[Study of sociodemographic and psychopathological risk factors in suicide attempts. 2008-2010]. / Análisis de los intentos de autolisis en un área de salud. 2008-2010.

OBJECTIVE: The aim of this study is to determine the sociodemographic and psychopathological features and risk factors associated with suicide attempts. DESIGN: A descriptive cross-sectional study based on medical records. Emergency Primary Care Centres (Jumilla, Yecla) and Hospital Emergency Departments (Yecla, Murcia, Spain). RESULTS: The suicide attempt rate increases in younger people (average of 36.4 years old). Suicide attempts are higher among women (67%). In terms of psychopathological data, suicide attempts were characterised by a higher prevalence of depression and anxiety disorder (30%), and substance abuse (13%). The percentage of patients who had made a previous suicide attempt was 37%. Self-poisoning was the most recurrent method of suicide attempt, present in at least 80% of the cases. Gender was a significant factor in the cause of suicide attempt (P=.042) and psychopathology (P=.011). The geographic origin of the patient is significantly associated with the suicide method used (P=.000). CONCLUSIONS: Suicide treatment protocols and suicide prevention programs must be developed, as well as recording the risk factors in the patient history.

[Quality recording of information in the health centre medical records on the use of analgesic and anti-inflammatory drugs]. / Calidad del registro de la información acerca del consumo de antiinflamatorios y analgésicos en la Historia clínica del Centro de Salud.

INTRODUCTION: To examine medical records within a health centre to determine whether there are data in the information process on the secondary effects and interactions of analgesic and anti-inflammatory drugs, and to determine the patient profile as regards whether or not this information is recorded in their medical records. MATERIAL AND METHODS: Descriptive, cross-sectional study based on electronic medical records in the Mariano Yago Primary Care Centre in Yecla (Murcia), Spain. A systematic random sample of 232 electronic medical records was reviewed. All the 232 patients, of legal age, gave their consent to review of their electronic medical records for the purposes of the study. RESULTS: The percentage of doctors who recorded the fact that they had provided information regarding secondary effects and non-compatibilities of the prescription of analgesic and antiinflammatory drugs was 21.6%. The factors involved in the non- recording of this information in the medical record were the type of prescription, the type of analgesic and anti-inflammatory drug prescribed, glomerular filtration, and adequate gastrointestinal protection. CONCLUSIONS: The degree of compliance to patients rights to information about treatment with analgesic and anti-inflammatory drugs is low.

Analysis of ionic ratios in the interventricular wall and their relation with cardiac damage as seen in anatomo-pathological and cardiac biomarkers.

UNLABELLED: In the present work, we have compared the behaviour of some commonly used markers for the immunohistochemical diagnosis of cardiac suffering (myoglobin, myosin, troponin I), with the modifications of the ionic quotients (K(+)/Na(+), Ca(2+)/Mg(2+) and Ca(2+)/Zn(2+)) that are observed in the interventricular partition in different causes of death. MATERIALS AND METHOD: we have studied a total of 50 hearts coming from autopsies carried out in the Legal Medicine Institute of Murcia (Spain) deceased 21 by natural cardiac deaths, 9 by mechanical asphyxias, 5 by politraumatism, 5 cardiac ruptures and 10 by craneoencephalic trauma. For the biochemical analysis, samples were taken from weave of 0.5 g of the interventricular partition, the corresponding dilutions were made in bidistilled water for flame atomic absorption spectrophotometry with a hollow cathode multielement lamp. For the immunohistochemical study, samples were taken from the same locations, kept in tamponed formol, dyed with hematoxylin-eosin and later 3 microm-sections were practised, antigenic recovery by heat, in pressure cooker. Our results show the existence of a statistically significant relation between the modifications of the K(+)/Na(+) quotient and the found values of troponin, which confirms its utility for the precocious diagnosis of the cardiac ischemia.

Association between immunohistochemical markers of myocardial damage and apoptosis.

Cardiac disease is the most common cause of sudden unexpected death. In forensic practice there is a need for more sensitive diagnostic methods for the post-mortem diagnosis of myocardial damage. The aim of this study was to evaluate the association of the markers routinely used for the diagnosis of acute cardiac necrosis (myosin, troponin I and myoglobin with) and the presence of apoptosis, in order to evaluate the utility of apoptosis for use as a diagnostic marker during the early stage of acute myocardial damage. A positive correlation was observed between neovascularization and signs of recent and past necrosis. Not relationship was observed between age at death, post-mortem interval and apoptosis. No statistical association was found between the expression of acute cardiac necrosis markers and the presence of apoptosis.

Histological findings and immunohistochemical surfactant protein A (SP-A) expression in asphyxia: its application in the diagnosis of drowning.

The histopathological alterations that permit the diagnosis of death by asphyxia are very unspecific, although pulmonary alterations are of great importance in this respect. The postmortem diagnosis of drowning, particularly, continues to be one of the most difficult in forensic pathology. The aim of this study is to jointly evaluate microscopic findings and immunohistochemical surfactant protein A (SP-A) expression in the upper and lower lobes of lungs in different causes of death, and their possible application to the diagnosis of drowning. We studied 120 cadavers from subjects with a mean age of 48.73 years (SD 19.45; range 2-86 years), and with a mean post-mortem interval of 30 hours (SD 39.59; range 3-216 hours). According to the scene, cause and circumstances of death, and autopsy findings, cases were classified into groups as follows: (a) drowning (n=47); (b) other asphyxia (n=44) and (c) other causes (n=29). In the upper and lower lobes of lungs, histological studies of H&E staining and immunohistochemical surfactant protein A expression were made. The presence and severity of congestion, haemorrhage and oedema, together with immunohistochemical SP-A expression, may have a diagnostic value in differentiating asphyxia and drowning from other causes of death, and drowning from other types of asphyxia. Our findings suggest that both lobes should be investigated to establish the diagnosis, although the findings in the upper lobe might be the most important for differentiating the exact cause of death.

Expression and significance of cell immunohistochemical markers (HHF-35, CD-31, Bcl-2, P-53 and apopDETEC) in hypertrophic cardiomyopathy.

There are several hypotheses concerning the pathogenesis of hypertrophic cardiomyopathy (genetic, ischaemic, immune, inflammatory and apoptosis induction). We have studied three types of cardiomyopathy in order to observe the expression and assess the significance of different immunohistochemical markers (muscular actin, CD-31, proliferation cell nuclear antigen -PCNA-, Ki-67, and markers related with programmed cell death, bcl-2, p-53 and apopDETEC). We studied different microscopic (haematoxylin-eosin and Masson's thrichrome) and immunohistochemical parameters (streptavidin-biotin-peroxidase and "in situ" hybridisation) of forty cases: ten each of hypertensive hypertrophic cardiomyopathy, essential hypertrophic cardiomyopathy, hypertrophic cardiomyopathy in patients treated with chemotherapy and morphologically "normal" hearts. Our findings point to an absence of structural marker expression (actin and CD-31) in cases of hypoxic damage. The distribution and intensity of apoptosis markers, a seen by "in situ" hybridisation were irregular, and the rest of the markers studied showed negative results, with the exception of acridin orange (a marker of hypoxic damage). In our opinion, the above immunohistochemical markers, especially actin and CD-31, could be used for differentiating hypoxic lesions in these three types of cardiomyopathy. Moreover, it is difficult to know the significance of the apoptosis markers, because the autolysis process produces cross reactions with false positive results. We think that there is a need for new studies on DNA breakdown processes during the post-mortem interval. To avoid autolysis problems the post-mortem material needs to be as fresh as possible.

Morphological characterization of renal cell lines (BGM and VERO) exposed to low doses of lead nitrate.

The response to lead nitrate has been assessed in two cell lines of renal origin. The range of toxic concentrations was determined by Neutral Red assay after 24-h of exposure. Morphological changes in the Buffalo Green Monkey (BGM) and VERO cell lines after exposure to subcytotoxic doses (1.38 mM and 1.04 mM, respectively) equivalent to EC10 (effective concentrations 10%) of lead nitrate were evaluated at the ultrastructural level by transmission microscopy. The most notable finding in treated cells was the presence of inclusion bodies in the form of irregular granules of varying size in both cytoplasm and lysosomes. Cell membrane integrity was not affected. The number of phagolysosomes and myeline figures associated to the inclusion bodies was higher than in the control cultures. We conclude that the phagolysosomic mechanism fails to digest this metal ion and the BGM and VERO renal cell lines can be considered as useful tools for toxicological studies involving lead nitrate.

Comparison of cytopathological changes induced by mercury chloride exposure in renal cell lines (VERO and BGM).

The response to mercury chloride was assessed in two cell lines of renal origin, determining the range of toxic concentrations by Neutral Red assay after 24-h of exposure. Morphological changes in the Buffalo Green Monkey (BGM) and VERO cell lines after exposure to subcytotoxic doses (0.045 and 0.038mM, respectively) equivalent to EC10 (effective concentrations 10%) of mercury chloride were evaluated at the structural and ultrastructural level by optic, transmission and scanning microscopy. Using transmission electron microscopy, the most notable findings in treated cells were the presence of intracytoplasmic inclusion bodies and apoptotic bodies. Scanning microscopy pointed to a cell with a disrupted perinuclear region and a decreased number of surface microvilli. Similar alterations in both in vivo and in vitro experiments have been described by other authors. We conclude that BGM and VERO renal cell lines can be considered as useful tools for toxicological studies involving mercury chloride.

Morphological characterisation of BGM (Buffalo Green Monkey) cell line exposed to low doses of cadmium chloride.

Morphological changes in the Buffalo Green Monkey (BGM) cell line after exposure to a subcytotoxic dose (0.062 mM, equivalent to EC(10)-effective concentration 10%) of cadmium chloride have been evaluated. Cells were exposed for 24 h and the effects observed at the ultrastructural level by transmission and scanning microscopy. Using transmission electron microscopy, the most notable findings in treated cells were the presence of intranuclear inclusion bodies and thin intracytoplasmic granules associated to myelin figures and the presence of apoptotic bodies. Other morphological alterations included cell vacuolisation and a reduced cytoplasm volume, condensation of the mitochondria and a decreased number of cytoplasmic organelles, except lysosomes and autophagic vacuoles, which increased in number. Scanning electron microscopy pointed to a cell with a disrupted perinuclear region and a decrease in the number of surface microvilli. We conclude that the BGM cell line may be considered an useful tool for toxicological studies involving cadmium.

Medicolegal problems associated with do not resuscitate orders.

The use and potential abuse of the do not resuscitate (DNR) order has wide-ranging ethical, legal and economic implications. A DNR order is essential for clear communication between health care professionals, but the order itself may affect the care that patients subsequently receive. In addition, the DNR order may be a crucial therapeutic decision point in the care of the critically ill. Although general guidelines exist for withholding resuscitative measures from the terminally ill and general principles have been established, Spanish legislation is ambiguous on a number of points, forcing medical professionals to make difficult choices. This has led to the systematic, indiscriminate application of resuscitative measures, motivated in many cases by the desire to avoid a possible future lawsuit. We believe clearer and more precise legislation should be developed to bring Spanish criteria into line with those of international organizations that provide a common set of guidelines on important issues relating to the right to life and the right to refuse treatment.

Attitudes of medical personnel (doctors and nurses) toward informing the terminal patient.

The right to be informed, an indispensable condition of informed consent for a given therapeutic intervention, results in numerous practical problems in extreme situations. The purpose of this study was to analyze the relevant attitudes of medical practitioners and nursing staff. A total of 108 doctors and 102 nurses ranging in age from 22 to 63 years (mean 29, 67; SD 8, 73) was randomly selected from personnel currently in practice in Murcia (Spain) and asked to respond to a 72 item questionnaire developed by the authors. The results underline the need to approach the doctor-patient relationship from standpoint more closely attuned to the real circumstances of medical practice.

Study of postmortem blood circulation.

The objective of this work was to study the postmortem redistribution of blood volumes and its influence of the distribution of substances of different molecular weight (194.2 and 150,000 Da). Lipiodol Ultrafluide, Omnitrast, or a radioisotopic mixture of aminohippuric acid and human IgG were injected into the left ventricle of a total of 20 rabbits divided into three groups. Our results demonstrate the importance of related factors, including left ventricular postmortem contraction, the arterial vascular bed, diffusion processes connected to the physicochemical characteristics of the substances, and the anatomical distribution of the vessels. Postmortem diffusion of aminohippuric acid to the urine was observed.

A cytologic study of the sediments in pericardial fluid as it relates to a diagnosis of the mechanism of death.

We have studied the sediments obtained from the pericardial fluids of 70 cadavers subject to different causes of death. The fluids were taken in the course of corresponding legal autopsies. The samples were organized according to the cause of death and cellular predominance, in the following groups, respectively: hanging, multiple trauma, craniocerebral trauma, other violent deaths, myocardial infarction, pulmonary embolism, and other natural deaths. According to cell type followed these categories: Group 1 (isolated mesothelial cells), group 2 (isolated and plated mesothelial cells), group 3 (inflammatory cells and mesothelial cells, isolated and plated), and group 4 (inflammatory cells and mesothelial cells). The statistical analysis was attained through Pearson's coefficient. We have found a significant statistical relation (P less than or equal to 0.05) between the presence or lack of inflammatory cells and the mechanism of death. In those cases with a short survival period and without cardiac affectation, the presence of inflammatory cells was practically null. Furthermore, differences in the cross-sections of inflammatory cells reflected the duration of the death process, with elements characteristic of acute inflammation revealing acute cardiac process.