Perioperative and anesthetic deaths: toxicological and medico legal aspects

Background: Anesthesia has become safer during decades, though there is still a preventable mortality; the complexity of medical and surgical interventions, increasingly older and sicker patients, has created a host of new hazards in anesthesiology. In this paper, some of these perioperative (PO) fatal adverse events are investigated in terms of health responsibility. Selective literature research in several data bases, concerning perioperative and anesthetic deaths and medical responsibility, was performed. Main text: A generally accepted definition of the anesthesia and perioperatory-related death still remains one of the major concerns in forensic pathology, and the terms “operative deaths” and “anesthetic deaths” are usually applied inaccurately within the medico-legal literature. Such events involve comprehensively PO fatalities and allow for subtle separation of natural and unnatural death, at least from the prospective of forensic pathology. Iatrogenic deaths in this field can be separated into some major categories, as attributable to previous patient’s unfavorable conditions or depending from surgical procedure per se (such as PO cardiac and cerebrovascular events). In this review, the authors carried out syntheses of specific research areas regarding epidemiology, complications of general and spinal anesthetic, failure in airway management and patient’s circulatory homeostasis, and adverse drugs reactions; analysis considering the challenge of anesthetic-related mortality, epidemiology and classifications, by indicating causal chain of death, in respect of both contributing and associated anesthetic and surgery facts. Conclusions: Perioperative quality control programs and its relevance for medico-legal evaluation are emphasized as, although mortality rates have decreased worldwide over the last decades, however, preventable drug-related deaths still happen. Such fatal events have to be considered within the field of forensic pathology experts, with regard of malpractice claims, to implement a strategy for preventing potentially fatal complications

Effect of junction quality on the performance of a silicon solar cell

In this work, a modeling study of the effect of the junction quality on the performance of a silicon solar cell is presented. Based on a one dimensional modeling of the solar cell, the continuity equation of excess minority carriers is solved with boundary conditions taking into account the intrinsic junction recombination velocity and led to analytical expressions of photocurrent density, photovoltage and electric power. The effect of the intrinsic junction recombination velocity or the solar cell junction quality on photocurrent, photovoltage and electric power, is exhibited and we determine the maximum electric power, the junction dynamic velocity at the maximum power point and the conversion efficiency according to the junction quality of the solar cell. From the electric power lost at the junction, we calculated the shunt resistance of the solar cell according to the junction quality.Keywords: Efficiency; Intrinsic junction recombination velocity; Joule effect; Solar cell; Shunt resistanc

Work activities at increased risk of traumatic injuries: an integrated preventive approach

Included in the scope of workplace safety is that relating to potential accidents, i.e. the harmful consequences for human health crossed with the work environment factor. In the study of the determinism of these accidental events, it is important to achieve a biomechanical balance between two main elements: the human and the work environment (consisting of the physical, chemical and environmental factors, i.e. the equipment and what generates its use). Considering the most recent statistically recorded incidents, our analysis has focused on the accident sphere proper, where an imbalance in the above-mentioned binomial triggers the activation of multiple disciplines that actively and pro-actively study the event and assess its sequelae, in all possible facets (economic, engineering, clinical, medical-legal)

Progress Report on Implementation of Regional Committee Resolution AFR/RC59/R3 on Accelerated Malaria Control

Several resolutions have been adopted and commitments made to scale up malaria control towards elimination in the African Region. These include United Nations, African Union, regional economic communities, World Health Assembly and Regional Committee resolutions. WHO AFRO provides support to countries, regional economic communities and the African Union in planning, implementing monitoring and evaluating their malaria control and elimination strategies. WHO also provides guidance and support for capacity building and resource mobilization towards reduction of the burden of malaria. As a result of scaling up evidence-based and high impact malaria interventions, the overall estimated incidence of malaria in the African Region fell by 33% from 2000 to 2010 and the upward trend of the disease was reversed. Furthermore, 12 countries in the African Region are on track to reduce malaria incidence by at least 50–75% by 2015. The action points of Resolution RC 59/R3 on Accelerated Malaria Control: Towards Elimination in the African Region remain relevant and should continue to guide countries in the context of their broader health, development and poverty reduction agenda.\u

Neonatal cytokines and chemokines and risk of Autism Spectrum Disorder: the Early Markers for Autism (EMA) study: a case-control study.

BackgroundBiologic markers of infection and inflammation have been associated with Autism Spectrum Disorders (ASD) but prior studies have largely relied on specimens taken after clinical diagnosis. Research on potential biologic markers early in neurodevelopment is required to evaluate possible causal pathways and screening profiles.ObjectiveTo investigate levels of cytokines and chemokines in newborn blood specimens as possible early biologic markers for autism.MethodsWe conducted a population-based case-control study nested within the cohort of infants born from July 2000 to September 2001 to women who participated in the prenatal screening program in Orange County, California, USA. The study population included children ascertained from the California Department of Developmental Services with Autism Spectrum Disorder (ASD, n = 84), or developmental delay but not ASD (DD, n = 49), and general population controls randomly sampled from the birth certificate files and frequency matched to ASD cases on sex, birth month and birth year (GP, n = 159). Cytokine and chemokine concentrations were measured in archived neonatal blood specimens collected for routine newborn screening.ResultsCytokines were not detected in the vast majority of newborn samples regardless of case or control status. However, the chemokine monocyte chemotactic protein-1 (MCP-1) was elevated and the chemokine Regulated upon Activation Normal T-Cell Expressed and Secreted (RANTES) was decreased in ASD cases compared to GP controls. The chemokines macrophage inflammatory protein-1alpha (MIP-1α) and RANTES were decreased in children with DD compared to GP controls.ConclusionMeasurement of immune system function in the first few days of life may aid in the early identification of abnormal neurodevelopment and shed light on the biologic mechanisms underlying normal neurodevelopment

Palatal Rugae as a Discriminating Factor in Determining Sex: A New Method Applicable in Forensic Odontology?

The purpose of this study is a new method that can help to identify the sex through the study of palatal rugae, comparing sagittal sections of the hard palate using Cartesian coordinates and evaluating the assistance given by digital technology and its applicability in this method. In this study, 57 digital impressions were examined and divided in two groups based on sex. Results: 2223 impression sections were studied and 145 coordinates that were present with a frequency greater than 50% in one or both groups were obtained: 52 discriminating traits (DT) in the male group, 29 discriminating traits in the female group, and 64 common traits (CT). The DTs in the female group showed no statistically significant difference from the same coordinates in the male one (p = 0.832). Statistically significant differences were observed in the DTs in the male group compared to the same coordinates in the female group (p = 0.018). No statistically significant differences were observed in the frequency of DTs in both sexes (p = 0.056). Further research in forensic odontology is needed to determine its scientific certainty. It is certain that digital technology may one day be a valuable support for the forensic odontologist but to date the lack of dedicated and certified programs limits its reliability

The role of vitamin deficiency in liver disease: To supplement or not supplement?

Over the past few years, growing interest has been shown for the impact of dietary requirements and nutritional factors on chronic diseases. As a result, nutritional programs have been reinforced by public health policies. The precise role of micronutrients in chronic liver disease is currently receiving particular attention since abnormalities in vitamin levels are often detected. At present, treatment programs are focused on correcting vitamin deficiencies, which are frequently correlated to higher rates of comorbidities with poor outcomes. The literature reviewed here indicates that liver diseases are often related to vitamin disorders, due to both liver impairment and abnormal intake. More specific knowledge about the role of vitamins in liver disease is currently emerging from various results and recent evidence. The most significant benefits in this area may be observed when improved vitamin intake is combined with a pharmacological treatment that may also affect the progression of the liver disease, especially in the case of liver tumors. However, further studies are needed

Utility of post mortem computed tomography in clivus fracture diagnosis. Case illustration and literature review

Clivus fractures are usually associated with head blunt trauma due to traffic accident and falls. A 23–year-old man died immediately after a smash-up while he was stopping on his motorcycle. Post-mortem Computed tomography (PMCT), performed before autopsy, revealed a complex basilar skull base fractures associated with brainstem and cranio-vertebral junction injuries, improving the diagnostic performance of conventional autopsy. Imaging data were re-assessable and PMCT offers the possibility to perform multiplanar and volume rendered reconstructions, increasing forensic medicine knowledge related to traumatic injuries

Evaluation des moyens de lutte contre les simulies dans le cadre du programme OCP (Onchocerciasis Control Programme)

Le Programme de Lutte contre l'Onchocercose en Afrique de l'Ouest, pour contrôler le vecteur #S. damnosum s.l., utilise des larvicides qui sont essentiellement épandus par voie aérienne. Malgré la résistance plus ou moins réversible de certaines espèces du complexe #S. damnosum aux organophosphorés (téméphos et chlorphoxime), le Programme a réussi à trouver des insecticides de remplacement efficaces. Ces larvicides utilisés en alternance en tenant compte des débits des rivières, des espèces simulidiennes présentes, et de leur sensibilité aux divers insecticides, ont permis de maintenir les bons résultats acquis par le Programme. Par la seule lutte antivectorielle, l'OCP a réussi à contrôler la maladie sur plus de 90 % de l'aire initiale. Les terres fertiles qui étaient autrefois abandonnées du fait de l'onchocercose sont en voie de repeuplement et de nombreux projets de développement socio-économique sont en cours d'exécution. Les extensions effectuées vers l'Ouest et le Sud du Programme, et l'utilisation de l'ivermectine, un microfilaricide, permettront encore d'améliorer ces résultats. (Résumé d'auteur