Compare of optic coherence tomography parameters in recreational synthetic tetrahydrocannabinol use and healthy control.

PURPOSE: To evaluate retinal thickness (RT), retinal nerve fiber layer thickness (RNFLT), and choroidal thickness (CT) changes in synthetic cannabinoid (SC) users. METHODS: This prospective study evaluated the RT, RNFLT, and CT values of 56 SC users and 58 healthy controls. The individuals using SCs were referred to us by our hospital's forensic medicine department. Retinal and choroidal images were obtained using spectral-domain optical coherence tomography (OCT). Measurements (one subfoveal, three temporals, three nasal) were taken at 500 µm intervals up to 1500 µm using the caliper system. Only the right eye was used for subsequent analysis. RESULTS: Mean ages were 27.7 ± 5.7 years in the SC-user group and 25.4 ± 6.7 in the control group. Subfoveal Global RNFLT was in the SCs group 102.3 ± 10.5 µm and 105.6 ± 20.2 µm in the control group (p = 0.271). Subfoveal CT was in the SC group mean of 316.1 ± 100.2 µm and in the control group mean 346.4 ± 81.8 µm (p = 0.065). RT, T500 (283.3 ± 36.7 µm, 296.6 ± 20.5 µm, p = 0.011) and N1500 (355.1 ± 14.3 µm, 349.3 ± 18.1 µm, p = 0.049) were significantly higher in the SC group than in the control group, respectively. CONCLUSION: Analysis of OCT findings of individuals who had been using SC for more than one year revealed no statistically significant difference between RNFLT and CT, although N1500 was significantly higher in RT. Further studies in the field of OCT are important to explore the pathology of SC.

Factors affecting disclosure time of sexual abuse in children and adolescents.

BACKGROUND: The aim of this study is to determine the factors affecting early and delayed disclosure time of child sexual abuse (CSA). Early disclosure of CSA is considered to be crucial for child protection. METHODS: A total of 125 sexually abused children and adolescents, who had been evaluated by child adolescent psychiatry and forensic medicine specialists, were enrolled in this study. Files of medical and criminal data were analyzed retrospectively and synchronously by child adolescent psychiatrist and forensic medicine specialist authors who had evaluated victims using the standard procedures of Düzce University Faculty of Medicine Child Abuse Assessment Council. Univariate and multivariate logistic regression analyses were conducted to evaluate predictors. RESULTS: Delayed disclosers were found to be younger than early disclosers. Among the delayed disclosers, there were also more victims of intrafamilial CSA, fewer victims of penetration, and fewer voluntary disclosures. Multivariate logistic regression revealed that "younger age" and "intrafamilial CSA" were independent predictors of delayed disclosure of CSA. CONCLUSIONS: The results of our study contribute to an understanding of the factors related to delayed disclosure and underline the need for age-appropriate education and prevention programs targeted to increase the awareness of sexual abuse, particularly intrafamilial abuse, and to promote voluntary disclosure in children and adolescents, especially for younger age groups. The education of potential recipients of CSA and further education of professionals is extremely important in order to support children and adolescents' voluntary disclosure of CSA.

[Secondary victimization of traffic accident victims: getting buried without the declaration of forensic case and without having performed autopsy]. / Trafik kazasina maruz kalan olgularda ikincil magduriyet: Adli olgu bildirimi yapilmadan veya otopsi uygulanmadan defnedilme.

BACKGROUND: In this study, it was aimed to analyze the cases of traffic accident related deaths, buried without performing autopsy, in order to increase awareness of the physicians about declaration liability of forensic cases and also emphasize the declaration of the forensic case and autopsy importance. METHODS: In the First Specialization Board of Council of Forensic Medicine, 542 cases of death, reported between the years 2004-2008, who were involved in traffic accidents and buried without an autopsy performed, were evaluated retrospectively. RESULTS: It was found that 69.4% of the cases (n=376) were males, whereas %30.6 (n=166) were females; mean age was 58.5±20.9 (range, 3-98 years). Age 61 and above was the most frequent age group with 301 cases (55.5%). Of the cases, 336 (62.0%) had died in hospital, 241 (44.5%) had died in 1-12 months following the accident and medico-legal corpse examination was performed only in 123 (22.9%) cases. Three hundred fourty-four (63.5%) of the cases were not reported as forensic cases and death certificate was signed by any physician other than medical examiner without being declared as a legal case. According to the decisions of Board, since an autopsy was not duly performed, the cause of death could not be determined for 95 cases (17.5%) and for 57 cases (10.5%), it was not possible to determine whether there was causality between the accident and death. DISCUSSION: Our findings emphasize the importance of declaration of forensic cases and performing autopsy in time in traffic accident victims.

Pseudoaneurysm originating from left ventricle aneurysm: an autopsy case and review of literature.

Rupture of the free wall of the left ventricle is a catastrophic complication of acute myocardial infarction. Rarely, free wall rupture is contained by overlying adherent pericardium, producing a pseudoaneurysm of the left ventricle. In this report, a case of a left ventricular pseudoaneurysm due to a previous myocardial infarction is described. A 55-year-old woman had a severe chest pain 11 months prior to death. No cardiac investigation was performed. Three days prior to death, she suffered from fatigue and weakness, and had a witnessed sudden cardiac death. At autopsy, a 8.5 × 10 × 8 cm pseudoaneurysm of the left ventricle was found. There was severe coronary artery atherosclerosis. There were extensive adhesions between pericardium and pseudoaneurysm wall. The cause of death was attributed to heart failure and resulting arrhythmia. The case illustrates the rare event of left ventricular pseudoaneurysm first diagnosed at forensic autopsy.

Analysis of tractor-related deaths.

The aim of the study was to evaluate the properties of tractor-related death cases and discuss the precautions in order to prevent such events. For this aim, reports made between 2006 and 2009 by the First Specialty Board of Council of Forensic Medicine (FSBCFM), Turkey, were evaluated retrospectively. Forty-one tractor-related death cases were included in this study. Thirty-five (85.4%) of the cases were male. The mean age was 42.52 ± 25.1 (with a range between 1 and 84 years old). The average time interval between the incident and death was 13.76 ± 33.53 days (range: 0-176 days) and 20 (48.8%) cases died on the incident spot or during transportation to the hospital. Among the cases, 34.1% (n = 14) were drivers, whereas 39.0% (n = 16) were passengers and the remaining were pedestrians (26.9%, n = 11). The accident was caused by the tractor rolling over in 34.1%, the victim being run over in 22.0%, and the victim falling from the tractor or trailer in 22.0% of the cases. Most of the events (56.1%) occurred on the road. In conclusion, tractors must not be used as a transportation vehicle for passengers. Periodic training of drivers can be useful for reducing tractor-related accidents.

Accidental ligature strangulation by an ironing machine: an unusual case.

In this paper, we present a case of a 53-year-old woman who had her headscarf catch on the cylinder ironing machine in the laundry of the hospital where she worked. The hospital workers found the woman dead with her head stuck to the ironing machine. After the death scene investigation and autopsy were completed, it was determined that the death occurred as a result of accidental ligature strangulation. Accidental ligature strangulation in which an article of clothing is caught in such an electrical machine and strangles the wearer is very rare. This case highlights the fact that these kinds of machines can be hazardous to work around and that increased safety measures should be taken to insure worker safety; additionally, the people who use these machines should be educated on the potential hazards.

Homicide-suicide in Konya, Turkey between 2000 and 2007.

Homicide followed by the suicide of the murderer is a relatively rare lethal incident in which an individual kills another person and subsequently dies by suicide. Cases involving a homicide and a suicide in which death examinations and autopsies were performed at The Konya Branch of the Forensic Medicine Council between 2000 and 2007 were retrospectively investigated. During the studied time period, there were 10 homicide-suicide cases identified with 10 perpetrators killing 12 victims. Nine of the perpetrators were men and eight of the victims were women. The precipitating motive was an impending divorce in four of the cases. Two perpetrators were described as severely depressed, one had a diagnosis of antisocial personality disorder, and one was a pedophile who had reactive depression. Firearms were used in eight of the homicide cases and seven of the suicides. Constricting the use of firearms may reduce/prevent future homicide-suicide cases, as it is the most commonly used method to carry out homicide-suicides.

[The effect of firearms in inducing stress in high school students in the city of Düzce (Turkey)]. / Atesli Silahlarin Adolesans Döneminde Stres Yapici Faktör Olarak Etkisi.

OBJECTIVE: This study aimed to examine the behaviors of high school students exposed to firearms and firearms- related violence, which they had perpetrated or witnessed, and whether or not these events were related to stress. METHOD: The study was conducted in Düzce province, which is characterised by the widespread use of firearms. A questionnaire was prepared to ascertain students' attitudes and behaviors towards owning firearms, their thoughts about firearms- related violence, and whether or not they had been a victim or witness to firearms- related violence. After a stress level scale was added to the questionnaire, it was administered to 791 students randomly chosen from the 8304 students that were attending all high schools in Düzce. The results were evaluated with using SPSS v.11.0 software. RESULTS: The level of stress in students that had contact with firearms, whether or not they were faced with a violent act, may be reached the adaptation difficulty level. Aggressive behaviors like hectoring occurred between coequal groups and brothers/sisters, affectedstress levels. Exposure to and witnessing violent acts had important roles on level of stress. Gender, income level, and lack of a private room at home for adolescents affected stress levels. Contrary to expectations, the presence of firearms at home or in their surroundings did not have an effect on stress levels. Hearing the sound of gunfire was one of the most important factors related to stress levels. CONCLUSION: Because of its ability to induce stress in adolescents, they must be protected form exposure firearms and their use, which is widespread in Düzce.

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.

Comparison of the three age estimation methods: which is more reliable for Turkish children?

BACKGROUND: Three atlases-the GOK, the Greulich-Pyle (GP), and the Tanner-Whitehouse (TW3)-are used frequently for age determination in Turkey. The purpose of this study was to evaluate the applicability of these three methods related to the skeletal age assessment for Turkish adolescents. MATERIALS AND METHODS: The conventional roentgenograms of the left hands and wrists, elbows, shoulders, and pelvises of 333 healthy Caucasian children (164 females, 169 males) who fit the study and the criteria of each atlas were obtained. The mean differences (+/- standard deviation [S.D.] in years) between the chronologic age (CA) and the skeletal age (BA), which were obtained by using each age estimation method, were calculated and tested using t-test. RESULTS: For girls, the most accurate method was the TW3 (mean differences (d): -0.21 (p<0.05)), following by the GP (d: 0.66 (p<0.001), and the GOK (d: 2.99 (p<0.001)). For boys, the most accurate method was the GP (d: -0.02 (p>0.05)), followed by the TW3 (d: -0.18 (p<0.05)) and GOK (d: 1.05 (p<0.001)). DISCUSSION AND CONCLUSIONS: Results show that the TW3 (for girls) and the GP (for boys) methods are more appropriate than the GOK atlas for estimating the BA. GOK could be used for boys aged 11-14 years but it should not be used for girls.

Is the assessment of bone age by the Greulich-Pyle method reliable at forensic age estimation for Turkish children?

BACKGROUND: Estimation of age is an important task for forensic experts especially in developing countries where birth records are often not well maintained. In this study, we investigated whether or not the Greulich-Pyle (G-P) method is sufficient at forensic age estimation for Turkish children. METHODS: Plain radiographies of left hands and wrists of 492 (241 (49.0%) female, 251 (51.0%) male) healthy children between 11 and 18 years of age for girls and 11 and 19 years of age for boys were taken. Mean chronological ages (CA) were compared with mean skeletal ages according to G-P atlas for each gender and in the second step the differences those for each age group were determined. The children were Caucasian and had a low-middle socioeconomic status in this study population. The paired sample t test was used to indicate the difference between G-P (mean skeletal age according to G-P atlas) and CA (mean chronological age). In order to indicate the relation Pearson correlation coefficient was used. Modeling the relationship between G-P and CA linear regression was used. The analyses were done under SPSS 11.5. RESULTS: The G-P compared to their CA. The CA was 14.52+/-2.18 S.D. years, S.E.: 0.14 (median: 14.47, range: 11.07-18.92 years) whereas G-P was 15.06+/-2.31 S.D. years, S.E.: 0.15 (median: 15.00, range: 10-18 years) for girls. The difference between the two parameters was statistically significant (p<0.001). The CA was 15.28+/-2.41 S.D. years, S.E.: 0.15 (median: 15.09, S.E. range 11.13-19.94 years) and G-P was 15.41+/-2.92 S.D. years, S.E.: 0.18 (median: 15.60, range 9-19 years) for boys. The difference was not statistically significant (p>0.05). There was a high correlation (Pearson r=0.882, p<0.001) for girls and (Pearson r=0.900, p<0.001) for boys. The determination coefficient (R2) is equal to 0.778 for girls and 0.81 for boys. The regression model also tested by ANOVA and it is found significant (p<0.01) for both genders. According to age groups G-P was advanced (0.17-1.1 year) almost for all ages and differences were significant at 11, 12, 14, 16 ages for girls. G-P was delayed at 11-14 ages (0.01-0.58 year) but not significant except for 13 years and G-P were significantly advanced in 15-17 ages (0.88-0.98 years) but then delayed in 18-19 years of age (0.02-0.48) for boys. The difference's standard deviation at 12, 13, 15, 16 years of ages for girls and between 12 and 16 and 18 years of ages for boys were more than 1 year. CONCLUSION: When the results of the previous study and this study are compared, the test method could be used technically by pediatricians and other clinicians, but it is even more important for ethically unacceptable errors to disappear, especially in cases involving the possible criminal liability of the supposed minor. So standard deviation at 12, 15 years of ages for girls and 12, 15, 18 years of ages for boys were more than 1 year. But it is not known that the other methods whether more useful or not than this method. For the time being unless any other methods will be proved more useful, we have to use this method cautiously for possible criminal liability cases in forensic age diagnosis.

STR data for the AmpFlSTR identifier loci from an old settlement in northwestern Turkey.

The polymorphism of 15 STR loci has been studied in a population sample of 193 healthy unrelated individuals from the population of Duzce, a city in the northwestern Turkey. The most valuable loci, from forensic point of view according to their power of discrimination values, were D2S1338, D18S51, FGA, and D19S433 where CSF1PO appeared to be the least powerful one. From paternity point of view, FGA, D21S11 were found to be the loci with highest exclusion value whereas D3S1358 and TPOX were the locus with the lowest exclusion.

Obstetric and gynecologic malpractice in Turkey: incidence, impact, causes and prevention.

The Forensic Medicine Association was established in Turkey by law number 2659 for the purpose of providing expertise in legal cases. In this study the opinions given by the lawcourts and public defenders in the Forensic Medicine Association's First, Second, Third, and Fifth Specialization Divisions between the years 1990 and 2000 (approximately 680,000 files) were examined retrospectively. It was determined from these that there were 636 cases of medical malpractice. In examining the distribution of cases based on specialty branch, it was established that 16.82% (n=107) were in the area of obstetrics and gynecology, 10.69% (n=68) in general surgery, 10.53% in neurology and neurosurgery, and the remaining areas were found to be at lower percentages. It also showed that in recent years there has been an increase in the number of cases claiming medical malpractice in the area of obstetrics and gynecology, and that 58% of the cases (n=62) from 1998 to 2000 were in this area. 96% of the 107 cases that claimed malpractice in the area of obstetrics and gynecology were found to be related to obstetrics and 3.8% (n=4) to gynecology and surgical procedures. In 31% (n=33) of the 107 cases fault was found; all of the cases where medical malpractice was found were in the area of obstetrics and none of the cases related to gynecology were found to have an element of error. Cases that had an element of error were evaluated from the aspect of profession of the health care personnel at fault, areas of fault, places where fault occurred, situations that resulted in death, cause of death, whether or not an autopsy was done, injury that resulted from fault, intervention that was done, and obstetric and gynecologic risk factors that set the stage for claims. Care standards and breach of standards were examined.