Short term outcomes of brachio - basilic fistula with immediate superficialization for haemodialysis in chronic renal failure patients

The aim of this study was to assess the immediate and early results of brachio-basilic shunts with immediate superficialization created for chronic haemodialysis. Twenty chronic renal failure patients who had failure of the primary A-V fistula and need a second method for angioaccess were enrolled in the study. Patients' selections were done after detailed history, physical examination, laboratory investigations, colour duplex evaluation of brachial artery and basilic vein and optimizations of the hemodynamic and coagulation status. Surgery was performed under appropriate anesthetic techniques. Antibiotics postoperatively may be used depending on the operating circumstances and considering the patients individual susceptibility to infection. No anticoagulation should be used at least 48 hours postoperatively. Maintenance of adequate hydration and blood pressure both during operation and in the post operative period is important. Follow up of patients for thirty days postoperatively regarding; any complications, Colored duplex for reevaluation of the shunt, and assessment of the feasibility of the shunt for dialysis. our study include 20 patients; 13 male and 7 female, their age ranging from 17 to 70 years and 70% of our patients were in the 5th or sex decade with undefined etiology of renal failure. 45% of our patients had other associated disease, while 55% had previous trials of AVF, 20% had failure of the procedure, and 35% had postoperative complications. The study showed that the age, size of vein and artery pre-operatively previous trials had no significant effect on the outcome of the shunt. While the diseases associated with chronic renal failure showed significant difference on the outcome of the shunt. the brachio basilic fistula with immediate superficialization is a reliable method for angioaccess for hemodialysis in patients suffering chronic renal failure had been losing their primary angioaccess or having poor superficial veins

Ramadan fasting: relation to atherogenic risk among obese muslims

Increased platelet aggregation as well as changes in coagulation factors have an important effect on the occurrence of atherogenicity and cardiovascular diseases. Fasting in general has been used in medicine for medical purposes when other measures fail. Since Ramadan fasting is different from total fasting, the present work was conducted to study the effect of Ramadan fasting on lipid pattern, some blood coagulation parameters, blood pressure and body mass index [BMI] - as atherosclerotic risk factors - in one hundred and three apparently healthy obese volunteers [15 men and 88 women] aged 15-52 years. The study comprised an initial visit for assessment V1 [before Ramadan] and three other follow up visits: V2 [at the end of Ramadan], V3 [4 weeks after Ramadan] and V4 [8 weeks after Ramadan], Targets were subjected to an interview questionnaire, complete physical and clinical examination, anthropometric measurements, dietary profile, and laboratory assay of complete blood picture [CBC], fasting serum glucose level [FSG], serum lipid pattern: total cholesterol [TC], triglycerides [TG], high density lipoproteins [HDL-c] and low density lipoprotein [LDL-c], lipoprotein a Lp [a], apolipoprotein A1 [APA], and apolipoprotein B [APB] levels; bleeding [BT] and clotting time [CT], prothrombin time [PT], activated partial thromboplastin time [APTT], fibrinogen and plasma factor VII activity. Statistical analysis was performed using Chi squared, Fisher exact, Student t test, paired t test and Pearson's correlation coefficient. Statistical significance was defined at P<0.05. The study showed that by the end of Ramadan fasting, there was a significant improvement in the mean levels of hemoglobin [Hb], TC, TG, HDL-c, LDL-c, TC/HDL, LDL/HDL, Lp [a], APA, APB, PT and systolic [SBP] and diastolic blood pressure [DBP] that persisted for four weeks after fasting [P<0.05]. Ramadan fasting has not adversely affected leucocytic count or coagulation parameters [P>0.05]. There was also a significant association between dietary intake, SBP, DBP, weight, BMI, percent body fat and waist, fibrinogen and factor VII activity and TC, TG, HDL-c, LDL-c, LDL/HDL, Lp [a] and APB [P<0.05]. The model of Ramadan fasting could be followed as a behavior modification program to control or prevent atherogenicity because of its positive impact on the lipid pattern, blood count and coagulation parameters