Dark side of customs: scalding burns in childhood due to use of traditional teacup and teapot, in Turkey.

The most common type of burn among children is scalding burn. This study aims to reveal child abuse and neglect as a specific etiological factor that specific to our country, traditional teapot- and teacup-related scalding burns. Burn cases that admitted to our Burn Center were investigated, and among these, 72 cases suffering from scalding burns were included in the study. The interview forms issued upon admission of these cases were evaluated in detail. Out of 148 scalding burn cases, 48.6% were related to the use of traditional teapots and teacups. After a detailed assessment, all cases were considered neglect-related burns. As a result of considering the role of traditional teapots and teacups in pediatric injuries in our country, parents and caregivers should be warned about these types of injuries. Also, physicians must determine the possibility of child abuse or neglect in all pediatric burn cases.

Physicians' attitudes at the end-of-life: a cross-cultural evaluation.

Physician's attitudes towards patients with incurable cancer or at the end-of-life process--treatment of patients, withholding ventilation support, physician-assisted suicide--have changed rapidly in recent years. In cases such as incurable cancer, illnesses in the terminal phase, some neurologic diseases and AIDS, physicians and other health care workers experience dilemmas, arguments and problems on the subjects of whether or not to tell the truth or how to do it, who should inform the patient or his/her guardian, and then, how to give treatment to patients with incurable cancer or withhold ventilation support. All of these issues are affected by the country's' sociocultural and economic structures, the physician's attitudes at the end of life,the medical practice and the form of health structures. In this study our objectives are to assess physicians' views in Turkey regarding the process of the end of life and decision-making, to compare them with views from the USA, Japan and Saudi Arabia and to cristalize a cross-cultural assessment. Our study contains three clinical situations covering the following areas: (1) a patient's right to be informed of incurable cancer, (2) doctor-assisted suicide (3) the conflicting rights of patients, doctors and the family in issues such as refusing ventilatory support or witholding treatment. The four-point Likert Scale was used to mark the responses to the statements. The significant cultural, social and economic differences that exist in health care services between regions in our country affect physician-patient communication and end of life decision-making, as reflected in the process of obtaining informed consent.

Analyzing two decades of intimate partner femicide-suicides in Türkiye.

Intimate partner femicide-suicide (IPF-S) is an understudied subgroup of homicide-suicide deaths. Limited research has been conducted on IPF-Ss in the Eastern Mediterranean region. This study thus aimed to evaluate the characteristics of IPF-Ss that occurred in Türkiye between 2000 and 2019. IPF-Ss (n = 226) were extracted from electronic news stories. Data on victims, perpetrators, their relationships, and incidents of murder and suicide were collected. Descriptive statistics were calculated, and logistic regression analysis, mortality rates, and proportion of IPF-S in femicide calculations were conducted, showing that 13.3% of the femicides (n = 1699) were IPF-Ss. The IPF-Ss increased in 5-year intervals and were the highest during the 2015-2019 period (62.5%). Victims were married in 48.2% of the cases and 56% were aged <35 years, while 51.3% of the perpetrators were married and 52.6% were aged >40 years. In 42.0% of the cases, the perpetrator lived with the victim. Most (79.2%) of the cases took place in urban settlements, and the perpetrators used firearms in 84.1% of femicide cases. Firearm use was the most common method in cases where IPF-S was planned (OR = 2.98), when the IPF-S method was the same (OR = 29.6), and when the perpetrator committed suicide (OR = 7.82). In addition, it was found that firearm ownership is an important risk factor for IPF-S in Türkiye. Therefore, we recommend legislation to restrict firearms, as well as new measures to prevent illegal access to weapons.

The analysis of child abuse and neglect cases assessed by a multidisciplinary study group between 2005-2008.

This study aimed to evaluate the diagnosis, treatment and follow-up of child abuse and neglect (CAN) cases. Subjects were 102 cases that were clinically assessed by the multidisciplinary hospital team. Early and late childhood cases (according to the age at first abuse) were compared by means of characteristics of abuse. Among the 102 subjects, 64 were female and 38 were male (mean age: 8.68 years). Being abused by someone within the family was found to be significantly higher in preschool children compared to children in late childhood. 27.5% (n: 28) of the cases concomitantly had low socioeconomic and educational level and high parental psychological problems and 64.8% had psychiatric problems. A limited number of studies have compared characteristics of early and late childhood abuse considering the age of onset of maltreatment. Consistent with the literature, our study showed that early age of onset of maltreatment is a poor prognostic factor in many ways.

Burn injuries among children aged up to seven years.

We investigated characteristics of burns in children aged up to seven years and hospitalized at our Burn Unit between 1 January 2000 and 31 December 2007 in order to detect risk factors and prepare a program for prevention of burn injuries in children. There were 119 boys and 81 girls (ratio 1:0.67) and the mean total body surface area burned was 16.6 +/- 12.5%. Sixty-nine percent (n = 138) of the burn-injured children were under three years old. Scalds accounted for more than 60% of the pediatric burns occurring in all age groups. The anterior trunk was the most frequently affected body part (51.5%). The overall mortality rate was 4% (8 deaths). The children included in this study were younger than seven years and they were supposed to be under the care of their parents. Parental neglect might have played a role in burn injuries in these children. In developing countries like Turkey, parents should be offered education about prevention of burn injuries in childhood.

Medicolegal evaluation of a maternal filicide attempt: a case report.

Foto-Özdemir D, Balseven-Odabasi A, Teksam Ö, Karadag F, Akçan F, Yilmaz E. Medicolegal evaluation of a maternal filicide attempt: a case report. Turk J Pediatr 2019; 61: 622-628. Filicide mainly refers to the murder of a child by his/her parents. Even though filicide is a rare event, outcome of filicide is more severe compared to other types of murders. In this report, we aim to discuss the factors in which the case of a woman who attempted to kill her 2.5-year-old daughter along with the demographical characteristics. Twenty-nine-year-old mother attempted to kill her daughter by hanging. Even though the victim did not die as the mother, regretted her action the triggers and the plot of the case discussed within the filicide framework. Therefore, the presented case report would contribute to the understanding of the nature of the filicide, and it might bring a different perspective, because of the different development process of filicide, sharing the disorder and interwoven motivations between the child and mother. In this respect, we aim to draw attention of pediatricians, child psychiatrists and forensic pathologists about the importance of filicide.

Forensic medicine evaluation of Alzheimer patients: a series from Ankara, Turkey.

BACKGROUND/AIM: Pathophysiological changes due to Alzheimer disease and increasing age might result in situations requiring forensic evaluation in the elderly. Judicial bodies might need forensic evaluation of trauma and the decision-making capacity of Alzheimer patients. This study aimed to determine the demographic and clinical characteristics of Alzheimer patients seen for forensic evaluation. MATERIALS AND METHODS: Forensic records issued by the Department of Forensic Medicine of Hacettepe University in 2012 and 2013 were investigated. Patients with Alzheimer disease were included in the study and were analyzed in terms of age, sex, reason for application, comorbid medical conditions, occupation, and place and status of living. RESULTS: There were 30 Alzheimer patients examined in the study period. Of these, 17 (56.6%) were male and 13 (43.3%) were female. The patients' ages ranged between 51 and 90 years, and the mean age was 78.7 years. The majority of cases (25, 83.3%) were transferred for evaluation of decision-making capacity, while only 5 (17.7%) were referred to our department for forensic reporting of bodily damage. CONCLUSION: Forensic reporting of bodily damage in Alzheimer patients is similar to common injury cases. However, in conditions requiring evaluation of decision-making capacity in Alzheimer patients, all records should be carefully examined and a complete neuropsychiatric evaluation should be performed.

Age and sex estimation by metric measurements and fusion of hyoid bone in a Turkish population.

The hyoid bone is of great importance in forensic medicine practice and it has been studied for various forensic purposes; however, there have been few studies dealing with age and sex estimation using the hyoid bone. Using discriminant function analysis this study attempts to determine the utility of metric measurements and non-metric variations of the hyoid bone in terms of estimation of sex and age in a Turkish population and to find out differences with other populations by comparison of obtained results with the literature. For this purpose, the hyoid bones of 85 cadavers of known sex and age were extracted and 33 measurements were made with a computer program following photography with a camera. In addition to these measurements, the degree of fusion of the greater cornua to the hyoid corpus was examined. Out of 33 measurements, 18 showed significant sex-related differences. There was a sharp rise in hyoid bone fusion in both males and females after the age of 60 years. However, no marked sex-related differences were observed regarding fusion. The unstandardised canonical discriminant function was estimated based on three variables, and the correct classification ratio was 77.4% for males and 81.3% for females. The obtained findings suggest that measurements of hyoid bone can be used for sex estimation in the Turkish population.

[A case of Munchausen Syndrome by proxy in the context of folie a famille]. / Paylasilmis ailesel psikoz kapsamindabir "bakim verenin yapay bozuklugu" olgusu.

The occurrence of similar psychotic symptoms in two or more people is called shared paranoid disorder. In this disease, the person who exhibits psychotic symptoms first is the "primary patient". The symptoms are contracted by the other people through persuasion. This disorder is seen among people who share the same house or are emotionally bound. In some cases, shared paranoid disorder may include other diagnoses, such as Munchausen Syndrome. This report discusses the case of a six-year-old, sexually abused boy who, when admitted to the hospital at the age of 10, claimed to have been repeatedly sexually harassed by several different people. His family's frequent changes in hospitals, negative perceptions of and accusations against medical staff, and improper methods of responding to harassment led clinicians to a diagnosis of Munchausen by proxy syndrome. In addition, both parents believed the abuse story, suggesting a potential diagnosis of shared psychotic disorder. In the literature, Munchausen by proxy has rarely been reported with symptoms of sexual abuse. The psychotic symptoms were shared by the family, complicating the case. This report emphasizes that psychodynamic evaluations of Munchausen by proxy and shared psychotic disorder may be helpful in understanding underlying factors.

Munchausen syndrome by proxy presented as recurrent respiratory arrest and thigh abscess: a case study and overview.

While many physicians are familiar with the sexual or physical abuse of children, there is little awareness about Munchausen syndrome by proxy (MSBP). As case reports of MSBP increase, awareness among physicians is thought to increase as well. We thus present herein a 16-month-old girl who admitted to Hacettepe University Ihsan Dogramaci Children's Hospital with the complaint of seizure, recurrent apnea and thigh abscess, who was later diagnosed as MSBP. The case was being followed by the Child Protection Team of the hospital (Haceteppe University Child Protection Unit [HU-CPU]). HU-CPU contributed to the early detection of this case and protected the child from a possible fatal outcome. The mother was confronted for MSBP and refused to take responsibility for her child's symptoms. As seen in this case, when MSBP is suspected, psychiatric evaluation of the mother, evaluation of the mother-child interaction and collection of a detailed family and social history can have a positive impact on the prognosis in these cases. This case report underlines the importance of multidisciplinary team work to share the responsibility and reduce the burden during the treatment process of these difficult and complicated cases.

Postmortem burning of the corpses following homicide.

Although there have been a great number of studies focussing on antemortem burns or fire-related deaths, the present study is the first dealing exclusively with postmortem burnings aiming to cover up a homicidal action. This study aims to draw attention to postmortem burning following homicide by determining the general characteristics of a series of burned corpses. Thirteen cases of homicide involving postmortem burning were included in the scope of the study. The cases were examined with regard to age, gender, place of death or discovery, autopsy findings, accompanying injuries and manner of death. Eleven of the cases were male and two were female. Victims' ages ranged between 24 and 62 years with a mean age of 43.5 years. All of the victims were discovered in unfamiliar places. Autopsy findings indicated postmortem burning of corpses to cover homicide. Discovering a burned body in an unfamiliar, outdoor or abandoned place, scene or autopsy findings attributable to a violent death, presence of accelerant use and absence of vitality signs are factors indicative of postmortem burning following homicide.

Measurement of ethyl glucuronide in vitreous humor with liquid chromatography-mass spectrometry.

BACKGROUND: It is important to detect alcohol intake in postmortem investigations. However it can be difficult to interpret the results of alcohol analysis in putrefied corpses. To avoid this difficulty, there have been studies on detection of ethyl glucuronide (EtG), a non-oxidative metabolite of ethyl alcohol. The aim of this study was investigate EtG levels in vitreous humor (VH), a valuable material in postmortem investigations, and to compare VH EtG levels with blood and urine EtG levels. METHODS: Blood, urine and VH specimens were collected from 110 cases. Twenty-four cases in which ethyl alcohol was detected were included in the study. Although ethanol could not be detected, one case was added after having positive results of EtG levels in urine and VH as if he was claimed that he was an alcoholic and he had taken alcohol when he died but it could not be detected after 6 days of hospitalization. Liquid chromatography-mass spectrometry was used to investigate EtG in blood, urine and VH specimens from 25 cases. RESULTS AND CONCLUSION: VH EtG was in measurable amounts in 19 cases (n: 25). In fact, VH EtG levels ranged from 0.05 to 1.90 mg/L and were below the limit of detection (LOD is 0.03 mg/L) in six cases (n: 25). Blood EtG was in measurable amounts in 21 cases (n: 25). Blood EtG levels ranged from 0.64 to 5.82 mg/L and were below the limit of detection (LOD is 0.083 mg/L) in four cases. EtG was detected in urine in 17 cases (n: 19). Urine EtG levels ranged from 0.25 to 623 mg/L and were below the limit of detection (LOD is 0.12 mg/L) in one case. There was a significant relation between VH EtG levels and blood and urine EtG levels. The results of the study showed that postmortem VH EtG can be measured to reveal alcohol intake.