Roles y responsabilidades del odontólogo como auxiliar de la justicia / Dentists´ roles and responsibilities as auxiliaries to justice

La ciencia odontológica cuenta con diversas metodologías a la hora de brindar auxilio a la Justicia, tanto en la resolución de casos criminales como en procedimientos de índole civil y laboral. La odontología legal requiere de un trabajo interdisciplinario con las otrasespecialidades odontológicas. En ese contexto, el rol capital del perito odontólogo es contribuir al esclarecimiento de la identidad de unapersona. El diente es susceptible de variantes fisiológicas y patológicas en sus estructuras, como así también estigmas inherentes a los tratamientos restauradores, hechos que confiere información dental que individualiza a una persona. Las piezas dentarias pueden ser utilizadas como un arma en determinadas circunstancias, brindando información relevante sobre los caracteres odontológicos de la víctimay/o del agresor, pudiendo entonces desempeñar la odontología legal un importante rol en la investigación de situaciones de agresión sexual yabuso en todas las edades. El odontólogo en su tarea asistencial tiene la responsabilidad de labrar y documentar de manera fiel y completasu devenir profesional, pudiendo ser requerido por las autoridades encargadas de administrar Justicia en casos de responsabilidad profesional, negligencia, fraude, abuso, e identificación de restos humanos.

Dental science has various methodologies when providing aid to justice, both in solving criminal cases and civil procedures and labor issues.Legal Dentistry requires interdisciplinary work with other dental specialties. In this context, the principal role of the dentist expert is helpclarify the identity of a person. The tooth is subject to physiological and pathological variations in their structures, as well as inherentstigmas restorative treatments, facts which confers dental individualized information to a person. The teeth can be used as a weapon incertain circumstances, providing relevant information about dental characteristics of the victim and/or perpetrator can then LegalDentistry play an important role in investigating cases of sexual assault and abuse in all the ages. The dentist in their care task isresponsible for faithfully document and complete their professional procedure that may be required by the authorities responsible foradministering justice in cases of professional liability, negligence, fraud, abuse, and identification of human remains.

Optimizing the organ procurement process: organizational prerequisites and monitoring strategies in a national network.

The current project sought to collect detailed information on the Italian donation system and in particular on the organization and functioning of the local coordinating centers. The final objective was to provide local and regional institutions with the information required to improve the system. While improving the knowledge of current Italian donation system, the project had constructive purposes. Our intention was to analyze how the national system is working, what the coordinating centers are actually doing, how they are organized, to what extent existing rules are obeyed, and what are the main limits of the system. This analysis sought to lead to the development of a set of proposals that can be summarized in two categories: (1) "intrinsic" actions, that is, those established and implemented at the hospital level; and (2) supporting "extrinsic" actions, that is, those identified by the National Transplant Centre and addressed to the regional and interregional coordinating networks. Finally, the analysis of the application of the existing rules should lead to the development of practice guidelines such that each center conforms to the existing regulations established by European directives.

GPs' satisfaction with the doctor-patient encounter: findings from a community-based survey.

OBJECTIVE: The aim of this study was to explore the characteristics of the doctor-patient relationship from the GP's point of view. METHODS: We performed a cross-sectional 1-day study in family practice. Thirty-three GPs volunteered to fill in a questionnaire at the end of each of 20 consecutive consultations on an index day. Six hundred and sixty-one patients (out of 665) participated in the study. Descriptive frequencies of GPs' judgements about personal experiences during the consultations, and predictors of GP's global satisfaction score on patient encounters were analysed. RESULTS: The mean age of the 33 GPs was 44.7 +/- 3.6 years. Professional skills (62% of the GPs had no doubts on diagnosis, therapy or prognosis) and the quality of the human/interpersonal interaction were major determinants of GPs' satisfaction in the patient-doctor relationship. Doctors felt professionally esteemed by 90% of their patients, and the median value of their global satisfaction score (matching the expectations from an 'ideal patient' to that experienced when meeting the real one) was very high (median 8, range 1-10). Nevertheless, GPs did not know if they were satisfied with the actual encounter with the patient in about one-third of the consultations. CONCLUSIONS: Professional skills and quality of the human/interpersonal interactions are major determinants of GPs' satisfaction in their professional activities.

PfPK6, a novel cyclin-dependent kinase/mitogen-activated protein kinase-related protein kinase from Plasmodium falciparum.

We have isolated a novel protein kinase cDNA, PfPK6, by differential display RT-PCR (DDRT-PCR) of mRNA obtained from different asexual erythrocytic stages of Plasmodium falciparum, which shows sequence similarity to both cyclin-dependent kinase (CDK) and mitogen-activated protein kinase (MAPK) family members. The 915 bp open reading frame (ORF) is interrupted by seven introns and encodes a 305-residue polypeptide with a predicted molecular mass of 35848 Da. Several cDNA clones with some of the intron sequences were isolated, indicating alternate or defective splicing of PfPK6 transcripts because the gene seems to be a single copy located on chromosome 13. The similarity of the catalytic domain of PfPK6 to those of CDK2 and MAPK is 57.3% and 49.6%, respectively. The signature PSTAIRE (single-letter amino acid codes) CDK motif is changed to SKCILRE in PfPK6. The TXY residues that are phosphorylated in MAPKs for their activation are T(173)PT in PfPK6. Three size classes of PfPK6 transcripts of 6.5, 2.0 and 1.1 kb are up-regulated during the transition of P. falciparum from ring to trophozoite. Western blot analysis suggested the expression of a 35 kDa polypeptide in trophozoites and schizonts. Immunofluorescence studies indicated both nuclear and cytoplasmic localization of PfPK6 in trophozoite, schizont and segmenter stages. In vitro, recombinant PfPK6 phosphorylated itself and also exogenous substrates, histone and the small subunit of the malarial ribonucleotide reductase (R2). The kinase activity of PfPK6 is sensitive to CDK inhibitors such as olomoucine and roscovitine. PfPK6 showed a preference for Mn(2+) over Mg(2+) ions as a cofactor. The Lys(38)-->Arg mutant is severely defective in its interaction with ATP and bivalent cations and somewhat defective in catalytic rate for R2 phosphorylation.

Protein prenyl transferase activities of Plasmodium falciparum.

Prenylated proteins have been shown to function in important cellular regulatory processes including signal transduction. The enzymes involved in protein prenylation, farnesyl transferase and geranylgeranyl transferase, have been recent targets for development of cancer chemotherapeutics. We have initiated a systematic study of protein prenyl transferases of the malaria parasite, Plasmodium falciparum, to determine whether these enzymes can be developed as targets for antimalarial chemotherapy. We report here the identification of protein farnesyl transferase and protein geranylgeranyl transferase-I in the malaria parasite, P. falciparum. The farnesyl transferase has been partially purified from the cytosolic fraction through ammonium sulfate precipitation and Mono-Q chromatography. Farnesyl and geranylgeranyl transferase-I activities are present at all stages of P. falciparum intraerythrocytic development with maximum specific activity in the ring stage. Geranylgeranyl transferase-I specific activity is two times that of farnesyl transferase in the ring stage. Peptidomimetics and prenyl analogues of protein farnesyl transferase substrates were tested as in vitro inhibitors of partially purified P. falciparum prenyl transferase and of malaria parasite growth. The peptidomimetics were significantly more potent inhibitors than lipid substrate analogues of both the activity of Mono-Q purified enzyme and parasite growth in intraerythrocytic cultures. Exposure of the parasite to the peptidomimetic L-745,631 also showed significant inhibition of morphological development beyond the trophozoite stage. These studies suggest the potential of designing or identifying differential inhibitors of P. falciparum and mammalian prenyl transferases as an approach to novel malaria therapy.

Serum lipoprotein(a) and coronary artery disease in uremic patients on chronic hemodialysis.

There is convincing clinical and experimental evidence to support the notion that lipoprotein(a) [Lp(a)] is atherogenic. Patients undergoing chronic hemodialysis have an increased risk of atherosclerotic cardiovascular complications. In the present study, we investigated the possible relation between the alteration, if any, in serum Lp(a) and coronary artery disease in such patients. The mean serum concentration of Lp(a) tended to be higher in the 64 hemodialysis patients than in the 30 normal controls (15.1 +/- 15.2 vs. 9.7 +/- 10.4 mg/dl). However the difference did not reach statistical significance. The prevalence of levels above 30 mg/dl was 14% (9/64) and 10% (3/10), respectively, and the difference was also not statistically significant. Eleven hemodialysis patients with coronary artery disease had a significantly higher mean serum concentration of Lp(a) than the unaffected 53 (33.7 +/- 18.4 vs. 11.1 +/- 11.2 mg/dl, p < 0.001). Elevated levels were present in 63.6% (7/11) and 3.8% (2/53), respectively (p < 0.01). Other parameters of lipid metabolism were not different between the two groups. We observed statistically significant positive correlations of Lp(a) to total cholesterol, LDL cholesterol and apolipoprotein B in controls, in hemodialysis patients as a whole and in those without coronary artery disease. No such correlations were obtained when hemodialysis patients with coronary artery disease were analysed separately. It is concluded that firstly, high serum levels of Lp(a) in hemodialysis patients are strongly associated with coronary artery disease, as well as in the general population; and secondly, abnormalities in the metabolism of Lp(a) may underlie atherogenesis in these patients, independently of alterations in other lipid constituents.

Serum alpha-1-antitrypsin in hemodialysis patients with dialysis arthropathy.

Dialysis arthropathy is the most prominent dialysis-related amyloidosis feature. Alpha-1-antitrypsin (alpha-1-proteinase inhibitor) is the major circulating antiprotease. Twenty-three otherwise uncomplicated hemodialysis patients with well-documented dialysis arthropathy had a significantly (p < 0.05) lower serum mean concentration, 1,960 +/- 410.4 mg/l of alpha-1-antitrypsin than 47 patients with no joint symptoms who had a mean concentration of 2,256.6 +/- 424.5 mg/l. Decreased levels of the substance were detected in 13 (56.5%) of the 23 patients with dialysis arthropathy and in 13 (27.6%) of those 47 with no joint symptoms, the incidence in the former group being significantly (p < 0.05) higher than in the latter. In the dialysis arthropathy group, serum alpha-1-antitrypsin levels correlated inversely (r = -0.54, p < 0.01) with the dialysis duration and directly (r = 0.413, p < 0.05) with the corresponding beta-2-microglobulin determinations. We speculate that reduced antiprotease activity may play a role in amyloidogenesis in the setting of long-term hemodialysis.

Evolution of serum prealbumin following hemodialysis: effect of different dialysis membranes.

The effects of hemodialysis on the levels of serum prealbumin (pA) were studied on a crossover basis in 17 uncomplicated patients. Bicarbonate dialysate was used exclusively, and two different membranes, cuprophane and polysulfone, were compared. We aimed to prove the induction of an acute-phase response during the procedure. Serum pA, corrected for hemoconcentration, decreased significantly 24 h after the start of cuprophane hemodialysis and returned to the initial value within 48 h. No such change was observed using polysulfone membranes. These results were seemingly correlated with the effects of the membranes on complement activation. It is concluded that cuprophane hemodialysis is indeed associated with an acute-phase response, probably due to interleukin-1 release during the treatment, and that the membrane composition has some role in inducing it. Thus, serum pA analysis may prove useful as an indicator of the biocompatibility of the dialysis procedure.

External quality assessment programme for in vitro allergy tests: ISS/CNR scheme--the first one organized in Europe by government--and European scheme "Galileo".

Accordingly with the new tendency of employing Rast Units (RU) instead of Rast Classes (RC) in the specific-IgE testing field, is necessary that internal Quality Control (QC) and external Quality Assessment (QA) programmes take account of these RU. So far only few experiences of controlling and assessing the quality concerned with RU, have been carried out. In Italy, a National QA-scheme organised by the National Health Institute (ISS) and the National Research Council (CNR), which involves about 90 laboratories, is starting just now, and a commercial QA programme (Galileo), started in 1989, by now is the only one which helped valuate each laboratory's performance for specific-IgE assays. The results collected in a 12 months period were elaborated in different ways as they were expressed in RC or in RU and the trial confirms that the specific-IgE testing field is still far from reaching the reliability already established for other assays. So we hope the National and the Galileo schemes will help stimulate major improvements in internal precision and in between-laboratories agreement.

[Significance of serum levels of beta-2-microglobulin in dialysis patients]. / Significato dei livelli sierici di beta-2-microglobulina nei pazienti in dialisi.

beta 2M has been shown to be a major constituent of the amyloid deposits developing in uremic patients undergoing long-term hemodialysis. In this study, serum levels of beta 2M were determined in 67 hemodialysis patients and a mean +/- SD concentration of 57.8 +/- 18.5 mg/L was obtained. There was no difference in the concentration of the substance between the patients with evidence of dialysis-related amyloidosis and those without it. Moreover, no correlation between beta 2M levels and duration of hemodialysis was found. Interestingly, the patients with residual diuresis had a significantly lower mean beta 2M concentration than the anuric patients (35.0 +/- 13.1 vs 62.8 +/- 15.8 mg/L, p less than 0.001). Not surprisingly, a significant decrease in the predialysis serum concentration of the substance was obtained after changing treatment from cuprophan hemodialysis to hemodialysis with high-permeable membranes (delta beta 2M = -16.1 +/- 14.4 mg/L at month 6, p less than 0.01). These results suggest the possible long-term use of these membranes to reduce risk of dialysis-related amyloidosis.

Urinary red blood cell volume analysis in the investigation of haematuria.

The mean cellular volume (MCV) of urinary red blood cells was measured with an autoanalyser in 85 patients with definite causes of haematuria (31 had glomerulonephritis, 54 urological disorders). We found that red blood cells of glomerular origin had a smaller volume than non-glomerular cells (59.4 +/- 10.23 vs 87.35 +/- 11.17 fl; P less than 0.001). If an MCV equal to 70 fl was taken as the cut-off value between glomerular and non-glomerular haematuria, a correct assessment of the site of bleeding was made in 78 (91.7%) of the 85 patients studied. 'Microcytic' haematuria (i.e., MCV less than 70 fl) was present in 34 patients and correlated strongly with the diagnosis of glomerulonephritis (five false positives, specificity 90.7%; two false negatives, sensitivity 93.5%). Conversely, the presence of larger red blood cells in the urine coincided with the diagnosis of urological disorders in 96.1% (49/51) of the cases.

Red blood cell volume distribution width (RDW) in uraemic patients on chronic haemodialysis.

Red blood cell volume distribution width (RDW) was obtained with the Coulter counter in 60 haemodialysis patients and 55 normal individuals. RDW tended to be higher in the former and the degree of increase was to some extent correlated with the underlying nephropathy. Although RDW failed to correlate with conventional tests of iron status, it was observed that iron administration could produce a decrease toward normal in RDW and a parallel increase in haemoglobin when the initial RDW was increased. In contrast, the response to iron was negligible in the patients with normal RDW basally. It was concluded that high RDW is an acceptable indicator of iron deficiency in haemodialysis patients.

Detection of glomerular bleeding by urinary-red-cell-size distribution.

Midstream urine specimens from 60 consecutive patients with hematuria were examined with an autoanalyzer to determine whether the source of bleeding could be predicted on the basis of the size distribution of urinary red blood cells. In 54 patients a definite diagnosis was made which correlated with the urinary-red-cell-size distribution in 93.7% (15/16) of cases for whom hematuria was considered to be glomerular and in 100% (38/38) of cases of nonglomerular hematuria. It is concluded that this method can greatly help the clinician in distinguishing between glomerular and nonglomerular bleeding in patients with hematuria and channeling such patients towards the most appropriate investigations.

Effect of different dialyzer membranes on serum angiotensin-converting enzyme during hemodialysis.

The effects of different dialyzer membranes on serum concentration of angiotension-converting enzyme (ACE) and white blood cells during hemodialysis were examined on a cross-over basis in 20 chronically uremic patients. Hemodialysis with cuprophane membranes was associated with a significant (p less than 0.001) fall in the mean leukocyte count during the 1st hour of treatment. The use of polymethylmethacrylate membranes resulted in a more attenuated form of leukopenia and with polyacrylonitrile membranes no change was observed during hemodialysis. Hemodialysis with each membrane caused a comparable, significant (p less than 0.005) increase in serum ACE, independent of the degree of leukopenia but significantly (p less than 0.001) correlated with the increases in serum proteins. We conclude that this increase in serum ACE concentration after hemodialysis does not reflect acute damage of the pulmonary vascular endothelium during treatment and most probably is a result of hemoconcentration. Therefore, serum ACE analysis is not an indicator of dialyzer membrane biocompatibility.

Lack of evidence for the role of secondary hyperparathyroidism in the pathogenesis of uremic thrombocytopathy.

The possible relationship between platelet dysfunction and secondary hyperparathyroidism (HPT) in chronic renal failure was examined in 23 uremic patients on conservative therapy (group I) and in 27 patients on maintenance hemodialysis (group II). Platelet function was assessed by measuring the degree of aggregation in response to various concentrations of adenosine diphosphate. Secondary HPT was evaluated by means of serum biochemistry (parathyroid hormone, calcium, phosphorus, and alkaline phosphatase) and radiographic examinations (x-ray films of the hand skeleton). This study showed impaired platelet aggregation in group I patients, compared to either group II patients or controls. There were no significant differences when group II patients were compared to controls. No significant correlations between platelet aggregation and the hematochemical changes associated with secondary HPT were found. No differences in platelet aggregation were found with regard to the activity (alkaline phosphatase) and the severity (x-ray findings) of secondary HPT. Effective treatment of secondary HPT with 1,25-dihydroxycholecalciferol in both group I and group II patients was not associated with consequent changes in platelet aggregation. It is concluded that secondary HPT is probably not a major factor in the pathogenesis of platelet dysfunction in chronic renal failure.