An evaluation of traumatic deaths associated with animal attacks: A 10-year autopsy study.

BACKGROUND: Just as throughout the world in general, deaths related to animal attacks continue to be a public health problem in Turkey. A decrease in areas of natural habitat because of human invasion, and the use of these areas for hunting, wood-cutting, recreational and sporting activities has increased the possibility of humans encountering wild animals. METHODS: A physical retrospective screening was made of the forensic records of a total of 8944 autopsy cases in the Forensic Medicine Institute of the Trabzon Group Directorate in the 10-year period between Januarry 2007 and December 2016. RESULTS: When the types of animals causing the traumatic death were examined, the most frequent was cattle in 15 cases followed by horses in 7 cases, bears in 4 cases, wolves in 2 cases, and wild boars in 2 cases. According to the autopsy results, the cause of death was most often intrathoracic bleeding and intrathoracic organ damage, the regions of the body injured were seen to be most often the chest and back, and the most common form of injury was blunt/crush trauma. CONCLUSION: From these records, cases were identified where the cause of death was traumatic animal attack, and examination was made of the sociodemographic characteristics, the type of animal that caused the injuries, information about the location of the incident, witness statements, information about the healthcare centre, findings of external examination and autopsy, and the cause.

Medicolegal evaluation in terms of physical abuse of children aged 0-3 years presenting at the emergency department with brain hemorrhage.

BACKGROUND: Physical abuse of children covers all types of non-accidental and preventable physical violence and injury perpetrated by the caregiver. METHODS: The study included children in the 0-3 years age group who presented at the Emergency Department (ED) with the finding of intracranial hemorrhage during the 5-year period of 2017-2021. These children were evaluated retrospectively, and findings that should be considered were revealed. RESULTS: In the 32 cases included in the study, the most common cranial finding was subdural hematoma, and the most common extracranial finding was ecchymoses. Presentation at the ED was seen to be 2 days after the trauma in 9.37% of the cases. CONCLUSION: Any physician who encounters findings related to physical abuse of a child must make a forensic and social services report. Physicians who do not make the necessary reports or act to the contrary have both a legal and moral responsibility in the subsequent process.

Evaluation of the fire-related deaths: Autopsy study.

BACKGROUND: The fire is a public health problem that occurs because of various reasons, threatens the lives of organisms, and may cause economic losses. The forensic investigation and the crime (event) scene investigation and first medical examination to be performed for the persons in the fire scene might reveal important evidences. METHODS: The autopsy reports prepared in Trabzon Branch Office, The Ministry of Justice Council of Forensic Medicine, for the death cases found in fire scene between 2007 and 2016 were retrospectively examined. RESULTS: As a result of analyzing the 10-year archive data, it was determined that 100 (63.3%) of 158 cases, which have been found in the fire scene and undergone forensic autopsy, were male and 58 (36.7%) were female. By excluding the group of cases with undetected origin, it was determined that there was a statistically significant difference between the homicide-caused deaths and the deaths with other causes (accident and suicide) in terms of the carboxyhemoglobin (HbCO) levels. By grouping the fire scene as outdoor and indoor areas, the comparison made between the HbCO levels of cases is presented in table. The difference between the two groups was found to be statistically significant (p<0.05). CONCLUSION: Starting from the crime scene investigation, a detailed radiological, toxicological, and pathological investigation must be performed for the persons taken out from the fire scenes. It was observed that the HbCO levels can be used in determining the space in which death occurred, the origin, and the comorbidities of the individual.

Medicolegal evaluation of cases with burn trauma: Accident or physical abuse.

INTRODUCTION AND OBJECTIVE: Burns are thermal injuries that may have a wide variety of clinical consequences from simple injuries to mortality. There are many aspects that must be medicolegally addressed in both non-survivors and survivors from burn injuries. The objective of this study was to determine sociodemographic characteristics, injury patterns, treatment requirements and prognoses of patients with burn injuries to evaluate the findings of neglect-abuse and forensic reporting processes. This study also aimed to contribute to the medicolegal classification criteria in respect of the factors that have an effect on the prognosis in the analyses. MATERIAL AND METHOD: The study was conducted by retrospective review of digital files and paper records of patients who received therapy in the Burns Unit of KTU Farabi Hospital between 1st January, 2013, and 31st December, 2017. RESULTS: Evaluation was made of a total of 1225 patients, comprising 769 (62.8%) males and 456 (37.2%) females, with a mean age of 21.8 ± 23.8 years (range, 1-89 years). The mean burnt body surface area was 14.29 ± 13.74. A trauma-related psychiatric disorder was diagnosed in 60 (4.9%) patients during treatment. When the medical history and physical examination findings were evaluated together, burn injuries suggested physical abuse in 54 patients (4.4%). The doctors who evaluated the patients with burn injuries in the emergency room and those who applied treatment in the Burns Unit made a forensic notification for 379 (30.9%) patients. The mean age of non-survivors was significantly higher than that of patients who survived to discharge (56.54 ± 28.60 years for non-survivors and 19.39 ± 23.12 years for survivors; p < 0.001). CONCLUSION: Burn injuries are frequently encountered, and they require precautionary measures. Burn injuries due to abuse are more frequently observed in the elderly and especially in children. Thus, the findings must be correctly interpreted, and more effort should be made to improve the knowledge of healthcare professionals about forensic reporting. Moreover, regulations should be implemented in respect of the medicolegal classification of trauma.

A Nonrandom Sample of 55 Sexual Abuse Cases in Sivas.

BACKGROUND Sexual abuse in childhood is a significant public health problem because of the destructive results both to the individual and to the community. The aim of this study was to examine the sociodemographic characteristics of children who were victims of sexual abuse, the relationship of the victim and abuser, and the findings of sexual abuse. MATERIAL AND METHODS An examination was made of the results of forensic medicine and psychiatric evaluations of child victims of sexual abuse. The sociodemographic characteristics of the cases and the characteristics of the incidents of sexual abuse were evaluated at the Forensic Medicine Department of Cumhuriyet University between 2013 and 2016. RESULTS A total of 55 cases were included in the study, comprising eight males (14.5%) and 47 females (85.5%) in the age range of 5-17 years. The vast majority of the cases were high school students. The place of the abuse incident was the home of the victim or the perpetrator in 29 cases (52.7%). The sexual abuse was determined to be bodily penetration in 32 cases (58.1%). In 32 cases (58.1%), the perpetrator was known to the victim. CONCLUSIONS The study findings that the perpetrator of the sexual abuse was known to the child, that predominantly female children were attacked, and the low sociocultural level of the cases were consistent with other studies reported in the literature. To prevent sexual abuse of children, to make an early diagnosis, and to provide rehabilitation for the abused children, it is essential that the evaluations of these cases are made using a professional multidisciplinary approach.

Violence towards women is a public health problem.

BACKGROUND: Violence within the family is a significant health problem which threatens the health of the community. The global rates of domestic violence directed at women have been reported as 10%-69% and in Turkey as 25%-30%. MATERIALS AND METHODS: The data of our study were obtained from the database of the official internet website of the Turkish Statistics Institute as the data related to violence between 2007 and 2012. In the evaluation of the data, SPSS 11.0 statistics software was used. RESULTS: Although it was determined that women from all groups experienced sexual, physical and emotional violence, higher rates were observed in those living in rural areas compared to those in urban areas, in the eastern region compared to all other regions, in the 45-59 years age group, those with low level of income and with a low level of education. CONCLUSION: When physicians encounter women who have experienced violence, by evaluating the violence in the context of a legal case, violence is identified and not allowed to become a cycle passed from generation to generation, and in addition to the medical intervention, without forgetting that violence is a public health problem, it is necessary to find a way to provide psychosocial and legal support for the victim.

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.

Determination of skin wound age by using cytokines as potential markers.

Interleukin-1 beta (IL-1ß), IL-6, tumour necrosis factor-alpha (TNF-α) and epidermal growth factor (EGF) play important roles in the wound healing process. In the present study, human wound specimens (n = 50) were collected from cases of death due to injuries from firearms, penetrating trauma by sharp objects and blunt trauma with a known time of injury and death identified by forensic autopsy. Full-thickness tissue specimens were obtained from injured skin sites, and equally sized intact tissues obtained from the same person were used as controls. Protein determination was performed using ELISA according to the Bradford method for each specimen, and results were provided for individual proteins. IL-1ß levels did not reach statistical significance in any of the wound groups and were not markedly higher than those in the control group. However, IL-6 showed a biphasic pattern and reached statistical significance in the group with wounds less than 30 min old and in the group with wounds more than 18 h old. IL-6 was consistently higher in all wound groups than in the control group. TNF-α showed a statistically significant increase within the first 30 min and remained at a high level in all groups except for those with wounds 2-4 h old. On the other hand, EGF was high in all groups excluding those with wounds 2-4 h old and more than 18 h old, but statistical significance was not reached. Our results suggest that IL-6 and TNF-α in particular may be used as early-phase markers. We believe that IL-1ß and EGF should be more extensively evaluated in further studies.

Relationship between organisational commitment and burnout syndrome: a canonical correlation approach.

Objective Burnout syndrome can significantly reduce the performance of health workers. Although many factors have been identified as antecedents of burnout, few studies have investigated the role of organisational commitment in its development. The purpose of the present study was to examine the relationships between subdimensions of burnout syndrome (emotional exhaustion, depersonalisation and personal accomplishment) and subdimensions of organisational commitment (affective commitment, continuance commitment and normative commitment). Methods The present study was a cross-sectional survey of physicians and other healthcare employees working in the Ministry of Health Ordu University Education and Research Hospital. The sample consisted of 486 healthcare workers. Data were collected using the Maslach Burnout Inventory and the Organisation Commitment Scale, and were analysed using the canonical correlation approach. Results The first of three canonical correlation coefficients between pairs of canonical variables (Ui , burnout syndrome and Vi, organisational commitment) was found to be statistically significant. Emotional exhaustion was found to contribute most towards the explanatory capacity of canonical variables estimated from the subdimensions of burnout syndrome, whereas affective commitment provided the largest contribution towards the explanatory capacity of canonical variables estimated from the subdimensions of organisational commitment. Conclusions The results of the present study indicate that affective commitment is the primary determinant of burnout syndrome in healthcare professionals. What is known about the topic? Organisational commitment and burnout syndrome are the most important criteria in predicting health workforce performance. An increasing number of studies in recent years have clearly indicated the field's continued relevance and importance. Conversely, canonical correlation analysis (CCA) is a technique for describing the relationship between two variable sets simultaneously to produce both structural and spatial meaning. What does this paper add? To our knowledge, CCA has not been used to determine the relationships between burnout and organisational commitment of physicians and other healthcare staff. Accordingly, the present study adds information regarding the relationship between burnout and organisational commitment variables determined using CCA. This analysis is used to describe the relationship between two variable sets simultaneously and allows for an easy method of interpretation. What are the implications for practitioners? Burnout syndrome is a major threat to both the health workforce and its organisations. In addition, it affects the quality and effectiveness of health care. Thus, the findings of the present study offer a solid foundation from which actions to decrease burnout levels in healthcare professionals can be implemented by successfully increasing levels of organisational commitment.

Evaluation of the Postmortem Glucose and Glycogen Levels in Hepatic, Renal, Muscle, and Brain Tissues: Is It Possible to Estimate Postmortem Interval Using These Parameters?

The aim of our study was to investigate the postmortem levels of glucose and glycogen in hepatic, renal, muscle, and brain tissues and then examine the changes in those levels that could be useful for estimating postmortem interval. We established an animal model. Seventy female BALB/c albino mice were used in this study. After being sacrificed, the mice were randomly divided into six groups according to time elapsed since death (Group 1: 0 h; Group 2: 12 h; Group 3: 24 h; Group 4: 36 h; Group 5: 48 h; and Group 6: 60 h). Glucose levels were significantly different between groups for all tissues studied. Slope of the change per unit time was higher for the hepatic glucose levels. Based on these results, it is possible to estimate postmortem interval using postmortem glucose levels in hepatic tissue. Tissue-specific assessment may contribute valuable information to postmortem interval studies.

Evalution of Femicide Cases Committed Between the Years 1996-2005 in Antalya.

Criminal death incidence of women varies between developed and developing countries, and it has become a common public problem in almost every country. We do not have any data about femicide cases published in Turkey until today. In our study, we tried to call attention to femicide cases. In our study, we evaluated 141 cases of female homicides with an interval of 10 years between January 1996 and May 2005, retrospectively. Data retrieved were statistically evaluated using chi-square test. Most of the cases were between 21 and 35 years of age. Spouse murders are usually witnessed during the process of divorce. Establishment of institutions which will ensure the security of women during this period is of paramount importance. If we protect women during divorce and separation proceedings, we can prevent femicide cases. We also think that laws may be strengthened for protecting women who are vulnerable at such times.

Evaluation of the Post-Mortem Superoxide Dismutase, Glutathione Peroxidase Activities and Malondialdehyde Level in Renal and Brain Tissues: Is it Possible to Estimate Post-Mortem Interval Using these Parameters?

BACKGROUND: Estimation of the postmortem interval (PMI) is one major area of interest in forensic medicine. We investigated changes of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activities and malondialdehyde (MDA) levels in rat brain and renal tissues in the PMI and examined the potential changes which may be useful for an estimation of time of death. METHODS: Forty albino female rats were used in this study. The rats were sacrificed and divided into five groups: Group 1: 0 hour, Group 2: 6 hours, Group 3: 12 hours, Group 4: 24 hours, and Group 5: 48 hours. The rats were housed at room temperature (22 degrees C ± 2 degrees C) for the defined period for each group, and their brains and kidneys were excised. RESULTS: The postmortem MDA levels were significantly different between groups for both renal and brain tissues (p = 0.003; p = 0.007). The diagnostic adequacy of MDA was calculated. Regarding SOD and GSH-Px, we were not able to obtain any date that would be useful for the prediction of PMI. CONCLUSIONS: According to this study, it is possible that an estimation of the PMI can be made using postmortem MDA levels. Regarding SOD and GSH-Px, we were not able to obtain any data that would be useful for the prediction of PMI.

An evaluation of childhood deaths in Turkey due to yellow phosphorus in firecrackers.

Yellow phosphorus (YP) is a powerful protoplasmic poison used in the manufacturing of matches, pest poisons, firecrackers, firework cracker, lights for watches, military ammunition, and agriculture fertilizer. YP is extremely flammable and toxic and easily absorbed from the gastrointestinal tract. In this study, we examined childhood deaths from 1997 to 2012 resulting from the ingestion of firecrackers. The patients ranged from 2 to 15 years of age and were admitted to the hospital with a variety of symptoms. Those that presented with nausea, vomiting, and hypotension rapidly deteriorated and entered a coma. An autopsy was performed in all but one of the 16 cases reviewed. Macroscopically, the livers had a yellowish discoloration with petechial bleeding. Histopathologic examination revealed acute toxic hepatitis. In conclusion, these firecrackers are found in corner shops throughout Turkey, may cause death in children with little warning, and should be banned to prevent further deaths.

Evaluation of social and demographic characteristics of incest cases in a university hospital in Turkey.

BACKGROUND: Incest is defined as any sexual activity between close blood relatives including step relatives and family members who are forbidden by law to marry. It is a problem that can be seen in all the social classes in developed and undeveloped societies. The World Health Organization classifies this problem as a silent health emergency. Father-daughter incest is reported to be the most common incest type followed by the other types like brother-sister, sister-sister and mother-son incest. MATERIAL AND METHODS: Subjects for this study were recruited from a sample of incest cases referred to Forensic Medicine Department of Gaziosmanpasa University Medical Faculty Hospital between 2008 and 2012. Data involved social and demographic characteristics and clinical features of victims, perpetrators and the families. The ethical committee of the faculty of medicine approved the study. RESULTS: The study sample consisted of 43 incest cases (36 females and 7 males) with an age rage 4-40 years. Two third of the victims were under 18 years old. All perpetrators were males. Father - daughter incest (34.9%) was found to be most common incest type followed by brother - sister incest (14%). 75% of the perpetrators were family members and relatives with consanguinity while 25% of them were not consanguineous but faithful and intimate relatives to victims. CONCLUSIONS: Increasing awareness about incest and its damaging effects is so important and clinicians should keep in mind sexual abuse or incest when examining the risky population. Multidisciplinary approach is necessary for determining short term or long term results and preventing the negative consequences of incest.

Underage mothers in Turkey.

BACKGROUND: All individuals under the age of 18 are considered as children by the Convention on the Rights of Children. Underage mothers are a pediatric-age group of children that become pregnant and give birth. It may be unfamiliar in Western countries, but in Middle-Eastern countries ruled by religious laws and old-fashioned traditions, it is common for an older man to marry a girl. The aim of this study was to describe the status of underage mothers within the framework of children's rights and to draw attention to this issue. We presented this study to increase awareness and sensitivity, and to scrutinize and discuss these topics. MATERIAL AND METHODS: We retrospectively investigated cases of underaged pregnant girls who applied to Forensic Science Department outpatient clinics and Obstetrics and Gynecology Department outpatient clinics of Gaziosmanpasa University Faculty of Medicine between 2003 and 2013. Results We accessed records of 163 underage mothers (≤ 18 age). Mean age was 16.9 ± 0.83 (14-18 years). Gravida and parity rates increased proportionately with increasing age. Most of our cases were 16 and 17 years of age (n: 117, 71.8%). CONCLUSIONS: Underage motherhood is not only a medical issue; it is a multi-dimensional problem with social, economic, traditional, religious, and legal aspects.

Evaluation of suicide cases in Turkey, 2007-2012.

BACKGROUND: The aim of this study was to determine the demographic and sociocultural characteristics of suicide attempts by using data from the Turkish Statistical Institute. It is our intent that the work data may contribute to the national suicide data and the development of suicide prevention policies. MATERIAL AND METHODS: We obtained our data, which cover the years 2007 to 2012, from the database accessible at the official website of the Turkish Statistical Institute, which permits the use of its data for research purposes. The data were evaluated by using the SPSS 10.0 program. The chi-square test was used for statistical analysis, and the percentage distribution and odds ratios were calculated. RESULTS: According to data from the Turkish Statistical Institute, the total number of suicide deaths in Turkey between 2007 and 2012 changed yearly (χ2=42,035-59,209; P<0.001). While suicide deaths in 2007 made up 0.00396% of the total deaths for that year, that figure increased to 0.00426% in 2013. According to the data from the Turkish Statistical Institute, over 1.9 million people died due to all causes between 2007 and 2012 in Turkey. Over 17,000 deaths (0.9%) were due to suicide. CONCLUSIONS: Suicide is an important public health problem and is multidimensional in nature. Examining this subject from etiological, epidemiological, biological, psychological, sociological, and anthropological perspectives is important to improve the prevention of suicides.

Autopsy evaluation of coal mining deaths in the city of Zonguldak, Turkey.

BACKGROUND: In this study, our aim was to evaluate the fatal occupational accidents that occurred in Zonguldak coal mines between the years 2005-2008. MATERIAL AND METHODS: We retrospectively evaluated 42 fatal coal mine occupational accidents in Zonguldak (Turkey) between the years 2005-2008. The forensic records of autopsies referred to the chief prosecutors' office during 2005-2008 were reviewed retrospectively. There were 42 cases. The cases were evaluated with respect to age, mechanism of injury, body region of wound, cause of death, and legality of the mine. RESULTS: Ages of the deceased ranged between 17 and 52 (median: 32.9 yrs). Deaths were mostly in the 21-30 (35.8%), and 31-40 (30.9%) age groups. Only 1 case was younger than 18 years of age. Review of occupational fatalities has revealed that fatal accidents occurred mostly (76.2%) in the private, and fewer (23.8%) in the public mining enterprises. Crime scene investigation findings have demonstrated that of all occupational deaths (total n=42), 27 (64.3%) were due to subsidence, followed by methane gas poisoning (n=6, 14.2%), tram crash (n=3, 7.1%), log falls (n=2, 4.8%), electrocution (n=2, 4.8%), and methane explosion (n=2, 4.8%). CONCLUSIONS: Despite laws and regulations concerning mining and because of problems in their implementation, Turkey leads the world in work-related accidents, occupational injuries, and deaths. Evaluation of autopsy findings of deaths in fatal occupational accidents occurring in coal mines is quite important in planning to decrease rates of occupational fatalities.