Occupational contact allergy to omeprazole and ranitidine.

Omeprazole is a proton pump inhibition and ranitidine is an H2 histamine receptor antagonist widely used in the treatment of gastroesophageal reflex disease, peptic ulcer disease, Zollinger-Ellison syndrome and as a protector of the gastric mucosae. We report a case of occupational contact allergy to omeprazole and ranitidine. A 48-year-old man, with no pre-existing history of atopy or lifestyle factors. He neither had any medical history of consumption of drugs such as ranitidine and omeprazole. He worked for 19 months in the pharmaceutical company that manufactured ranitidine base. He presented rash in the face and eczema on the dorsum of the hands with itching. The study by prick tests with ranitidine gave negative response. Patch testing with ranitidine base and ranitidine hydrochloride gave positive response. A month later, when the patient was asymptomatic he returned to the pharmaceutical company, being switched from this previous job to the reactor manufacturing omeprazole. A few days after that, he presented erythematous eruptions involving face and neck with itching. Prick tests, path tests and in vitro laboratories studies with omeprazole gave positives. In this case the patient presented hypersensitivity type I at omeprazole and hypersensitivity type IV at omeprazole and ranitidine. Our aportation indicates the importance of careful analysis of the occupational exposure histories of patients with the suspected type I or type IV hypersensitivity to allergens, to determine whether work exposure is the cause. Med Pr 2017;68(3):433-435.

Fatal accident involving a welder employed by a shipping container company, associated with the use of tramadol and antidepressant agents.

The widespread use of opioids for the treatment of moderate or severe acute and chronic pain has become a public health problem due to the physical and psychological dependence and tolerance they produce. The increasingly higher doses that patients require may reach toxic levels or lead to accidents, including fatalities. We present the case of a welder who, while working for a shipping container company, fell from height without a safety harness and subsequently died as a result of a traumatic brain injury. Post-mortem examination revealed a cardiac blood tramadol concentration of 2.83 mg/L, which is 3-4 times higher than the maximum therapeutic dose. The combined use of synthetic opioids and antidepressants may heighten the adverse neurological and psychiatric effects. A review of the literature, identified studies, including previous reports of fatalities, supported our causal hypothesis of a serotonin syndrome. This syndrome can lead to a loss of cognitive and sensory capacity, interfere with decision-making ability, and produce mental confusion and dizziness, among other symptoms. In order to prevent harm to themselves and others, all persons who are currently taking these kinds of drugs should avoid dangerous tasks at work and must be advised by a physician regarding the type of activities that are safe for them to perform.

Perchloroethylene: acute occupational poisoning and a proposal for its replacement with other less toxic substances.

Perchloroethylene is used mainly as a solvent in dry cleaning, cleaning of electrical equipment, and degreasing of metal parts. The authors report a case of acute poisoning with perchloroethylene contracted by a maintenance worker when cleaning an electric transformer. Since perchloroethylene may cause severe poisoning and the International Agency for Research on Cancer has classified it as a probable carcinogen for humans, the authors have revised the main substances that may replace perchloroethylene in the workplace. Med Pr. 2019;70(3):393-5.

Occupational disease due to Anisakis simplex in fish handlers.

BACKGROUND: Anisakis is a marine nematode. Its larvae can be found encysted in several species, both in the abdominal cavity and in the adjacent musculature. The most commonly affected commercial species are hake, whiting, cod, and mackerel. The prevalence in fish varies according to the fishing area and the size of the host. MATERIALS AND METHODS: Until now only three species have been confirmed to be involved in human anisakiasis, the most common ones being A. simplex sensu stricto (s.s.) and A. pegreffii, and anecdotally, A. physeteris. Infestation in humans occurs when they eat raw or undercooked parasitized fish or cephalopods (pickled, cold-smoked, salted, semi-preserved, prepared in certain Asian styles like sushi or sashimi, ceviche). RESULTS: The majority of anisakiasis cases have been described by Japanese authors. However, over the last few years there has been an increase in the number of cases reported in other countries including Italy and Spain. It is estimated that its incidence in the European Union is 0.32/100,000, and in the Basque Country (Spain), this parasite is responsible for 10% of anaphylaxis cases and 32% of urticaria cases in adults aged 40-60 years, around 300 cases/year. Anisakis-related disease in the work environment (occupational disease) is less common. CONCLUSIONS: We present three cases of the occupational disease in Spain due to a type I hypersensitivity to Anisakis simplex in individuals who handle fish (one fishmonger, one supermarket employee, and one chef).

Valoración medicolegal de la infección por COVID-19 en el ámbito laboral / Medico-legal assessment of the COVID-19 infection in workplace

España ha sido uno de los países con mayor afectación por la pandemia COVID-19. Hasta la fecha, un 22% de los casos notificados son personal sanitario, siendo significativamente mayor este porcentaje entre las mujeres (76% del personal sanitario contagiado). Ante la evidencia de que muchos profesionales sanitarios pueden haberse contagiado en su puesto de trabajo, hemos revisado la problemática en el ámbito de la salud laboral que produce la COVID-19. Se describen los decretos publicados por el Gobierno de España y las recomendaciones de la Organización Internacional del Trabajo. Concretamente se analiza la clasificación del SARS-CoV-2 como agente biológico del grupo 3, su calificación como accidente de trabajo o enfermedad profesional y sus repercusiones en las situaciones de incapacidades (temporales y permanentes), secuelas y muerte, así como el estudio de las posibles demandas de aquellos que lo han sufrido como consecuencia de falta de medidas preventivas

Spain is one of the countries most affected by the COVID-19 pandemic. To date, 22% of reported cases are healthcare professionals, and 76% of them are women. Given that many healthcare professionals may have been infected in their workplace, we have reviewed the occupational health challenges posed by COVID-19. The Spanish laws and the recommendations of the International Labor Organization are described. The review covers the classification of SARS-CoV-2 as a biological agent in group 3 and of COVID-19 as an occupational accident or disease, its repercussions in temporary and permanent disabilities, sequelae and death, and the possible claims of those who may have developed the disease due to the lack of preventive measures

[Temporary disability and its legal implications]. / La incapacidad temporal y sus implicaciones legales.

Temporary disability is the condition that workers face when, as the result of illness (common or professional) or accident (work-related or not), they are temporarily prevented from performing their work and require health care. The management of temporary disability is a medical act that involves (in addition to a complex clinical assessment) obvious social, occupational and financial connotations and requires continuing medical follow-up from doctors, as well as responses to medical-legal conflicts. The regulatory framework on the subject is extensive in the Spanish setting and highly diverse in the European setting. Beyond the regulatory framework, the repercussions of temporary disability are self-evident at all levels. Although determining temporary disability is a common medical act for practicing physicians, it is not exempt from risks or difficulties arising from the assessment itself and the characteristics of practicing medical care. Established medical-legal conflicts include the processing of health data and the requirements for transferring information related to workers' temporary disability to their company's medical services. The interest and usefulness demonstrated by the data obtained from forensic medicine for public health require the incorporation of these data into general healthcare information, as it could be essential to the surveillance of worker health. The recommendations established by medical societies, as good practice guidelines, are especially useful in this type of conflict.

Valoración del daño corporal en el trastorno orgánico de la personalidad / Evaluation of body injury in organic personality disorder

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Wrongful birth: responsabilidad profesional en el diagnóstico prenatal (1989-2004) / Wrongful birth: professional liability in prenatal diagnosis (1989-2004)

Objetivo/introducción: el error en el diagnóstico prenatal puede privar a la mujer de la información necesaria para decidir con plena autonomía si ejerce su derecho a interrumpir el embarazo. 'Wrongful birth' es la doctrina anglosajona utilizada como acción para exigir responsabilidades si el resultado es una malformación o enfermedad detectable en el estudio prenatal. Sujetos y método: se realizó un estudio descriptivo retrospectivo de las demandas por 'wrongful birth' en la provincia de Barcelona en el período 1989-2014. Resultados: Se encontraron 38 reclamaciones (incidencia de 3 por cada 100.000 nacimientos). Las patologías más frecuentes son: malformaciones múltiples (23%), cromosomopatías (13%), malformaciones cardiovasculares (13%) y esqueléticas de extremidades (13%). La vía de reclamación más utilizada es la extrajudicial (52,63%). Conclusiones: el 'error humano o de gestión' supone un riesgo muy alto de responsabilidad profesional médica, mientras que el error en la interpretación ecográfica supone indemnización en el 23,53% de los casos (AU)

Objective/introduction: Error in prenatal diagnosis can deprive woman of the information needed to decide with full autonomy whether to exercise their right to a pregnancy termination. The Anglo-Saxon concept of wrongful birth is a legal cause of action if the result is a malformation or disease detectable in prenatal study. Subjects and method: We performed a retrospective and descriptive study of wrongful birth claims in the province of Barcelona in the period 1989-2014. Results: There were 38 claims (an incidence of 3 complaints per 100,000 births). The most frequent entities were multiple malformations (23%), chromosomopathies (13%), and malformations of the heart and extremities (13% each). Most claims (52.63%) were settled out of court. Conclusions: 'Human or management error' represents a very high risk for medical professional liability claims. Error in ultrasound interpretation leads to compensation in 23.53% of cases (AU)

La especialidad de Medicina Legal y Forense en España: La consolidación por el sistema de residencia / Legal and Forensic Medicine Specialty in Spain: the consolidation by the medical residency system

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La discapacidad intelectual: criminalidad, evaluación y repercusión en el ámbito forense / Intellectual disability: criminality, assessment and forensic issues

La discapacidad intelectiva resulta del máximo interés en el ámbito forense. La presente revisión comprende la búsqueda electrónica de artículos en inglés o castellano registrados en la base de datos Medline con los términos FORENS* e INTELLECTUAL DISABILITY en el «Título» o «Resumen», hasta el 1 de enero de 2018, seleccionándose aquellos que abordaban cuestiones relativas a los antecedentes históricos y consideración jurídica, la criminalidad y tipología delictiva, la comorbilidad en sujetos que delinquen, los factores de riesgo y reincidencia y la evaluación forense, excluyendo los artículos sobre tratamiento o resultados del mismo. Se identificaron 80 artículos que cumplían criterios de inclusión, que subrayaban la consideración especial históricamente dispensada por la justicia a los sujetos afectos de discapacidad intelectiva, las elevadas tasas descritas en prisión, discuten su relación con la violencia, incluida la sexual, describen tasas elevadas de comorbilidad con otros trastornos psiquiátricos, con discrepancias respecto a los trastornos relacionados con tóxicos y, por último, repasan los factores de riesgo y la reincidencia en estos sujetos, así como los métodos de evaluación forense de la discapacidad. Asimismo, se explicitan las limitaciones de la bibliografía revisada especialmente en relación con los conceptos que definen la discapacidad intelectiva en investigación

Intellectual disability is of maximum interest in the forensic field. This review includes an electronic search of articles in English or Spanish registered in the Medline database with the terms FORENS* and INTELLECTUAL DISABILITY in the Title or Abstract, up until January 1, 2018, selecting those that addressed issues related to the condition's historical background and legal consideration, criminality and criminal typology, comorbidity in offenders, risk factors and recidivism, and forensic assessment, excluding articles on treatment or treatment outcomes. We identified 80 articles that fulfilled criteria for inclusion, which highlighted the special consideration historically given by the law to subjects affected by intellectual disability, their high rates of imprisonment, which discussed their relationship with violence, including sexual violence, which describe high rates of comorbidity with other psychiatric disorders, with discrepancies regarding toxic-related disorders, and lastly which reviewed these subjects' risk factors and recidivism, as well as the forensic assessment methods. We also outline the limitations of the literature review, especially in relation to the research criteria that define intellectual disability

Autopsias judiciales en personas mayores de 65 años / Forensic autopsies of elderly patients

Introducción. Las personas mayores de 65 años son pacientes con pluripatología, siendo la causa de muerte la confluencia de múltiples factores. El objetivo del presente estudio es conocer el perfil y las causas de muerte en una serie de autopsias judiciales de personas de la tercera edad en Barcelona. Material y métodos. Estudio descriptivo y retrospectivo de las autopsias judiciales en mayores de 65 años realizadas en el Servicio de Patología Forense de Barcelona del Instituto de Medicina Legal de Cataluña entre octubre de 2010 y septiembre de 2011. Resultados. Se practicaron 1.494 autopsias, de las cuales 641 (42,9%) correspondieron a fallecidos de una edad de 65 o más años (63,8% varones y 36,2% mujeres). De estas 179 (28%) fueron muertes violentas (57% accidentales, 31,3% suicidas, 8,4% indeterminadas y 3,4% homicidios). Se solicitó análisis toxicológico en 277 casos y las sustancias más frecuentemente halladas fueron etanol en 34 casos (12,8%) y antidepresivos en 30 (11,3%). Conclusiones. La información procedente de las autopsias judiciales en personas mayores de 65 años aporta más información clínica que judicial (AU)

Introduction. Comorbidity is common in people over 65 years, where the confluence of multiple factors can be the cause of death. The aim of this study is to know the profile and the causes of death in a series of judicial autopsies of elderly persons in Barcelona. Material and methods. Descriptive and retrospective study of the judicial autopsies of persons aged 65 years or more that were performed at the Forensic Pathology Service of Barcelona of the Institute of Legal Medicine of Catalonia between October 2010 and September 2011. Results. Among 1494 autopsies performed, 641 (42.9%) were from people aged 65 years or more (63.8% men and 36.2% women). Among them, 179 (28%) were violent deaths (57% accidents, 31.3% suicides, 8.4% undetermined and 3.4% homicides). A toxicological analysis was performed in 277 cases and the substances more commonly found were ethanol in 34 cases (12.8%) and antidepressants in 30 (11.3%). Conclusions. The information provided by the forensic autopsies of persons aged 65 years or more is more clinical than judicial (AU)

La enseñanza de la Medicina del Trabajo en la licenciatura y en el grado de Medicina / Occupational Medicine in the degree of Medicine program

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Introduction: Medicina Legal y Responsabilidad Médica / No disponible

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La incapacidad temporal y sus implicaciones legales / Temporary disability and its legal implications

La incapacidad temporal es la situación en la que se encuentra un trabajador que, a consecuencia de una enfermedad (común o profesional) o accidente (sea o no de trabajo), está impedido para desempeñar temporalmente su trabajo y requiere asistencia sanitaria. La gestión de la incapacidad temporal es un acto médico que implica, al margen de una compleja valoración clínica, evidentes connotaciones sociales, laborales y económicas, exigiendo al médico un seguimiento clínico continuo y dar respuesta a conflictos medicolegales. El marco regulatorio en la materia es extenso en el ámbito español y muy diverso en el europeo. Más allá del marco normativo, la repercusión de las incapacidades temporales es indiscutible a todos niveles. Aunque la determinación de una incapacidad temporal es un acto médico muy frecuente para los médicos asistenciales, no está exento de riesgos ni de dificultades derivados de la propia valoración y de las características del ejercicio de la medicina asistencial. Algunos conflictos medicolegales planteados son el tratamiento de los datos de salud o la obligatoriedad de trasladar a los servicios médicos de empresa la información relacionada con la incapacidad temporal del trabajador. El interés y utilidad que han demostrado los datos obtenidos desde la medicina forense para la salud pública obligan a incorporar a estos al común de la información sanitaria, pudiendo ser clave en la vigilancia de la salud de los trabajadores. Las recomendaciones establecidas por sociedades médicas, como códigos de buenas prácticas, son especialmente útiles en este tipo de conflictos (AU)

Temporary disability is the condition that workers face when, as the result of illness (common or professional) or accident (work-related or not), they are temporarily prevented from performing their work and require health care. The management of temporary disability is a medical act that involves (in addition to a complex clinical assessment) obvious social, occupational and financial connotations and requires continuing medical follow-up from doctors, as well as responses to medical-legal conflicts. The regulatory framework on the subject is extensive in the Spanish setting and highly diverse in the European setting. Beyond the regulatory framework, the repercussions of temporary disability are self-evident at all levels. Although determining temporary disability is a common medical act for practicing physicians, it is not exempt from risks or difficulties arising from the assessment itself and the characteristics of practicing medical care. Established medical-legal conflicts include the processing of health data and the requirements for transferring information related to workers’ temporary disability to their company’s medical services. The interest and usefulness demonstrated by the data obtained from forensic medicine for public health require the incorporation of these data into general healthcare information, as it could be essential to the surveillance of worker health. The recommendations established by medical societies, as good practice guidelines, are especially useful in this type of conflicto (AU)

Institutos de Medicina Legal: un nuevo modelo organizativo de la medicina forense en España / Medicolegal instituts, a new management system in forensic medicine in Spain

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