Packed Red Blood Cell Transfusion Associates with Acute Kidney Injury After Transcatheter Aortic Valve Replacement

Background: Acute kidney injury after cardiac surgery significantly associates with morbidity and mortality. Despite not requiring cardiopulmonary bypass, transcatheter aortic valve replacement patients have an incidence of post-procedural acute kidney injury similar to patients who undergo open surgical aortic valve replacement. Packed red blood cell transfusion has been associated with morbidity and mortality after cardiac surgery. We hypothesized that packed red blood cell transfusion independently associates with acute kidney injury after transcatheter aortic valve replacement, after accounting for other risk factors. Methods: This is a single-center retrospective cohort study of 116 patients undergoing transcatheter aortic valve replacement. Post-transcatheter aortic valve replacement acute kidney injury was defined by Kidney Disease: Improving Global Outcomes serum creatinine-based criteria. Univariate comparisons between patients with and without post-transcatheter aortic valve replacement acute kidney injury were made for clinical characteristics. Multivariable logistic regression was used to assess independent association of packed red blood cell transfusion with post-transcatheter aortic valve replacement acute kidney injury (adjusting for pre-procedural renal function and other important clinical parameters). Results: Acute kidney injury occurred in 20 (17.2%) subjects. Total number of packed red blood cells transfused independently associated with post-procedure acute kidney injury (OR = 1.67 per unit, 95% CI 1.13–2.47, P = 0.01) after adjusting for pre-procedure estimated glomerular filtration rate (OR = 0.97 per ml/min/1.73m2, 95% CI 0.94–1.00, P = 0.05), nadir hemoglobin (OR = 0.88 per g/dL increase, CI 0.61–1.27, P = 0.50), and post-procedure maximum number of concurrent inotropes and vasopressors (OR = 2.09 per inotrope or vasopressor, 95% CI 1.19–3.67, P = 0.01). Conclusion: Packed red blood cell transfusion, along with post-procedure use of inotropes and vasopressors, independently associate with acute kidney injury after transcatheter aortic valve replacement. Further studies are needed to elucidate the pathobiology underlying these associations

Multi-gene measurable residual disease assessed by digital polymerase chain reaction has clinical and biological utility in acute myeloid leukemia patients receiving venetoclax/azacitidine

Venetoclax with azacitidine (ven/aza) is a lower-intensity therapeutic regimen that has been shown to improve outcomes in elderly patients with acute myeloid leukemia (AML). Measurable residual disease (MRD) using flow cytometry is a valuable tool for the prediction of relapse in AML using conventional therapies and ven/aza; however, the prognostic value for broadscale molecular MRD after ven/aza treatment is less clear. We aimed to determine the utility of retrospective assessment using multi-gene molecular MRD by droplet digital polymerase chain reaction (ddPCR). We found this approach correlates with outcomes in a cohort of patients receiving frontline ven/aza for AML. The predictive value of ddPCR MRD persisted when NPM1 mutations were removed from analysis, as well as after adjustment for the impact of stem cell transplant on outcomes. Late achievement of MRD negativity, including after SCT, was still associated with superior outcomes compared to persistently detectable MRD. We further explored the impact of ven/aza on the burden of different classes of mutations, and identified the persistence of splicing factor mutations, commonly associated with MDS, as a consistent finding after ven/aza treatment. These data add to our understanding of the effects of ven/aza on AML disease biology and provide details on molecular depth of remission that can guide prospective trials in the future

Higher-dose venetoclax with measurable residual disease-guided azacitidine discontinuation in newly diagnosed acute myeloid leukemia

Venetoclax+azacitidine is the standard of care for newly-diagnosed patients with acute myeloid leukemia (AML) for whom intensive chemotherapy is inappropriate. Efforts to optimize this regimen are necessary. We designed a clinical trial to investigate two hypotheses: i) higher doses of venetoclax are tolerable and more effective, and ii) azacitidine can be discontinued after deep remissions. Forty-two newly diagnosed AML patients were enrolled in the investigator-initiated High Dose Discontinuation Azacitidine+Venetoclax (HiDDAV) Study (clinicaltrials gov. Identifier: NCT03466294). Patients received one to three “induction” cycles of venetoclax 600 mg daily with azacitidine. Responders received MRD-positive or MRDnegative “maintenance” arms: azacitidine with 400 mg venetoclax or 400 mg venetoclax alone, respectively. The toxicity profile of HiDDAV was similar to 400 mg venetoclax. The overall response rate was 66.7%; the duration of response (DOR), event-free survival (EFS) and overall survival were 12.9, 7.8 and 9.8 months, respectively. The MRD negativity rate was 64.3% by flow cytometry and 25.0% when also measured by droplet digital polymerase chain recation. MRD-negative patients by flow cytometry had improved DOR and EFS; more stringent measures of MRD negativity were not associated with improved OS, DOR or EFS. Using MRD to guide azacitidine discontinuation did not lead to improved DOR, EFS or OS compared to patients who discontinued azacitidine without MRD guidance. Within the context of this study design, venetoclax doses >400 mg with azacitidine were well tolerated but not associated with discernible clinical improvement, and MRD may not assist in recommendations to discontinue azacitidine. Other strategies to optimize, and for some patients, de-intensify, venetoclax+azacitidine regimens are needed

Cognitive therapy for depressed adults with comorbid social phobia

Item does not contain fulltextBackground: Evidence Suggests that comorbid depression influences the outcome of cognitive behavioral treatment for patients presenting with social phobia. Little is known, however, about the influence of comorbid social phobia on the response to cognitive therapy (CT) for depression among adults presenting with recurrent major depressive disorder (MDD). These analyses seek to clarify this relationship. Methods: Patients (N 156) with recurrent DSM-IV MDD entered CT (20% also met DSM-IV criteria for social phobia). Every week during the course of CT, clinicians assessed depressive symptoms and patients completed self-report instruments measuring severity of depression and anxiety. Results: At presentation, outpatients with comorbid social phobia reported greater levels of depressive symptoms and clinicians rated their impairment as more severe, compared to their counterparts without social phobia. Patients with or without comorbid social phobia did not differ significantly in (1) attrition rates; (2) response or sustained remission rates; (3) time to response or sustained remission; or (4) rate of improvement in symptoms of depression or anxiety. Limitations: The lack of domain-specific measures limits inference with respect to the improvements in social anxiety that occur with CT of depression. Conclusions: These findings introduce the hypothesis that CT for depression may be flexible enough to treat the depressive symptoms of patients presenting with MDD who also suffer from social phobia

IMPLEMENTASI PRINSIP BAGI HASIL DI BANK MUAMALAH CABANG MAROS

ABSTRAKIQBAL S. Implementasi Prinsip Bagi Hasil di Bank Muamalat Cabang Maros (dibimbing oleh Minhajuddin dan Saleh Suratmin)Indonesia merupakan Negara dengan jumlah penduduk muslim terbesar di dunia, akan tetapi penerapan nilai nilai Islam secara Kaffah dan utuh dalam kehidupan sehari hari belum dilaksanakan seutuhnya. Misalnya dalam lembaga keuangan perbankan, perbankan syariah di Indonesia baru muncul pada tahun 1992 ketika di sahkannya Undang undang No 7 Tahun 1992 tentang Perbankan dalam Undang undang ini mulai mengakomodir perbankan syariah dengan nama perbankan bagi hasil, selanjutnya diganti dengan Undang undang No. 10 Tahun 1998 yang kemudian disempurnakan dalam Undang undang No. 21 Tahun 2008 .Permasalahan yang dihadapi adalah bagaimana implementasi prinsip bagi hasil dan risiko dalam kegiatan penghimpunan dana, implementasi prinsip bagi hasil dalam kegiatan pembiayaan di Bank Muamalah cabang Maros dan apa yang menjadi kendala operasional yang dihadapi dalam implementasi prinsip bagi hasil hasil tersebut.Penelitian ini menggunakan metode pendekatan doktrinal dan non doktrinal atau socio legal yakni memandang hukum bukan saja teks dalam Undang undang akan tetapi juga melihat hukum berinteraksi dengan masyarakat.Salah satu prinsip usaha Perbankan Syariah adalah akad Bagi Hasil dan resiko dimana bank dan nasabah membagi keuntungan berdasarkan rasio Bagi Hasil yang ditentukan sebelumnya. Fungsi perbankan adalah sebagai lembaga perantara (intermediary institution) antara pemilik dana dan orang yang membutuhkan dana, untuk itu kegiatan utama Perbankan Syariah adalah menghimpun dana dari masyarakat dan menyalurkan kembali dalam bentuk pembiayaan. Kegiatan penghimpunan dana di Bank Muamalah Cabang Maros dilakukan dengan prinsip wadiah dan mudharabah, beberapa produknya seperti giro wadiah bank Muamalat dalam mata uang Rupiah maupun Valas, pribadi maupun perusahaan, tabungan umat junior, tabungan simpatik. Sedangkan mudharabah seperti: Tabungan Haji, Tabungan Investa Cendekia, Tabungan Qurban dan Tabungan dengan Kartu SharE dan Deposito Mudharabah. Sedangkan penyaluran dana dalam bentuk pembiayaan Bagi Hasil adalah dengan akad mudharabah dan musyarakah. Prinsip Bagi Hasil ini merupakan karakteristik utama dalam Perbankan Syariah, akan tetapi dalam kegiatan pembiayaan di Perbankan Syariah masih rendah di bandingkan dengan pembiayaan lainnya seperti Murabahah (jual beli), hal ini disebabkan antara lain karena tingginya resiko yang harus di tanggung oleh bank apabila terjadi kerugian yang di akibatkan bukan dari kesengajaan atau kelalaian dari nasabah sehingga bank akan sangat berhati hati dalam memberikan pembiayaan kepada nasabah. Kendala lainnya adalah Sumber daya Manusia yang kurang memadai, manajemen perbankan syariah, system informasi dan teknologi, sikap masyarakat yang masih memandang Bank Syariah sama dengan bank Konvensional dan tidak adanya standar moral yang diterapkan dalam kegiatan pembiayaan

Prediction of acute-phase treatment outcomes by adding a single-item measure of activity impairment to symptom measurement: Development and validation of an interactive calculator from the star∗d and co-med trials

10.1093/ijnp/pyz011International Journal of Neuropsychopharmacology225339-34

Daily activity level improvement with antidepressant medications predicts long-term clinical outcomes in outpatients with major depressive disorder

Manish K Jha,1 Raymond B Teer,2 Abu Minhajuddin,3 Tracy L Greer,1 A John Rush,4 Madhukar H Trivedi1 1Center for Depression Research and Clinical Care, University of Texas Southwestern Medical Center, Dallas, 2University of Texas, Austin, 3Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA; 4Duke-NUS, Singapore, Singapore Background: Major depressive disorder (MDD) significantly impacts performance of both work- and nonwork-related routine daily activities. We have shown that work productivity is significantly impaired in employed MDD patients, but the extent of impairments in nonwork-related routine activities and its association with antidepressant treatment outcomes has not been established. Materials and methods: Activity impairment was measured using the sixth item of Work Productivity and Activity Impairment Scale in the Combining Medications to Enhance Depression Outcomes (CO-MED) trial (n=665). Published norms were used to define activity impairment levels. The relationship between activity impairment and baseline sociodemographic and clinical characteristics was evaluated along with changes in activity impairment and its relationship with other clinical outcomes such as symptom severity, function, and side effect burden. Remission status at 3 and 7 months was predicted based on week 6 activity impairment level. Results: Higher psychosocial and cognitive impairments and greater number of comorbid medical conditions were associated with greater activity impairment at baseline. Proportion of participants with severe activity impairment declined from 47.6% at baseline to 18.7% at 3 months, while mean activity impairment decreased from 57.1 at baseline to 32.8 at 3 months. During course of treatment, levels of activity impairment correlated most strongly with psychosocial function among measures of symptom severity, function, quality of life, and side effect burden. No or minimal activity impairment at week 6 was associated with two to three times higher rates of remission at 3 and 7 months as compared to moderate or severe activity impairment levels even after controlling for remission status at week 6 and select baseline variables. Conclusion: Depressed patients have high levels of nonwork-related activity impairment at baseline that improves significantly with treatment and independently predicts long-term clinical outcomes. Brief systematic assessment of activity impairment during the course of antidepressant treatment can help inform clinical decision-making. Keywords: depression, activity impairment, predictors, functional recovery, productivit