An unusual case of chronic cough: Professional liability in dentistry?

Foreign body aspiration (FBA) is a serious medical problem, also in dental practice. The case report describes the case of a patient who for 12 years has suffered from chronic cough as a result of the aspiration of a polymeric silicone resin fragment during a dental procedure. In November 2002, the patient was underwent dental care, and she points out that, when performing dental imprint, she had sensed that something "went down in the throat" but she was immediately reassured by the dentist. After lung CT was performed, the foreign body was identified and removed with benefit to the patient. The knowledge of this case report could be useful for dentists who perform dental impressions, to be aware of the fact that the material used is radiolucent e.g. cannot be seen on plan radiographs and it can be accidentally inhaled by the patient. The knowledge of the case is also important for doctors who come in contact with patients who previously underwent dental treatment, suffering from persistent cough, in the absence of positive radiological signs

Outlier admissions of medical patients: Prognostic implications of outlying patients. The experience of the Hospital of Mestre

ABSTRACT The admission of a patient in wards other than the appropriate ones, known as the patient outlying phenomenon, involves both Medicine and Geriatric Units of many Hospitals. The aims were to learn more about the prognosis of the outlying patients, we investigated 3828 consecutive patients hospitalized in Medicine and Geriatrics of our hub Hospital during the year 2012. We compared patients\u2019 mean hospital length of stay, survival, and early readmission according to their outlying status. The mean hospital length of stay did not significantly differ between the two groups, either for Medicine (9.8 days for outliers and 10.0 for in-ward) or Geriatrics (13.0 days for both). However, after adjustment for age and sex, the risk of death was about twice as high for outlier patients admitted into surgical compared to medical areas (hazard ratio 1.8, 1.2-2.5 95% confidence interval). Readmission within 90 days from the first discharge was more frequent for patients admitted as outliers (26.1% vs 14.2%, P<0.0001). We highlight some critical aspects of an overcrowded hospital, as the shortage of beds in Medicine and Geriatrics and the potential increased clinical risk denoted by deaths or early readmission for medical outlier patients when assigned to inappropriate wards. There is the need to reorganize beds allocation involving community services, improve in-hospital bed management, an extent diagnostic procedures for outlier patients admitted in nonmedical wards

AN EMBLEMATICAL CASE OF FIRST ACCESS IN EPILEPSY WHILE DRIVING ACCORDING TO THE ITALIAN LAW N. 41 OF 23 MARCH 2016 AND A REVIEW OF LITERATURE

Introduction: People with epilepsy, all over the world, have many problems in everyday life because of unpredictable seizures that could hinder every human activity. In particular, they are restricted from driving because of the fear over seizure-related car accidents. The purpose of this work is to raise some questions about risk of traffic accident, driving restriction and personal liability in people with and without diagnosis of epilepsy. Case presentation: We present a case of a 49-year-old woman who accidentally hit a pedestrian with her car, causing him severe personal injury. After many clinical and instrumental examinations, the physicians diagnosed to her generalized epilepsy and she started a daily anti-epileptic therapy. Results: Studies have tried to estimate the real risk of road traffic accident in order to evaluate when a person with epilepsy reaches an acceptable risk of driving, balancing public traffic safety and personal freedom, without a real success. Therefore, we present an overview of laws regarding epilepsy-driving restriction and a recent court case related to a car accident during a first seizure, according to the Italian law n. 41 of 23 march 2016 about personal injuries and murder caused by vehicular accident and a review of Literature about the first seizure while driving. Conclusion: We believe that the driver cannot be held liable for any personal injuries or murder caused by vehicular accident, according to the Italian law n. 41 of 23 march 2016, likewise it happened in the case presented. Indeed, the crisis represent a temporary reduction of liability (incapacity to understand and want), making the person not imputable for own actions during the time of the seizure. Keywords: first seizure, people with epilepsy (PWE), car accident, personal injuries

The new Italian law 219/2017: an extraordinary clinical tool in internal medicine

Abstract On December 2017, Law 219 named Provisions for informed consent and advance treatment directives was approved in Italy, and on one side this law helped the daily medical activity on the other side it enhanced the patient's self-determination. This contribution analyzes the new legislative disposition and the possible medical-legal and practical implications for patients entrusted in hospitals. In particular, it focuses on the usefulness of an early planning of medical care decision in complex pathological situations in order to enhance the patient's self-determination and his eventual impassable refusal. It also safeguards the medical work from disputes and claims, preserving medical autonomy and competence

Disabling outcomes after peripheral vascular catheter insertion in newborn patient: a case of medical liability?

The positioning of peripheral venous catheters (PVC) is an invasive procedure commonly performed in pediatrics hospital wards to obtain vascular access for the administration of fluids, medications and other intravenous (IV) therapies. Many studies exist about management of peripheral venous access in adults. On the contrary, scientific evidence on the management of this procedure in children and newborns, especially regarding the optimal duration of infusion and the possible related side effects, is still poor. To minimize the risk of phlebitis, the guidelines of the US Centers for Disease Control and Prevention suggest the replacement of the catheter every 72\u201396 hours in adult patients, while in pediatric patients the catheter can remain in place for the entire duration of the IV therapy, unless complications arise

Patient blood management: The best approach to transfusion medicine risk management

In advanced health systems it is increasingly important to offer effective medical services that have high quality and safety standards. We present an overview of the direct hazards and the indirect hazards associated with blood transfusions. Our aim is to focus on the potential medico-legal impacts of these hazards in the context of clinical risk management, incorporating the accumulating evidence from Patient Blood Management programs. The direct or deterministic hazards of transfusion refer to scenarios where the mechanisms for post transfusion damage are clearly traceable to the blood transfused in a 1:1 cause and effect manner. The indirect hazards can be defined as probabilistic and are associated with transfusion through epidemiological studies. The implementation of Patient Blood Management programs demonstrates that the use of a blood transfusion is not always necessary or unavoidable but can be considered modifiable. Review of the literature confirms that transfusion should not be the default option to manage anemia or blood loss. Instead, accumulating evidence demonstrates that a patient-centred, proactive approach to managing a patient’s own blood is the new standard of care. It thus follows, an adverse transfusion event, where the transfusion was avoidable through the application of patient blood management, may constitute a profile for medical professional medical negligence. In an effort to maximise patient safety, transfusion medicine practice culture needs to shift towards a patient blood management approach, with hospitals implementing it as an important tool to minimize the risks of allogeneic blood transfusion

La nuova legge sulla responsabilit\ue0 professionale: cosa cambia in punto di linee guida?

Il tema della sicurezza delle cure e quello della necessit\ue0 di affrontare il nodo della responsabilit\ue0 professionale sono per la prima volta affrontati in Parlamento nel 2012, anno in cui \ue8 promulgato un primo provvedimento, il cosiddetto \u201cDecreto Balduzzi\u201d, che introduce la doverosit\ue0 di attenersi a linee guida quale riferimento per la valutazione dell\u2019eventuale colpa del medico. Le principali innovazioni che la legge 24/2017 ha introdotto su questi aspetti sono la regolamentazione dell\u2019esercizio professionale, basata su linee guida accreditate e buone pratiche, e le ricadute che questo comporta sul versante della responsabilit\ue0 per colpa. Nel presente articolo offriamo una chiave di lettura della nuova legge, con particolare riguardo alle linee guida, proponendo anche un confronto con i dettami del precedente assetto normativo sul tema

Considerazioni medico-legali sulla mozione del Comitato Nazionale per la Bioetica sull’accanimento clinico nei confronti di bambini con limitate aspettative di vita

The motion approved by the Italian National Bioethics Committee January 30th,2020, entitled “Aggressive treatments or unreasonable obstinacy in medical care of children with short life expectancy”, sets out 12 recommendations for physicians who take care of these children and have the duty to communicate with their parents. The intent of this motion is to give the family the necessary information and support during the decision-making process. Each recommendation is analytically commented. Recommendation 1 advocates the adoption of shared decision-making by the entire healthcare team; promotes the relief of pain and suffering; inhibits disproportionate and ineffective medical treatments; opposes a defensive medicine. Recommendation 2 asks for the promulgation of a national law that establishes clinical ethics committees in Children’s Hospitals. Recommendation 3 implies that parents or legal guardians should be involved in the decision-making process of physicians and clinical ethics committees. Recommendation 4 states that a second opinion may be requested by both the parents and the physicians. Recommendation 5 admits an appeal to the judge in the event of an irreconcilable conflict between the health care team and the family. Recommendation 6 endorses the medical accompaniment of the dying patient, also by means of continuous deep sedation and analgesia. Recommendation 7 enunciates the principle that patients shall have the right to access to palliative care. Recommendation 8 confirms the necessity to strengthen research focused on pediatric pain and suffering. Recommendation 9 excludes that excessive medical treatment may be justified by the need to carry out experiments or research projects. Recommendation 10 concerns the training of physician, other healthcare workers and psychologists in order to support children’s parents both emotionally and practically. Recommendation 11 exhorts to encourage the interaction between parents and seriously ill children. Recommendation 12 assigns a prominent role to parents’ associations for ill childre

The Phenotypic Characterization of the Oldest Italian Man from December 28, 2020, to September 23, 2021, A.T., Strengthens the Idea That the Immune System can Play a Key Role in the Attainment of Extreme Longevity

: In this paper, we present demographic, clinical, anamnestic, cognitive, and functional data, as well as haematological, haematochemical, immunological, and genetic parameters of an exceptional individual: A.T., a semi-supercentenarian who held the title of the oldest living Italian male centenarian from 28 December 2020, to 23 September 2021. The purpose of this study is to provide fresh insights into extreme phenotypes, with a particular focus on immune-inflammatory parameters. To the best of our knowledge, this study represents the first phenotypic investigation of a semi-supercentenarian, illustrating both INFLA-score, a metric designed to assess the cumulative impact of inflammatory markers and indicators of age-related immune phenotype (ARIP), recognized as significant gauges of biological ageing. The aim of this study was, indeed, to advance our understanding of the role of immune-inflammatory responses in achieving extreme longevity. The results of laboratory tests, as well as clinical history and interview data, when compared to the results of our recent study on Sicilian centenarians, demonstrate an excellent state of health considering his age. Consistent with previous studies, we observed increased IL-6 inflammatory markers and INFLA score in A.T. More interestingly, the semi-supercentenarian showed values of ARIP indicators such as naïve CD4+ cells, CD4+/CD8+ ratio, and CD4+TN/TM ratio in the range of young adult individuals, suggesting that his immune system's biological age was younger than the chronological one. The results support the notion that the immune system can play a role in promoting extreme longevity. However, this does not rule out the involvement of other body systems or organs in achieving extreme longevity

Transcriptional profiling in response to terminal drought stress reveals differential responses along the wheat genome

Background: Water stress during grain filling has a marked effect on grain yield, leading to a reduced endosperm cell number and thus sink capacity to accumulate dry matter. The bread wheat cultivar Chinese Spring (CS), a Chinese Spring terminal deletion line (CS_5AL-10) and the durum wheat cultivar Creso were subjected to transcriptional profiling after exposure to mild and severe drought stress at the grain filling stage to find evidences of differential stress responses associated to different wheat genome regions. Results: The transcriptome analysis of Creso, CS and its deletion line revealed 8,552 non redundant probe sets with different expression levels, mainly due to the comparisons between the two species. The drought treatments modified the expression of 3,056 probe sets. Besides a set of genes showing a similar drought response in Creso and CS, cluster analysis revealed several drought response features that can be associated to the different genomic structure of Creso, CS and CS_5AL-10. Some drought-related genes were expressed at lower level (or not expressed) in Creso (which lacks the D genome) or in the CS_5AL- 10 deletion line compared to CS. The chromosome location of a set of these genes was confirmed by PCR-based mapping on the D genome (or the 5AL-10 region). Many clusters were characterized by different level of expression in Creso, CS and CS_AL-10, suggesting that the different genome organization of the three genotypes may affect plant adaptation to stress. Clusters with similar expression trend were grouped and functional classified to mine the biological mean of their activation or repression. Genes involved in ABA, proline, glycine-betaine and sorbitol pathways were found up-regulated by drought stress. Furthermore, the enhanced expression of a set of transposons and retrotransposons was detected in CS_5AL-10. Conclusion: Bread and durum wheat genotypes were characterized by a different physiological reaction to water stress and by a substantially different molecular response. The genome organization accounted for differences in the expression level of hundreds of genes located on the D genome or controlled by regulators located on the D genome. When a genomic stress (deletion of a chromosomal region) was combined with low water availability, a molecular response based on the activation of transposons and retrotransposons was observed