A Case of Nosocomial Outbreak of Pantoea agglomerans Related to Parenteral Nutrition Procedures

Pantoea agglomerans is a Gram-negative bacterium that infrequently infects humans. Most reports involving it are about infections in soft tissues or bone/joint infections caused by contamina- tion from soil or penetrating trauma by vegetation, such as thorns and splinters. More frequently, it is found as an opportunistic pathogen in immunocompromised patients. It is not rare to find reports of bacteremia and sepsis from contamination of intravenous fluid, parenteral nutrition, blood products and anesthetic agents\u2014that is, through contamination of medical devices and products. We reported a bacterial infection epidemic occurred in 2011 in a hospital in middle Italy which involved different hospital wards; Pantoea agglomerans was isolated from blood cultures of all infected patients and the source of infection was identified in contaminated parenteral nutrition prepared from the local pharmacy

Liability and Medico-Legal Implications in Estimating the Likelihood of Having Attained 14 Years of Age in Pediatric Clinical Practice: A Pilot Study

Accurate methods of age estimation are more essential than ever due to the rise in undocumented individuals without proper identification, often linked to illegal immigration and criminal activities. This absence of reliable records presents challenges within the legal systems, where age thresholds in the context of children’s rights vary across countries. Age 14 has global significance, as established by the UN Convention on the Rights of the Child and the EU for administrative purposes. Accurate age estimation is crucial in medical decisions, reproductive health, and forensics. This study focuses on age estimation via dental of having attained the age of 14. Orthopantomograms were analyzed from two samples, 191 Italian children (aged 5–15) and 822 Chilean subjects (aged 11–22), using dental maturity indices. These indices evaluated open tooth apices and complete root development. Statistical analysis confirmed the method’s reliability in identifying individuals aged 14 or older, with sex-specific cut-offs. The proposed method particularly advocates an approach based on dental mineralization, which could surpass those relying on bone growth. The collaboration between medical experts, including pediatricians and diagnostic imaging specialists, is vital for standardized age estimation strategies. Ethical concerns regarding radiation exposure and accountability are recognized, although the method’s low radiation doses are deemed acceptable. The proposed method will help health professionals to accurately predict whether or not the 14-year threshold has been reached, opening up new avenues of medico-legal interest and laying the foundations for a legal framework that would allow the pediatrician, when involved, to use a valid and recognize

Dispositivi medici: norme, responsabilit\ue0, rischio clinico

La monografia si articola in 4 capitoli; il primo capitolo \ue8 dedicato agli aspetti di carattere generale, definitorio e classificativo, unitamente ad aspetti economici, assicurativi e di mercato. Il secondo capitolo riporta la normativa nazionale ed europea inerente i dispositivi medici e le sua evoluzione nel corso degli anni. Nel terzo capitolo si affrontano i rapporti tra uso dei dispositivi medici e responsabilit\ue0, sia del produttore che delle strutture che degli utilizzatori. Nel quarto capitolo si occupa dei dispositivi medici nell'ambito della gestione del rischio clinico e della qualit\ue0 dell'assistenza. Il quinto ed ultimo capitolo sono descritti alcuni casi concreti, derivanti dall'osservazione personale. Infine \ue8 presente una appendice giuridica recante la normativa di rilievo

La normativa italiana relativa alle misure di prevenzione e di controllo dell\u2019infezione da COVID-19

Gli Autori espongono una scansione temporale delle norme emanate in tema di conteni- mento dell\u2019epidemia di Covid-19, proponendo al termine una riflessione sul ruolo avuto dalle scelte sanitarie degli ultimi anni sul disastro sanitario che sta affrontando l\u2019Italia

Casi \u201caccertati\u201d versus \u201cconfermati\u201d SARS-Cov-2: considerazioni ed implicazioni medico-legali in ambito assicurativo sociale.

Sono passati diversi mesi dalla diffusione del Sars-Cov-2, colpendo ogni fascia di popolazione e assumendo progressivamente la dimensione di una pandemia. Il fenomeno ha assunto un peculiare rilievo assicurativo-sociale, essendo stato l\u2019evento infettivo da Covid-19 annoverato ad infortunio tutelato in sede assicurativa (cosiddetta \u201cmalattia - infortunio\u201d), qualora verificatosi in occasione di lavoro, come recentemente legiferato dallo Stato Italiano (Legge 24 aprile 2020, n. 27). \uc8 nostro obiettivo evidenziare tutte le possibili questioni medico-legali inerenti il mancato riscontro di una positivit\ue0 al tampone mediante test molecolare, pur a fronte di elementi di diversa natura, anamnestico-clinica e strumentale, altamente suggestivi. Ad oggi numerosi risultano i casi di Covid-19 negativi al test molecolare; ci\uf2 anche per test ripetuti in pi\uf9 momenti successivi nel corso della malattia, interessando sia soggetti affetti da forme lievi, sia quelli necessitanti assistenza ventilatoria invasiva. Trattasi di situazioni che assumono particolare criticit\ue0 in ambito medico-legale, particolarmente in ambito assicurativo sociale, causa le ricadute previdenziali potenziali derivanti dall\u2019operativit\ue0 della garanzia assicurativa; ancor pi\uf9 se, in conseguenza dell\u2019infezio- ne, vi siano postumi permanenti o addirittura il decesso. Fermo restando il valore anche morale assunto dal riconoscimento dello status di infortunio lavorativo, in ambito assicurativo sociale appare opportuno un criterio di selezione diagnostico \u201cintegrato\u201d al test molecolare. Scopo del nostro contributo sar\ue0 quello di fornire tutti gli elementi possibili volti ad inquadrare, sotto il profilo squisitamente medico-legale, i casi accertati o confermati inerenti il lavoratore, ai fini di garantire una massima tutela verso coloro che sono esposti ad un concreto rischio lavorativo

An Effective Model for Estimating Age in Unaccompanied Minors under the Italian Legal System

This article presents an effective model for estimating the age of subjects without identification documents, in accordance with Italian legislation covering unaccompanied minors, using instrumental methods recognized by the scientific community for age estimation. A decision-making tree has been developed, in which the first step is a physical examination. If secondary sexual characteristics are fully developed and there are no obvious signs of abnormal growth, dental X-rays are the next step. If the roots of the seven left mandibular teeth between the central incisor and the second molar are completely developed, the focus then moves to the third molar. If the index of the third molar (I3M) value is less than 0.08, or if third molars are not assessable, the following step is to study the clavicle which, if fully formed, indicates that the subject is an adult with 99.9% probability; otherwise, the probability is 96%. In all other cases (where the I3M is over 0.08), the probability that the subject has reached 18 years is less than 60%. The research, carried out initially on x-rays of the wrist, teeth and clavicle, highlighted the uselessness of the x-ray of the wrist for determining the age of majority, because in our sample, all subjects with incomplete maturity of hand/wrist bones were under 16 years of age; thus, OPT was necessary anyway. What we propose is a practical, easily feasible, fast, economical, and extremely reliable method, which can be used on Caucasian populations and beyond for multiple forensic purposes