Biomedical subjects

E Osuna

Publications and source records attributed to E Osuna.

At least 19 recordsLinked to original sources

PubMed2006

Primary care confidentiality for Spanish adolescents: fact or fiction?

BACKGROUND: By providing healthcare to adolescents, a major opportunity is created to help them cope with the challenges in their lives, develop healthy behaviour and become responsible healthcare consumers. Confidentiality is a major issue in adolescent healthcare, and its perceived absence may be the main barrier to an adolescent seeking medical care. Little is known, however, about confidentiality for adolescents in primary care practices in Spain. OBJECTIVE: To ascertain the attitudes of Spanish family doctors towards the right of adolescents to confidentiality in different healthcare situations and in the prescription of treatment. METHOD: A descriptive postal questionnaire was self-administered by family doctors. RESULTS: Parents of patients under 18 years are always informed by 18.5% of family doctors, whereas parents of those under 16 years are informed by 38.8% of doctors. The patients are warned of this likelihood by 79.3% of doctors. The proportion of doctors supporting confidentiality for adolescents increases with the age and maturity of the patients, whereas workload and previous training has a negative effect. CONCLUSIONS: Spanish laws on adolescent healthcare are not reflected by the paternalistic attitude that Spanish primary care doctors have towards their adolescent patients. Doctors need to be provided with up-to-date and clinically relevant explanations on contemporary legal positions. In primary care, more attention should be paid to adolescents' rights to information, privacy and confidentiality. Doctors should be more aware of the need to encourage communication between teenagers and their parents, while also safeguarding their patients' rights to confidential care.

Adolescent↗

PubMed2005

Balancing confidentiality and the information provided to families of patients in primary care.

BACKGROUND: Medical confidentiality underpins the doctor-patient relationship and ensures privacy so that intimate information can be exchanged to improve, preserve, and protect the health of the patient. The right to information applies to the patient alone, and, only if expressly desired, can it be extended to family members. However, it must be remembered that one of the primary tenets of family medicine is precisely that patient care occurs ideally within the context of the family. There may be, then, certain occasions when difficulties will arise as to the extent of the information provided to family members. OBJECTIVES: This study aimed to describe family doctors' attitudes to confidentiality and providing patient information to relatives as well as their justifications for sharing information. METHOD: A descriptive postal questionnaire was self-administered by family doctors. RESULTS: Of 227 doctors, 95.1% provided information to a patient's family and over a third (35%) disclosed information to others without prior patient consent. CONCLUSIONS: The findings reveal that family doctors should pay more attention to their patients' rights to information, privacy, and confidentiality, and reflect very carefully on the fine balance between this and the occasional need for the support and collaboration of family members in delivery of care. Emphasis should be placed on ethics and legal problems during undergraduate education and in-service training of doctors.

Attitude of Health Personnel↗

PubMed2005

Biochemical analysis and immunohistochemical determination of cardiac troponin for the postmortem diagnosis of myocardial damage.

Cardiac disease is the most common cause of sudden death in Western nations. In forensic practice there is a need for more sensitive diagnostic methods for the postmortem diagnosis of myocardial damage. The aim of this study was to analyse the diagnostic efficacy of biochemical markers in cadaver fluids in conjunction with histological studies and the immunohistochemical determination of cardiac troponin C (cTnC) and cardiac troponin T (cTnT) levels in myocardial tissue fixed in formol and included in paraffin. We studied 50 cadavers (43 males and 7 females) with a mean age of 47.5 years (SD 19.2; range 12 to 87 years). Cases were chosen according to the postmortem interval, cause of death, and circumstances of death. Pericardial fluid and serum were tested in duplicate for cardiac troponin I (cTn I), myoglobin and CKMB by immunoassay system using commercial kits. In myocardial tissue, histological studies were performed with hematoxylin and eosin (HE), Masson's trichrome staining and immunohistochemical techniques involving streptavidin-biotin-peroxidase were performed. The results pointed to statistically significant differences for all the biochemical markers in pericardial fluid. The highest levels were obtained in the group of cadavers who had died from myocardial infarction. The immunohistochemical expression of cTnC was detected in 86% of cases; it was strongly positive and usually diffuse. The expression of cTnT, was much less frequent (46% of cases) and less intense. It was concluded that the immunohistochemical determination of cTnC and cTnT levels in myocardial tissue may be used as an index of myocardium damage.

Adolescent↗

PubMed2004

Diagnostic efficacy of biochemical markers in diagnosis post-mortem of ischaemic heart disease.

In forensic medicine, there is a need for more sensitive biochemical markers for the post-mortem diagnosis of acute myocardial infarction. A study of the distribution of biochemical markers in different fluids is of great significance in post-mortem diagnosis, because their distribution depends on the location of tissue damage and release kinetics. The aim of this study is to compare the sensitivities and specificities of creatine kinase-MB (CK-MB), myoglobin and cTnI in serum and pericardial fluid for the post-mortem diagnosis of acute myocardial infarction (AMI). We studied 188 cadavers selected during 1 year from medicolegal autopsies. The groups were as follows: (1) myocardial infarction (n = 52); (2) asphyxia (n = 59); (3) multiple trauma (n = 41); (4) natural deaths excluding myocardial infarction (n = 36). We obtained statistically significant differences in pericardial fluid for all the biochemical markers, the highest levels being obtained in the group of cadavers who had died from myocardial infarction. A common factor is the high negative predictive value found in biochemical markers, which is contrary to the findings obtained in clinical practice, when the percentages of sensitivity are very high.

Adolescent↗

PubMed2004

HCH and DDT residues in human placentas in Murcia (Spain).

Organochlorinated insecticides are ubiquitous toxicants that are transplacentally transferred from mother to fetus and are reported to produce adverse health effects in pregnant woman and neonates. To investigate hexachlorocyclohexane (HCH) and 1,1,1-trichloro-2,2-bis(4-chlorophenyl)ethane (DDT) exposure in pregnant woman, a total of 102 placentas were analyzed by a gas chromatograph equipped with electron capture detector. Organochlorine residues were found in 69.6% of the samples. Lindane was detected in 24.5%, alpha-HCH in 2.9%, beta-HCH in 6.9%, p,p'-DDE in 44.1%, p,p'-DDT in 14.7% and p,p'-DDD in 10.8% of the samples. The pattern of dispersal by these substances in Murcia is similar to that described by different authors in other countries. Therefore, the past use of DDT and the present employment of lindane seem to be reflected in body tissues of the residents of this area.

Adult↗

PubMed2003

Application of postmortem lipid peroxidation in heart tissue to the diagnosis of myocardial damage.

The response by the myocardial tissue to injury may be manifested as macroscopical or microscopical lesions or, following an ischemia-reperfusion process, by the formation of reactive oxidant substances (ROS) which, in turn, may increase lipid peroxidation levels in myocardial tissue. The aim of this study was to determine whether the levels of lipid peroxidation in myocardial tissue from subjects who had died from different causes are related to cardiac lesions of ischemic or traumatic aetiology. We studied 825 hypostasis-free samples taken from the myocardial tissue of 75 cadavers. In all cases, a survival period was known to have existed. Lipid peroxidation in myocardial tissue was estimated by the colorimetric determination of malondialdehyde. The highest levels of tissue peroxidation were observed in the group of subjects who died from myocardial infarction. We observed a statistically significant correlation between the extent of peroxidation and the presence of myocardial damage of ischemic or traumatic aetiology. In our study, lipid peroxidation was associated with myocardial injury. The data suggest that the extent of lipid peroxidation in myocardial tissue may be used as a reliable indicator of myocardial damage in support of data obtained by conventional microscopy.

Adolescent↗

PubMed2002

A case of self-inflicted wounding by the introduction of needles through the abdominal wall to induce abortion.

The self-inflicted wounding of a 23-year-old woman who introduced needles through the abdominal wall to induce abortion is reported. The woman first came to hospital with metrorrhagia and pain in the right iliac fossa. Initially she refused treatment and went home. Twenty-two hours later she was admitted to hospital after giving birth at home to a male fetus of 610 g. The placenta was expelled in the hospital and a sewing needle was found. Lateral and anteroposterior radiographs revealed 15 such needles in the hypogastric region, most of them at subcutaneous level. The newborn was admitted to the intensive care unit in a generally poor condition, with hypothermia, cyanosis and bradycardia. An X-ray showed a metallic object in the abdominal region which, again, corresponded to a sewing needle. The newborn did not respond to treatment and died 2h after admission.

Abdominal Muscles↗

PubMed2002

Informed consent of the minor. Implications of present day Spanish law.

In Spain, any person under the age of 18 is a minor. Generally, minors lack the legal capacity to take legally binding actions because they are deemed incapable of legally binding consent. Spanish civil law recognises, however, that the child, in accordance with the law and being sufficiently mature, may act for himself. It stands, then, that consent, as expressed by the "sufficiently mature" minor, should be legally valid.

Child↗

PubMed2002

Reports of medical experts in cases of drug addiction and assessment of mitigating circumstances by the court.

In Spain, as the law stands, an accused person wishing to cite drug addiction as a mitigating circumstance in sentencing must demonstrate this addiction. Expert evidence therefore acquires great importance for an eventual sentence. The aim of this study is to analyse the sentencing process in cases in which the relevance of drug addiction as a mitigating circumstance in criminal responsibility is sought. Of a total of 261 sentences handed down in the Criminal Court of Murcia, we studied 139 sentences that cited drug addiction as one of the mitigating circumstances in criminal responsibility. A forensic report was presented in only 36 cases (25.9%) and in most of these cases (61.1%) the individual's drug addiction was assumed from observing signs of recent venous punctures. There were no objective data (blood and urine analysis) in 128 cases (92.1%). However, mitigating circumstances as regards criminal responsibility were considered and accepted by the Court in 130 cases (93.4%). We should emphasise the limited, not to say total absence of, clinical data in the submitted reports, which implies the impossibility of scientifically testing the disputed circumstances.

Adolescent↗

PubMed2001

Mortality in maximum security psychiatric hospital patients.

Numerous studies have mentioned to the high percentage of violent deaths in prison psychiatric hospitals, with suicide being the principal cause. The aim of this study was to analyze the circumstances related with the deaths recorded in a high security institution. Postmortem reports on all the deaths at the Alicante Psychiatric Prison between 1984 and 1997 were studied (36 cases of unnatural death and 28 of natural death). Of the violent deaths recorded 34 (94.4%) were suicides. Demographic, clinical and interpersonal variables factors were registered. In the cases of suicides, the method used, the place of death, season, month and time of suicide were analyzed. In our study, 64.7% of suicides were schizophrenic and 32.4% had inflicted self-harm previously. We found a statistically significant association between the cause of death (natural, suicide or homicide) and age, 47.1% of suicides being between the ages of 18 and 30 and 29.4% between the ages of 30 and 45. Natural causes predominated in older subjects. The prison population studied showed grave negative traits, mental illness and criminal behavior having forced them to the very edge of society. Our results were compared with the death and suicide rates of the general Spanish population.

Adult↗

PubMed2001

Glucose and lactate in vitreous humor compared with the determination of fructosamine for the postmortem diagnosis of diabetes mellitus.

Diabetes mellitus is a chronic metabolic illness responsible for a great number of deaths. In postmortem diagnosis, because of the difficulty involved in interpreting blood glucose levels and relatively nonspecific pathologic features, biochemical markers in vitreous humor are useful. The aim of this study was to compare the results obtained for the combined determination of lactate and glucose with fructosamine levels recorded in the vitreous humor of two diagnostic groups (one diabetic and the other nondiabetic). The authors intended to ascertain the capacity of different markers measured in vitreous humor to diagnose diabetes mellitus. Fifty-one cadavers (mean age, 58.7 years; standard deviation, 17.09) were studied. The mean postmortem interval was 16.4 hours (standard deviation, 9.05). Cases were assigned to two diagnostic groups according to whether they were previously diagnosed as either diabetic or nondiabetic. Statistically significant differences for glucose, fructosamine, and the sum values of glucose and lactate were found between the two diagnostic groups. The highest levels were obtained in the group of cases with a previous diagnosis of diabetes mellitus. After the comparison of receiver operating characteristic curves, the sum values of glucose and lactate in vitreous humor is a better predictor of antemortem diabetes mellitus than the fructosamine.

Adult↗

PubMed2001

Informed consent: evaluation of the information provided to elderly patients.

The doctor-patient relationship has undergone important changes in recent years. In the new concept of health care, the individual has the right to take decisions and the right to self-determination is only meaningful if the person is appropriately informed, is free to make decisions without coercion and has the ability or "capacity" to make the decision. The aims of this study is to evaluate the information received by the patients and the immediate family's provided by health. A total of 200 randomly chosen patients (109 male and 91 female), were interviewed. The mean age was 74 years (range from 65 to 102 years). In addition, the family member most frequently accompanying the patient was asked their opinion. Our study, found that the information was mainly directed to the family member/companion and that the information offered to the elderly patient was generally scant and insufficient for any consent to be based thereon. We believe that more attention should be paid to the issue of obtaining informed consent in the elderly.

Aged↗

PubMed2000

Vitreous humor carbohydrate-deficient transferrin concentrations in the postmortem diagnosis of alcoholism.

Deaths from the effects of alcohol intoxication are encountered routinely in forensic practice. In an important number of cases difficulty may arise in interpreting the significance of results obtained in the autopsy. In clinical practice biochemical markers, particularly serum gamma-glutamyl-transpeptidase (GGT), alanine aminotransferase (ALT), aspartate transaminase (AST), carbohydrate-deficient transferrin (CDT), and erythrocyte mean corpuscular volume are used to diagnose heavy alcohol consumption. CDT is used as a reliable and specific marker. In postmortem diagnosis, because of the difficulty in interpreting blood alcohol levels and relatively non-specific pathological features, biochemical compounds have been studied for use as possible markers. The aim of this study was to evaluate the usefulness of the postmortem determination of CDT in vitreous humor as a confirmation of antemortem alcoholism. CDT levels were studied in 66 male cadavers with a mean age of 55.9 years (S.D. 17.0, range 22-87 years) with a mean postmortem interval of 17.9 h (S.D. 11.4, range 4-72 h). Cases were assigned to two diagnostic groups according to the antemortem diagnosis of alcoholism. Statistically significant differences were found for CDT and ALT concentrations between the two diagnostic groups. The highest vitreous humor levels of CDT and ALT were obtained in the group of cases with a previous diagnosis of alcoholism. Our results suggest that vitreous humor CDT levels are useful in cases where the postmortem diagnosis of alcoholism is hindered by the non-specificity of data.

Adult↗

PubMed1999

Vitreous humor fructosamine concentrations in the autopsy diagnosis of diabetes mellitus.

In clinical practice, biochemical markers, particularly serum glucose levels are used to diagnose diabetes mellitus. However, at autopsy this marker is of no value due to the substantial and capricious fluctuations in glucose levels after death. The aim of this study was to evaluate the usefulness of the postmortem determination of fructosamine in vitreous humor for confirming the presence of antemortem hyperglycemia. This was a study of 92 cadavers with a mean age of 60.05 years (SD 17.73) and a mean postmortem interval of 17.02 h (SD 9.76, range 2-58 h). Cases were assigned to two diagnostic groups according to the antemortem diagnosis of diabetes mellitus based on the patients' medical records. In vitreous humor statistically significant differences were found in glucose and fructosamine concentrations between the two diagnostic groups, the highest values being obtained in the group of subjects with a previous diagnosis of diabetes mellitus.

Adult↗

PubMed1999

Medical personnel and death.

Increased life expectancy and increases in the number of terminally ill patients, the rapid change in healthcare technology and diagnostic protocols and treatment means that we must re-examine medico-social problems and the attitude of healthcare professionals when confronted by death and terminal illnesses. The aim of this paper is to analyse the attitudes of medical personnel towards death and terminal patients. A total of 375 (168 doctors and 207 nurses) were asked about their attitudes toward death and the terminally ill. The sample comprised 165 males and 210 females aged between 20 and 64 years (mean age 34.96, SD 7.83 years). The results showed that 51.0% of the subjects interviewed were afraid of death. Although 59.4% thought that they were personally prepared to treat and help the terminally ill and 75.3% professionally prepared for such a task 42.7% of those interviewed would prefer not to work with the terminally ill.

Adult↗

PubMed1998

Cardiac troponin I (cTn I) and the postmortem diagnosis of myocardial infarction.

In clinical practice several biochemical markers are used for the diagnosis of myocardial infarction. Because of its extremely high specificity for myocardial damage, cardiac troponin I (cTn I) is frequently used. The aim of this study was to evaluate the diagnostic efficacy of postmortem cTn I determinations in pericardial fluid and serum and to compare these results with other biochemical markers and with structural findings used to diagnose acute myocardial ischaemia. We studied 89 cadavers with a mean age of 51.38 +/- 2.04 (SD 19.27 years). Cases were allocated to 1 of 4 diagnostic groups depending on the probable intensity of myocardial damage and cause of death. In pericardial fluid we obtained statistically significant differences for the four biochemical parameters, while in serum myosin heavy chains and myoglobin showed statistically significant differences. The highest levels of biochemical markers in pericardial fluid were observed in subjects who had died from definite myocardial infarction.

Asphyxia↗

PubMed1998

Lipid peroxidation in lung tissue after chest trauma and correlation with the duration of the post-trauma survival period.

Blunt chest trauma is a frequently encountered cause of death in forensic pathology and one of the organs most likely to be affected are the lungs. Assuming that the victim survives the initial trauma, reperfusion processes take place, free radicals are formed and lipid peroxidation occurs. The aim of this study was to ascertain whether the length of the survival time is correlated with the extent of lipid peroxidation in the lung tissue following such ischaemia-reperfusion processes. A study of 470 samples taken from all five pulmonary lobes from 94 cadavers was carried out. Cases were allocated to different groups according to whether there was chest trauma and/or a known survival period. Lipid peroxidation was investigated by determining malondialdehyde (MDA) levels. The lowest mean level of peroxidation was found in control cases showing no evidence of chest trauma at autopsy and no apparent survival period. Our results suggest that the level of lipid peroxidation in lung tissue can be a reliable indicator of survival processes.

Adult↗

PubMed1998

Distribution of biochemical markers in biologic fluids: application to the postmortem diagnosis of myocardial infarction.

We evaluated the usefulness of postmortem determination of biochemical markers and the ratio of their concentrations in pericardial fluid and serum to diagnose acute myocardial necrosis. One hundred cadavers from routine necropsies were studied. Cases were allocated in diagnostic groups according to the cause of death. Myoglobin and myosin heavy chain concentrations and creatine kinase MB isoenzymes (CK-MB) activities were measured in serum and pericardial fluid. Ratios of the concentrations obtained in these fluids were calculated. Hematoxylin and eosin (H&E) and acridine orange stains were used for microscopy studies. Pericardial fluid-serum ratios of the concentrations of biochemical markers were significantly different. The ratio of the concentrations of myosin is the best indicator of wide-spread muscle damage or cardiac necrosis.

Adolescent↗