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

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

Intravascular ultrasound as a novel tool for the diagnosis and targeted treatment of functional popliteal artery entrapment syndrome

Functional popliteal artery entrapment syndrome can be difficult to diagnose, as the imaging modalities presently employed are designed to detect anatomic entrapment. We describe a novel imaging technique to aid in diagnosis in this cohort. A 22-year-old cyclist presented with exercise-limiting claudication. Magnetic resonance angiography with provocative maneuvers was nondiagnostic. Digital subtraction angiography revealed long-segment occlusion of the popliteal artery with plantar flexion; however, the specific site of compression remained unclear. Intravascular ultrasound allowed specific localization of compression and further confirmed the diagnosis. Thus, we report this as an adjunctive imaging modality to definitively diagnose functional popliteal artery entrapment syndrome and to assist in operative planning