The article explores the challenges of ensuring voluntary and informed consent which is obtained from potential research subjects in the north-eastern part of Romania. This study is one of the first empirical papers of this nature in Romania. The study used a quantitative survey design using the adapted Quality of Informed Consent (QuIC) questionnaire. The target population consisted of 100 adult persons who voluntarily enrolled in clinical trials. The informed consent form must contain details regarding the potential risks and benefits, the aim of the clinical trial, study design, confidentiality, insurance and contact details in case of additional questions. Our study confirmed that although all required information was included in the ICF, few clinical trial participants truly understood it. We also found that the most important predictive factor for a good subjective and objective understanding of the clinical trial was the level of education. Our study suggests that researchers should consider putting more effort in order to help clinical trials participants achieve a better understanding of the informed consent. In this way they will ensure that participants' decision-making is meaningful and that their interests are protected.
Although a disease with a particularly historical, war-related implication, gas gangrene still retains its importance in pathology through its highly severe prognosis and rapid death in the absence of immediate treatment. The most common occurrences of the infection in times of peace are traffic accidents and natural disasters, but this can also occur in a non-traumatic context, in carcinomas and digestive tract ulcers or diabetes. The most commonly cited etiological agent is Clostridium perfringens, but other anaerobic germs as well as various aero-anaerobic associations may be responsible for the appearance of gangrene. The accumulation of gas bubbles through the action of etiological agents, highlighted by the presence of crevices or radiological examinations, is the hallmark of this condition. In this paper, the authors present the case of a 26-year-old man who died as a result of the gas gangrene with a rapid evolution (60 hours), which occurred in the progress of a soil telluric wound in the right thigh despite doctors' efforts. The authors emphasize the importance of suspicion of the possibility of the occurrence of gangrene in wounds contaminated with vegetal remains or soil, on the one hand because the pathognomonic sign appears at an advanced stage of the infection and on the other hand because the prophylactic, surgical and medicinal treatment together with the resuscitation measures may be life-saving when applied in a timely manner.
Cardiac arrest is a life-threatening condition which requires fast maneuvers for saving the victim's life. Cardio-pulmonary resuscitation (CPR) is one of the easiest and handiest maneuver which proved many times to be savior even though sometimes it could worsen the victim's prognosis. In this paper the authors present the case of a 75-year old male, with a significant medical history and long term thrombolytic treatment who suffered a witnessed cardiac arrest. The emergency team who arrived at the victim's home initiated the CPR and transported him to the hospital. The electrocardiogram showed inferior-lateral acute myocardial infarction and the cardiologist in the emergency room decided to transfer him to another hospital for specialized treatment. Despite the fact that the CPR was continued in the ambulance in order to maintain the cardiac activity, the blood pressure decreased gradually and he died couple of hours later. Internal examination at the autospy revealed multiple injuries caused by the cardiac massage: rib and sternum fractures, massive intraperitoneal bleeding, liver laceration and contusion. This paper brings to the attention of the physicians the issue of the iatrogenic injuries following the CPR and the possibility for these injuries to contribute to thanatogenesis. The authors also analyze the factors influencing the quality of the life-saving procedures and the role of the pathologist in establishing the correct cause of death taking into the gravity of the CPR related injuries.
Spontaneous rupture of the urinary bladder is a rare clinical condition, with a prevalence of about 1 in 126.000 hospitalizations. Idiopathic rupture is even more rarely encountered, constituting less than 1% of all cases. Given the low incidence, atypical symptoms and poor history data, the diagnosis is often established late and treatment is delayed, resulting in a high rate of mortality. Also, spontaneous rupture of the urinary bladder may be a surprise at the autopsy. In this paper, the authors present the case of a 67 years old woman who died due to idiopathic spontaneous rupture of the urinary bladder after ingestion of alcoholic beverages. The autopsy showed no signs of pathological or traumatic injury and the toxicological examination revealed a blood alcohol concentration of 2.05 g ‰. The case is analyzed in the context of existing literature data, taking into account the elements of anatomy, physiology and pathophysiology that can determine or favour the idiopathic spontaneous rupture of the urinary bladder.
Drug facilitated sexual assault (DFSA) can be defined as sexual activity occurring where consent is invalid or absent due to the effects of drugs and/or alcohol. We report a rare case of pro-active drug facilitated sexual assault involving non-oral administration of sedative-hypnotic intoxicant without primary alcoholic ingestion. For eight years, a male nurse administered sedative-hypnotic drugs to patients admitted to the hospital unit, in order to subsequently maintain sexual intercourse with them. The intravenous administration without primary alcoholic ingestion distinguishes this case of pro-active drug facilitated sexual assault from those presented in associated literature.
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