The Relationship between Subclinical Hypothyroidism and Carotid Intima-Media Thickness as a Potential Marker of Cardiovascular Risk: A Systematic Review and a Meta-Analysis.

BACKGROUND AND OBJECTIVES: Thyroid dysfunction is known to have significant consequences on the cardiovascular system. The correlation between carotid intima-media thickness (CIMT) and subclinical hypothyroidism (SCH) has been frequently evaluated in clinical studies in recent years. This study aimed to evaluate the significance of this association through a meta-analysis. METHODS: We conducted a systematic search of PubMed, MedLine, Scopus, and Web of Science databases using the keywords 'subclinical hypothyroidism and carotid intima-media thickness', from the beginning of each database until January 2023. We established the inclusion and exclusion criteria and considered studies that met the inclusion criteria. We used Jamovi for statistical analysis of the data. RESULTS: We identified 39 observational studies that met the inclusion criteria, with 3430 subjects: 1545 SCH and 1885 EU. Compared to euthyroid subjects (EU), subjects with subclinical hypothyroidism (SCH) had significantly increased carotid intima-media thickness (CIMT) values; the estimated average mean difference was 0.08 (95% CI 0.05 to 0.10), p < 0.01, I2 = 93.82%. After the sensitivity analysis, a total of 19 from the 39 abovementioned studies were analyzed, with most studies showing a positive association between SCH and thickening of the carotid wall; the estimated average mean difference was 0.04 (95% CI 0.02 to 0.07), p = 0.03, I2 = 77.7. In addition, female sex, advanced age, and high cholesterol levels statistically significantly influenced this association. CONCLUSIONS: Our meta-analysis indicates a significant positive association between SCH and increased CIMT, but with some limitations.

Ethical implications of developing RNA-based therapies for cardiovascular disorders.

The awareness concerning RNA-based therapies was boosted significantly after the successful development of COVID-19 vaccines. However, they can potentially lead to significant advances in other areas of medicine, such as oncology or chronic diseases. In recent years, there has been an exponential increase in the number of RNA-based therapies that were evaluated as potential treatments for cardiovascular disorders. One of the areas that was not explicitly assessed about these therapies is represented by their overall ethical framework. Some studies evaluate ethical issues of RNA-based treatments in general or targeting specific disorders (especially neurodegenerative) or interventions for developing RNA-based vaccines. Much less information is available regarding the ethical issues associated with developing these therapeutic strategies for cardiovascular disorders, which is the main aim of this study. We will focus our analysis on three main topics: risk-benefit analysis (including the management of public awareness about these technologies), and justice (in both research and clinical medicine).

Current Trends in Biohumoral Screening for the Risk of Sudden Cardiac Death: A Systematic Review.

Background and Objectives: Sudden cardiac death (SCD) represents a challenge to health systems globally and is met with increased frequency in the population. Over time, multiple screening methods have been proposed, including the analysis of various plasma biomarkers. This article aims to analyze for illustrative purposes the specialized literature in terms of current biomarkers and testing trends, in the case of cardiovascular diseases and implicitly sudden cardiac death. Materials and Methods: In this regard, we searched the PubMed database from 2010 to the present time using the keywords "sudden cardiac death" and "biomarkers". The inclusion criteria were clinical trials that analyzed the effectiveness of screening methods in terms of biomarkers used in stratifying the risk of cardiac distress and/or sudden cardiac death. We excluded reviews, meta-analyses, and studies looking at the effectiveness of treatments. Results: An extended approach was found, through studies that brought to the forefront both classical markers analyzed by new, more performant methods, markers for other pathologies that also determined cardiovascular impact, non-specific molecules with effects on the cardiovascular system, and state-of-the-art markers, such as microRNA. Some molecules were analyzed simultaneously in certain groups of patients. Conclusion: The observed current trend revealed the tendency to define the clinical-biological particularities of the person to be screened.

An Ethical Analysis Regarding the COVID-19 Pandemic Impact on Oral Healthcare in Patients with Mental Disorders.

During the COVID-19 pandemic, restrictive measures were imposed that significantly impacted the healthcare system in general, and the dental healthcare system in particular. The literature cites a possible association between mental and oral health, as psychiatric patients have decreased awareness of their oral health and, therefore, poor dental status. Moreover, several studies have found a positive association between SARS-CoV-2 infection and oral health conditions, as well as between SARS-CoV-2 infection and mental health status. This context generated multiple ethical dilemmas in the case of persons with mental health disorders who require dental treatment because they are more vulnerable in this respect. This article aims to analyze the ethical issues in dental care for patients with mental disorders concerning the COVID-19 restrictive measures. The ethical aspects involved here are the basic principles of bioethics and the related elements of accessibility, equity, consent, and confidentiality.

Physician-Patient Relationship in Current Cosmetic Surgery Demands More than Mere Respect for Patient Autonomy-Is It Time for the Anti-Paternalistic Model?

The ethical framework of cosmetic surgery is distinct from the one associated with clinical medicine. This distinctiveness has led to significant difficulties in conceptualizing the physician-patient relationship (PPR), as most models have been developed specifically for the latter. The purpose of this article is to show that the PPR in cosmetic surgery can be better described through a distinct approach that we name the anti-paternalistic model of the PPR, and we will briefly present the differences between it and autonomy-based models. We will analyze the principle of non-interference, the variable degree of autonomy of both the patient and the physician within this relationship, the handling of the relevant information, the principle of beneficence as satisfaction, the difficulties regarding the informed consent, the algorithm allowing for the refusal of the procedure, and children-related issues. Based on this analysis, we will show that an anti-paternalistic model of the PPR is preferable to an autonomy-based one, as it allows for better clarification of the underlying ethical issues involved in cosmetic surgery.

From Monastic Benevolence to Medical Beneficence: The Inception of Medical Ethics in Wallachia and Moldavia before the Second Half of the 19th Century.

In Middle Ages, in Moldavia and Wallachia, the healthcare system was almost non-existent, medical practice being the attribute of old women, midwives, charmers, and later monastic personnel. The first elements of medical ethics are identifiable in written texts from the 17th century, associated with a process of laicization of medicine and the appearance of the first combined civil and penal codes (Vasile Lupu's Law from 1646 and Matei Basarab's Law from 1652). In the next 150 years, elements of medical ethics were rarely identified, usually in legal regulations, personal letters, or literary works. Starting with the end of the 18th century, associated with the emergence of the position of public physician, detailed regulations regarding the healthcare system associated with an increased number of ethical norms began to emerge. The purpose of this article is to increase awareness to an international audience about the history of Romanian medical deontology and the roots of concepts appertaining to medical ethics in the territories of Moldavia and Wallachia.

Malpractice Claims and Ethical Issues in Prison Health Care Related to Consent and Confidentiality.

Respecting the consent and confidentiality of a patient is an underlying element in establishing the patient's trust in the physician and, implicitly, obtaining the patient's compliance. In particular, cases of inmate patients require increased attention in order to fulfill this goal against a background of institutional interferences, which, in certain situations, may endanger the autonomy of the physician and their respect for the inmate's dignity. The purpose of this article is to depict the characteristics of consent and confidentiality in a prison environment, in special cases, such as hunger strikes, violent acts, HIV testing, COVID-19 measures, and drug use, bringing into focus the physician and the inmate in the context of the particular situation where the target is disciplining someone in order for them to conform to social and juridical norms. Respecting the dignity of the inmate patient requires an adequate approach of informed consent and confidentiality, depending on each case, considering the potential unspoken aspects of the inmate's account, which can be key elements in obtaining their compliance and avoiding malpractice claims.

Ethical Challenges Regarding Cosmetic Surgery in Patients with Body Dysmorphic Disorder.

Body dysmorphic disorder (BDD) is an obsessive-compulsive disease, associated with increased addressability to plastic surgeons; however, as patients perceive body defects due to decreased insight, they are often unsatisfied with their appearance after cosmetic surgery. The purpose of this study is to evaluate the ethical reasoning that should be performed before accepting these patients as cosmetic surgery candidates. We will focus our analysis on three main areas of interest: autonomy, which in these patients is significantly decreased, beneficence as satisfaction, which in these particular patients does not justify performing the intervention, and loyalty, which should render cosmetic procedures immoral in patients with body dysmorphic disorder.

Medical-Legal and Psychosocial Considerations on Parental Alienation as a Form of Child Abuse: A Brief Review.

Parental alienation, an entity situated at the limit of psychiatry, sociology, and justice, still represents a controversial concept despite the legal dispositions that take it into account. The scope of this paper is to consider the relationship between parent and child, and child abuse from a psychosocial perspective, as well as to depict parental alienation, considered a form of child abuse, without omitting contradictory arguments which are also based on prudence in the minor's interest, turning the attention to parental estrangement. Although parental alienation is not a psychiatric diagnosis per se and neither is parental estrangement, recognizing the difference between them is vital to adequately manage the situation at the time of establishing custody.

Perceptions of Dental Medicine Students on Equity within Healthcare Systems in Romania: A Pilot Study.

The scope of this paper is to evaluate the opinion of future dentists on equity within healthcare systems from a social and medical perspective. MATERIAL AND METHODS: We conducted an observational study based on a survey among year five students from the "Carol Davila" Faculty of Dental Medicine Bucharest using an online questionnaire composed of graded answers to 14 statements on the theme of equity within healthcare systems before taking this course. RESULTS: The questionnaire was sent to 300 students, of whom 151 (50.3%) responded; 79.47% of these were female and 20.53% were male; 9.3% had a rural background and 90.7% had an urban background. The majority of respondents expressed strong agreement that equity in public healthcare and acknowledging disadvantaged populations was important. The majority of students also strongly agreed that inequity came about from a lack of accessibility to medical care, lack of financial resources, and the absence of a second medical opinion. There were no statistically significant differences specific to the gender and background environment of the respondents. CONCLUSIONS: The notion of equity is known to future dentists. However, contextual clarifications of the concept itself and its adequate quantification are necessary.

Relationship Between Injury Pattern and Domestic Violence in a Romanian Population.

ABSTRACT: Physical violence is a cause of morbidity and mortality worldwide. An often-underreported subtype of physical violence is domestic violence (DV). The main aim of this study was to identify DV-specific patterns of traumatic injuries in comparison to other types of interpersonal violence (OV) in a Romanian population from a medical-legal standpoint. We performed a retrospective study drawing on 500 medical-legal certificates (medical-legal document attesting the traumatic injuries) of victims of interpersonal violence issued by the National Institute of Legal Medicine Bucharest during the 2017-2020 period. A total of 500 victims comprised the sample, including 188 DV victims and 312 victims of OVs. A majority of the DV victims were women (153 victims; 81%), whereas a majority of the OV victims were men (231 victims, 74%). Overall, DV victims were older compared with OV victims (40.9 ± 15.4 vs 37.3 ± 14.8 years, respectively). We found a pattern of frequent upper limb injuries specific to DV, whereas head injuries were specific to OV.

Accuracy of the Chaillet's Method for Assessing the Age in Subadults. A Meta-Analysis.

Introduction Assessing the dental development plays a key role in forensic dentistry. Dental age based on stages of teeth mineralization can be assessed by using different methods, and is especially useful in subadults. Chaillet's method was developed based on the Demirijan's method. In this study, we aimed to study the applicability of Chaillet's method in subadults. MATERIALS AND METHODS: We performed systematic reviews and meta-analysis of observational studies published in English using the following databases Pubmed, Web of Science, Embase and Scopus, with a timeframe between 2013 and 2019. RESULTS: The difference between chronological age and dental age was calculated separately, for each gender. In girls, the method underestimated the age with an average difference between dental and chronological of 0.83 years (CI= [-1.34; -0.31]), with significant heterogeneity and publication bias. In boys, the method underestimated the age with an average difference between dental and chronological of 0.64 years (CI= [-1.28; 0.01)], with significant heterogeneity and publication bias. Chaillet's method showed an advanced dental maturity in European boys by 0.35 years [-0.85; 1.55], while it underestimated the age in South Asian boys by -1.03 (CI= [-1.60; -0.46]). For girls this method showed a delayed dental development for both regions, with a rather smaller difference for Europeans of -0.06 years (CI= [0.91; 0,78]) compared to South Asian girls: -1.19 years (CI= [-1.86; -0.51. CONCLUSION: Dental age estimation provided by the Chaillet's method showed an age overestimation in both genders, in most studies geographic groups.

Particularities of Offenders Imprisoned for Domestic Violence from Social and Psychiatric Medical-Legal Perspectives.

Background and Objectives: It is known that there may be an interconditionality between social status, personality disorders, and aggressive behavior. This study aimed to analyze the social and psychiatric diagnosis characteristics in subjects imprisoned for domestic violence acts compared to other types of aggressive behaviors. Materials and Methods: We performed a retrospective study using psychiatric medical-legal reports at the National Institute of Legal Medicine "Mina Minovici" Bucharest from 2016 to 2020. Results: We included 234 cases in our analysis, from which 132 (56%) were domestic violence offenders (DVO), and 102 (44%) were violence offenders imprisoned for other aggressions (OVO). Overall, DVOs were older than OVOs (43.0 +/- 14.7 vs. 36.1 +/- 16.6 years-old). In both study groups, most subjects were men, but the DVO group had more women than the OVO group: 23 cases (17%) and 3 cases (3%), respectively. In 14 cases (11%), previous criminal records were found from the DVO and 31 (30%) from the OVO group. Significantly fewer DVO were chronic psychoactive substance users: 83 (63%) in the DVO group versus 78 (86%) in the OVO group. Significantly more DVO had suicidal tendencies 26 (20%) compared to OVO 9 (9%). DVO subjects had significantly less often unsocialized conduct disorder or antisocial personality disorder compared to the OVO group. Conclusions: We found that DVO, compared to the OVO, were more numerous, older, less abusive, with a less frequent history of psychoactive substance abuse and addictions, and were less frequently indifferent to the committed acts.

Perspectives and Values of Dental Medicine Students Regarding Domestic Violence.

Background and Objectives: The purpose of this study is to evaluate dental medical students' opinions concerning domestic violence from a social and medical standpoint and from the perspective of the moral values of the physician-patient relationship. Materials and Methods: We performed an observational study with 4- and 5-year dental medical students at the UMF "Carol Davila" in Bucharest from October 2020-May 2021, using a questionnaire containing 20 items on domestic violence (DV). The questionnaire was uploaded online on the e-learning platform where the students have access. To collect the data, we used Microsoft Excel 365, and the statistical analysis was performed using Jamovi. Results: Of the 600 students enrolled, 415 answered the questionnaire, the answering rate being 69.16%. A total of 215 (53.1%) personally knew victims of DV, 4 (1.0%) considered that violence within a couple is necessary for certain situations, 401 (99.0%) considered that domestic violence is a fundamental problem in today's society, and 170 (41.5%) felt that in domestic violence situations, the blame lies solely with the partner who resorts to physical violence. Regarding the role of the physician, 220 (56%) considered that the physician should breach confidentiality and report cases when patients state they are a victim of DV, 337 (88.2%) thought that free medical treatment should be provided for DV victims who have a dire financial situation, and 212 (56.7%) considered that victims of DV are non-compliant patients. Conclusions: Domestic violence is a phenomenon well-known to stomatology students, which creates the premise of an excellent physician-patient relationship with them, aiding in proper management of ethical issues such as a potential need to breach confidentiality or evaluate the potential conflicts between autonomy and beneficence.

Accuracy of the Demirjian's method for assessing the age in children, from 1973 to 2020. A meta-analysis.

One of the most common ways to assess the age in subadults using dental records is the Demirjian method. As the number of the studies using this method increased significantly in the recent years, and as their results were often conflicting, we investigated the accuracy of the method. We performed a systematic review and meta-analysis of observational studies obtained from Pubmed, using a random-effects model with the DerSimonian-Laird estimator, and raw mean difference for effect size measure. Prediction intervals (at 95%) were used to assess the presence of significant statistical differences between chronological and dental age. Our meta-analysis showed that Demirijan's method overestimated dental age by 0.48 years in girls and 0.51 in boys. Depending on the location and sex, in girls the smallest average overestimation was found in Asia (except India), with a value of 0.36 years, and the largest overestimation in Turkey/Arabia, with a value of 0.66 years. In boys, the smallest average overestimation was found in India (0.45 years), but Asia (except India), Africa - both with 0.46 years and Oceania - with 0.47 years were close, while the largest overestimation was found in Turkey/Arabia, with an average value of 0.63 years. The Demirjian method overestimated the age by about half a year for both sexes. Even if there are some geographical/ethnic differences, they are rather small, making the method useful irrespective of the ethnic profile of the subjects.

The duty to treat in the context of the Covid-19 pandemic / El deber de tratar en el contexto de la pandemia de covid-19 / O dever de tratar no contexto da pandemia de covid-19

Abstract The duty to treat has been at the center of the moral and public debate surrounding the physician-patient relationship, especially in epidemics. The topic of discussion may be the physician who "fights" (the "hero physician"), the contaminated professional, the doctor who refuses to treat or the resigning physician. This may increase potential conflicts between the physicians' individual values and those of their patients, conflicts that can have personal and social consequences. Doctors implicitly assume that treating patients may generate risks for his/her own well-being, but none should accept risks related to insufficient protective equipment or inappropriate protocols, or other external causes that unjustifiably increase them. Everybody involved in healthcare has the duty to minimize the risks imposed on the patient; otherwise not only physicians are at risk, but also patients and society, which could receive less healthcare or even develop other diseases.

Resumen El deber de tratar está en el centro del debate moral y público que rodea la relación médico-paciente, especialmente en epidemias. El tema de discusión puede ser el médico que "lucha" (el "médico héroe"), el médico contaminado, el médico que se niega a tratar o el médico que renuncia. Este aumento de posi-bles conflictos entre los valores del profesional y del paciente puede tener consecuencias personales y sociales. Todo médico acepta, implícitamente, que su trabajo puede poner en riesgo su bienestar, pero ningún profisional debe aceptar los riesgos causados por un equipo de protección insuficiente, por pro-tocolos inapropiados u otras causas externas. Todos los involucrados tienen el deber de minimizar los riesgos al paciente, ya que de lo contrario no solo el médico está en riesgo, sino también toda la socie-dad, visto que los pacientes pueden recibir menos atención médica o desarrollar más enfermedades.

Resumo O dever de tratar está no centro do debate moral e público sobre a relação médico-paciente, especialmente em epidemias. O tópico da discussão pode ser o médico que "luta" (o "médico herói"), o profissional contaminado, aquele que se recusa a tratar ou se demitiu. Este aumento de potenciais conflitos entre os valores individuais do profissional e os do paciente podem ter consequências pessoais e sociais. Qualquer médico aceita, implicitamente, que o tratamento do enfermo pode gerar riscos para o próprio bem-estar, mas nenhum profissional deve aceitar riscos causados por equipamento de proteção insuficiente ou protocolos inadequados ou outras causas externas que os aumentem sem motivos justificáveis. Todos os envolvidos no cuidado à saúde devem minimizar os riscos impostos ao enfermo; caso contrário, não apenas o profissional está em risco, mas também os pacientes e a sociedade, que podem receber menos cuidados de saúde ou ainda desenvolver outras doenças.