Vasoactive–inotropic score after pediatric heart transplant: A marker of adverse outcome

VIS , a quantitative index of pressor support, has been shown to be a predictor of morbidity and mortality in infants younger than six months who underwent CPB . Data on its prognostic utility following pediatric OHT are lacking. This study compared clinical outcomes in children with differential VIS after pediatric OHT . A retrospective cohort study of 51 consecutive heart transplants from 2004 to 2011 was performed at a pediatric tertiary care facility. Peak VIS was computed within initial 24 and 48 h after OHT and was weighted for peak dose and administration of any or all of six pressors. Patients with peak VIS ≥ 15 constituted high VIS group. Children who persistently required a higher magnitude of pressor support for the first 48 h after OHT , as reflected by high peak VIS , had significantly longer ICU stay (30.2 vs. 15.9 days, p = 0.01), pressor (11.4 vs. 6.8 days, p = 0.02) and ventilatory durations (12.4 vs. 5.9 days, p = 0.05), and higher rates of short‐term morbidities. Patients with longer CPB (213 vs. 153 min, p = 0.005) time have higher peak VIS . High peak VIS at 48 h is an effective, yet simple clinical marker for adverse outcomes in pediatric OHT recipients.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/99070/1/petr12112.pd

A Quantitative Model for CRM Performance Evaluations

This paper identifies important performance measurements for the operation of CRM units in the call center industry, and then uses Data Envelopment Analysis (DEA) to compare the performances of a selected set of call centers. The results provide several managerial insights that will assist CRM managers in effective decision making, especially in the areas of increasing efficiencies and improving customer service. Overall, this paper contributes towards managing resources and processes that would aid in the acquisition and support of information technology within a firm

Functional Critical Aortic Stenosis with Transient Retrograde Flow in a Neonate with Left Diaphragmatic Hernia

We report a neonate with left congenital diaphragmatic hernia and severe left ventricular dysfunction, in whom the blood flow in the transverse arch and its branches was supported in a retrograde fashion by patent ductus arteriosus. There was only minimal antegrade flow across the aortic valve and hemodynamic physiology resembled critical aortic stenosis, necessitating the immediate use of prostaglandin E1 infusion to maintain the patent ductus arteriosus.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98145/1/chd679.pd

Single‐center Experience of Outcomes of Tracheostomy in Children with Congenital Heart Disease

Objective A subset of children with repaired congenital heart disease ( CHD ) may require tracheostomy for ongoing ventilatory support. Data on outcomes of children with CHD and tracheostomy are scarce. Our objectives were to describe indications for tracheostomy and outcomes, including readmission data in this population. Methods This is a retrospective chart review of children (<18 years old) with CHD who underwent tracheostomy at a single center over a 12‐year period. Exclusion criteria were prematurity with isolated patent ductus arteriosus ligation. Outcomes until discharge and data on all readmissions after the initial discharge were reviewed. Results A total of 21 subjects with CHD underwent tracheostomy at a median (range) age of 4 (1–84) months and mean (standard deviation) weight of 7.2 (5.9) kg. The most common indication for tracheostomy was tracheomalacia with ventilator‐dependent respiratory failure (14/21 subjects), followed by subglottic stenosis (5) and vocal cord palsy (2). Genetic syndromes were present in 13 (62%) subjects. The mean (standard deviation) post‐tracheostomy length of stay was 55 (35) days. All subjects survived to discharge; 17 (81%) required home ventilation. A total of 11 (52%) subjects died during follow‐up, all of whom were mechanically ventilated while three (14%) children underwent successful decannulation. The mean number of nonelective readmissions decreased from 2.4/patient‐year in the first year to 1.4/patient‐year in the second year, respectively. The commonest reasons for readmission were respiratory deterioration, infections, and mechanical tracheostomy‐related problems. Conclusions The majority of children with CHD who underwent tracheostomy did so for ventilator dependence and tracheomalacia and had coexisting genetic syndromes. About half the cohort died; among survivors, readmissions were common but decreased after the first year. These results underscore the ongoing mortality and morbidity risks faced by this vulnerable population.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/102228/1/chd12048.pd

Hybrid procedure of bilateral pulmonary artery banding and bilateral ductal stenting in an infant with aortic atresia and interrupted aortic arch

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/109582/1/ccd25424.pd

Effect of thermal annealing on optical properties of CR-39 polymeric track detector

The samples of CR-39 polymer (TASTRAK, Bristol, England) were annealled thermally at various temperatures ranging from 100oC to 180oC for 1 hour, in air. FTIR spectroscopy reveals the structural degradation of CR-39 polymer due to thermal annealing above its glass transition temperature. Optical band gap of pristine and thermally annealed samples has been determined using UV-Visible absorption spectra. It has been observed that the optical band gap decreases continuously as a result of annealing.Department of Physics, Kurukshetra University,Kurukshetra-136 119, Haryana, Indi

Abiotrophia Endocarditis in Children with No Underlying Heart Disease: A Rare but a Virulent Organism

Infective endocarditis is extremely rare in children with structurally normal hearts. The most common etiological agents are staphylococcal and streptococcal species. Nutritionally variant streptococci also classified as A biotrophia species are a group of fastidious organisms that account for only 5% to 6% of all cases of culture‐negative infective endocarditis. Only seven cases of A biotrophia infective endocarditis have been previously reported in children with no underlying structural heart disease. We report two cases of A biotrophia infective endocarditis in children without any predisposing factors. Both patients presented with nonspecific symptoms leading to delay in diagnosis. While bacteriological clearance was achieved in both cases, both had a complicated course including development of brain mycotic aneurysms, splenic infarction, renal failure, and irreversible damage to the mitral valve. Both patients required surgical removal of the native mitral valve and replacement. We also present review of seven cases with similar diagnosis published previously in literature and highlight important differences. Our cases highlight special challenges in management of A biotrophia endocarditis in pediatric patients. As the organism may not be isolated in routine culture media, may present with atypical clinical symptoms and may have a complicated course even without antibiotic failure, a high index of suspicion should be maintained in children with subacute symptoms even with no underlying structural cardiac disease.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/108296/1/chd12095.pd

Cardiac Juvenile Xanthogranuloma in an Infant Presenting with Pericardial Effusion

Juvenile xanthogranuloma is a rare histiocytic disorder of childhood mainly affecting skin and rarely deep soft tissues and viscera. We report a 2‐month‐old infant who presented with respiratory distress secondary to a large pericardial effusion associated with an epicardial mass. Excisional biopsy was performed and the mass was diagnosed as juvenile xanthogranuloma. The child is well without evidence of disease 8 months following the excision. The corresponding literature on juvenile xanthogranuloma with cardiac manifestations is reviewed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/99091/1/chd688.pd

B‐type natriuretic peptide levels in preterm neonates with bronchopulmonary dysplasia: A marker of severity?

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/109265/1/ppul22942.pd