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PURPOSE@#To develop and validate a clinical scoring model to predict 1-year access survival among end-stage renal disease (ESRD) patients who received a new arteriovenous fistula (AVF).@*METHODS@#The data of 195 ESRD patients in the development cohort who underwent first-time AVF creation between January 2009 and June 2013 and who had successful cannulation for dialysis use were reviewed. The clinical features that were significantly associated with 1-year AVF survival were incorporated into a clinical scoring model. The validity of this clinical score was then tested in a validation cohort of 204 ESRD patients who received a new AVF between July 2013 and December 2017.@*RESULTS@#Of the 195 patients in the development cohort, 168 patients (86.2%) had a well-functioning AVF at 1 year. Absence of diabetes mellitus, no previous history of central venous catheter insertion, and absence of intervention performed to achieve access maturation were positively associated with 1-year AVF survival. These 3 factors were incorporated into a clinical scoring model, which ranged from 0 to 4 points. For a cutoff score of ≥3, the sensitivity, specificity and area under the receiver operating characteristic curve to predict 1-year AVF survival were 81.5%, 70.4%, and 0.760, respectively. The predictive performance of the clinical score was confirmed in the validation cohort, with a sensitivity of 76.1%, a specificity of 64.4% and an area under the curve of 0.703.@*CONCLUSION@#The scoring model using clinical data yielded acceptable performance in predicting 1-year access survival among patients receiving a new AVF.
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Abstract Fungal Peptic Ulcer Perforation: a Case Report Yuthapong Wongmahisorn MD, FICS Arkom Suesawatee MD Suphakarn Techapongsatorn MD, FICS, MSc Department of Surgery, BMA Medical College and Vajira Hospital Peptic ulcer perforation is the most common complication of peptic ulcer disease. Surgical management is the standard treatment. The mortality and mobidity depend on age, underlying disease, delay of operation, pre-operative status. The Helicobacter pylori is the common organism that related to and should be treated with peptic ulcer perforation. In this report, we present the patient who had peptic ulcer perforation and septicemia from Candida albicans. This is an uncommon organism in peptic ulcer disease. In spite of the surgical management, appropriate antibiotics and anti-fungal agents, the patient died during post-operative period. Vajira Med J 2009 ; 53 : 299-304