A Case of Child Physical Abuse With a Rolling Pin Insertion, Resulting in Bladder and Rectal Perforation.

Visceral injuries are not uncommon in nonaccidental trauma and often require emergent operative intervention. However, sometimes it can be difficult to assess the extent of injury. In this report, we present a case of child physical abuse resulting in bladder and rectal perforations, which was initially referred to our hospital as acute abdomen with intraperitoneal free fluid on ultrasonography. An exploratory laparotomy revealed the perforations and surgical repair was performed. The patient was evaluated by the Hospital Child Protective team and it was revealed that bladder and rectum perforations were due to insertion of rolling pin into the rectum by the stepmother. The child was discharged home uneventfully with a temporary colostomy. We believe that this is the first reported case in the English literature of inflicted perforation of the rectum and bladder through insertion of a rolling pin.

Heart-type fatty acid binding protein and cardiac troponin I may have a diagnostic value in electrocution: A rat model.

Although cardiac injury is known to be the leading cause of death in electrocution, the differential diagnosis can be challenging in forensic practice since the exact mechanism is poorly understood and there is lack of reliable markers. Thus, death due to electrocution may be classified as a negative autopsy. The serum levels of and myocardial immunostaining loss for cardiac troponins and heart-type fatty acid binding protein (H-FABP) are highly sensitive and specific biomarkers of ischemic myocardial damage and may have a diagnostic value in determining the myocardial injury or the cause of death due to electrocution. Due to this reason, a rat model is prepared to investigate these issues. Thirty-two Wistar albino female rats were included and randomly divided into four groups of eight subjects. Group A was the control group, and Group B, C, and D were exposed to electrical current of 110 volt (V), 220 V, and 600 V, respectively. Blood samples and the hearts were collected from the rats for biochemical and immunostaining analyses. It is found that increased serum H-FABP levels were significantly associated with the higher voltage immediately after electrocution. However, serum cardiac troponin I (cTnI) levels did not show significant changes associated with the higher voltage in the early period of electrocution. As for histopathological examinations, the only significant difference in myocardial immunostaining loss was for H-FABP in Group B. Serum H-FABP levels may have a diagnostic value in the early postmortem period immediately after electrocution. Besides, it seems that serum H-FABP levels may be a better indicator than those of cTnI to reflect the myocardial damage in the early period of the electrocution.

Offline glucose biomonitoring in yeast culture by polyamidoamine/cysteamine-modified gold electrodes.

This article deals with the use of pyranose oxidase (PyOx) and glucose oxidase (GOx) enzymes in amperometric biosensor design and their application in monitoring fermentation processes with the combination of flow injection analysis (FIA). The amperometric studies were carried out at -0.7 V by following the oxygen consumption due to the enzymatic reactions for both batch and FIA modes. Optimization studies (enzyme amounts and pH) and analytical parameters such as linearity, repeatability, effect of interference, storage, and operational stabilities have been studied. Under optimized conditions, for the PyOx-based biosensor, linear graph was obtained from 0.025 to 0.5 mM glucose in phosphate buffer (50 mM) at pH 7.0 with the equation of y = 3.358x + 0.028 and R(2) = 0.998. Linearity was found to be 0.01-1.0 mM in citrate buffer (50 mM and pH 4.0) with the equation of y = 1.539x + 0.181 and R(2) = 0.992 for the GOx biosensor. Finally, these biosensor configurations were further evaluated in a conventional flow injection system. Results from batch experiments provide a guide to design sensitive, stable, and interference-free biosensors for FIA mode. Biosensor stability, dynamic range, and repeatability were also studied in FIA conditions, and the applicability for the determination of glucose in fermentation medium could be successfully demonstrated. The FIA-combined glucose biosensor was used for the offline monitoring of yeast fermentation. The obtained results correlated well with HPLC measurements.

Gold nanoparticle modified conducting polymer of 4-(2,5-di(thiophen-2-yl)-1H-pyrrole-1-l) benzenamine for potential use as a biosensing material.

Gold nanoparticle (AuNP) modified conducting polymer of 4-(2,5-di(thiophen-2-yl)-1H-pyrrol-1-yl)benzenamine (SNS-NH2) was used as the biosensing platform for glucose analysis. Electrochemical measurements were carried out by following the consumed oxygen due to the enzymatic reaction of glucose oxidase (GOx) at -0.7V vs Ag/AgCl. Optimisation of pH, enzyme loading, stability experiments were carried out. Effect of NP was investigated by monitoring the signal responses at different AuNP sizes and amounts. A linear relation of y=1.597x+0.264 (R(2)=0.993) was found for glucose concentrations between 0.002 and 5.0mM. The analytical characteristics of the system were also evaluated for glucose determination in flow injection analysis (FIA) mode. Finally, the system was checked for glucose detection on real samples.

In situ synthesis of biomolecule encapsulated gold-cross-linked poly(ethylene glycol) nanocomposite as biosensing platform: a model study.

In situ synthesis of poly(ethylene glycol) (PEG) hydrogels containing gold nanoparticles (AuNPs) and glucose oxidase (GOx) enzyme by photo-induced electron transfer process was reported here and applied in electrochemical glucose biosensing as the model system. Newly designed bionanocomposite matrix by simple one-step fabrication offered a good contact between the active site of the enzyme and AuNPs inside the network that caused the promotion in the electron transfer properties that was evidenced by cyclic voltammetry as well as higher amperometric biosensing responses in comparing with response signals obtained from the matrix without AuNPs. As well as some parameters important in the optimization studies such as optimum pH, enzyme loading and AuNP amount, the analytical characteristics of the biosensor (AuNP/GOx) were examined by the monitoring of chronoamperometric response due to the oxygen consumption through the enzymatic reaction at -0.7 V under optimized conditions at sodium acetate buffer (50 mM, pH 4.0) and the linear graph was obtained in the range of 0.1-1.0 mM glucose. The detection limit (LOD) of the biosensor was calculated as 0.06 mM by using the signal to noise ratio of 3. Moreover, the presence of AuNPs was visualized by TEM. Finally, the biosensor was applied for glucose analysis for some beverages and obtained data were compared with HPLC as the reference method to test the possible matrix effect due to the nature of the samples.

Homicidal poisoning by injection of methidathion: the first ever report.

UNLABELLED: We present the first ever case of homicidal poisoning due to injection of methidathion, an organophosphate insecticide. CASE: A 4-month-old baby presented to the emergency department with chief complaints of unconsciousness and irregular respiration. A bitter odour and an injection site with a greenish blue colouration and two bullaous lesions were noticed by the emergency department physicians. Postmortem examinations revealed a wide shiny blue colouration of the antecubital region with oedematous muscular fascia and focal liquefaction necrosis. Blood and tissue levels were positive for methidathion. Our case report emphasizes the necessity of a detailed crime scene investigation and postmortem examination for the possibility of homicide in such cases. Although injection sites may be the expected results of medical treatment, dermal lesions also may be associated with injections of toxic substances.

Experiences with endosulfan mass poisoning in rural areas.

This paper describes very rare chemical poisoning and characteristics of patients with acute endosulfan mass poisoning in a rural area of Turkey and our experiences of these patients. We included 41 patients who were treated in our hospital with the diagnosis of endosulfan poisoning. After the first vital intervention they were examined in terms of age, sex, symptoms and physical examination findings, laboratory results, treatment and outcome. Forty-one patients were admitted to the emergency department (ED) after triage. Nineteen (46.3%) of the patients were female, 22 (53.7%) were male. The mean age was 27.9+/-16.0 years (1-67 years). The mean time to the ED was 4.1+/-0.9 h (3-6.5 h). The most common symptoms were anxiety (97.6%), nausea (56.1%) and vomiting (48.8%). Tests of the blood samples obtained at the ED revealed leucocytosis (11 070.6+/-4302.5/microl), increased blood glucose, LDH, CK and CK-MB levels. Toxicological analysis of blood and urine samples revealed endosulfan as the causative agent. Especially in the rural areas, cases with acute repetitive seizures should suggest endosulfan intoxication when the aetiology is uncertain even in the absence of any signs of intoxication. Health care professionals should understand the hazards associated with the pesticide use as well as diagnosis and treatment of these types of poisonings.

Soccer related sudden deaths in Turkey.

Regular physical exercise is recommended by the medical community, because it offers the potential to reduce the incidence of coronary events. On the other hand, vigorous exertion may act as a trigger of acute myocardial infarction and sudden cardiac death in susceptible individuals. Death during sports activities differs among sports disciplines and countries. In Turkey, soccer attracts more spectators than any other sports activity and the attention of the press and media, and is preferred over other sports by many young and middle-aged individuals. As autopsy-based studies are infrequent in literature and there is a lack of data detailing sudden death during physical activity in Turkey, we present a Turkish series of sudden deaths that occurred during soccer games based on data provided by the Morgue Specialization Department of the Council of Forensic Medicine. We identified 15 male cases of soccer-related sudden death aged from 10 to 48 years. Coronary artery disease was identified as the cause of sudden death in 11 cases. Key pointsThis study is one of the largest series of soccer related SD with reported 15 cases.In our series, CAD is the most common cause of SCD also in very young athletes in contrast with international literature.In autopsy, detailed cardio-vascular system evaluation and toxicological analysis including doping agents are essential to determine precise cause of exercise induced SD.Medical screening is important for all people interested in sport, not only for athletes, as a powerful means of prevention.

Acute organophosphate poisoning in university hospital emergency room patients.

OBJECTS: In the present study, we evaluated patients who were admitted to our emergency department with a diagnosis of organophosphate poisoning and discussed clinical, social and demographic features. METHODS: A retrospective study was conducted with organophosphate poisoning patients admitted to our emergency department between January 1995 and December 2004. Data regarding the age, sex, occupation, type of agent, route of poisoning, clinical effects of cholinergic overactivity, laboratory findings, and mortality rate were obtained from the patient files. RESULTS: During the study period, 220 patients who had organophosphate poisoning with a known agent were admitted to the ED. The estimated mean admission time to the ED after the exposure was 3.9 +/- 3.1 (1-14) hours. There were 131 (59.5%) female and 89 (40.5%) male patients. The most affected age group was 15-24 years (40.5%), in both sexes. Oral ingestion (86.5%) was found to be the most common route of poisoning. The most frequent reason for poisoning was attempted suicide (75.9%). The most common organophosphate compounds exposed were dichlorvos, diazinon and parathion-methyl. The most frequent clinical signs were miosis, respiratory system findings, tachycardia, loss of consciousness, and hypertension. Twenty patients (9.1%) died due to sudden respiratory and cardiac arrest (45%), respiratory failure (25%), CNS depression (5%) and septic shock (25%). CONCLUSION: We think that the appropriate use of these compounds, instruction of the public about their harmful effects and restriction of their uncontrolled sales by legal regulations can reduce the incidence of organophosphate poisoning.

Image analysis as an adjunct to sodium rhodizonate test in the evaluation of gunshot residues: an experimental study.

It is important to investigate the clothing, as well as the body, to determine the range of fire of entry wounds in firearm injuries. Clothing can affect the amount of gunshot residues (GSR) reaching the body and their distribution. The amount and distribution of the GSR also vary according to the distance between the firearm and the target. Sodium rhodizonate test provides valuable data when clothing is available for examination. In the absence of clothing, light microscopic examinations may add additional information regarding the range of fire. In this study, a sodium rhodizonate test was done on 80 garment samples containing the bullet entrance. The 80 calfskin samples were processed histologically and were stained using Alizarin Red S. These were also evaluated with computer-assisted image analysis. Gross residues were seen on military camouflage clothing in samples from < or = 45-cm group. White flannel undershirts under the military camouflage contained rhodizonate-positive particles only around the contact wounds. With image analysis, however, the residues could be detected also in the skin samples of the 2.5-cm- and 5-cm-range groups. We suggest that the image analysis can be combined with other techniques and it can provide valuable data in the determination of entry wounds and also in the estimation of firing distance.

Childhood foreign body aspiration in Istanbul, Turkey.

In this study, we present the data concerning 10 children (six boys, four girls) with a diagnosis of foreign body aspiration (FBA) amongst 19,951 cases that underwent autopsy between the years 1996-2002. Eight of the children were under 2 years old. All the incidents took place at home. One of the parents was in the company of the child at the time of incident. At least one of the risk factors was positive. Interestingly, all of the aspirated material was related to food except one. Only four cases had subpleural petechiae, whereas five of the seven subjects undergoing histopathological evaluation had edema, hyperemia or intra-alveolar fresh bleeding. The legal instructions, which regulate the standards of toy materials, came into force at the end of 2003. Even though the legal instructions regulating the size and consistency of toys are very important to prevent FBA, we believe that the education of the parents and carers in the prevention of food aspiration is of greater importance.

[Juguler vein gunshot injury from blank cartridges]. / Kurusiki tabanca atisi sonucu gelisen juguler ven yaralanmasi.

Blank cartridge guns, which are produced for self-defence needs and considered harmless, can be easily purchased by adults due to lack of legal regulations. We present this case because injuries caused by gunshot from blank cartridges may be fatal and are rarely encountered in emergency departments. A 3-year-old boy was brought to the emergency department since he had a wound on his neck caused accidentally by gunshot from blank cartridges. He had a moderate general condition and pale appearance. There was an irregular-edged, defective wound 2 cm above the sternal notch in midline localization with a dimension of 3 x 4 cm. Computed tomography of the thorax revealed contusion in the apex of the left lung. A 2-mm plastic piece embedded in the left internal jugular vein was removed during the operation. A mass education on danger and harm of these guns as well as legal regulations for restricted use seem to be necessary. Also, physicians should keep in mind that blank cartridge guns can cause fatal injuries.

Investigation of alcohol use disorders in a group of driving-while-intoxicated offenders.

This preliminary study was carried out to investigate alcohol use disorders and personality profiles in a group of driving-while-intoxicated offenders. Thirty nine volunteer offenders were assessed by CAGE, while 21 of them were assessed by SCID-I Alcohol and Drug Use Disorders module and 14 drivers completed MMPI test. According to CAGE scores, 11 was found to have an indication of alcohol problem and 7 had clinically significant alcohol use disorder. Within 21 drivers, 4 had a DSM-IV diagnosis of alcohol abuse. Independent of their diagnosis, MMPI profiles revealed the psychopathic personality characteristics which might explain drinking while driving as a risky behaviour in this group. These results suggest that, besides legal applications, referring offenders to associated centers, in order to be evaluated and informed about alcohol use disorders, would be an important step in the prevention of recurrent alcohol impaired driving as well as alcohol related incidents.