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

BACKGROUND: 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.

Testicular Germ Cell Tumors in Children and Adolescents Treated With Bleomycin, Etoposide, and Cisplatin (BEP) Protocol: A Survival Analysis.

BACKGROUND: Germ cell tumors (GCTs) represent a diverse group of rare neoplasms that vary in location, histology, and clinical presentation. This study focuses on the clinical outcomes and survival rates of children and adolescents treated with the bleomycin, etoposide, and cisplatin (BEP) protocol. METHODS: This observational study evaluated children under 18 years diagnosed with testicular germ cell tumors and treated with the BEP protocol from January 2008 to December 2018. We employed descriptive analysis and used the Kaplan-Meier method to calculate event-free survival (EFS) and overall survival rates. RESULTS: The study included 32 patients with an average age of 9.8 years (SD ± 6.7). The primary reason for consultation was a testicular mass. The classification of patients was E-I for 14 patients (44%) and E-III and E-IV for nine patients (28%). Endodermal sinus tumors and mixed germ cell tumors were the most commonly identified histological types. With a median follow-up of 7.8 years (95% confidence interval {CI}: 5.9-9.6), the event-free survival was 63.7%. The overall survival at a median follow-up of 9.1 years (95% CI: 7.5-10.7) was 76.1%. CONCLUSION: The BEP chemotherapy regimen offers promising results for treating testicular germ cell tumors in children and adolescents, characterized by its low toxicity and minimal late side effects. However, patients older than 11 years displayed more adverse histological indicators, advanced disease stages, and higher relapse and mortality rates.

Conocimientos y percepciones sobre el cambio climático en estudiantes universitarios / Knowledge and Perceptions of Climate Change Among University Students

Resumen Atendiendo a la relevancia de adaptarse y mitigar el cambio climático, las universidades son un escenario clave para el desarrollo de acciones que impacten a nivel social, económico, político y cultural sobre esta problemática. Como un aporte a este propósito, se realizó una investigación para describir los conocimientos y las percepciones sobre cambio climático en estudiantes universitarios de la Región Caribe colombiana. La muestra incluyó 1 275 estudiantes de siete universidades públicas. Los principales hallazgos muestran una marcada tendencia al reconocimiento de causas y efectos del cambio climático, así como de estrategias para su mitigación. Sin embargo, no suele asociarse a efectos relacionados con su cotidianidad y contextos inmediatos. Los resultados evidencian la necesidad de articular explícitamente los procesos de formación profesional al reconocimiento de acciones relacionadas con el cambio climático. Asimismo, esta información permite fortalecer lineamientos contextualizados sobre el abordaje de este fenómeno en la educación superior.

Abstract Adaptation and mitigation of climate change are relevant in current societies. In this way, universities are an important scenario for the development of strategies that contribute to social, economic, political, and cultural factors associated with this topic. As a contribution to this purpose, research was carried out to describe the knowledge and perceptions of climate change among university students in the Colombian Caribbean region. The sample included 1275 students from seven public universities. The main findings show a trend to recognize causes and effects of climate change, as well as mitigation strategies. However, climate change is not usually associated with effects related to their daily lives and immediate contexts. Results indicate that more articulation between professional training processes to the recognition of actions related to climate change is necessary. Likewise, conclusions allow us to strengthen contextualized guidelines on the approach to this phenomenon in higher education.

Escala Multidimensional de trastornos afectivos-EMTA: análisis desde la teoría clásica de los test y la teoría de respuesta al ítem / Multidimensional scale for affective disorders-Msad: analysis from the classic tests theory and the item response theory

La presente investigación responde a una de las fases del proceso de diseño y estandarización de la Escala Multidimensional de Trastornos Afectivos (EMTA), cuyo propósito fue su análisis desde la Teoría Clásica de los Test (TCT) y la Teoría de Respuesta al Ítem (TRI) a partir de una muestra de 384 estudiantes vinculados a tres instituciones de educación superior de Barranquilla, cuyas edades oscilaron entre los 17 y los 26 años de edad. Los datos fueron recolectados a través de la administración de tres instrumentos: la Escala Multidimensional de Trastornos Afectivos, el Inventario de Depresión de Beck (a= .791) y la Escala Autoaplicada de Altman (a= .566). Se reportaron resultados ajustados a los parámetros de ambos modelos. En el análisis desde la TCT, se evidenciaron índices alfa de Cronbach significativos para ambas subescalas (a = .942 para la Subescala de Depresión y a = .864 para la Subescala de Manía), una alta consistencia interna con correlaciones ítem escala superiores a .3 para todos los ítems. Desde la TRI, se reportó una fiabilidad en el caso de la Depresión de .88 (personas) y .99 (ítems), mientras que en lo referente a Manía, los índices fueron de .84 (personas) y .87 (ítems). A lo largo de los resultados se conservó un ajuste monotónico creciente, con lo cual se corrobora el cumplimiento del principio de la invarianza en la medición del rasgo latente.

This research responds to one phase of the process for the design and standarization of the MSAD Multidimentional Scale of Affective Disorders -EMTA in Spanish-, whose purpose was to analyze MSAD, from the Classical Test Theory (CTT) and the Item Response Theory (TRI), from a sample of 384 students enrolled to three universities in Barranquilla, aged between 17 and 26 years. This is considered an instrumental study, due to its purpose. The data were collected through he administration of three instruments: Scale Multidimensional Affective Disorder, The Beck Depression Inventory (a= .791) and the self-administered Altman Scale (a= .566). Finally, results were reported as adjusted to the parameters of both models. Analysis from the TCT showed high Cronbach alpha indexes for both subscales (a= .942 for the Depression Subscale and a= .864 for the Subscale Mania), as well as high internal item-scale correlations above .3 for all items. Since the TRI, reliability in the case of Depression .88 (individuals) and .99 (items) were reported, while rates regarding Mania were .84 (persons) and .87 (items). Results retained an increasing monotonic configuration; thus the principle of invariance in measuring the latent trait is corroborated.

Resultados clínicos en pacientes con anastomosis intestinal primaria en cirugía de control de daños / Clinical results in patients with primary intestinal anastomosis in the damage control operative technique

Objetivo: Describir la experiencia en la aplicación de la técnica de control de daños en pacientes exanguinados con trauma abdominal severo. Evaluar en la cirugía por etapas del control de daños la utilización de la ligadura transitoria del intestino delgado y del colon con hiladilla, y la anastomosis primaria diferida como una técnica viable. Material y métodos: Entre 1999-2004 se estudiaron los pacientes consecutivos que fueron sometidos a la técnica de control de daños. Se analizaron parámetros de morbi-mortalidad, estancia en UCI y complicaciones...

Pancreatitis necrotizante infectada: resultados en una cohorte de baja mortalidad / Infected necrotizing pancreatitis: results in a low mortality cohort

Objetivo: Analizar los factores pronósticos asociados con mortalidad en pacientes con pancreatitis aguda severa. Métodos: Cohorte retrospectiva, pacientes consecutivos entre 1995-2004 con datos demográficos, clínicos y quirúrgicos, el diagnóstico de pancreatitis aguda severa definido como APACHE II > 8 o Ranson > 3. Resultados: Se incluyeron 64 pacientes. El origen más frecuente fue colelitiasis (51,6 porciento). La mediana del APACHE II=13. El promedio de estancia en la UCI fue de 16 más/menos 14,8 días (rango 1 – 63), la estancia hospitalaria total fue de 28,1 más/menos 19,8 días (1 - 84). El 82,8 porciento de los pacientes fueron operados, el promedio de re-laparotomías fue de 4,2 más/menos 4,4 (1-18). El 81,3 porciento desarrollaron necrosis: infectada o absceso=84,9 porciento y estéril=26,4 porciento. El 81,3 porciento de los pacientes se manejaron con antibióticos durante catorce días. El 60,9 porciento de los pacientes presentaron cultivos positivos en abdomen, los gérmenes más frecuentes fueron Enterococcus fecalis y Estafilococcus aureus...