Applicability of Magnetic Resonance Imaging of the Knee in Forensic Age Estimation.

ABSTRACT: Age estimation in forensic medicine practice is of particular importance to the legal systems, and it is one of the current research topics in forensic medicine. Age determination is most frequently performed by radiological methods, but recently, nonionized methods are preferred for nonmedical indications. Therefore, we aimed to examine feasibility of MRI imaging, which provides nonionized, noninvasive, and detailed images, in forensic age estimation and to expand the database on this subject. The MRI images of the patients between the ages of 10 and 25 years, who visited Cukurova University Faculty of Medicine between January 2012 and April 2018 for any reason, were retrospectively analyzed according to the staging method described by Dedouit et al. The stage 5 ossification in distal femoral epiphysis indicated an age over 18 years in both sexes (except for 2 cases of 14 and 15 years). The stage 5 ossification in proximal tibial epiphysis indicated an age older than 18 years (except for 1 male case at the age of 15 years and 2 female cases at the age of 14 and 17 years, respectively). It was determined that stage 1 and stage 2 in both distal femur and proximal tibial epiphysis were last seen in younger than 18 years in both sexes. Our study data show that MRI imaging is a nonionized method that can be used in addition to other radiological methods in determining the age limit of 18 years.

Forensic age estimation with ankle MRI: Evaluating distal tibial and calcaneal epiphyseal fusion.

Forensic authorities often request age estimation from forensic experts, particularly in cases related to sexual abuse, child pornography, illegal migration, marriage, etc. The most commonly used method in this regard is radiological methods. Because of the potential dangers of radiation exposure outside of clinical indications, new researches are focusing on non-ionizing and non-invasive technologies. This study aimed to demonstrate the applicability of age estimation in living individuals from ankle magnetic resonance images as a non-ionizing method, and to determine whether it is compatible with individuals' real ages and to establish a database. Ankle MRI images of patients aged between 7 and 26 years who applied to the Cukurova University Faculty of Medicine Balcali Hospital between January 2011 and December 2020 were retrospectively evaluated. A six-stage staging method proposed by Lu et al. was applied to the distal tibial and calcaneal epiphyseal ossification points by examining ankle MRI images of a total of 331 patients, 197 males and 134 females. In the study, images obtained from a sagittal section fast spin echo T1-weighted sequence, with a section thickness of 3-4 mm, were evaluated. As a result of the study, Stage 1 in both distal tibial and calcaneal epiphysis was observed only in patients under 18 years of age in both sex. In males, stage 2 in distal tibial epiphyseal ossification was observed under 18 years of age, except for one case, and stage 5 in both distal tibial and calcaneal epiphyseal ossification was observed in almost all cases over 18 years of age in males. According to the results of our study, magnetic resonance imaging was found to be a non-ionizing method that could be used in addition to other radiological methods aimed at determining the 18-year age limit in age estimation. Multicenter, comparative, and prospective studies conducted by experienced researchers are needed to enable the routine use of MRI in age estimation.

An unusual cause of death at preschool age: scalding by hot milk.

Scalding is one of the most painful and devastating burn injuries a child can suffer. Victims are generally scalded by splashed or spilled hot fluids in the home environment. Interestingly, scalding by hot milk is a common cause of burns in rural parts of Turkey. This study aimed to identify the general features of scalding by hot milk, and to make the authorities aware of this problem through educational programs for parents and caregivers.The records of the Council of Forensic Medicine Adana Group Administration and public prosecutor's office were used. Forty-four deaths in children of preschool age (under 6) due to scalding by hot milk during 2001-2005 were analyzed.Scalding with hot milk constituted 1.05% of all medico-legal deaths (4183) during the period considered. Twenty-five (56.81%) of the victims were male while 19 (43.19%) were female. The victims' ages ranged between 18 months and 6 years, with a mean age of 3.03.Scalding by hot milk appears to be an important public health problem, especially in rural areas of Turkey. Educational programs for families and caregivers and implementation of simple safety measures will decrease the prevalence of deaths due to such preventable injuries.

Detection of cocaine and benzoylecgonine in formalin fixed rat tissues.

The stability of drugs in formalin solution is an important factor in forensic investigation. Tissues (liver, lung, kidney, brain) taken from rats, which have been poisoned acutely with cocaine, were preserved in two different conditions, analyzed by GC-MS, and then compared. Organs of the first group were preserved and stored at -20 degrees C without adding formalin, whereas the organs of the second group were preserved and stored in formalin solution at room temperature (25 degrees C). Serum samples were taken immediately after poisoning and studied as well. In specimens stored at -20 degrees C, cocaine and its metabolite benzoylecgonine were detected in the tissues. Only benzoylecgonine was detected both in tissues and their formalin solution. It was observed that the distribution of cocaine in tissues had differed depending on the preservation conditions. The formalin solution in which benzoylecgonine was mostly detected was from liver. As a result, cocaine was detected in tissues stored at -20 degrees C. It is recommended that both the formalin-fixed tissues and formalin solution should be analyzed concurrently to assure the accurate results (LOD = 3 ng/ml).

An act of homicide and what it brings to mind: a case presentation.

There are many views and studies as to the motive, manner, and victim of homicide, which is one of the severest forms of violence. The case presented here is that of a man who was strangled with a nylon ligature by his prison cellmate who later stabbed his victim's eyes with a piece of wood and a nail and slashed his face. The study is presented with respect to how the murder was committed and how the defendant was evaluated.

Methanol intoxications in adana, Turkey.

Methanol is a highly toxic substance that is commonly used as an industrial solvent and antifreeze in automobiles. Methanol intoxication usually occurs following inhalation or topical exposure of spirit, homemade alcohol, or eau de cologne. The goal of this study was to examine methanol fatalities and methanol poisoning characteristics in our region and to contribute to form a database concerning methanol intoxication cases in our country. The records of the Morgue Department, Council of Forensic Medicine Adana Group Administration, were reviewed retrospectively for all methanol poisoning deaths for the period of January 1, 1997, to December 31, 2003. Age, gender, death places, methanol blood levels of the cases, and consumed products were recorded. Total number of deaths between 1997 and 2003 was 4725 and the number of deaths due to methanol poisoning was 41 (0.86%) during this period; 38 (92.68%) of the total methanol fatality cases were male and three (7.32%) female, with an age range of 16 to 54 years.

Organophosphate poisoning associated with fetal death: a case study.

The increasing use of organophosphorus insecticides in agriculture and inside homes and schools, as well as its widespread existence in the environment, poses a potential health hazard. As the use of these agents increases, acute and chronic exposure has become more common. As with other organophosphates, chlorpyrifos kills insects and other animals, including human beings, because of its toxicity to the nervous system. Exposure of pregnant women to organophosphates is an important clinical entity because of its effects on two organisms--mother and fetus. There are few reports about fetal toxicity of organophosphates in the literature because of the relatively few cases reported. In this paper we report a case of intoxication from chlorpyrifos, an organophosphorus compound, during pregnancy, causing fetal death.

Malpractice and system of expertise in anaesthetic procedures in Turkey.

Deaths which occur during the administration of anaesthetics require medicolegal investigations. The objective of this study is to form a database for future comparisons related to anaesthetic-associated malpractice claims and also to investigate the system of expertise, pertaining to such procedures. The decisions of the Supreme Health Council, whose expert opinion is requested by legal authorities (judges, prosecutors) for health workers brought to trial in a criminal court, were examined retrospectively over the period 1995-1999. In 21 (2.3%) of the 888 decision reports prepared by the council the team members (the anaesthesiologist , the anaesthetic assistant, the anaesthetic technician, the nurse) were directly interrogated. Data concerning these 21 council decisions were evaluated within the scope of this study. It was found that 57% of the 21 decisions were related to medical procedures carried out in state hospitals. Of the 21 cases, 62% were males, 38% females. General anaesthesia was applied to 19 of the cases while one received regional (local) anaesthesia and one axillary blockade. Twenty died of complications associated with anaesthesia. Autopsy was performed on 11 (55%) of the dead. Health workers were found to have different degrees of liability in the 16 (76%) of the 21 decision reports. In their medical practices, anaesthesiologists , like other specialists, are subject to legal procedures in the country where they perform their duties, to national and international principles of ethics, and to diagnostic and curative standards/procedures relevant to the scientific level of the country concerned. In anaesthetic malpractice claims, certain standards need to be followed in inquiries and approaches so as to determine the real reasons behind the disabilities and/or deaths which occur. In order that sound evaluations could be made in such cases, the experts as well as the system of expertise should be efficient and authorized.

Determination of ethyl glucuronide in human hair by hydrophilic interaction liquid chromatography-tandem mass spectrometry.

Ethyl glucuronide (EtG) is a direct metabolite of ethanol and has been utilized as a marker for alcohol intake. This study presents development, validation and application of a new hydrophilic interaction liquid chromatography-tandem mass spectrometry (HILIC-MS/MS) method for the analysis of EtG in human hair samples. The linearity was assessed in the range of 5-2000 pg/mg hair, with a correlation coefficient of >0.99. The method was selective and sensitive, with a limit of detection (LOD) and limit of quantitation (LOQ) of 0.05 pg/mg and 0.18 pg/mg in hair, respectively. Differently from the extraction procedures in the literature, a fast and simple liquid-liquid method was used and highest recoveries and cleanest extracts were obtained. The method was successfully applied to 30 human hair samples which were taken from those who state they consume alcohol. EtG concentrations in the hair samples of alcohol users participated in this study, ranged between 1.34 and 82.73 pg/mg. From the concentration of EtG in hair strands 20 of the 30 subjects can be considered regular moderate drinkers.

Forensic geriatric deaths in Adana, Turkey.

The World Health Organization describes geriatric age group as the population aged 65 years or older. Parallel with the development of medical and technological areas, the life expectancy gets longer and geriatric population has been dramatically increasing. In this respect, geriatric deaths are frequently encountered due to increasing risk factors and pathophysiological changes in aging process. The records of the Forensic Medicine Institution Adana Group Authority Morgue Specialty Office were used. Death certificates and autopsy records of 9007 cases autopsied between the years of 1998 and 2007 were examined retrospectively. Seven hundred and twenty-six geriatric age (>or=65 years) deaths were taken in the scope of the study. All of the cases were analyzed with regard to age, sex, cause of death, incident place, and the place and origin of death. Geriatric deaths comprised 8.1% (726 cases) of all the medico-legal autopsy cases (9007) during these ten years. Of all geriatric deaths, 73.8% (536) were male while 26.2% (190) were female. Ages of cases were between 65 and 96 years, and the mean age was 72.3. Majority (310 cases, 42.7%) of deaths were by natural causes, while this was followed by accidental deaths with 227 cases (31.4%). This study was aimed to discuss the general features of geriatric deaths accepted as forensic cases, in the light of the literature.

Determination of pesticides in postmortem blood and bone marrow of pesticide treated rabbits.

Forensic toxicological analyses have traditionally focused on the use of blood, body fluids, and certain organs in examinations of deaths due to intoxication. However, in some situations, putrefaction and contamination make proper sampling from tissues impossible, such as in exhumation cases. In these cases, bone marrow might be useful as an alternative specimen since it is a potential depot for drugs. This study aims to determine pesticides in postmortem and putrefied bone marrow of pesticide treated rabbits, so as to reveal the diagnostic value of toxicological analysis of bone marrow in exhumation cases. Out of thirteen rabbits, a 110 mg/kg dose of endosulfan was orally given to six through a gavage tool, and a 2500 mg/kg dose of diazinon was given to six using the same method. One rabbit was not treated with anything and served as a control sample. Venous blood, liver, lung, kidney, brain, and bone marrow samples were collected just after spontaneous death or cervical dislocation. After this, the rabbits were buried in soil. All of them were exhumed 1 month later, and putrefied viscera and bone marrow were sampled. Blood and tissue samples underwent solvent extraction and solid phase extraction, and then the samples were analyzed by GC-MS. Mean residue levels of diazinon in early postmortem samples were 85 mg/kg, 71 mg/kg, 23 mg/kg, 21 mg/kg, 19 mg/kg, and 0.4 mg/l in the liver, bone marrow, kidney, lung, brain, and blood, respectively. Mean residue levels of diazinon in the putrefied body were 3327 mg/kg in putrefied viscera and 1783 mg/kg in the bone marrow. Mean residue levels of endosulfan isomers and metabolites in early postmortem samples (blood, liver, lung, kidney, brain, and bone marrow) were 0.46 mg/kg (endosulfan sulfate), 0.32 mg/kg (alpha and beta isomers of endosulfan), and 0.14 mg/kg (endosulfan ether) while the same levels were 0.26 mg/kg (endosulfan sulfate), 0.24 mg/kg (alpha and beta isomers of endosulfan), and 0.1 mg/kg (endosulfan ether) in putrefied samples (putrefied bone marrow and putrefied viscera). Based on these experimental results, it can be concluded that cause of death can be determined as acute pesticide poisoning by toxicological analysis of samples from bone marrow and putrefied viscera in exhumation cases.

Midwives and nurses awareness of patients' rights.

AIM: to determine the level of awareness of patients' rights among midwives and nurses working in the third and fourth largest cities in Turkey. METHODS: cross-sectional descriptive survey conducted among participants working in university hospitals, state hospitals and village clinics. Questionnaires were distributed to 150 midwives and 350 nurses working in university hospitals (n = 200), state hospitals (n = 100) and village clinics (n = 100); 60% (n = 298) of the forms were returned. FINDINGS: fifty-one per cent (n = 152) of midwives and nurses stated that they had not read any legislation related to patients' rights. Seventy-five per cent (n = 222) of respondents were aware of the legal arrangements. Only 34% (n = 74) of participants who knew of any legal basis for patients' rights said that legislation was in the form of a directive. No significant differences were observed in midwives' answers compared with nurses' answers. CONCLUSION: violation of patients' rights and health professionals' ignorance of appropriate practice means that there is an urgent need to reconsider how to approach this issue. It should be included in continuing education programmes at both graduate and postgraduate midwifery and nursing schools, and also demands more research.

Deaths due to burns in Adana, Turkey.

A series of 502 deaths due to burn, which comprised 5.7% of all medicolegal deaths were reviewed in order to determine general features of burn related death. Victims' ages were ranged between 2 months and 91 years, and male to female ratio was 1.7. The majority of the victims (175 cases, 35.9%) were in the 0-5 age group, followed by 21-30 age group with 83 cases. Unintentional burning (91.4%) was the most common manner of deaths followed by suicide (4.6%) and homicide (2%) burning. Although fire burns constituted 57% of overall, scalding related burns (138 cases, 65.7%) were the commonest type under 10 years of age. The present study will contribute to taking and disseminating safety measures by determining general properties and risk factors of such preventable deaths.

Suicide among children and adolescents: data from Cukurova, Turkey.

The purpose of this study was to investigate the general properties of suicide among children and adolescents in our region, and to evaluate the results in the light of the literature. The autopsy records of the morgue of the Adana branch of the Turkish Forensic Medicine Council were investigated retrospectively. Focus of the study was shaped by suicide cases in children and adolescents (under 18) between the years of 1997-2005. All of the cases were analyzed with regard to age, sex, method of suicide, and year. The childhood and adolescent (0-18 years) deaths comprised 24.4% (n: 1390) of all medico-legal autopsy cases (n: 6808). The origin of death in 186 (13.4%) cases involving victims younger than 18 years of age was suicide. The majority of suicide cases (62.9% n: 117) were females. Adolescents of 16-18 years of age constituted the overwhelming majority (70.43% n: 131) of all childhood suicides. Mean age was 16.13. The most frequent method of suicide was shooting in males, and poisoning in females. However, hanging was the most frequent method (34.41% n: 64) overall.

Homicide in Adana, Turkey: a 5-year review.

Violence is a significant public health problem. Thus, so as to prevent this problem, homicide, the severest form of violence depriving a human being of his right to live, deserves a detailed examination. This study is a retrospective research examining the 2951 cases of medicolegal autopsies in Adana during a period of 5 years (1997-2001). Among these cases, 620, which were determined to be homicidal, were taken into the scope of this study. The cases were examined with respect to sex, age groups, the method used during the act of homicide, the number and the localization of the wounds on the body. A total of 620 (21%) of the medicolegal autopsies conducted within this period were homicides. Of these cases, 515 (83.06%) were male and 105 (16.94%) female, and the rate of the males to females was 4.9; 72.74% of the victims were between the ages of 21 and 50. It was seen that 54.83% of the homicides involved firearms, while 35.16% of the victims were stabbed to death with a cutting object. It was also determined that the victims suffered a single wound in 47.35% of firearm-related murders and 29.35% of stabbings resulted in death. Alcohol was found in the blood of 7.58% of the homicide victims, while none had any illicit drugs.

Medicolegal childhood deaths in Adana, Turkey.

The objective of this study is to determine the characteristics of and changes in the medicolegal childhood deaths that occurred in the provincial center of Adana, and to contribute to the establishment of a database for the development of national and international policies. The study is a retrospective research examining the 1,110 cases in the age group 0 to 18, which were specified as medicolegal deaths in the provincial center of Adana-Turkey between the years 2000-2004. The cases were examined according to age, sex, causes of deaths, the origins and scenes of occurrence. Among all the deaths, 523 cases (47.2%) were seen in the age group of 0-6 years. Accidents account for 900 cases (81.1%), and blunt traumas (594 cases) represent the most common cause of deaths. The share of traffic accidents in total blunt traumas was found to be 441 cases (74.2%). And 270 (24.3%) of all medicolegal deaths occurred as a result of household accidents. The present study has also indicated that the home and surroundings represent the highest-risk areas. As a conclusion, setting up childhood injury prevention committees and providing training programs for parents will be effective for the prevention of childhood injuries and deaths.

Prevalence of Demodex in health personnel working in the autopsy room.

The health personnel working in the autopsy rooms and laboratories are considered among the professional groups carrying a high risk of contamination with infection. In this study, we have investigated the prevalence of Demodex, which provides a convenient environment for bacteria and acts as a vector for certain microorganisms, in the health personnel working in autopsy rooms. The study, which was cross-sectional, was conducted on 58 health personnel working in autopsy rooms. A questionnaire was administered to the individuals. Specimens were obtained from 4 different regions of the face using the standard skin-surface biopsy technique. The data obtained were then evaluated statistically. This study group consisted of 76% males and 24% females. The prevalence of Demodex was 26%. Demodex was found to occur more frequently in women. The most frequent occurrence of Demodex was seen among people with darker complexion and in cheek localizations. We believe that Demodex, which has a role in the pathogenesis of dermatologic diseases, provides a convenient environment for bacteria, and acts as a vector for some pathogenic microorganisms, poses a risk as far as individuals working in the autopsy room are concerned.