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

Epidermolysa bullosa in Danish Hereford calves is caused by a deletion in LAMC2 gene

BACKGROUND Heritable forms of epidermolysis bullosa (EB) constitute a heterogeneous group of skin disorders of genetic aetiology that are characterised by skin and mucous membrane blistering and ulceration in response to even minor trauma. Here we report the occurrence of EB in three Danish Hereford cattle from one herd. RESULTS Two of the animals were necropsied and showed oral mucosal blistering, skin ulcerations and partly loss of horn on the claws. Lesions were histologically characterized by subepidermal blisters and ulcers. Analysis of the family tree indicated that inbreeding and the transmission of a single recessive mutation from a common ancestor could be causative. We performed whole genome sequencing of one affected calf and searched all coding DNA variants. Thereby, we detected a homozygous 2.4 kb deletion encompassing the first exon of the LAMC2 gene, encoding for laminin gamma 2 protein. This loss of function mutation completely removes the start codon of this gene and is therefore predicted to be completely disruptive. The deletion co-segregates with the EB phenotype in the family and absent in normal cattle of various breeds. Verifying the homozygous private variants present in candidate genes allowed us to quickly identify the causative mutation and contribute to the final diagnosis of junctional EB in Hereford cattle. CONCLUSIONS Our investigation confirms the known role of laminin gamma 2 in EB aetiology and shows the importance of whole genome sequencing in the analysis of rare diseases in livestock

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

The contribution of legal medicine in clinical risk management

Background: In advanced health services, a main objective is to promote the culture of safety and clinical risk management. In this regard, the reporting of sentinel events fits within a perspective of error analysis, attempting to propose solutions aimed at preventing a new occurrence of the harmful event. The purpose of this study is to analyze the contribution of medico-legal litigation in the management of clinical risk and to propose an organizational model so as to coordinate the intervention of clinical risk management and medico-legal services. Methods: Retrospective review of 206 cases of medico-legal litigation, settled against a Hospital of a North-eastern city in Italy from January 1, 2014 and December 31, 2015. Results: Approximately 20% of cases, that are classifiable as "sentinel events", were not reported due to various factors. The reason that these events are under-reported is mainly due to the latency between the event itself and its manifestation as a serious damage to health as well as the discomfort in reporting the events of this kind, which is still widespread among healthcare workers. The systematic research of the available documentation for medico-legal purposes permits the acquisition of more information concerning the clinical event, thereby increasing the number and accuracy of the reports to the clinical risk unit. Conclusion: The analysis of medico-legal litigation is a valid tool to enhance the reporting of "sentinel events". One possible proposal is the implementation of an organizational model to establish a rapid procedure for the reporting of sentinel events during the evaluation of medico-legal litigations

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

Simple Modifications of Branched PEI Lead to Highly Efficient siRNA Carriers with Low Toxicity

Polymer carriers like PEI which proved their efficiency in DNA delivery were found to be far less effective for the applications with siRNA. In the current study, we generated a number of nontoxic derivates of branched PEI through modification of amines by ethyl acrylate, acetylation of primary amines, or introduction of negatively charged propionic acid or succinic acid groups to the polymer structure. The resulting products showed high efficiency in siRNA-mediated knockdown of target gene. In particular, succinylation of branched PEI resulted in up to 10-fold lower polymer toxicity in comparison to unmodified PEI. Formulations of siRNA with succinylated PEI were able to induce remarkable knockdown (80% relative to untreated cells) of target luciferase gene at the lowest tested siRNA concentration of 50 nM in Neuro2ALuc cells. The polyplex stability assay revealed that the efficiency of formulations which are stable in physiological saline is independent of the affinity of siRNA to the polymer chain. The improved properties of modified PEI as siRNA carrier are largely a consequence of the lower polymer toxicity. In order to achieve significant knockdown of target gene, the PEI-based polymer has to be applied at higher concentrations, required most probably for sufficient accumulation and proton sponge effects in endosomes. Unmodified PEI is highly toxic at such polymer concentrations. In contrast, the far less toxic modified analogues can be applied in concentrations required for the knockdown of target genes without side effects

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

Effects of maceration length after prefermentative cold soak: Detailed chromatic, phenolic and sensory composition of cabernet sauvignon, malbec and merlot wines

Cabernet Sauvignon, Malbec and Merlot grapes were processed with prefermentative cold soak (CS) for 5 days followed by a short maceration time of 5 days (CS + 5d), or a long maceration time of 10 days (CS + 10d). CS did not affect the basic chemistry of the wines, nor improved anthocyanins, polymeric pigments and total phenolics relative to Control wines (10 days maceration). Wine tannins were lowered in CS + 5d wines by 71 % (Cabernet Sauvignon) and by 29 % (Merlot). CIELab coordinates showed a negative impact on L*, C*, and copigmentation in CS wines indicating that these wines were lighter in color than their Control counterparts and these differences could be distinguished by the human eye. Astringency and bitterness were lower in CS + 5d wines, whereas CS + 10d wines showed enhanced fresh fruit aroma, body, bitterness, and astringency.EEA MendozaFil: Casassa, Luis Federico. California Polytechnic State University. Wine and Viticulture Department; Estados UnidosFil: Bolcato, Esteban Augusto. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Mendoza; ArgentinaFil: Sari, Santiago Eduardo. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Mendoza; ArgentinaFil: Barda, Nora. Instituto Nacional de Tecnología Industrial (INTI), Villa Regina; Argentin

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