Evaluation of the discrepancy between clinical diagnostic hypotheses and anatomopathological diagnoses resulting from autopsies

OBJECTIVES: An objective of clinical autopsies is to determine the final cause of death and the pathological changes that may have triggered it. Despite advances in Medicine, the level of discrepancy between clinical and autopsy diagnoses remains significant. The aim of this study was to compare the data obtained from autopsies carried out at the São Bernardo do Campo/SP Death Verification Section with clinical diagnostic hypotheses proposed during medical care. METHOD: This was a retrospective study involving the comparison of necroscopic reports issued by the São Bernardo do Campo/São Paulo Death Verification Section in 2014 and 2015 and the Cadaver Referral Guides completed by attending physicians prior to the necroscopic examination. RESULTS: A total of 465 cases were analyzed. In general, discrepancies between the clinical diagnostic hypothesis and the autopsy diagnosis occurred in 28% of the cases. A logistic regression model, with diagnostic discrepancy as a response variable and sex, age, duration of care, type of institution providing medical care and organ system as explanatory variables, was fit to the data; the results indicated that all explanatory variables with the exception of organ system are not significant (p>0.132). CONCLUSIONS: Discrepancies between clinical diagnostic hypotheses and autopsy diagnoses continue to occur, despite new developments in complementary examinations and therapies. The odds of a discrepancy when patients present with diseases of the cardiac system are greater than those when there are problems in the vascular, endocrine and neurological systems.

ASPECTOS BIOÉTICOS DO SIGILO PROFISSIONAL RELACIONADOS À AUDITORIA MÉDICA / BIOETHICAL ASPECTS OF THE PROFESSIONAL SECRECY RELATED TO MEDICAL AUDIT / ASPECTOS BIOÉTICOS DEL SECRETO PROFESIONAL RELACIONADOS CON LA AUDITORIA MÉDICA

Objetivo: discutir aspectos bioéticos do sigilo profissional relacionados à auditoria médica. Método: levantamento bibliográfico sobre a temática com os seguintes descritores: "confidencialidade" (confidentiality), "auditoria médica" (medical audit) e "ética" (Ethics) no Pubmed e Scielo. Os termos foram utilizados de maneira conjunta no Pubmed e de maneira isolada no Scielo. Foram incluídos os artigos publicados nos últimos 20 anos (1996-2016), no idioma Português (Brasil) e Inglês, disponíveis na íntegra e gratuitamente. Resultados: devem permanecer em segredo os fatos que se tornarem conhecidos em decorrência da atividade profissional. Tal exigência não vale só para o médico, abrangendo também os profissionais de outras áreas da saúde que transitam nesse ambiente, cabendo ainda àqueles que atuam na área de auditoria de serviços de saúde e que terão acesso as informações particulares e íntimas de pessoas. Considerações finais: sendo o relatório da auditoria destinado ao recursos humanos da empresa, o médico deve fazer um tipo de registro genérico, evitando exposições que desrespeito os principios bioéticos.

Objective: discuss bioethical aspects of professional secrecy related to medical audit. Method: literature on the subject with the following descriptors: "confidentiality" (confidentiality), "medical audit" (medical audit) and "Ethics" (Ethics) in Pubmed and Scielo. The terms were used jointly in Pubmed and Scielo in isolation. Articles were included published in the last 20 years (1996-2016), the Portuguese language (Brazil) and English available in full and free. Results: must remain secret the facts become known due to professional activity. Such a requirement is not only true for the doctor, also including professionals from other areas of health transiting this environment, leaving even those who work in auditing of health services and will have access to private and intimate information of people. Final considerations: as the audit report for the human resources of the company, the physician should make a generic type of record, avoiding exposure to disregard the bioethical principles.

Objetivo: discutir los aspectos bioéticos de secreto profesional en relación con la auditoría médica. Método: la literatura sobre el tema con los siguientes descriptores: "confidencialidad" (confidencialidad), "auditoría médica" (auditoría médica) y "Ética" (Ética) en PubMed y Scielo. Los términos se utilizan de forma conjunta en PubMed y Scielo en forma aislada. Se incluyeron artículos publicados en los últimos 20 años (1996- 2016), el idioma portugués (Brasil) e Inglés disponible en el pleno y libre. Resultados: debe permanecer en secreto los hechos dado a conocer debido a la actividad profesional. Tal requisito no sólo es cierto para el médico, que también incluye a profesionales de otras áreas de la salud que transitan por este medio, dejando incluso a aquellos que trabajan en la auditoría de los servicios de salud y tendrán acceso a la información privada e íntima de las personas. Consideraciones finales: dado que el informe de auditoría de los recursos humanos de la empresa, el médico debe hacer un tipo genérico de registro, evitando la exposición a no tener en cuenta los principios de la bioética.

Deposição óssea por fluoreto de alumínio: intoxicação ocupacional? / Bone deposition of aluminum fluoride: occupational poisoning?

Contexto: Paciente de 38 anos foi encaminhado por ordem judicial para ambulatório de saúde ocupacional de hospital público terciário com queixa de dor difusa em membros inferiores, superiores, coluna e bacia, além de dificuldade na deambulação. Trazia imagens de ressonância magnética e tomografia com sinais de osteosclerose/osteonecrose em diferentes ossos (tíbia, fêmur, úmero, osso da bacia). Havia sido atendido pela equipe de clínica médica do mesmo hospital e realizado biópsia de crista ilíaca, que evidenciou infarto ósseo e grande quantidade de alumínio ósseo. Tem histórico laboral de atividade na produção de alumínio durante quatro anos, em mineradora do estado do Maranhão. Objetivos: O presente trabalho tem como objetivo revisão na literatura de possíveis causas ocupacionais em distúrbios ósseos, e identificar elementos técnico-científicos que permitam relacionar a deposição óssea de alumínio com as alterações clínico-radiológicas do caso em questão. Métodos: Foi realizada revisão de literatura baseada em publicações nas principais bases de pesquisa (PubMed, SciELO, Lilacs), além de avaliação de etapas de beneficiamento do alumínio na indústria mineradora. Resultados: Por meio da constatação da exposição do trabalhador a subprodutos químicos do beneficiamento do alumínio metálico, que, sabidamente podem causar fluorose óssea, e a associação desta doença com os achados de exame radiológico, bem como sintomatologia apresentada por este trabalhador, é possível estabelecer nexo ocupacional. Conclusão: A sintomatologia apresentada pelo trabalhador, bem como suas alterações de exame de imagem e anatomopatológico, permitem inferência de causalidade entre a exposição a compostos de fluoreto e criólita e seu distúrbio ósseo.

Context: A 38 year old patient was referred by court order for occupational health medical service of tertiary public hospital complaining of diffuse pain in lower and upper limbs, spine and pelvis, and walking difficulty. Magnetic resonance imaging and tomography signs of osteosclerosis/osteonecrosis in different bones (tibia, femur, humerus, hip bone). He was seen by the medical clinic of the same hospital and some procedures have been performed, such as iliac crest biopsy, which revealed bone infarction and a large amount of aluminum bone. This patient has worked for four years in aluminum production, in Maranhão, Brazil. Objectives: This paper aims to review the literature of possible occupational causes for bone disorders and identify technical and scientific elements that may allow to relate the bone aluminum deposition with clinical and radiological changes of the case. Methods: For this purpose, we performed a literature review based on publications in major research bases (PubMed, SciELO, Lilacs), and evaluation stages of processing of aluminum in the mining industry. Results: Through the observation of the worker exposure to chemical byproducts from the processing of aluminum metal, which is known to cause skeletal fluorosis, and the association of this disease with radiological findings and symptoms presented by this paper, it is possible establish relationship between his occupational activity and the diasease. Conclusion: The symptoms presented by the worker, as well as their changes of imaging and pathologic examination, allow inference of causality between exposure to fluoride and cryolite compounds and their bone disorder.

Differences between postmortem computed tomography and conventional autopsy in a stabbing murder case

Objective: The aim of the present work is to analyze the differences and similarities between the elements of a conventional autopsy and images obtained from postmortem computed tomography in a case of a homicide stab wound. Method: Comparison between the findings of different methods: autopsy and postmortem computed tomography. Results: In some aspects, autopsy is still superior to imaging, especially in relation to external examination and the description of lesion vitality. However, the findings of gas embolism, pneumothorax and pulmonary emphysema and the relationship between the internal path of the instrument of aggression and the entry wound are better demonstrated by postmortem computed tomography. Conclusions: Although multislice computed tomography has greater accuracy than autopsy, we believe that the conventional autopsy method is fundamental for providing evidence in criminal investigations. .