Pre and Postoperative Management of Pediatric Patients with Congenital Heart Diseases

Stabilization during preoperative cardiac surgery especially in neonates has an important role to predict outcome for pediatric congenital heart surgery. We tried to elaborate general guidelines on how to diagnose and some anticipations for emergency treatments tailored by the type of congenital heart disease in neonates. Stabilization consists of medical treatment including emergent prostaglandin institution in some types of duct dependent lesion. The role of interventional catheterization such as patent ductus arteriosus (PDA) stent, balloon pulmonary valvotomy, etc. as modalities for stabilization before surgery was also elaborated. Some general and specific guidelines based on the type of surgeries for postoperative management were also discussed

Feasibility Profile of Endometrial Nodule Resection in the Uterosacral and Rectovaginal Ligament

Objective: To know the feasibility of uterosacral and rectovaginal nodule resection in endometriosis patients who underwent laparoscopy surgery in Fatmawati Hospital. Methods: Observational study was done by involving trained and experienced laparoscopist who performed deep infiltrating endometriosis (DIE) nodule resection laparoscopy on uterosacral and rectovaginal ligament. We observed on 35 patients which were histologically proven of DIE. We recorded the total procedure time, surgical complications occurred intra-operative, postoperative, and length-of-stay. The data were described descriptively. Results: Mean (SD) of total laparoscopic procedure time including nodule resection was 200 (SD 52) minutes. There were two procedures (5.7%) with intra-operative complications, one (2.9%) with bowel injury which was converted to laparotomy, and the other one (29%) with intra-operative bleeding so that the operator cancelled nodules resection. Mean (SD) on length of stay after the procedures was 2.5 (2.1) days. On follow up observation, there was not any postoperative complication. Conclusion: Laparoscopic uterosacral and rectovaginal nodules resection in endometriosis patient is feasible to be done by trained and experienced laparoscopic surgeon. [Indones J Obstet Gynecol 2017; 5-1: 42-45] Keywords: endometriosis, laparoscopy, nodule resectio

Does malnutrition influence outcome in children undergoing congenital heart surgery in a developing country?

Background Most children undergoing cardiac surgery for congenital heart disease (CHD) in developing countries are malnourished. Malnutrition is known as a co-morbidity factor that might predict and influence outcomes after surgery. Objectives To evaluate the effect of malnutrition and other associated risk factors on post-operative outcomes in children with CHDs underwent cardiac surgery. Methods We conducted a retrospective cohort study in a single center tertiary pediatric cardiac intensive care unit (PCICU) in Indonesia. Our cohort included all children between 5 and 36 months of age undergoing congenital heart surgery with cardiopulmonary bypass from November 2011 until February 2014. Outcomes measured were the length of intubation and the length of ICU stay. Variables for potential influence investigated were the nutritional status, age, gender, type of cardiac anomaly (acyanotic vs. cyanotic), Aristotle score, cardiopulmonary bypass time, aortic cross-clamp time, and Pediatric Risk of Mortality (PRISM) III score. Results Out of 249 patients included, 147 (59%) showed malnourishment on admission. Malnourished patients were significantly younger in age, presented with an acyanotic heart defects, and had higher PRISM III score. Additionally, they also had a longer mechanical ventilation time and ICU stay than those with a normal nutritional status. After adjusting for various variables using a multiple logistic regression model it could be demonstrated that a higher Z-score for weight to age was a significant protective factor for the intubation time of more than 29 hours with an odds ratio of 0.66 (95% CI 0.48 to 0.92, P = 0.012). Non-malnourished patients had a 49% significantly higher chance for extubation with a hazard ratio of 1.49 (95% CI 1.12 to 1.99, P= 0.007). Conclusion Malnourishment is clearly associated in a linear fashion with longer mechanical ventilation and ICU stay. As one of significant and potentially treatable co-morbidity factors, prevention of malnourishment by early diagnosis and optimal timing for surgery is important

Glycated LDL increases monocyte CC chemokine receptor 2 expression and monocyte chemoattractant protein-1-mediated chemotaxis

Background Previous reports have suggested that levels of advanced glycation end product-modified LDL (AGE-LDL) increase in patients with diabetes due to elevated plasma glucose. However, understanding of the mechanisms by which AGE-LDL may accelerate atherogenesis remains incomplete. Methods and results Microarray and reverse transcription real-time PCR (RT-PCR) analyses revealed that AGE-LDL significantly increased levels of CC chemokine receptor 2 (CCR2) mRNA in human macrophages compared with LDL, an effect accompanied by increased levels of CCR2 protein. Flow cytometry also showed that AGE-LDL increases CCR2 expression on the cell surface following stimulation (48 h) (P < 0.05). This effect appeared to depend on the receptor for AGE (RAGE), since an anti-RAGE antibody significantly blocked increased CCR2 mRNA. Functional studies demonstrated that exposure of THP-1 monocytoid cells to AGE-LDL increases chemotaxis mediated by monocyte chemoattractant protein-1 (MCP-1) up to 3-fold compared to LDL treatment (P < 0.05). Conclusions These data show that AGE-LDL can increase CCR2 expression in macrophages and stimulate the chemotactic response elicited by MCP-1. This novel mechanism may contribute to accelerated atherogenesis in diabetic patients

Rectovaginal Examination, Transvaginal Ultrasonography, and Magnetic Resonance Imaging as Diagnostic Tools for Identifying Deep Infiltrating Endometriosis Nodules

Objective: To investigate the comparison between rectovaginal examination (RVT), transvaginal ultrasonography (TVUS) and magnetic resonance imaging (MRI) as diagnostic tools for identifying various Deep Infiltrating Endometriosis (DIE).   Methods: Prospective longitudinal study was done involving 31 women referred for surgical management of DIE. Calculation of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of RVT, TVUS and MRI for DIE were recorded.   Results: The mean age was 35.1 years. DIE were present in 95.45% of women which commonly located at uterosacral ligaments (58.33%), followed by rectovaginal (16,67%), rectosigmoid- colon (16.67%) and bladder-ureter (8.3%). TVUS had the best accuracy (RVT 50.24%; TVUS 88.85%; MRI 75.77%) among other diagnostic tools for nodules located at uterosacral ligaments (RVT 52.63%; TVUS 87%; MRI 40%) and rectovaginal (RVT 76.75%; TVUS 93.34%; MRI 80%), but it poorly identified nodules located at rectosigmoid (RVT 20%; TVUS 65.56%; MRI 88.75%) and bladder-ureteral area (RVT 50.44%; TVUS 87.66%; MRI 93.55%). RVT had good PPV (88.89%) but bad NPV (32.01%) profile, made it worth to be a screening diagnostic tool.   Conclusion: RVT was a good screening diagnostic tools as it could be done easily but was weak in diagnosing anterior DIE. TVUS gave a better diagnosis rates on DIE located at sacrouterina ligaments and rectovaginal area whereas MRI did better on bowel DIE (rectosigmoid- colon area) and urological DIE (bladder-ureteral area).    Keywords: deep infiltrating endometriosis, magnetic resonance imaging, tranvaginal ultrasonograph

Bounded droop controller for parallel operation of inverters

In this paper, the stability of parallel-operated inverters in the sense of boundedness is investigated. At first, the non-linear model of parallelled inverters with a generic linear or non-linear load is obtained by using the generalised dissipative Hamiltonian structure and then the robust droop controller, recently proposed in the literature for parallel operation of inverters, is implemented in a way to produce a bounded control output. The proposed controller is called the bounded droop controller (BDC). It introduces a zero-gain property and can guarantee the boundedness of the closed-loop system solution. Therefore, for the first time, the closed-loop stability in the sense of boundedness is guaranteed for parallelled inverters feeding generic non-linear/linear loads. The controller structure is further improved to increase its robustness with respect to initial conditions, numerical errors or external disturbances while maintaining the stability property. Moreover, the controller is tuned to avoid any possible limit cycles in the voltage dynamics. Real-time simulation results for two single-phase inverters operated in parallel loaded with a non-linear load are presented to verify the effectiveness of the proposed BDC

Low Cardiac Output Syndrome in Children After Open Heart Surgery In National Cardiovascular Center – Indonesia Predictor and Clinical Result

Background. A Low cardiac output syndrome (LCOS) was defined as poor perfusion due to transient myocardial dysfunction.The purpose of this study was to identify patients at risk for the development of LCOS in pediatric after cardiac surgery. Methods and results.The patient characteristics that were independent predictors of LCOS were identified among472 consecutive pediatric pa-tients who underwent cardiac surgery at the National Cardiovascular Center – Indonesia between January 2005 and December2005. The overall preva-lence of LCOS was 15.43 % (n= 73). Logistic regression analyses identified  eight independent predictors of LCOS and calculated the factor-ad-justed odds ratiosassociated with each predictor: (1) residual lesion (odds ratio 141.98); (2) complexity score(odds ratio 1.74);(3) Cardiopulmonary bypass (CPB) time (odds ratio1.01); (4) preoperative Intensive Care Unit (ICU) (odds ratio 8.51); (5) preoperative Congestive Heart Failure (CHF) (odds ratio 3.14); (6) bleeding (oddsratio 24.88); (7) arrhythmia (odds ratio 4.78); and (8) pulmonary hypertension (odds ratio3.75). The opera-tive mortality rate was higherin patients in whom LCOS developed than in those in whom it did not develop (39.72% versus 0.75%, p<0.001). Mean basic complexity score was 6.25 with mortality rate 6.76, and the overall performance was 5.83. Conclusions. Compared to STS and EACTS, the performance of National Cardiovascular Center– Indonesia was still lower. LCOS caused longer time of intubation time, ICU and hospital stay. There were eight independents predictor that can be used to predicts LCOS in pediatric patients after open heart surgery. Patients at high risk for the develop-ment of low cardiacoutput syndrome should be the focus of more inten-sive management to prevent the development of LCOS

Advocacy at the Eighth World Congress of Pediatric Cardiology and Cardiac Surgery

The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery (WCPCCS) will be held in Washington DC, USA, from Saturday, 26 August, 2023 to Friday, 1 September, 2023, inclusive. The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery will be the largest and most comprehensive scientific meeting dedicated to paediatric and congenital cardiac care ever held. At the time of the writing of this manuscript, The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery has 5,037 registered attendees (and rising) from 117 countries, a truly diverse and international faculty of over 925 individuals from 89 countries, over 2,000 individual abstracts and poster presenters from 101 countries, and a Best Abstract Competition featuring 153 oral abstracts from 34 countries. For information about the Eighth World Congress of Pediatric Cardiology and Cardiac Surgery, please visit the following website: [www.WCPCCS2023.org]. The purpose of this manuscript is to review the activities related to global health and advocacy that will occur at the Eighth World Congress of Pediatric Cardiology and Cardiac Surgery. Acknowledging the need for urgent change, we wanted to take the opportunity to bring a common voice to the global community and issue the Washington DC WCPCCS Call to Action on Addressing the Global Burden of Pediatric and Congenital Heart Diseases. A copy of this Washington DC WCPCCS Call to Action is provided in the Appendix of this manuscript. This Washington DC WCPCCS Call to Action is an initiative aimed at increasing awareness of the global burden, promoting the development of sustainable care systems, and improving access to high quality and equitable healthcare for children with heart disease as well as adults with congenital heart disease worldwide

The Discovery of LOX-1, its Ligands and Clinical Significance

LOX-1 is an endothelial receptor for oxidized low-density lipoprotein (oxLDL), a key molecule in the pathogenesis of atherosclerosis.The basal expression of LOX-1 is low but highly induced under the influence of proinflammatory and prooxidative stimuli in vascular endothelial cells, smooth muscle cells, macrophages, platelets and cardiomyocytes. Multiple lines of in vitro and in vivo studies have provided compelling evidence that LOX-1 promotes endothelial dysfunction and atherogenesis induced by oxLDL. The roles of LOX-1 in the development of atherosclerosis, however, are not simple as it had been considered. Evidence has been accumulating that LOX-1 recognizes not only oxLDL but other atherogenic lipoproteins, platelets, leukocytes and CRP. As results, LOX-1 not only mediates endothelial dysfunction but contributes to atherosclerotic plaque formation, thrombogenesis, leukocyte infiltration and myocardial infarction, which determine mortality and morbidity from atherosclerosis. Moreover, our recent epidemiological study has highlighted the involvement of LOX-1 in human cardiovascular diseases. Further understandings of LOX-1 and its ligands as well as its versatile functions will direct us to ways to find novel diagnostic and therapeutic approaches to cardiovascular disease