Head Trauma-Related Deaths Among Preschool Children in Istanbul, Turkey.

OBJECTIVE: Head trauma takes place among the leading causes of mortality in children. This study aimed to determine the risk factors of head trauma-related deaths among children younger than 5 years in Istanbul, Turkey. MATERIAL AND METHODS: This study was conducted using the records of the Morgue Department of the Council of Forensic Medicine in Istanbul. The records of cases autopsied between 2008 and 2012 were retrospectively investigated. Of all preschool children deaths, 203 head trauma-related deaths were included in the study. RESULTS: Of all, 117 (57.6%) were males and 86 (42.4%) were females. Most cases (107, 52.70%) were between the ages of 12 and 36 months. The most common mechanism of injury was "fall from a height" with 97 cases (47.78%), followed by "traffic accidents" (67, 33%) and "hit by falling objects" (19, 9.35%). Skull fracture was detected in 176 cases (86.69%), of which 81 (46.02%) were characterized with linear fracture. Furthermore, skull fracture was accompanied by 1 or more skeletal bone fracture in 64 cases. Retinal hemorrhage was investigated in 5 cases of suspected physical abuse and only 2 of them showed retinal hemorrhage findings. CONCLUSIONS: Obtained findings revealed that fall from a height was the leading cause of death among unnatural deaths in children younger than 5 years. Domestic accident was found to be a significant risk factor in childhood deaths. Traffic fatalities were among leading causes of death in childhood in our country, likewise in all around the world. Children were found to be more vulnerable to traumas when they start to move around with incomplete motor skills. Therefore, education of parents in terms of child supervision and installing safety precautions toward preschool children will be helpful in preventing such injuries. On the contrary to some findings in the literature, more severe lesions were also prominent even in case of short-range falls from a height.

A life-threatening presentation of child physical abuse: jejunal perforation.

Intra-abdominal injuries from impacts are the second most common cause of death in battered children. However, it may be difficult to distinguish between accidental abdominal injury and abuse, especially in the absence of other clinical findings. Published reports are also limited about the diagnosis of abuse in children with intra-abdominal injury. We report a case with jejunal perforation, multiple soft tissue injuries, and occipital fracture secondary to child abuse who was initially admitted to our hospital with complaint of fever, cough, and vomiting. An exploratory laparotomy revealed perforation of the jejunum, and an end-to-end anastomosis was performed. The patient was evaluated by the hospital's child protective team to implement appropriate diagnostic and child-protective interventions, and the child was discharged home in 10 days.

Still an unknown topic: child abuse and "shaken baby syndrome".

BACKGROUND: Shaken baby syndrome (SBS) is a severe form of physical child abuse, and can even cause death. In this study, we aimed to investigate whether or not the primary healthcare workers had received any education regarding child abuse and neglect, whether they could diagnose the cases, whether they had sufficient knowledge about SBS as a part of child abuse, and whether they were in need of education on the topic. METHODS: Health workers in the primary healthcare centers in the province of Kayseri were enrolled. A questionnaire was applied. RESULTS: In this study, 35.0% of the study group were physicians. 43.7% of the study group stated that they had not recieved any education regarding child abuse and neglect, and 52.1% stated that they believed that physical abuse was the most prominent form of abuse in society. While 64.1% of the participants stated that they had heard about SBS, 10.4% of these stated that they had heard about it, but did not have adequate knowledge on the topic. CONCLUSION: There is a lack of knowledge and a need for education regarding child abuse and neglect among the personnel working in primary healthcare, especially on the subject of SBS. Undergraduate and postgraduate education regarding child abuse and SBS will help to increase the number of people well-informed and sensitive to this important issue.

Fatal abusive head trauma cases: consequence of medical staff missing milder forms of physical abuse.

OBJECTIVES: Missed diagnosis of child abuse may lead to chronic abuse with potential for death. This paper reports 3 such cases. METHODS: This is a retrospective chart review of 38 cases diagnosed as abusive head trauma between January 1, 2004 and December 31, 2006 at a university hospital. We sought to identify fatal cases with a past medical history of physical abuse that was missed by the medical staff. RESULTS: Three cases (7.9%) had a past medical history of physical abuse that was missed by the medical staff. Infants were 2 males and 1 female. Their ages were 2.5, 3.5, and 6 months, respectively. Missed abuse episodes involved rib fractures, a metaphyseal tibial fracture, and a shaking episode, respectively. The intervals that had elapsed between the missed and the fatal abuse episodes were 24 hours, 12 days, and 6 weeks, respectively. Perpetrators of fatal head trauma were all biological fathers. One plead guilty, and 2 were convicted of involuntary manslaughter. The infants were in the care of the perpetrators of the fatal abuse episodes at the time the missed abuse episodes occurred. CONCLUSIONS: Physicians assessing children, especially infants, should be alert to indicators of abusive trauma to recognize abuse early on. Including abusive trauma in the differential diagnostic list and taking appropriate steps to rule out or confirm the diagnosis are of paramount importance in establishing child protective services and preventing further abuse and neglect that may at times be fatal.

Calcium carbide poisoning via food in childhood.

The fast ripening of fruits means they may contain various harmful properties. A commonly used agent in the ripening process is calcium carbide, a material most commonly used for welding purposes. Calcium carbide treatment of food is extremely hazardous because it contains traces of arsenic and phosphorous. Once dissolved in water, the carbide produces acetylene gas. Acetylene gas may affect the neurological system by inducing prolonged hypoxia. The findings are headache, dizziness, mood disturbances, sleepiness, mental confusion, memory loss, cerebral edema and seizures. We report the case of a previously healthy 5 year-old girl with no chronic disease history who was transferred to our Emergency Department with an 8-h history of coma and delirium. A careful history from her father revealed that the patient ate unripe dates treated with calcium carbide.

Third-molar development in relation to chronologic age in Turkish children and young adults.

OBJECTIVE: To assess estimation of chronologic age based on the stages of third-molar development following the eight stages (A-H) method of Demirjian et al and to compare third-molar development by sex and age with results of previous studies. MATERIALS AND METHODS: The final sample consisted of 900 orthopantomograms from young Turkish subjects of known chronologic age (range, 8-25 years; mean age, 15.18 +/- 4.81 years) and sex (380 males with a mean age of 14.51 +/- 4.55; 520 females with a mean age of 15.67 +/- 4.94). Statistical analysis was performed using the Mann-Whitney U-test and the Wilcoxon test between sex and age. Regression analysis was performed to obtain regression formulas for dental age calculation with the chronologic age RESULTS: Statistically significant differences (P < .05) in third-molar development between males and females were revealed regarding the calcification stages D and G. Third-molar genesis was attained earlier in males than in females. Statistical analysis showed a strong correlation between age and third-molar development for males (r(2) = .65) and for females (r(2) = .61). New equations (Age = 8.92 + 1.50 Development stage) were derived for estimating chronologic age. CONCLUSION: The use of third molars as a developmental marker is appropriate, especially when comparing the obtained standard deviation with other skeletal age calculation techniques.

An experimental evaluation of electrical skin conductivity changes in postmortem interval and its assessment for time of death estimation.

In forensic medicine, estimation of the time of death (ToD) is one of the most important and challenging medico-legal problems. Despite the partial accomplishments in ToD estimations to date, the error margin of ToD estimation is still too large. In this study, electrical conductivity changes were experimentally investigated in the postmortem interval in human cases. Electrical conductivity measurements give some promising clues about the postmortem interval. A living human has a natural electrical conductivity; in the postmortem interval, intracellular fluids gradually leak out of cells. These leaked fluids combine with extra-cellular fluids in tissues and since both fluids are electrolytic, intracellular fluids help increase conductivity. Thus, the level of electrical conductivity is expected to increase with increased time after death. In this study, electrical conductivity tests were applied for six hours. The electrical conductivity of the cases exponentially increased during the tested time period, indicating a positive relationship between electrical conductivity and the postmortem interval.

May Toxoplasma gondii increase suicide attempt-preliminary results in Turkish subjects?

Suicide attempts are one of the risk factors of suicide. Possible mechanisms by which Toxoplasma gondii may affect human behavior and it may also cause humans to attempt suicide. The aim of this study is to find out whether or not T. gondii is one of the reasons in suicide attempts. We investigated the sero-positivity level for anti-Toxoplasma IgG and IgM antibodies by enzyme-linked immunosorbent assay in subjects who have attempted to suicide to find out whether there is a probable relationship between T. gondii and suicide attempts. In our study, we selected 200 cases of suicide attempts and 200 healthy volunteers. The sero-positivity level for anti-Toxoplasma IgG antibodies among suicide attempts (41%) was significantly higher than the control group (28%). This signifies that there might be a causal relationship between toxoplasmosis and the etiology of suicide attempt.