Effect of an Albumin Infusion Treatment Protocol on Delayed Cerebral Ischemia and Relevant Outcomes in Patients with Subarachnoid Hemorrhage

Un protocolo de manejo institucional para pacientes con hemorragia subaracnoidea (HSA) basado en la evaluación cardíaca inicial, la permisividad de los balances negativos de líquidos y el uso de una infusión continua de albúmina como fluidoterapia principal durante los primeros 5 días de estancia en la unidad de cuidados intensivos (UCI). se implementó en nuestro hospital en 2014. Tenía como objetivo lograr y mantener la euvolemia y la estabilidad hemodinámica para prevenir eventos isquémicos y complicaciones en la UCI reduciendo los períodos de hipovolemia o inestabilidad hemodinámica. Este estudio tuvo como objetivo evaluar el efecto del protocolo de manejo implementado sobre la incidencia de isquemia cerebral retardada (ICD), la mortalidad y otros resultados relevantes en pacientes con HSA durante la estancia en la UCI.Q1Background An institutional management protocol for patients with subarachnoid hemorrhage (SAH) based on initial cardiac assessment, permissiveness of negative fluid balances, and use of a continuous albumin infusion as the main fluid therapy for the first 5 days of the intensive care unit (ICU) stay was implemented at our hospital in 2014. It aimed at achieving and maintaining euvolemia and hemodynamic stability to prevent ischemic events and complications in the ICU by reducing periods of hypovolemia or hemodynamic instability. This study aimed at assessing the effect of the implemented management protocol on the incidence of delayed cerebral ischemia (DCI), mortality, and other relevant outcomes in patients with SAH during ICU stay. Methods We conducted a quasi-experimental study with historical controls based on electronic medical records of adults with SAH admitted to the ICU at a tertiary care university hospital in Cali, Colombia. The patients treated between 2011 and 2014 were the control group, and those treated between 2014 and 2018 were the intervention group. We collected baseline clinical characteristics, cointerventions, occurrence of DCI, vital status after 6 months, neurological status after 6 months, hydroelectrolytic imbalances, and other SAH complication. Multivariable and sensitivity analyses that controlled for confounding and considered the presence of competing risks were used to adequately estimate the effects of the management protocol. The study was approved by our institutional ethics review board before study start. Results One hundred eighty-nine patients were included for analysis. The management protocol was associated with a reduced incidence of DCI (hazard ratio 0.52 [95% confidence interval 0.33–0.83] from multivariable subdistribution hazards model) and hyponatremia (relative risk 0.55 [95% confidence interval 0.37–0.80]). The management protocol was not associated with higher hospital or long-term mortality, nor with a higher occurrence of other unfavorable outcomes (pulmonary edema, rebleeding, hydrocephalus, hypernatremia, pneumonia). The intervention group also had lower daily and cumulative administered fluids compared with historic controls (p < 0.0001). Conclusions A management protocol based on hemodynamically oriented fluid therapy in combination with a continuous albumin infusion as the main fluid during the first 5 days of the ICU stay appears beneficial for patients with SAH because it was associated with reduced incidence of DCI and hyponatremia. Proposed mechanisms include improved hemodynamic stability that allows euvolemia and reduces the risk of ischemia, among others.Revista Internacional - IndexadaS

CRASH-3 - tranexamic acid for the treatment of significant traumatic brain injury: study protocol for an international randomized, double-blind, placebo-controlled trial.

BACKGROUND: Worldwide, over 10 million people are killed or hospitalized because of traumatic brain injury each year. About 90% of deaths occur in low- and middle-income countries. The condition mostly affects young adults, and many experience long lasting or permanent disability. The social and economic burden is considerable. Tranexamic acid (TXA) is commonly given to surgical patients to reduce bleeding and the need for blood transfusion. It has been shown to reduce the number of patients receiving a blood transfusion by about a third, reduces the volume of blood transfused by about one unit, and halves the need for further surgery to control bleeding in elective surgical patients. METHODS/DESIGN: The CRASH-3 trial is an international, multicenter, pragmatic, randomized, double-blind, placebo-controlled trial to quantify the effects of the early administration of TXA on death and disability in patients with traumatic brain injury. Ten thousand adult patients who fulfil the eligibility criteria will be randomized to receive TXA or placebo. Adults with traumatic brain injury, who are within 8 h of injury and have any intracranial bleeding on computerized tomography (CT scan) or Glasgow Coma Score (GCS) of 12 or less can be included if the responsible doctor is substantially uncertain as to whether or not to use TXA in this patient. Patients with significant extracranial bleeding will be excluded since there is evidence that TXA improves outcome in these patients. Treatment will entail a 1 g loading dose followed by a 1 g maintenance dose over 8 h.The main analyses will be on an 'intention-to-treat' basis, irrespective of whether the allocated treatment was received. Results will be presented as appropriate effect estimates with a measure of precision (95% confidence intervals). Subgroup analyses for the primary outcome will be based on time from injury to randomization, the severity of the injury, location of the bleeding, and baseline risk. Interaction tests will be used to test whether the effect of treatment differs across these subgroups. A study with 10,000 patients will have approximately 90% power to detect a 15% relative reduction from 20% to 17% in all-cause mortality. TRIAL REGISTRATION: Current Controlled Trials ISRCTN15088122; Clinicaltrials.gov NCT01402882

Generations UNAB No.4

Esta cuarta edición de la revista Generaciones UNAB, gira en torno a la celebración de los 40 años de inicio de labores de la Facultad de Derecho, cuyo primeros 25 graduados obtuvieron su título en 1978; así como a la celebración de los primeros 30 años de inicio de labores de la Facultad de Comunicación Social que graduó a sus primeros 17 estudiantes en 1987. Hoy, cuatro y tres décadas después del inicio de labores respectivamente, y atendiendo al compromiso institucional con la región, ña Universidad ha permitido que Santander, Colombia y el mundo cuenten con 3.104 abogados y 1.647 comunicadores sociales que se destacan por su compromiso con la sociedad, su trabajo en equipo, ética y valores en el ejercicio profesional.Editorial; Por Marcela Peralta Bautista…03 Columnista invitado, Facultades bien dirigidas; Por Alfonso Gómez Gómez…06 40 años de la Facultad de Derecho…08 Cuatro décadas formando futuro; Por José Manuel Arias Carrizosa…09 Una facultad de libertadores; Por Jaime Gutiérrez Rivero…10 Defendiendo la libertad del conocimiento; Por Sergio Rangel Consuegra…11 La cara humana del derecho; Por Jorge González Aranda…13 La decanatura marcó mi vida; Por Gabriel Burgos Mantilla…14 La unión hace la fuerza; Por Jorge Castillo Rugeles…16 Mis estudiantes son lo más importante; Por Rodolfo Mantilla Jácome…18 La hermenéutica jurídica como sello diferenciador; Por Juan Carlos Acuña Gutiérrez...20 Equipo de trabajo y apoyo directivo; Por Jorge Eduardo Lamo Gómez…22 30 años de la Facultad de Comunicación Social…25 Haciendo el sueño realidad; Por Carlos H. Gómez…26 Un compromiso de vida; Por Maria Isabel León Carreño…28 Construir debatiendo; Por Rodrigo Velasco Ortiz…30 La importancia de potenciar capacidades; Por Luz Amalia Camacho Velásquez...32 Una propuesta académica única; Por Iván Darío Montoya Osorio…34 Graduados Destacando…37 Docente en la Facultad de Derecho UNAB…38 Comunicación Social-Periodista de la UNAB; Por Sonia Díaz…39 Emprendedores UNAB “Apps.com”; Por Marcela Peralta Bautista…40 Instigación “Trata de personas”; Por Lya Fernández de Mantilla, Johana Marcela Reyes…42 Encuentros…45This fourth edition of the magazine Generaciones UNAB, revolves around the celebration of 40 years of beginning of work of the Faculty of Law, whose first 25 graduates obtained their degree in 1978; as well as the celebration of the first 30 years of beginning of work of the Faculty of Social Communication that graduated its first 17 students in 1987. Today, four and three decades after the start of work respectively, and in response to the institutional commitment to the region, ña University has allowed Santander, Colombia and the world to have 3,104 lawyers and 1,647 social communicators who stand out for their commitment to society , their teamwork, ethics and values ​​in professional practice

Tranexamic acid in trauma: we need stronger global health policy.

Tranexamic acid substantially reduces death in bleeding trauma patients. So why are the World Health Organization, the United Nations, the World Bank, and Unicef not ensuring global implementation, ask Ian Roberts and colleague

Evaluación bioecológica y ambiental de áreas arrecifales del Caribe colombiano

IP 2105-09-120-97ARTICULO(S) EN REVISTA: Maps for Colombian reefs / Juan M.Diaz.'-- en: Reef Encounter. -- No. 25 (July;1999); p. 13. -- ISSN 02552787. -- Isla Arena, una formacion coralina saludable en el area de influencia de la;pluma del rio Magdalena, plataforma continental del Caribecolombiano / Jorge H. Pinzon, Adriana M. Perdomo y;Juan M. Diaz. -- En: Revista de investigaciones marinas ycosteras. -- Vol. 27 (1998); p. 21-37. -- ISSN;01229761. -- Patterns of octocoral and black coral distributionin the oceaniz barrier reef-complex of;Providencia Island, Southwstern Caribbean / Juan A. Sanchez, Sven Zea, Juan M. Diaz. -- En: Caribbean journal;of science. -- Vol. 34, no. 3-4 (Dec. 1998); p. 250-264. -'- isSN86452-- Arrecifes coralinos : ñun tesoro;camino a la extincion? / Jaime Garzon Ferreira. -- En: Colombia: cienciay tecnologia. -- Vol. 15, no. 1;(mar. 1997); p. 11-19. -- ISSN 01205595. -- Peces registradosenlos complejos arrecifales de los cayos;Courtdown, Albuquerque y los bancos Serrana y Roncador, Caribeoccidental,Colombia / Luz Stella Mejia ...;[et.al.]. -- En: Boletin ecotropica. -- No. 32 (1998); p.413892.-- ISSN 01223313. -- Gorgonian communities in;two contrasting enviroments on oceanic atolls of the southwestern caribbean / Juan A. Sanchez, Juan M. Diaz,;spread of diseases in Caribbean coral reefs / Thomas J. Goreau... [et.al.]. -- En: Revista de biologia;tropical -- Vol. 46, sup. 5 (1998); p. 157-171. -- ISSN 00347744. -- A newspecies of Antupatharian Coral;(Cnidaria: Anthozoa) from the caribbean coast of Colombia/ Dennis M. Opresko, Juan A. Sanchez. -- En:;Caribbean journal of science. -- Vol. 33, no. 1-2 (1997);p. 7-581. -- ISSN 00086452. -- PONENCIA(S) EN;CONGRESO: Habitat maps as a tool for assessment and managementof oral reef areas in Colombia /Juan Manuel;Diaz. -- En: Reunion Cientifica Bienal de la IMIA (1 : 1999 nov.9-11 : Panama) -- Mapping reefs and;associated habitats in the SW caribbean / Juan Manuel Diaz. --En: ReunionCientifica Bienal de la IMIA (1 :;1999 nov. 9-11 : Panama) -- Evaluacion de las principalescondiciones de deterioro en algunas formaciones;coralinas de la plataforma continental del Caribe colombiano /Lina M. Barrios Suarez, Jaime Garzon Ferreira,;Sven Zea. -- En: Reunion Asociacion de Laboratorios Marinos delCaribe (ALMC) (29 : 1999 jul. 18-24 : Cumana,;Venezuela) -- Geomorfologia y distribucion de las formacionesarrecifalesde Bajo Tortugas y Bajo Salmedina,;plataforma continental del Caribe Colombiano / Fernando J.ParraVelandia,Juan M. Diaz, Gloria H. Ospina. --;En: Reunion Asociacion de Laboratorios Marinos del Caribe(ALMC)(29 : 1999 jul. 18-24 : Cumana, Venezuela) --;Zonacion y estructura de los fondos coralinos del archipielagode san Bernardo, Caribe colombiano / Mateo;Lopez Victoria, Juan M. Diaz. -- En: Reunion Asociacion deLaboratorios Marinos del Caribe (ALMC) (29 : 1999;jul. 18-24 : Cumana, Venezuela) -- Caracterizacion de lasareascoralinasdel Caribe colombiano : rasgos;morfologicos y ecologicos / Juan Manuel Diaz. -- En: Reunion Asociacion deLaboratorios Marinos del Caribe;(ALMC) (29 : 1999 jul. 18-24 : Cumana, Venezuela) -- Coralhealth assessment in four southwestern caribbean;atolls / J. Garzon Ferreira, S. Zea, J.M. Diaz. -- En: Atlanticand Gulf Assessment (AGRA) workshop (1998 Jun.;2-6 : Miami);Sven Zea. -- En: Bulletin of marine science. -- Vol. 61, no. 2(1997); p.453-465. -- ISSN 00074977. -- Rapi