Acute Normovolemic Hemodilution Reduces Allogeneic Red Blood Cell Transfusion in Cardiac Surgery: A Systematic Review and Meta-analysis of Randomized Trials.

BACKGROUND: To better understand the role of acute normovolemic hemodilution (ANH) in a surgical setting with high risk of bleeding, we analyzed all randomized controlled trials (RCTs) in the setting of cardiac surgery that compared ANH with standard intraoperative care. The aim was to assess the incidence of ANH-related number of allogeneic red blood cell units (RBCu) transfused. Secondary outcomes included the rate of allogeneic blood transfusion and estimated total blood loss. METHODS: Twenty-nine RCTs for a total of 2439 patients (1252 patients in the ANH group and 1187 in the control group) were included in our meta-analysis using PubMed/MEDLINE, Cochrane Controlled Trials Register, and EMBASE. RESULTS: Patients in the ANH group received fewer allogeneic RBCu transfusions (mean difference = -0.79; 95% confidence interval [CI], -1.25 to -0.34; P = .001; I = 95.1%). Patients in the ANH group were overall transfused less with allogeneic blood when compared with controls (356/845 [42.1%] in the ANH group versus 491/876 [56.1%] in controls; risk ratio = 0.74; 95% CI, 0.62 to 0.87; P < .0001; I = 72.5%), and they experienced less postoperative blood loss (388 mL in ANH versus 450 mL in control; mean difference = -0.64; 95% CI, -0.97 to -0.31; P < .0001; I = 91.8%). CONCLUSIONS: ANH reduces the number of allogeneic RBCu transfused in the cardiac surgery setting together with a reduction in the rate of patients transfused with allogeneic blood and with a reduction of bleeding.

Agresión infantil como problema social en Costa Rica, desde enero de 2005 hasta mayo de 2006 / Child abuse as a social problem in Costa Rica, from January 2005 to May 2006

La agresión infantil es un problema social que ha persistido a lo largo de la historia. La problemática abarca lesiones tanto a nivel físico como psicológico. La clínica, en la mayor parte de las veces, es el eje principal en el diagnóstico acertado y el posterior manejo. En este trabajo se analizaron 192 casos de agresión infantil durante el período comprendido entre enero de 2005 y mayo de 2006 y se presentan sus resultados donde la mayoría de los maltratos infantiles incluye abuso sexual, no es común la atención médica luego de la agresión, las víctimas consultan mucho tiempo después y se presentan más casos de maltrato infantil en el mes de Diciembre lo cual podemos asociar con las conductas del mes que suelen ser más irresponsables (fiestas, alcohol, etc.). Es importante que el médico tenga claro los signos de abuso sexual y sus repercusiones tanto físicas como psicológicas ya que es el tipo de agresión más frecuente y muchas veces puede pasar desapercibida.

Child abuse is an issue which has persisted through history. This problem includes not only physical, but psychological damage. Clinical report, most of the times, is the principal axis in the correct diagnosis and the posterior treatment. In this study, 192 cases of child abuse were analyzed between January 2005 and May 2006, and the results presented most of the cases include child molesting, occasional medical attention after the assault, the victims receive medical attention long time after the assault, and most of the cases occur during December, which can be associated with irresponsible behavior (alcohol, parties, etc.). It is very important that the physician is very clear about the signs of sexual abuse and its physical and psychological consequences, since it is the most common type of aggression and in many cases can be unnoticed.