Revision of the medicolegal assessment criteria in hypovolemic patients.

Trauma scoring systems are often used for the determination of the severity level of the lesion and the clinical status in medico-legal assessment of the trauma patient. Trauma scoring systems are used also for the determination of the life-threatening conditions. Blood loss of more than 20% was reported as the only criterion for life-threatening conditions in the acute hypovolemia. The objective of this study was to revise the medico-legal assessment criteria in the patients with acute hypovolemia and to discuss other parameters, which might be used in the determination of the severity level of the clinical status.The medical reports of the patients with acute hypovolemia due to the trauma, which were sent by the judicial authorities and by other departments of our medical faculty to the department of the forensic medicine between 1999 and 2009, were evaluated. The characteristics such as age, gender, severity of the injury, type of the trauma, history of liquid replacement or blood transfusion, vital signs, type of the physical injury, injured region of the body, presence of any chronic disease were assessed and recorded.The mean age of the included 155 patients was 34.70 ±â€Š16.08 years (3-87 years). 118 (76%) of patients were males and 37 females (24%). Regarding the event types, road accidents were the most common cause (60.0%) and it was followed by sharp object injuries (18.7%) and firearm injuries (11.6%). 27.7% of the subjects received 2 units blood and blood products transfusion and 21.3% only 1 unit transfusion. According to the results of the medico-legal assessment, 84.5% of the patients had life-threatening conditions.While evaluating the severity of the clinical conditions in the hypovolemic patients, to report only the losses in percentage causes problems and limitations. Therefore, in respect of the medico-legal assessment of the hypovolemic patients, we believe that it would be more appropriate to use the physiological trauma scoring systems (like Revised Trauma Score) instead of the anatomic scoring systems.

Usage of Riot Control Agents and other methods resulting in physical and psychological injuries sustained during civil unrest in Turkey in 2013.

Turkey has experienced a wave of demonstrations in the summer of 2013, called Gezi Park Demonstrations. Between 31 May and 30 August, 297 people who had been subjected to trauma by several methods of demonstration control and Riot Control Agents applied to the Human Rights Foundation of Turkey Rehabilitation Centers to receive treatment/rehabilitation and/or documentation. 296 patients except one 5-year-old child were included in the study. Of the 296 patients; 175 were male, 120 were female, and one was a transgender individual. The highest number of applications was received by the Istanbul center with 216 patients. The mean age of applicants was 33.85, and the age range was 15-71 years. While 268 of applicants (91%) stated that they had been exposed to Riot Control Agents, 62 patients suffered only chemical exposure who had no other traumatic injuries whereas 234 patients suffered at least one blunt trauma injury. Blunt trauma injuries are due to being shot by gas canisters in 127 patients (43%), by plastic bullets in 31 patients (10%). 59 patients (20%) were severely beaten, and 30 patients (10%) were injured by pressurized cold water ejected by water cannons. Thirteen patients (4.4%) suffered injuries that caused loss of vision or eye. Psychiatric evaluations were carried out for 117 patients while 43% of them were diagnosed with Acute Stress Disorder. Post Traumatic Stress Disorder and Major Depressive Disorder followed this diagnosis. This study includes the medical evaluation of injuries allegedly sustained during Gezi Park demonstrations in 2013 as a result of several methods of demonstration control and/or by being exposed to Riot Control Agents. The aim is to discuss different types of injuries due to those methods and health consequences of Riot Control Agents.

Diagnosis of torture after 32 years: assessment of three alleged torture victims during the 1980 military coup in Turkey.

Torture is a crime against humanity and it is frequently encountered in countries that have a history of military intervention such as Turkey. Torture still exists despite absolute prohibition by human rights and humanitarian law. More than 1 million people were tortured in Turkey since 1980 coup d'état. Documentation of medical evidence is a prominent step for prevention of torture. Manual on the Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (Istanbul Protocol) provides international standards for medical documentation of torture. A holistic approach to trauma stories together with physical and psychological findings has been the main frame of the Protocol. The aim of this study is to discuss physicians' responsibility for prevention of torture, and to emphasize the importance of holistic approach to the assessment of particularly chronic patients. A team of two forensic medicine experts and a psychiatrist examined three male patients, who allegedly had been tortured severely during the 1980 military coup. The team arranged necessary referrals and diagnostic examinations. After conducting a comprehensive medical examination, some physical and psychological findings of trauma were observed and documented even after 32 years. The medico-legal evaluation and documentation of these cases many years after torture under the guidance of Istanbul Protocol were presented and significance of psychological assessment was especially emphasized. Furthermore, possible evidence of torture after a long period and physicians' responsibility for prevention of torture is discussed.

Demonstration control agents: evaluation of 64 cases after massive use in Istanbul.

An uncontrolled use of "demonstration control agents" commonly known as "teargas agents" has recently been a common practice in Turkey. One of the first massive uses of these agents had been during a meeting of the North Atlantic Council and NATO in 2004, in Istanbul. After the demonstrations, 64 patients were evaluated and treated by the Human Rights Foundation of Turkey. Their files have been reviewed retrospectively and were classified regarding age, sex, physical findings related of chemical agents, and other injuries.The patients were received 1 to 9 days after the chemical gas exposure. The maximum referral was 35 patients on the day of the gas exposure. The last application was 9 days after the exposure. Complaints and physical findings/symptoms were highest during the first 3 days.This study has been carried out to reveal the short- and long-term aftereffects of "demonstration control agents." The safety and effects of these agents are discussed in this article, based on our findings and existing references.

A significant diagnostic method in torture investigation: bone scintigraphy.

Torture appears to be a permanent feature in countries, which have experienced military coups or ruled by oppressive governments in the past, such as Turkey. The Human Rights Foundation of Turkey (HRFT) was established in 1990 to serve torture victims, mainly those who were the victims of the 1980 military regime. Since then the HRFT has been providing rehabilitation and documentation for torture survivors. Bone scintigraphy can be one of the diagnostic methods to reveal trauma, particularly after several years when it is challenging to find any physical or radiological evidence. The HRFT's Istanbul Branch referred 97 of their applicants for bone scintigraphy between 1992 and 2010. In this retrospective survey of 97 cases, 17 of them were female and 80 of them were male. Several aspects were evaluated, including working conditions, change of torture methods practiced in certain time periods, time since torture and duration of exposure to torture in comparison with findings of bone scintigraphies. The torture methods varied from beating to falanga, electric shock, suspension and several other types of torture within the period of practice, although beating was a common denominator among all. The findings were classified according to time since torture and duration of exposure to torture. More than half of the cases (59%) had a detectable bone lesion on bone scintigraphy, and the detectable bone lesion on scintigraphy increased significantly with the duration of exposure to torture, particularly among cases who had been subjected to torture for a longer period (8 days and more). Bone scintigraphy should be considered as a valuable non-invasive diagnostic method to assess and document long term torture practices and/or cases with no detectable marks upon physical examination.