± 1.8 months. Primary patency at 1 and 3 years of follow-up was 87% and 81% for the BC group and 86% and 73% for the BB group (P = .7) Secondary patency at one and three year follow-up was 87% and 70% for the BC group and 88% and 71% for the BB group, respectively (P = .8). Twenty-eight patients (28%) in the BC (18 patients) and BB (10 patients) group died with a patent fistula during the follow-up period (P = .18). Multivariate analysis revealed that use of dominant arm increased the risk of fistula failure.ConclusionWe conclude that brachiobasilic and brachiocephalic AVF are equally effective alternatives; however, a longer and demanding operation with BB AVF construction should be considered

Lyme Arthritis in Primary Care; Case Report

Primary health care is the closest point to the patient. The person who is ill or suspicious of his / her health goes to the family physician, the family health center or the closest health institution. The correct diagnosis and treatment at Primary health care center is of great importance in terms of the cost effectiveness and public health improvement. Lyme arthritis is one of the diseases caused by Borrelio Burgdorferi, spirochete passing through the bite of the hard ticks of Ixodes. Infections may involve the skin, central nervous system, heart, eye and other organs, while in most cases joints are the main site of involvement. A very small percentage of children presenting with arthritis complaints have Lyme arthritis. In Europe, the most common form of arthritis following bacterial infection in children and adolescents is Lyme arthritis. Frequently, joint swelling is accompanied by pain. In this case report, we present a patient with Lyme arthritis who complained of pain, swelling, and inability to walk

In a real-life setting, direct-acting antivirals to people who inject drugs with chronic hepatitis c in Turkey

Background: People who inject drugs (PWID) should be treated in order to eliminate hepatitis C virus in the world. The aim of this study was to compare direct-acting antivirals treatment of hepatitis C virus for PWID and non-PWID in a real-life setting. Methods: We performed a prospective, non-randomized, observational multicenter cohort study in 37 centers. All patients treated with direct-acting antivirals between April 1, 2017, and February 28, 2019, were included. In total, 2713 patients were included in the study among which 250 were PWID and 2463 were non-PWID. Besides patient characteristics, treatment response, follow-up, and side effects of treatment were also analyzed. Results: Genotype 1a and 3 were more prevalent in PWID-infected patients (20.4% vs 9.9% and 46.8% vs 5.3%). The number of naïve patients was higher in PWID (90.7% vs 60.0%), while the number of patients with cirrhosis was higher in non-PWID (14.1% vs 3.7%). The loss of follow-up was higher in PWID (29.6% vs 13.6%). There was no difference in the sustained virologic response at 12 weeks after treatment (98.3% vs 98.4%), but the end of treatment response was lower in PWID (96.2% vs 99.0%). In addition, the rate of treatment completion was lower in PWID (74% vs 94.4%). Conclusion: Direct-acting antivirals were safe and effective in PWID. Primary measures should be taken to prevent the loss of follow-up and poor adherence in PWID patients in order to achieve World Health Organization’s objective of eliminating viral hepatitis

Assessment of obesity frequency and related factors on ındividuals attending to the department of nutrition and dietetics

Amaç: Bu çalışma, Ankara Üniversitesi Tıp Fakültesi İbn-i Sina Eğitim ve Araştırma Hastanesi, Beslenme ve Diyet Bölümü’ne başvuranlarda obezite durumu ve etkili faktörlerin belirlenmesi amacıyla yapılmış bir araştırmadır. Çalışma Planı: Araştırma tanımlayıcı bir araştırma olup, ilgili bölüme başvuran ve araştırmaya katılmayı kabul eden 450 kişi üzerinde yürütülmüştür. Veri toplama aracı olarak 5 bölüm ve 59 so- rudan oluşan anket formu kullanılmıştır. İstatistiksel analizlerde ki-kare testi uygulanmış, yanılma olasılığı 0.05 olarak alınmıştır. Bulgular: Araştırma grubunda obezite oranı %28.0 olarak bulunmuştur. Obezite durumu cinsiyet, yaş, medeni durum, öğrenim düzeyi, meslek, aylık gelir gibi sosyodemografik özelliklerle ilişkili bulunmuştur. Evlilik süresi, çocuk sayısı, çocukluk çağında şişman olma durumu, daha önce obezite tedavisi görme ve daha önce zayıflamak için diyet yapma durumunun ve menopozun obezite durumunu etkilediği belirlenmiştir. Ailesinde obez bir kişi bulunanların, ana ve ara öğünleri atlayanların daha yüksek oranda obez olduğunun belirlenmesi, obezitenin beslenme biçimi ile ilişkili olduğunu düşündürmektedir. Sonuç: Obezitenin ortaya çıkmasında beslenme alışkanlıklarının yanı sıra, yaşam biçimi, yaş, cin- siyet ve sosyoekonomik özellikler gibi birden çok faktörün etkili olduğu düşünülmektedir. Bu nedenle yüksek risk taşıyan bireylere öncelik verilerek değiştirilebilir faktörlere yönelik korunma ve müdahale çalışmalarının düzenlenmesinin, obezitenin önlenmesi ve kontrolünde etkili olacağı düşünülmektedirObjectives: This research was planned to assess the obesity and related factors on individuals ap- plying to the department of Nutrition and Dietetics, İbn-i Sina Training and Research Hospital, Medi- cal School, Ankara University. Study Design: This descriptive study was conducted on 450 people accepted to participated in the study. The data were collected by a questionnaire including 5 sections and 59 questions. In statisti- cal analyses, test of chi-square was used and p value below 0.05 was accepted to be statistically significant. Results: The obesity ratio was 28.0% and obesity was associated with some sociodemographic characteristics such as gender, age, marital status, educational level, and monthly income. Duration of marriage, number of children, obesity in childhood, having obesity treatment before, dieting for loosing weight and menoupose were indicated to influence the obesity. High obesity ratios in participants having family history of obesity, neglecting main and in-between meals were contributed that obesity was related to nutritional habits. Conclusion: In the development of obesity it is thought that multiple factors such as nutritional habits, life-style, age, gender, and sociodemographic characteristics are effective. Therefore, for the prevention and control the obesity, it is suggested to develop modifiable risk factor centered pre- ventive and interventional studies prioritizing individulas under high risks will be convenient

Bilateral Tibial Stress Fractures in a Young Man Associated with Idiopathic Osteoporosis - Case Report

Stress fractures are defined as a partial or complete fracture of bone due to an inability to endure a non-violent stress. Two factors have been proposed to explain the aetiology of stress fractures: muscle fatigue, and direct muscle action. We want to point to third factor with our case report: Osteoporosis. (From the World of Osteoporosis 2010;16:58-60

Analyzing Attitude towards COVID-19 Vaccine in the Context of the Health Industry: The Role of Country of Origin Image

Aim: The aim of this study is to investigate individuals’ attitude towards the coronavirusdisease 2019 (COVID-19) vaccine, and explain vaccination intention in the framework of thetheory of reasoned action. The study extends the theory of reasoned action with country oforigin image variable.Material and Methods: The data of the study were collected by survey method. The surveyconsists of a total of 48 items, including individual innovativeness, subjective norms, attitudetowards COVID-19 vaccine, intention to get COVID-19 vaccine, country of origin image,demographic characteristics, and general opinions about the vaccine and COVID-19. 333participants answered the surveys. Data were analyzed by structural equation modeling usingSPSS v.21 and AMOS v.23 package programs.Results: Attitude towards German COVID-19 vaccine (?=0.888, p<0.001) and German’scountry of origin (?=0.436, p<0.001) variables have significant and positive relationships withintention to get German vaccine. Subjective norms (?=0.750, p<0.001), China’s country ofimage (?=0.265, p<0.001), attitude towards Chinese COVID-19 vaccine (?=0.198, p<0.001),variables have significant and positive relationships with intention to get Chinese COVID-19vaccine. Country of origin image is significantly and positively related to both attitude towardsGerman COVID-19 vaccine (?=0.690, p<0.001) and Chinese COVID-19 vaccine (?=0.461,p<0.001).Conclusion: The most important factor associated with the intention to get German COVID19 vaccine is the attitude towards the COVID-19 vaccine. The most important factor associatedwith the intention to get Chinese COVID-19 vaccine is the subjective norm. Country of originimage is a significant variable for both countries

Evaluation of articular eminence pneumatization using cone beam computed tomography

Aim. Knowledge about the anatomy of the temporomandibular joint (TMJ) and its surrounding structures is mandatory for success in surgical interventions and for understanding the pathway of spread of infections in this region. This study aims to investigate the anatomy and morphology of pneumatized articular eminence (PAT) using cone beam computed tomography (CBCT) imaging in a group of patients. Methods. A retrospective study on 825 patients (377 males, 448 females) aged between 18 and 91 years was performed using sagittal and coronal CBCT images. PAT was defined as non-expansile, nondestructive cyst-like radiolucency in the zygomatic process of the temporal bone, which appears similar to the mastoid air cells. It was classified in two groups as unilocular and multilocular. Statistical comparison of gender, age and localization was performed using chi-square test and correspondence analysis. P0.05). Conclusion. Pneumatization of the articular eminence is a challenging entity for TMJ surgery and spread of infections in this region. Practitioners who are dealing with TMJ surgery and pathology should have detailed information about this anatomical variation since it may cause serious complications

The Comparison Between Topical 5-Fluorouracil and Trichloroacetic Acid in The Treatment of External Genital Condyloma Accuminatum

OBJECTIVE: To investigate the effects of fluorouracil cream and 80% trichloroacetic acid solution in the treatment of condyloma accuminatum. STUDY DESIGN: 35 non-pregnant women with a diagnosis of vulvar condyloma accuminatum were randomly assigned to two groups as,5-fluorouracil group (n=17) and trichloroacetic acid group (n=18). All patients were examined after 7 days and after 6 months and were evaluated with respect to the effectiveness, side effects and recurrence rates. RESULTS AND CONCLUSION : Both methods were found to be effective in the treatment of external condyloma accuminatum. When the two groups were evaluated with respect to cost per patient, the average cost was detected to be 2 USD for the trichloroacetic acid group and 20 USD for the 5-fluorouracil group