Comprehensive examination of etiological factors and clinical manifestations of maxillofacial traumas in forensic cases: A five-year retrospective study.

BACKGROUND: Maxillofacial injuries, due to their diverse etiological causes, are often considered a component of multi-trauma and constitute a significant portion of trauma. This study aims to elucidate the incidence of maxillofacial traumas, particularly among military personnel, various clinical courses, and characteristics, thereby contributing to the literature. METHODS: Forensic reports, primarily related to military personnel and organized between 2011 and 2016 at the Forensic Medicine Department of Gülhane Medical Faculty, Health Sciences University, were retrospectively examined. The study involved a detailed analysis of cases with maxillofacial injuries resulting from trauma, focusing on aspects such as age, gender, the origin of the trauma, degree of injury, the presence of bone and dental fractures, and the occurrence of psychiatric disorders as a result of the trauma. RESULTS: This study demonstrated that maxillofacial traumas predominantly occurred in young male individuals, particularly among military personnel. The most common etiological factor identified was interpersonal violence. The majority of injuries were soft tissue damages, with the nasal bone being the most frequently fractured area. Injuries to the head and upper extremities were also detected in some of the cases, showing that multiple injuries are common in such cases. Post-traumatic psychological disorders developed in some cases, with anxiety disorders being the most commonly observed. CONCLUSION: It has been determined that maxillofacial injuries can affect multiple body regions, necessitating a multidisciplinary approach. This study underscores the importance of developing comprehensive strategies and policies for understanding and managing maxillofacial traumas, providing a fundamental reference for future studies in this field.

Postmortem Interval Estimation With Corneal Endothelial Cell Density.

OBJECTIVES: In the neonatal period, healthy people have the highest corneal endothelial cell density (CECD) (5000-7000 cells/mm2). Corneal endothelial cell density declines with age in adults (2500-3000 cells/mm2) and continues to decline in the postmortem period. We measured CECD in cases with different postmortem interval (PMI) and investigated its association with PMI. METHODS: A total of 555 corneas harvested from 285 cases with a known time of death were examined using a specular microscope. RESULTS: Postmortem corneal removal time ranged between 10 and 1395 minutes. The CECD averages were 2653 for right cornea and 2678 cells/mm2 for left cornea. An inverse but nonlinear relationship was found between age and CECD. In both men and women, there was an inverse and weak correlation between age and CECD (ρ = -0.282; P < 0.001; ρ = -0.264; P < 0.001, respectively). There was no significant relationship between postmortem corneal removal time and CECD (ρ = 0.049; P = 0.421; ρ = 0.011; P = 0.855 for right and left corneas, respectively). The highest decline in time dependent CECD was detected between the 480th and 540th minutes at -7.2%. CONCLUSIONS: We found no significant decrease in CECD numbers according to PMI or cause of death. Experimental studies on cases with known and standardized antemortem CECD values will provide essential results in estimating PMI.

Forensic mental health evaluations of military personnel with traumatic life event, in a university hospital in Ankara, Turkey.

INTRODUCTION: The definition of psychological trauma has been rephrased with the DSM-5. From now on, witnessing someone else's traumatic event is also accepted as a traumatic life event. Therefore, the psychiatric examination of forensic cases gains importance for not overlooking a psychiatric trauma. This research aims to discuss the psychiatric examinations of military personnel who had a traumatic life event and to reveal psychiatric states of soldiers after trauma. MATERIALS AND METHODS: The forensic reports prepared at Gulhane Military Medical Academy (GMMA), Forensic Medicine polyclinic between January 1, 2011 and November 30, 2014 were examined, and among them the cases sent to GMMA Psychiatry polyclinic for psychiatric examination were analyzed retrospectively. RESULTS: There were a total of 2408 cases who applied for the arrangement of a judicial report and 167 of them required a psychological examination. Among 167 cases, 165 were male and 2 were female, and the mean age was 25.6 years. Anxiety disorder (53.9%) was the most common diagnosis as a result of the psychiatric examination, following posttraumatic stress disorder (PTSD) (18.6%), and 3.6% had no psychopathology. It was determined that injuries caused by firearms (38.3%) and explosive materials (26.3%) had caused psychological trauma the most. On the other hand, 11 (6.6%) cases were determined to have undergone a psychological trauma on account of being a witness to their friends' injuries during the conflict without experiencing any physical injury. There were not any statistically significant relationships between the severity of physical injury and being PTSD or anxiety disorder. DISCUSSION: Development of PTSD risk is directly correlated with the nature of trauma. The trauma types of the cases in our study were in the high-risk group because of the military population. Our study is of importance in terms of putting forward the psychiatric disorders seen in the military population with traumatic life history associated with war (combat-related). In this research, 26.1% of the cases followed up due to combat-related trauma were diagnosed with PTSD. Interestingly, this ratio was lower than the studies that have larger case numbers. There is still the need to conduct studies that will involve larger participants.

Evaluation of geriatric suicides in Turkey.

INTRODUCTION: Suicide is defined as an individual taking action towards themselves with the intention of terminating their own life. According to the World Health Organisation (WHO), 800,000 deaths per year worldwide are due to suicide. In 2012, suicide cases constituted 1.4% of all the deaths worldwide. In most countries throughout the world, the suicide rates of the elderly are higher than those of other age groups. Epidemiological studies have concluded that suicide rates increase with advancing age in all societies, this increase accelerates after the age of 65 years and the highest rates are reached after the age of 75 years. The aim of this study was to evaluate the demographic features, suicide methods and reasons for suicide in geriatric suicide cases between 2009 and 2013 using the data of the Turkish Statistics Institute (TUIK). MATERIAL AND METHODS: A retrospective evaluation was made of the TUIK data related to proven suicide cases aged 65 years and older in the 5-year period of 2009-2013. RESULTS: A total of 1723 geriatric suicides were determined in Turkey between 2009 and 2013. These comprised 1284 (74.5%) males and 439 (25.5%) females, showing a rate of males approximately 3 times higher than that of females. An increase of approximately 10% was seen in the deaths by suicide in 2013 compared to 2009. The highest rate of geriatric suicides within total geriatric deaths was observed to be in 2012 (15.2%) and the lowest rate was in 2010 (12.4%). The most common method of suicide in both genders was hanging. In the majority of cases of geriatric suicide of both genders, the reason could not be determined. In those cases where the reason was known, the most common reason was illness. CONCLUSION: It has been reported that the most significant factors in suicide prevention are friends and family. As there continues to be an extensive family structure and family connections are strong in Turkey, this can be considered to be one of the reasons for lower rates of geriatric suicide compared to other countries. As there is a strong adherence to Islam in Turkey, another significant reason for the low rate could be the effect of the belief that suicide is a sin in the Islamic religion.

Evaluation of Vitality in the Experimental Hanging Model of Rats by Using Immunohistochemical IL-1ß Antibody Staining.

INTRODUCTION: Hanging is the most common suicide method in the world, and the discrimination of antemortem-postmortem hanging must be done at autopsy. The aim of this experimental study was to examine the immunohistochemical expression of IL-1ß antibody at the hanging mark skin samples of rats to discriminate antemortem and postmortem hangings. MATERIALS AND METHODS: A total of 20 Wistar albino rats were used for this study. The groups were as follows: A-1, antemortem control group; A-2, antemortem second-hour hanging mark skin samples; A-3, antemortem 24th-hour hanging mark skin samples; A-4, antemortem 72nd-hour hanging mark skin samples; B-1, postmortem control group; and B-2, postmortem second-hour hanging mark skin samples. Interleukin-1ß immunostaining was performed to all tissue samples. RESULTS: For epidermal cells, group A-1 samples did not show IL-1ß immunostaining, group A-2 samples were severely immunostained, and groups A-3 and A-4 samples' staining were slightly decreased. There was no IL-1ß antibody staining in groups B-1 and B-2 samples. For adnexal cells, groups A-1 and B-1 samples did not show IL-1ß immunostaining, staining of group A-2 samples was mild to severe, and groups A-3 and A-4 samples' staining were slightly decreased. Half of the group B-2 samples did not show IL-1ß immunostaining. For subepidermal cells, most of the samples of groups A-1 and B-1 showed slight immunostaining, groups A-2 and B-2 samples' staining were mild to severe, and there were slight immunostaining in groups A-3 and A-4 samples. The majority of vascular structure cells did not show IL-1ß immunostaining. CONCLUSION: Interleukin-1ß immunostaining of epidermal cells can discriminate antemortem-postmortem hangings, but vascular structure cells and subepidermal cells cannot discriminate vital hangings.

Electrocution fatalities in military personnel in Ankara, Turkey.

OBJECTIVES: To investigate various cases of death caused by electrical injuries among Turkish military personnel. METHODS: We retrospectively reviewed fatality cases of military personnel between 1994 and 2013 at the Department of Forensic Medicine, Gulhane Military Medical Academy, School of Medicine, Ankara, Turkey, the only forensic medicine center for the Turkish Armed Forces. Medical records and autopsy reports of cases of electrical fatalities were reviewed and analyzed in terms of age and gender-specific incidence, voltage, contact details, body region distribution, location, and season of incident, site, and severity of injuries sustained, and histopathological and toxicological findings. RESULTS: Sixteen (3.5%) out of the 450 autopsy cases involved electrocution. All deaths were accidental and most frequently occurred outdoors (75%). Eight (50%) died due to high voltage while 6 (37.5%) died due to low voltage. The entry and exit lesions were determined most frequently in cases with high voltage injury. The low voltage deaths commonly occurred at the scene of the event (66.6%), while almost all high voltage deaths occurred in the hospital (87.5%, p=0.03). Electrical burns were most commonly detected in the upper extremities (32.6%, n=14). CONCLUSION: The present study shows that deaths due to high voltage electrocution are more frequent than low voltage electrocution among military personnel.

Comparison of antemortem clinical diagnosis and postmortem findings in burn-related deaths.

BACKGROUND: Burn injuries are an important public health problem resulting in high morbidity and mortality. Mortality in burn patients is associated with age, the extent of the burn surface, and the presence of concurrent chronic diseases. Studies have revealed differences between antemortem clinical diagnoses and postmortem findings in burn-related deaths. METHODS: In the present study, postmortem examination reports and autopsy reports issued by the Department of Forensic Medicine in Gülhane Military Medical Academy between 1 January 1994 and 30 May 2013 were retrospectively reviewed together with patient charts in an attempt to compare postmortem findings and antemortem clinical findings in burn-related deaths. RESULTS: In a period of approximately 20 years, thirty-one (6.9%) of the deaths among 450 cases were burn-related. Of the injuries, 90.3% were caused by flame burns. Mean burn percentage was 70.52%, and the survival of these cases was found to decrease significantly with increasing burn percentage (r=-0.491, p=0.005). According to autopsy findings, pneumonia was the most frequently overlooked antemortem clinical diagnosis, and mortality was associated with systemic organ failures. CONCLUSION: Burn-related deaths are an important cause of mortality among soldiers. We believe that postmortem findings revealed by autopsies could significantly contribute to the treatment of burn cases, and that interdisciplinary data sharing would be important in this respect.