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- Condução sob influência de benzodiazepinas e antidepressivos : Prescrição médica e abusoPublication . Coutinho, Daniel; Vieira, Duarte Nuno; Teixeira, Helena M.As benzodiazepinas são fármacos maioritariamente utilizados nos distúrbios de ansiedade, dissonias, convulsões, distúrbios musculares, desintoxicação alcoólica e de outras substâncias de abuso, bem como na sedação/amnésia em procedimentos invasivos. Por seu lado, os antidepressivos apresentam como principal indicação terapêutica a depressão, podendo ser utilizados como terapêutica coadjuvante noutros distúrbios psiquiátricos. O consumo de benzodiazepinas e antidepressivos está associado a alguns problemas de saúde e segurança pública. A diminuição da atenção, da concentração, dos reflexos, da capacidade visual, da coordenação motora e do raciocínio, associados ao aumento dos tempos de reacção e à falta de consciencialização dos utilizadores para a diminuição das suas capacidades, torna estes fármacos num risco para a segurança rodoviária. Este risco pode ainda ser potenciado pelo desrespeito da prescrição médica, pelo seu consumo abusivo ou pelo consumo concomitante de álcool. A determinação de ligações entre o consumo destes medicamentos psicoactivos e a segurança rodoviária é, contudo, um assunto ainda extremamente complexo, sendo fundamental esclarecer melhor o papel dos efeitos das benzodiazepinas e dos antidepressivos sobre a condução rodoviária. A prevenção da condução sob influência destes fármacos depende, em grande medida, do conhecimento por parte da classe médica dos riscos inerentes à sua utilização. A consciencialização da prescrição médica, bem como o fornecimento de informações claras aos doentes revela-se, assim, de extrema importância.
- Syphilis an uncommon sexual abuse diagnosisPublication . Fonte Santa Silva, José Jerónimo; Cordeiro, Cristina; Sousa, Ana Paula; Costa, Graça Santos; Vieira, Duarte NunoTo diagnose sexual abuse is often a difficult task, in many cases no significant findings are present, sexually transmitted diseases are important pathognomic findings, they're not frequently observed in sexual abuse situations.
- Allele frequencies and haplotypes of 8 Y-chromosomal STRs in the Santa Catarina population of southern BrazilPublication . Cainé, Laura; Real, F. Corte; Vieira, Duarte Nuno; Carvalho, Mónica; Serra, Armando; Lopes, Virgı́nia; Vide, Maria C.Allele frequencies and haplotypes of eight Y-chromosomal short tandem repeats (STRs), DYS19, DYS385, DYS389 I, DYS389 II, DYS390, DYS391, DYS392 and DYS393 were determined in a sample of 109 males from Santa Catarina. The origin of this southern Brazilian population is mainly from Portuguese people, namely from Azores archipelago.
- Sudden death, motor vehicle accident, cerebellar tumourPublication . Simoes da Silva, Beatriz; Marques, C.; Coelho, S.; Ribeiro, O.; Vieira, Duarte NunoINTRODUCTION Portuguese forensic law determines that all the mortal victims of traffic accidents must be subjected to a forensic autopsy. In this particular case, a traffic accident with minor injury lead to unbalance a previous tumoral pathology with an unusual location (...)
- "You can touch the dead man". A suicide by electrocutionPublication . Fonte Santa Silva, José Jerónimo; Henriques, J.; Tavares, Susana; Vieira, Duarte NunoAlthough infrequent, deaths by electrocution occur. Usually in fatal cases, the manner of death is accidental, rarely homicidal and occasionally suicidal. In suicide the victim frequently has a professional skill, or some knowledge in electricity, creating a more or less complex electrical device that will produce the fatal shock.
- A silent death sentence. Traumatic vertebral artery dissectionPublication . Simón, A.; Vieira, Duarte Nuno; Simoes da Silva, BeatrizAlthough some traumatic injuries are not noticeable at the time they are produced and cause little or no symptoms, they should not be considered harmless. In fact, some of them can lead to a mortal outcome, if not perceived and treated promptly. This is the case of vertebral artery dissection. Vertebral artery dissection can occur after relatively minor head and neck injuries and precipitating events, mainly associated with minor indirect mechanisms causing hyperextension or sudden rotation of the neck such as motor vehicle accidents. It occurs in association with cervical spine fractures in almost 70% of the cases. Cerebellum and brainstem infarcts are typical findings that arouse neurological symptoms. These symptoms can be delayed in time, (...)
- Detection and intervention strategies by primary health care professionals in suspected elder abusePublication . Ferreira, Mafalda; Santos, César Lares dos; Vieira, Duarte NunoIntroduction: Primary health care professionals are in a privileged position to recognize and manage cases of suspected elder abuse. The purpose of this study was to provide some insight of these professionals’ views and knowledge on this subject. Material and Methods: A questionnaire was elaborated and sent to physicians and nursing staff practicing in 12 different health care units in Coimbra. The data collected included parameters related to demography, perception of abuse and management strategies, personal experience and training on this subject. Results: The global response rate was 67.9% corresponding to 127 validated questionnaires. From the results found, we highlight the following: there was a significant contact between these professionals and older people; most (64.6%) considered the abuse as more prevalent in the familiar context and 32.3% signed negligence as the most common type; the majority of professionals considered themselves as useful (97.6%); the uncertainty in the diagnosis was one of the most important causes for non-reporting; there were doubts concerning mandatory report of abuse to judicial authorities. It was also found that 87.4% of the respondents stated they would feel more comfortable having formal protocol to handle these cases and this subject was not included in the training curriculum of 70.9% of the respondents. Discussion: The significant contact between older population and health care professionals allows for an early diagnose and intervention. The professionals showed knowledge in accordance to some studies, namely, as to the context and prevalence of abuse. Doubts as to the best way to manage these cases could be solved by implementing protocols and by specific training, which is a fundamental cornerstone for preparing professionals to deal with these kind of cases. Conclusion: Health care professionals seemed to be aware of the relevance of elder abuse, as well as the importance of their role in preventing and diagnosing these abuses. However, a more extensive approach on this subject during clinical training and the definition of general clinical guidelines are important to increase the professionals’ confidence in managing suspected cases.
- Procedimentos técnicos, éticos e legais da competência do médico no cumprimento da lei da fiscalização da condução rodoviária sob influência do álcool e substâncias psicotrópicasPublication . Dinis-Oliveira, Ricardo Jorge; Nunes, Rui; Carvalho, Félix; Santos, Agostinho; Teixeira, Helena M.; Vieira, Duarte Nuno; Salgado de Magalhães, Teresa MariaA toxicologia forense é uma ciência de características essencialmente analíticas que tem como objectivo esclarecer sobre questões judiciárias e judiciais que possam estar relacionadas com intoxicações e suas potenciais consequências, fatais ou não fatais, no âmbito dos diversos domínios do Direito (Penal, Civil, do Trabalho, ou outros). Entre o tipo de perícias toxicológicas que mais vezes são solicitadas (e que revelam tendência crescente) estão as que dizem respeito aos procedimentos relacionados com a fiscalização da condução rodoviária sob influência do álcool e de substâncias psicotrópicas no vivo e no cadáver. São peças chave em todo este sistema: (a) as entidades fiscalizadoras que procedem ao rastreio e quantificação do álcool no ar expirado e ao rastreio de substâncias psicotrópicas na saliva; (b) os serviços públicos de saúde que procedem ao rastreio de substâncias psicotrópicas na urina (quando não é realizado na saliva); (c) o médico que colhe as amostras de sangue, no vivo ou no cadáver; (d) o toxicologista forense que realiza a análise toxicológica no sangue (ou, eventualmente, noutra amostra biológica); (e) os magistrados do ministério público que, em última estância, irão receber o relatório toxicológico para fundamentação de uma eventual decisão judicial. Sendo assim é importante conhecer a Lei da Fiscalização Rodoviária sob Influência do Álcool e de Substâncias Psicotrópicas, designadamente no que ao papel do médico diz respeito. Por conseguinte, é objectivo deste trabalho proceder a uma revisão destes tópicos fornecendo os elementos necessários tendo em vista o esclarecimento dos interessados sobre os procedimentos que devem considerar ao nível técnico, ético e legal.
- Oral health professional intervention and child physical abuse: European legal approachPublication . Corte-Real, Ana; Almiro, Pedro Armelim; Silva, Mafalda; Nunes, Tiago; Abreu, João; Carreira, Carla; Vieira, Duarte NunoPhysical violence against children and adolescents is an issue of Global Public Health. This study aims to identify traumatic injuries and the medicolegal temporary framework of the victim’s profile in the European legal approach. Participants and setting include the following: the clinical reports of a Portuguese European Clinical Academic Center database were analysed. An observational and prospective cohort study was performed. A descriptive analysis of the variables was conducted, considering gender, bimodal age groups, place of residence, offender data, place of occurrence, aetiology, localization, type of injuries, personal injury assessment by Quantum doloris, and injury time. The statistical analysis was performed by Spearman’s rho and Kendall’s tau-b correlation tests, Pearson’s chi-square test of independence (χ2), and Mann Whitney and Kruskal–Wallis nonparametric tests (P < 0.05). The relationship between age groups and the place of occurrence was statistically significant (P = 0.001). Orofacial and non-orofacial injuries were related (P = 0.035). The General Data Protection Regulation is not a barrier to the treatment and sharing of justified data but a framework for safeguarding individuals’ fundamental rights, including the Right to Health. Meticulous reporting of the clinical situation involves the victim, the occurrence, and the potential offender. Key points: • An oral health professional’s notification of the event is a fundamental step of the judicial process. • The timeline is the core of traumatic injury assessment in a child physical abuse scenario. • Medicolegal evaluation impacts disability prevention, imputability, and notification of the crime.