The effect of photography training on the accurate representation of gunshot and stab wounds in autopsies: a comparative study.

Accurate representation of findings in autopsy photographs is of paramount importance. This study investigates the influence of photography training on the precision of autopsy photographs in depicting these findings. In cases of fatal gunshot and stab wounds, photographs were concurrently taken by individuals without photography training (Group A) and a trained medical photographer (Group B). Two sets of photos were then anonymously presented to forensic medicine specialists, who had no prior knowledge of the associated autopsies, along with relevant survey questions. Responses were assessed according to the autopsy findings. 63.5% of the questions were correctly answered using Group A photographs, while Group B photographs achieved an accuracy rate of 81.2%. Although the rates of incorrect answers were equal (A: 10.9%, B: 11.0%), a notable disparity was observed in the category "could not be evaluated" (A: 25.5%, B: 7.8%). Hence, a significant difference emerged in these two photo groups' ability to depict the findings accurately. Conspicuously, the length of stab wounds was unassessable in 47.3% of Group A photographs, in contrast to only 1.4% in Group B. Furthermore, the mean deviation from the gold standard in estimating stab wound length was 3.09 mm for Group A and 0.77 mm for Group B. Considering the extent to which autopsy photographs faithfully represent findings is vital for preserving critical evidence over time, we recommend that basic photography training and specialized autopsy photography training become integral components of forensic pathology and medicine education worldwide, complemented by the development of standardized guidelines for autopsy photography.

Iatrogenic artefacts attributable to traditional cupping therapy in a shotgun fatality.

Cupping is a traditional treatment method that has been used for thousands of years to diminish pain, restore appetite and improve digestion, remove tendency to faint or remove 'bad blood' from the body. The suction of the cup is created by fire or mechanical devices. This procedure may result in circular erythema, petechiae, purpura, ecchymosis, burns and may be mistaken for trauma-related ecchymosis or livor mortis. Forty-year-old male was died by shotgun injuries in the same day of the wounding. Circular ecchymoses were observed on the forehead, within the scalp of occipital region, the back of the neck, and on the back. They were defined as ecchymoses in the first examination made by a general practitioner. In the external examination during the legal autopsy superficial incisions were observed on the circular ecchymoses. The shape, localization and color of and the characteristics of incisions on the circular lesions were concluded to be caused by the dry cupping therapy and wet cupping therapy procedures. These lesions and their formation mechanisms should be well-known by the forensic medical examiners and the other medical personnel involved in the forensic medical examination.

Elderly deaths in Ankara, Turkey.

According to World Health Organization, the life expectancy at birth is increasing. An increase in life expectancy might result in increased morbidity and mortality in elderly. The increase in the elderly population also leads to an increase in medico-legal problems, as well. Autopsy is of high importance for determination of cause of death in clinical and forensic cases. The purpose of this study was to find out general characteristics elderly deaths by examining forensic autopsy records. Out of 7033 forensic autopsies performed between years of 2007 and 2011, 1324 were elderly deaths and were included in the scope of the study. The records of public prosecutor office, crime scene investigation and autopsy findings were examined. The majority of victims (70.6%) were male, while 29.4% were female, with a male to female ratio of 2.4/1. Victims' ages ranged between 65 and 96 years, and the mean age was 74.8 years. A great number of presented elderly deaths were due to unnatural causes, followed by natural deaths cases. Out of unnatural deaths, 63.2% were related to accidents, 23.7% were suicides, and remaining 13.1% were homicides. More than half (56.6%) of all suicidal deaths were due to hanging. Of natural deaths, the majority (82.7%) were due to cardiovascular system disease. In the presented series the cause of death was determined in 90.9% of all elderly deaths, which validates the need for a forensic autopsy. Data obtained through autopsy procedures is of high importance for death statistics.

Nuclear morphometry in epidermal changes due to electrical current and thermal energy: trial for usage of image analysis in histological sections.

Distinguishing between injuries resulted from electrical current versus thermal energy is not only a difficult, but also a controversial issue in forensic medicine practice.In this study, an electrical current and a cautery were applied to dorsal skins of 10 rats and biopsies were taken from the injured sites as well as normal skin. In the histologic sections; some planimetric variables such as the perimeter, area, diameter equivalent circle, minimum feret, maximum feret, and the circular form factor of the nuclei located in normal and injured epidermis were measured with the aid of the computer-assisted image analysis.When compared with normal skin, all of the variables -nuclear area, perimeter, diameter equivalent circle, minimum feret, maximum feret, and circular form factor seemed to be decreased both in the electrical current- and cautery-applied skin samples.The differences between the variables measured in normal skin and in electrical- or cautery-applied skin samples were statistically significant (P < 0.05). However none of the variables showed any meaningful differences between the electrical- and cautery-applied areas.It was concluded that the nuclear changes due to electrical current and thermal injury are identical and morphometric analysis seems not to make any further contributions in the differentiating from each other. Therefore, conventional and more established methods for detection of metallization would be more effective.

Investigation of serotonin transporter gene promoter (5-HTTLPR) and intron 2 (variable number of tandem repeats) polymorphisms with suicidal behavior in a Turkish population.

The serotonin (5-hydroxytryptamine) transporter (5HTt) gene has been reported to be associated with suicidal behavior. In this study, we have investigated the 5' promoter region (i.e., 5HTt gene-linked polymorphic region [5-HTTLPR]) and a 17-base pair variable number of tandem repeats polymorphism in the 5HTt gene for potential association with suicidal behavior in a Turkish population. Genotypes were determined for 182 subjects of suicide (86 attempted suicide and 96 completed suicide) and 181 healthy control subjects. Our results showed that allele frequencies at individual loci were not significantly different in the two groups. This absence of altered individual locus haplotype (allele) frequency suggests the lack of a significant genetic contribution by the 5-HTTLPR or variable number of tandem repeats variations to the expression of suicidal tendencies. However, our linkage disequilibrium analyses indicated that there may be a greater risk for suicidal behavior in carriers of the S10 and L12 alleles of 5-HTTLPR.

Tuberculosis prevalence in forensic autopsies.

INTRODUCTION: According to the 2008 World Health Organization report, in 2006, 9.2 million new cases were determined, and 1.7 million people have lost their life due to tuberculosis (TB) in all around the world. In our country (Turkey), it is estimated that 35,000 to 40,000 people have TB disease annually. The Ministry of Health could just determine 18,500 of these cases, and only 6500 patient could be treated effectively. According to the Tuberculosis Dispensary records, the incidence for TB in Turkey is 28/100,000. MATERIALS AND METHODS: It is aimed to determine the infection with Mycobacterium tuberculosis using acidoresistant bacilli microscopy, TB culture, and histopathological methods in tissue samples that were obtained from lungs of forensic cases whose autopsies had been performed in Council of Forensic Medicine Ankara Department Morgue Specialized Committee. RESULTS: A total of 3 tissue samples that were obtained from lungs of randomized 302 cases, were positive for TB in Löwenstein-Jensen medium. Granuloma with caseating necrosis was found in histopathological examination and acidoresistant (+) bacilli (1+, 2+, and 2+, respectively) in microscopically analysis were also demonstrated in this 3 tissue samples. DISCUSSION: For this reason, we think that autopsy workers have to be careful about tuberculosis during their autopsy working.

A prospective study of serotonin transporter gene promoter (5-HTT gene linked polymorphic region) and intron 2 (variable number of tandem repeats) polymorphisms as predictors of trauma response to mild physical injury.

The aim of this study was to examine the effect of both promoter and intron polymorphisms of the serotonin transporter (5HTT) gene on posttraumatic stress disorder (PTSD) development. For this purpose, two polymorphisms of the 5-HTT gene, which are found in the promoter (5-HTT gene-linked polymorphic region) and second intron (variable number of tandem repeats) of the gene, were analyzed in 100 patients who were admitted to the Emergency Department after a mild physical trauma. None of the 5-HTT polymorphisms studied have an effect on PTSD development after a mild physical injury, but having L allele for 5-HTT gene-linked polymorphic region may cause milder hyperarousal symptoms in those patients who have developed PTSD.

Six-year experience of a hospital-based child protection team in Turkey.

The objective of this article was to review the case series' profile followed up by the Gazi University Multidisciplinary Team for Child Protection and to describe the challenges in our child protection system. The cases referred to this team between February 2001 and January 2007 were analyzed. In addition to the clinical management, challenges encountered during follow-up due to gaps in the child protection system were reviewed. A total of 139 patients were referred to the team during the study period. Mean age for physical abuse, sexual abuse, and neglect were 8.9 +/- 6.2, 10.8 +/- 4.2, and 5.1 +/- 5.5 years, respectively. Sexual abuse was significantly less common while neglect was significantly more common in the 0-5 years of age group. In addition to the gaps within each link of the child protection system (medical, legal and social services) in Turkey, interagency collaboration seems to be inadequate. Hospital-based multidisciplinary teams can start such a collaboration.

Establishment of interdisciplinary child protection teams in Turkey 2002-2006: identifying the strongest link can make a difference!

OBJECTIVES: The University of Iowa Child Protection Program collaborated with Turkish professionals to develop a training program on child abuse and neglect during 2002-2006 with the goals of increasing professional awareness and number of multidisciplinary teams (MDT), regional collaborations, and assessed cases. This paper summarizes the 5-year outcome. METHODS: A team of instructors evaluated needs and held training activities in Turkey annually, and provided consultation when needed. Descriptive analysis was done via Excel and SPSS software. RESULTS: Eighteen training activities were held with 3,570 attendees. Over the study period, the number of MDTs increased from 4 to 14. The MDTs got involved in organizing training activities in their institutions and communities. The number of medical curriculum lectures taught by MDTs to medical students/residents, conferences organized by the MDTs, and lectures to non-medical professional audiences increased significantly (R(2)=91.4%, 83.8%, and 69.2%, respectively). The number of abuse cases assessed by the MDTs increased by five times compared to pre-training period. CONCLUSIONS: A culturally competent training program had a positive impact on professional attitudes and behaviors toward recognition and management of child abuse and neglect in Turkey. The need to partner with policy makers to revise current law in favor of a greater human services orientation became clear. PRACTICE IMPLICATIONS: Pioneers in developing countries may benefit from collaborating with culturally competent instructors from countries with more developed child protection systems to develop training programs so that professional development can improve recognition and management of child abuse and neglect.

Farewell to the world: suicide notes from Turkey.

There has been limited study of suicide in Islamic countries. This paper marks the first study of suicide notes in Turkey, an Islamic country. Using a classification scheme, 49 suicide notes (a rate of 34.5%) were studied. The results show that note writers do not differ greatly from other suicides. Further analysis of younger (<40) and older (>40) suicide note writers reveal few significant differences. Our results, together with the results of classification studies in different countries, suggest that caution is in order in transposing findings from one country to other countries. Future study of suicide notes should, in fact, focus on cross-cultural investigation.

The analysis of hormones and enzymes extracted from endocrine glands of the neck region in deaths due to hanging.

Our study was designed to determine whether the hormone and enzyme levels that we have mentioned in serum specimens can be used in postmortem examinations of the cases of hanging or not. Our research includes the postmortem results of the thyroid tissue pathologic examinations, serum levels of triiodothyronine (fT3), thyroxine (fT4), thyrotropin (TSH), thyroglobulin, parathormone (PTH), calcitonin, and amylase in cases of death due to hanging. The mean of fT3 and thyroglobulin levels were higher in hanging cases than those of sudden death cases. This difference was statistically significant (P < 0.05). In our study, we obtained data demonstrating that high postmortem levels of free T3 and thyroglobulin may be indicators of vital reaction in hanging cases. In such cases of death, it seems that applying pressure on the neck region where the thyroid gland is located causes the leakage of thyroglobulin as well as fT3, the active form of the thyroid hormone.

The diagonal ear-lobe crease. As sign of some diseases.

OBJECTIVE: The present study dealt with the question of possible association between the diagonal ear lobe crease (ELC) and diabetes mellitus, hypertension, myocardial infarction, coronary artery diseases. METHODS: The present study was carried out as a field study with the contributions of 6 Primary Health Care Centers in Golbasi, Education and Research Area, Ankara, Turkey in May 2003 June 2003 and includes 3722 individuals (1250 males and 2472 females) of different age groups. From each individual, ELC was graded and a thorough medical history was taken. RESULTS: Ear lobe creases were found more in males and there was a statistically significant positive association between ELC and these diseases in both sexes. CONCLUSION: It was thus thought that ELC could well be included as a valuable sign in diagnosing and screening such diseases.