Serum Cystatin C as an Early Marker of Neutrophil Gelatinase‐associated Lipocalin‐positive Acute Kidney Injury Resulting from Cardiopulmonary Bypass in Infants with Congenital Heart Disease

ObjectiveAcute kidney injury (AKI) is a common complication resulting from cardiopulmonary bypass in infants. Urinary neutrophil gelatinase‐associated lipocalin (NGAL) is a sensitive and specific marker of such injury. In this study, we compared the performance of serum cystatin C (Cys C) and serum creatinine (Cr) as early markers of renal dysfunction in infants undergoing cardiac surgery under bypass.Study Design, Setting, and PatientsThe study was designed as a prospective observational study. The study was conducted in the cardiac intensive care unit (ICU) of a tertiary, academic children's hospital in the United States. Infants (age <1 year) undergoing cardiac surgery under cardiopulmonary bypass were included in the study.Outcome MeasureAcute kidney injury was defined based on postoperative urinary NGAL.ResultsA total of 17 infants were included in the study, and five of them developed AKI. Serum Cys C and Cr levels were measured postoperatively on days 1, 2, and 3, and compared with baseline levels. On postoperative day 2, infants with AKI showed significant change from baseline in serum Cys C levels compared with non‐AKI infants (28% vs. −9%, P = .03). The two groups did not show significant differences with respect to rise in serum Cr on any of the 3 postoperative days. Serum Cr on days 1 and 2 showed nonspecific increases in both AKI and non‐AKI groups. The area under the receiver operating characteristic curve for day 2 Cys C was 0.87 (95% CI 0.67–1.00) in recognizing NGAL‐positive AKI.ConclusionsPostoperative serum Cys C appears to be a more specific and sensitive biomarker for NGAL‐positive AKI resulting from cardiopulmonary bypass surgery in infants undergoing cardiac surgery.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/113151/1/chd12253.pd

CARACTERÍSTICAS SOCIOECONÔMICAS DO ACESSO POR MULHERES AO MICROCRÉDITO EM UMA INSTITUIÇÃO DE CRÉDITO NO SUL DE SANTA CATARINA, NO PERÍODO DE 2002-2012

O presente artigo tem como objetivo geral descrever características socioeconômicas do acesso ao microcrédito por mulheres em uma Instituição de Crédito no Sul de Santa Catarina, no período de 2002-2012. Em uma versão ampliada, originalmente, a pesquisa foi apresentada como Trabalho de Conclusão do Curso de Economia da Universidade do Extremo Sul Catarinense - UNESC (2013/1) da primeira autora. A pesquisa foi exploratória, descritiva, bibliográfica e documental

CARACTERÍSTICAS SOCIOECONÔMICAS DO ACESSO POR MULHERES AO MICROCRÉDITO EM UMA INSTITUIÇÃO DE CRÉDITO NO SUL DE SANTA CATARINA, NO PERÍODO DE 2002-2012

O presente artigo tem como objetivo geral descrever caracter&iacute;sticas socioecon&ocirc;micas do&nbsp;acesso ao microcr&eacute;dito por mulheres em uma Institui&ccedil;&atilde;o de Cr&eacute;dito no Sul de Santa Catarina,&nbsp;no per&iacute;odo de 2002-2012. Em uma vers&atilde;o ampliada, originalmente, a pesquisa foi&nbsp;apresentada como Trabalho de Conclus&atilde;o do Curso de Economia da Universidade do&nbsp;Extremo Sul Catarinense - UNESC (2013/1) da primeira autora. A pesquisa foi explorat&oacute;ria,&nbsp;descritiva, bibliogr&aacute;fica e documental

2015 SCAI/ACC/HFSA/STS Clinical Expert Consensus Statement on the Use of Percutaneous Mechanical Circulatory Support Devices in Cardiovascular Care: Endorsed by the American Heart Assocation, the Cardiological Society of India, and Sociedad Latino Americana de Cardiologia Intervencion; Affirmation of Value by the Canadian Association of Interventional Cardiology-Association Canadienne de Cardiologie d\u27intervention.

Although historically the intra-aortic balloon pump has been the only mechanical circulatory support device available to clinicians, a number of new devices have become commercially available and have entered clinical practice. These include axial flow pumps, such as Impella(®); left atrial to femoral artery bypass pumps, specifically the TandemHeart; and new devices for institution of extracorporeal membrane oxygenation. These devices differ significantly in their hemodynamic effects, insertion, monitoring, and clinical applicability. This document reviews the physiologic impact on the circulation of these devices and their use in specific clinical situations. These situations include patients undergoing high-risk percutaneous coronary intervention, those presenting with cardiogenic shock, and acute decompensated heart failure. Specialized uses for right-sided support and in pediatric populations are discussed and the clinical utility of mechanical circulatory support devices is reviewed, as are the American College of Cardiology/American Heart Association clinical practice guidelines

2015 SCAI/ACC/HFSA/STS Clinical Expert Consensus Statement on the Use of Percutaneous Mechanical Circulatory Support Devices in Cardiovascular Care: Endorsed by the American Heart Assocation, the Cardiological Society of India, and Sociedad Latino Americana de Cardiologia Intervencion; Affirmation of Value by the Canadian Association of Interventional Cardiology-Association Canadienne de Cardiologie d\u27intervention.

Although historically the intra-aortic balloon pump has been the only mechanical circulatory support device available to clinicians, a number of new devices have become commercially available and have entered clinical practice. These include axial flow pumps, such as Impella(®); left atrial to femoral artery bypass pumps, specifically the TandemHeart; and new devices for institution of extracorporeal membrane oxygenation. These devices differ significantly in their hemodynamic effects, insertion, monitoring, and clinical applicability. This document reviews the physiologic impact on the circulation of these devices and their use in specific clinical situations. These situations include patients undergoing high-risk percutaneous coronary intervention, those presenting with cardiogenic shock, and acute decompensated heart failure. Specialized uses for right-sided support and in pediatric populations are discussed and the clinical utility of mechanical circulatory support devices is reviewed, as are the American College of Cardiology/American Heart Association clinical practice guidelines

Neumonía grave comunitaria en menores de 5 años. Factores de riesgo asociados. Bayamo 2008-2009.

It  was performed a prospective, analytic observationl research of cases and controls, with the objective to identify some risk factors of Community Severe Pneumonia in children under 5 years old who were admitted in the Intensive Care Unit from General Luis Milanés Teaching Pediatric Hospital in Bayamo, during the period September 1rst, 2008 to September 30, 2009. Children under 5 years were selected as a control group, without respiratory symptoms. They belonged to Ojeda neighbourhood in Francisco Vicente Aguilera popular council, where the hospital is located. It was researched the association between the the sociodemographic nutritional risk factors pneumonia and the other factors related to the mother. To conclude, the males (p- 0.0117), the mothers under 20 years (p-0.00) mothers with low degree of knowledge (p-0.00), overcrowding (p-o.00) smoke exposure(p-0.00) and malnutrition(p-0.00), were the risk factors for the severe pneumonias.Se realizó un estudio, observacional, analítico, prospectivo, de casos y controles, con el objetivo de identificar, algunos factores de riesgo, para adquirir Neumonía Grave Comunitaria, en niños menores de 5 años, que ingresaron con ese diagnóstico, en la Unidad de Cuidados Intensivos Pediátricos, del Hospital Pediátrico Docente “General Milanés”, de Bayamo, Granma, en el período comprendido del 1º de septiembre del 2008 al 30 de septiembre 2009. Se seleccionaron como controles, niños menores de 5 años, sin síntomas respiratorios, residentes en el Reparto Ojeda, Consejo Popular F. V. Aguilera, donde se encuentra ubicado el hospital. Se investigó la asociación entre la neumonía con factores de riesgo sociodemográficos, ambientales, nutricionales y otros relacionados con la madre. Se concluye que el sexo masculino ( OR=2.2, p=0.0127), las madres menores de 20 años( OR=3.58, p=0.00), las madres con menor instrucción( OR=12.14,p=0.00), el hacinamiento de las viviendas( OR=10.0, p=0.00), la exposición al humo de cigarros( OR=10.0,p=0.00), la desnutrición( OR=34.0,p=0.00), y la lactancia materna inadecuada(  OR=45.0,p=0.00), constituyeron factores de riesgo para adquirir neumonías graves

Results of the combined U.S. multicenter postapproval study of the Nit‐Occlud PDA device for percutaneous closure of patent ductus arteriosus

ObjectivesTo report the results of the Nit‐Occlud PDA prospective postapproval study (PAS) along with a comparison to the results of the pivotal and continued access trials.BackgroundThe Nit‐Occlud PDA (PFM Medical, Cologne, Germany), a nitinol coil patent ductus arteriosus (PDA) occluder, was approved by the Food and Drug Administration in 2013.MethodsThe PAS enrolled a total of 184 subjects greater than 6 months of age, weighing at least 5 kg, with PDAs less than 4 mm by angiography at 11 centers. Patients were followed prospectively at 2 months, 12 months, and 24 months postprocedure. These outcomes were compared to the 357 subjects enrolled in the pivotal and continued access protocols. Efficacy and safety data were reported.ResultsAmong 184 subjects enrolled for the PAS between 2014 and 2017, 180 (97.8%) had successful device implantation. After 12 months, 98.7% (150/152) had trivial or no residual shunt by echocardiography and two subjects had only small residual shunts. There were three device embolizations that were all retrieved by snare without clinical consequence. Together with the pivotal and continued access study, 97.4% (449/461) had complete echocardiographic closure at 12 months in 541 enrolled subjects. The composite success was 94.4%. There were no mortalities and no serious device‐related adverse events.ConclusionsThe Nit‐Occlud PDA is a safe and effective device for closure of a small to moderate sized PDA. There were no serious device‐related adverse events in a large cohort of three clinical trials.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/148398/1/ccd27995_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/148398/2/ccd27995.pd

Polymorphic Cis- and Trans-Regulation of Human Gene Expression

Using genetic and molecular analyses, we identified over 1,000 polymorphic regulators that regulate expression levels of human genes