The autopsy is one of the main tools for the evolution of medicine. Nevertheless, the autopsy rate declined worldwide in the last decades due to several reasons: progress in diagnosis of diseases, fear of legal consequences if a wrong diagnosis is proved, refusal of the deceased's family, reluctance of forensic pathologists and pathologists because of infectious risk and time consumption. However, despite the huge progress of medical science, discrepancies between the death diagnosis established by the clinician and the diagnosis established by the pathologist after performing the autopsy still exist and have remained relatively constant over the last 50 years. Our study aimed to identify the concordance rate between the cause of death established in the hospital and the cause of death established after performing the forensic autopsy and to determine the factors that could influence the concordance rate. The study group included 100 patients who died in hospital and underwent autopsy. We found a concordance rate of 45% which could be influenced by certain factors, such as: duration of hospitalization, interclinic consultation, mechanism of death, postmortem microscopic examination and the biochemical analysis performed during hospitalization. Our results support the fact that autopsy remains an essential tool for assessing the quality of care, for improving medical education process and for highlighting those diseases that represent "diagnostic challenges".

Cobalt chloride (CoCl2) modifies mitochondrial permeability and has a hypoxic-mimetic effect; thus, the compound induces tolerance to ischemia and increases resistance to a number of injury types. The aim of the present study was to investigate the effects of CoCl2 hypoxic preconditioning for three weeks on thermonociception, somatic and visceral inflammatory pain, locomotor activity and coordination in mice. A significant pronociceptive effect was observed in the hot plate and tail flick tests after one and two weeks of CoCl2 administration, respectively (P<0.001). Thermal hyperalgesia (Plantar test) was present in the first week, but recovered by the end of the experiment. Contrary to the hyperalgesic effect on thermonociception, CoCl2 hypoxic preconditioning decreased the time spent grooming the affected area in the second phase of the formalin test on the orofacial and paw models. The first phase of formalin-induced pain and the writhing test were not affected by CoCl2 preconditioning. Thus, the present study demonstrated that CoCl2 preconditioning has a dual effect on pain, and these effects should be taken into account along with the better-known neuro-, cardio- and renoprotective effects of CoCl2.

Chronic pain is managed mostly by the daily administration of analgesics. Tramadol is one of the most commonly used drugs, marketed in combination with coanalgesics for enhanced effect. Trace elements are frequent ingredients in dietary supplements and may enhance tramadol's analgesic effect either through synergic mechanisms or through analgesic effects of their own. Swiss Weber male mice were divided into nine groups and were treated with a combination of the trace elements Mg, Mn, and Zn in three different doses and a fixed dose of tramadol. Two groups served as positive (tramadol alone) and negative (saline) controls. Nociceptive assessment by tail-flick (TF) and hot-plate (HP) tests was performed at baseline and at 15, 30, 45, and 60 min after intraperitoneal administration. Response latencies were recorded and compared with the aid of ANOVA testing. All three trace elements enhanced tramadol's analgesic effect, as assessed by TF and HP test latencies. Coadministration of these trace elements led to an increase of approximately 30% in the average pain inhibition compared with the tramadol-alone group. The most effective doses were 0.6 mg/kg b.w. for Zn, 75 mg/kg b.w. for Mg, and 7.2 mg/kg b.w. for Mn. Associating trace elements such as Zn, Mg, and Mn with the standard administration of tramadol increases the drug's analgesic effect, most likely a consequence of their synergic action. These findings impact current analgesic treatment because the addition of these trace elements may reduce the tramadol dose required to obtain analgesia.

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