Fisiopatología del TEC Grave en UCI en Adultos y Niños

Severe traumatic brain injury (severe TBI) is a severe injury that affects both the skull and the brain as a result of a blunt impact or significant external force to the head. It can occur in a variety of situations, such as car accidents, falls from considerable heights, serious sports injuries, or assaults. This injury can have serious and long-lasting consequences for brain function and general health, which is why it is important to know its pathophysiology and its influence on mortality rates in both the pediatric population and adults.El traumatismo craneoencefálico grave (TCE grave) es una lesión severa que afecta tanto al cráneo como al cerebro como resultado de un impacto contundente o una fuerza externa significativa en la cabeza. Puede ocurrir en diversas situaciones, como accidentes automovilísticos, caídas desde alturas considerables, lesiones deportivas graves o agresiones. Esta lesión puede tener consecuencias serias y duraderas para la función cerebral y la salud general, por lo cual es importante conocer la fisiopatología de esta y su influencia en índices de mortalidad tanto en población pediátrica como en adultos

Cardiac myosin activation with omecamtiv mecarbil in systolic heart failure

BACKGROUND The selective cardiac myosin activator omecamtiv mecarbil has been shown to improve cardiac function in patients with heart failure with a reduced ejection fraction. Its effect on cardiovascular outcomes is unknown. METHODS We randomly assigned 8256 patients (inpatients and outpatients) with symptomatic chronic heart failure and an ejection fraction of 35% or less to receive omecamtiv mecarbil (using pharmacokinetic-guided doses of 25 mg, 37.5 mg, or 50 mg twice daily) or placebo, in addition to standard heart-failure therapy. The primary outcome was a composite of a first heart-failure event (hospitalization or urgent visit for heart failure) or death from cardiovascular causes. RESULTS During a median of 21.8 months, a primary-outcome event occurred in 1523 of 4120 patients (37.0%) in the omecamtiv mecarbil group and in 1607 of 4112 patients (39.1%) in the placebo group (hazard ratio, 0.92; 95% confidence interval [CI], 0.86 to 0.99; P = 0.03). A total of 808 patients (19.6%) and 798 patients (19.4%), respectively, died from cardiovascular causes (hazard ratio, 1.01; 95% CI, 0.92 to 1.11). There was no significant difference between groups in the change from baseline on the Kansas City Cardiomyopathy Questionnaire total symptom score. At week 24, the change from baseline for the median N-terminal pro-B-type natriuretic peptide level was 10% lower in the omecamtiv mecarbil group than in the placebo group; the median cardiac troponin I level was 4 ng per liter higher. The frequency of cardiac ischemic and ventricular arrhythmia events was similar in the two groups. CONCLUSIONS Among patients with heart failure and a reduced ejection, those who received omecamtiv mecarbil had a lower incidence of a composite of a heart-failure event or death from cardiovascular causes than those who received placebo. (Funded by Amgen and others; GALACTIC-HF ClinicalTrials.gov number, NCT02929329; EudraCT number, 2016 -002299-28.)