Guía para prevenir las reclamaciones por presunta mala praxis médica, de cómo actuar cuando se producen y cómo defenderse judicialmente / Guideline to prevent claims due to medical malpractice, on how to act when they do occur and how to defend oneself through the courts

Las reclamaciones por presunta mala praxis médica aumentan en todos los países desarrollados, y muchas de ellas no tienen fundamento. Para prevenir las reclamaciones judiciales los médicos deberían conocer las razones por las que son reclamados por sus pacientes y adoptar las medidas preventivas adecuadas. En caso de reclamación es indispensable seguir unas normas que permitan una defensa jurídica adecuada, así como una actuación del médico ante el juez que inspire confianza y credibilidad. El riesgo de reclamaciones puede reducirse con una adecuada información al paciente, el seguimiento de las guías clínicas, el control de los factores de riesgo, y la adopción de listas de verificación en cada procedimiento invasivo. En caso de complicación o efecto adverso grave debe procederse a dar explicaciones al paciente y a sus familiares, y comunicarlo a la institución donde trabaja y a la compañía de seguros. Si el médico recibe una reclamación, debe comunicarlo a su compañía de seguros para que esta designe el abogado responsable de la defensa jurídica, que asesorará al médico para su comparecencia ante el juez(AU)

Claims due to presumed medical malpractice are increasing in all developed countries and many of them have no basis. To prevent legal complaints, the physicians should know the reasons why complaints are made by their patients and adopt the adequate preventive measures. In the case of a complaint, it is essential to follow the guidelines that allow for adequate legal defense and the action of the physician before the judge that inspires confidence and credibility. The risk of the claims can be reduced with adequate information to the patient, the following of the clinical guidelines, control of the risk factors and adoption of verification lists in each invasive procedure. In case of complication or serious adverse effect, explanations should be given to the patient and family and it should be reported to the facility where one works and to the insurance company. of the physician received a claim, he/she should report it to the insurance compare so that it can name a lawyer responsible for the legal defense who will advise the physician regarding the appearance in court before the judge(AU)

[Guideline to prevent claims due to medical malpractice, on how to act when they do occur and how to defend oneself through the courts]. / Guía para prevenir las reclamaciones por presunta mala praxis médica, de cómo actuar cuando se producen y cómo defenderse judicialmente.

Claims due to presumed medical malpractice are increasing in all developed countries and many of them have no basis. To prevent legal complaints, the physicians should know the reasons why complaints are made by their patients and adopt the adequate preventive measures. In the case of a complaint, it is essential to follow the guidelines that allow for adequate legal defense and the action of the physician before the judge that inspires confidence and credibility. The risk of the claims can be reduced with adequate information to the patient, the following of the clinical guidelines, control of the risk factors and adoption of verification lists in each invasive procedure. In case of complication or serious adverse effect, explanations should be given to the patient and family and it should be reported to the facility where one works and to the insurance company. If the physician received a claim, he/she should report it to the insurance compare so that it can name a lawyer responsible for the legal defense who will advise the physician regarding the appearance in court before the judge.

Guerra Civil Española (1936-1939): identificación de restos humanos procedentes de fosas comunes en Cataluña mediante análisis de ADN Mitocondrial. A propósito de un caso / Spanish Civil War (1936-1939): identification of human remains from mass graves in Catalonia using mitochondrial DNA analysis. A case report

La identificación de personas desaparecidas durante la Guerra Civil española se ha convertido en un tema de interés social. El presente trabajo describe la identificación del primer cadáver exhumado en Cataluña procedente de una fosa común de la guerra civil. Como técnicas confirmativas a la metodología clásica empleada en la identificación de restos humanos (antropométricas, fórmula del análisis dental...) la ciencia forense encuentra en el análisis del ADN una herramienta útil. La identificación se llevó a cabo analizando la región de control del ADN mitocondrial debido a la antigüedad de los restos humanos (aproximadamente 65 años) y a que la única muestra de referencia disponible procedía de un lejano pariente materno (sobrina). Los productos de secuenciación fueron analizados utilizando un ABI PRISM 310 (AB). Tras cumplir con todos los requisitos de aceptación de las secuencias y descartada la posible presencia de contaminaciones eventuales, se observó una total coincidencia entre las secuencias del ADNmt del fémur y la muestra de referencia aportada por el familiar. La secuencia obtenida era 16298C, 263G, 315.1C y después de consultar una base de datos de 2192 individuos caucásicos esta secuencia fue observada una vez, de modo que la frecuencia de esta secuencia es de 0.0013. Los resultados obtenidos apoyan el hecho de que cuando los análisis convencionales de ADN nuclear son inviables el análisis de ADNmt se convierte en una útil y poderosa herramienta (AU)

The identification of missing people during the Spanishcivil war has become a subject of social interest. The present work describes the identification of the first corpse from amass grave exhumed in Catalonia. As confirmatory technique to the classic methodology used in the identification of human skeletal remains (anthropometrics, dental charts...) forensic science finds in the DNA analysis an useful tool. The identification was carried out analyzing the control region of mitochondrial DNA due to the antiquity of the human remains (approximately 65 years) and because the only available sample of reference came from a distant maternal relative (niece). The sequencing products were analyzed using the genetic analyzer ABI PRISM 310 (AB). After fulfilling all the requirements of acceptance of the sequences and eliminated the possible presence of contaminations, a match was observed between the mtDNA sequences obtained for both samples, femur and the sample of reference contributed by the relative. The obtained sequence was 16298C, 263G, 315.1C and only one ocurrence of this sequence was observed in a database of 2192 Caucasian individuals (frequency 0,0013). The obtained results support the fact that when conventional nuclear DNA typing is not possible the analysis of mtDNA becomes an useful and powerful too (AU)

Neonatal pemphigus vulgaris with extensive mucocutaneous lesions from a mother with oral pemphigus vulgaris.

The clinical phenotype of pemphigus is well explained by the combination of desmoglein (Dsg) 1 and Dsg3 distribution pattern and antiDsg autoantibody profile (Dsg compensation theory). It has been reported that neonatal skin has a similar Dsg distribution pattern to adult mucosal epithelia. We describe a newborn girl with mucocutaneous pemphigus vulgaris (PV) from a mother with mucosal dominant PV. The mother had had painful oral erosions for at least 7 months. Histopathological examination and direct and indirect immunofluorescence studies confirmed the diagnosis of PV and neonatal PV in the mother and daughter, respectively. The mother had a high titre of anti-Dsg3 IgG and a low titre of antiDsg1 IgG, while the neonate had only a high titre of anti-Dsg3 IgG, but no detectable antiDsg1 IgG. AntiDsg3 IgG, which caused the oral dominant phenotype in the mother, induced extensive oral as well as cutaneous lesions in the neonate. Our case provides clinical evidence for the Dsg compensation theory in neonatal PV.

Intentional overdose and death with 3,4-methylenedioxyethamphetamine (MDEA; "Eve"): case report.

We report a case of suicide following ingestion of a large dose of 3,4-methylenedioxyethamphetamine (MDEA, "Eve") in a 27-year-old woman with a history of depression. Several days before her death, she had attempted suicide with benzodiazepines resulting in a 24-hour hospital admission; at that time, no physiologic abnormalities were detected. Findings on autopsy were nonspecific. Toxicologic analysis showed a high concentration of MDEA and the appearance of benzodiazepines in body fluids. Ethanol and other drugs of abuse were not found. We discuss the clinical manifestations, toxicologic syndromes, and mechanisms of death with amphetamine intoxication. MDEA intoxication in young people may result in sudden death.

Self-healing infantile familial cutaneous mucinosis.

Childhood cutaneous mucinoses have been rarely reported and are difficult to classify. We describe two brothers who developed multiple, extensive cutaneous lesions during the first few months of life. Histologically the lesions were composed of mucin deposits in the dermis. In the first patient, the lesions spontaneously disappeared over the years. We believe that familial self-healing cutaneous mucinosis represents a unique entity not previously reported.

Two sibs with cleft palate, ankyloblepharon, alveolar synechiae, and ectodermal defects: a new recessive syndrome?

Hay and Wells in 1976 reported seven patients from four families who had an inherited condition of which the main features were ankyloblepharon, ectodermal defects, and cleft lip and palate. The inheritance pattern was determined to be autosomal dominant. This condition is known as AEC syndrome or Hay-Wells syndrome. We report a family with two sibs showing some of these features and congenital adhesions between the upper and lower jaws (alveolar synechiae). There seems to be a recessive pattern of inheritance as neither of the parents has any features of the syndrome. This could be described as a recessive form of Hay-Wells syndrome with additional features or be named as a new syndrome.

[Frey syndrome in childhood]. / Síndrome de Frey en la infancia.

Frey's syndrome is distinguished by the appearing of erythema, sensation of hotness, sometimes pain, and transpiration discharge in the preauricular and temporal area when ingestion stars. We present an eleven month old child with this pathology and we review the etiology and clinic manifestations of this syndrome.

Reticuloendoteliose com eosinofia: doença de Omenn / Reticuloendotheliosis with eosinophilia: Omenn's disease

É apresentado o primeiro caso espanhol publicado de reticuloendoteliose com eosinofilia (doença de Omenn). Este quadro é considerado, atualmente, como uma imunodeficiência mista, grave e mortal, que dá lugar a uma proliferaçäo histiocitária reativa generalizada. No plano clínico, caracteriza-se por apresentar-se em lactentes, em forma de infecçöes diversas, diarréias, eritrodermia, alopécia, deterioraçäo do estado geral, hepatoesplenomegalia, adenopatias generalizadas e eosinofilia persistente. Em alguns casos, tem-se observado um déficit de 5-nucleotidase linfocitária e um aumento de IgE. O diagnóstico diferencial deve ser feito, fundamentalmente, com as histiocitoses malígnas (histiocitose X e histiocitoses que cursam com autocitofagia) e com outras histiocitoses reativas secundárias a déficits imunitários congênitos