Abusive head trauma: two cases and mini-review of the current literature.

BACKGROUND: Abusive head trauma (AHT) is the leading cause of fatal head injuries and are responsible for more than half of serious or fatal traumatic brain injury cases in children younger than 2 years of age. Long-term outcomes of AHT are death, spastic hemiplegia or quadriplegia, intractable epilepsy, microcephaly with corticosubcortical atrophy, visual impairment, language disorder and cognitive, behavioral and sleep disorders. CASES: Herein we present two cases of AHT (7-month-old boy, 7-month-old girl) according to forensic analysis, and discuss them in light of the current literature and share our experience. Inconsistency between the presenting history and the clinical findings were typical in both cases; follow-up histories and detailed workup revealed the diagnosis of AHT. The first case was deceased; the second case was discharged with neurological deficits. CONCLUSION: A multidisciplinary approach is critical for the prevention, diagnosis and treatment of AHT.

The relationship between subjective experience of childhood abuse and neglect and depressive symptoms during pregnancy.

INTRODUCTION: Childhood abuse and neglect have devastating effects in adulthood such as depression. During pregnancy, depression's effects in women have great importance due to its serious consequences for both children and families. It is aimed to find out a relationship between childhood abuse/neglect and depression among pregnant women. METHOD: One-hundred-forty-four married and healthy volunteer pregnant women were recruited between February-May 2015 during their regular hospital visit. Beck Depression Inventory and Childhood Trauma Questionnaire were used to evaluate depression and childhood abuse experiences. RESULTS: The participants' mean age was 29.37 years (SD ± 4.71) and the average duration gestation was 28.81 weeks (SD = 5.05). Depressed women tended to get marry earlier (M = 21.07, SD = 3.47) than the non-depressed group (M = 22.55, SD = 3.36) (p = 0.012) and they had higher number of lifetime gestations (M = 3.31, SD = 2.06) than their non-depressed counterparts (M = 2.33, SD = 1.26) (p = 0.001). Each abuse and neglect score helped to predict the participants' depression scores. CONCLUSIONS: Scanning of pregnant women for both depression and childhood trauma will give change to health providers to support this vulnerable group and their prospective children.

Tracheal length in adult human: the results of 100 autopsies / Longitud de la tráquea en humanos adultos: los resultados de 100 autopsias

The purpose of this study was to investigate the average tracheal length and number of the tracheal cartilages in Turkish people, with emphasis on the relationships to body height and sex. A hundred fresh human cadaver tracheas were harvested from 75 males and 25 females. Age, sex and body height of cadavers were recorded. All the neck and intrathoracic structures were removed. The tracheal length was measured between the subcricoid level to the carina in resting and maximally stretched positions. Average tracheal length and number of the tracheal cartilages were compared in different body height groups in both sexes. We found that average body height was 160±6.4 cm and average tracheal length in resting position was 8.5±1 cm (range 6.5­11 cm) in females and average body height was 168.6±5.6 cm, average tracheal length was 8.7±1.1 cm (range 7­11.6 cm) in males, average number of tracheal cartilages was 13.6±1.7 (range 10­16) in females and 13.3±1.6 (range 10­19) in males and average number of the tracheal cartilages per centimeter was 1.6±0.2 in female and 1.5± 0.2 in male cadavers in resting position. Average tracheal length in male group was found to be significantly different in cadavers with body height equal or taller than 170 cm in comparison to cadavers with body height shorter than 170 cm (p <0.05). This study revealed that the average tracheal length in Turkish people is shorter than the reported length in literature. It is worth commenting that there is a considerable difference between the different races with regard to tracheal length. Tracheal length may vary with body height.

El objetivo de este estudio fue investigar la longitud traqueal promedio y el número de los cartílagos traqueales en pueblo turco, con énfasis en las relaciones a la altura del cuerpo y el sexo. Cien tráqueas frescas de cadáveres humanos fueron extraidas de 75 hombres y 25 mujeres. Se registraron la edad, sexo y altura del cuerpo en cada caso. Se disecaron el cuello y las estructuras intratorácicas. La longitud de la tráquea fue medida entre el nivel subcricoides y la carina en reposo, y en posición de máximo estiramineto. Se comparó la longitud promedio traqueal y el número de los cartílagos traqueales ente grupos con diferente de la altura del cuerpo en ambos sexos. En las mujeres, la altura del cuerpo promedio fue 160±6,4 cm y la longitud traqueal promedio en posición de reposo 8,5±1 cm (rango 6,5­11 cm). En hombres, la altura del cuerpo promedio fue 168,6±5,6 cm y la longitud traqueal promedio 8,7±1,1 cm (rango 7­11,6 cm). El número promedio de cartílagos traqueales fue 13,6±1,7 (rango 10­16) en las mujeres y 13,3±1,6 (rango 10­19) en los hombres, y el número promedio de cartílagos traqueales por centímetro fue 1,6±0,2 en mujeres y 1,5±0,2 en los hombres, en posición de reposo. La longitud traqueal promedio en el grupo de hombres fue significativamente diferente en cadáveres con una altura del cuerpo igual o mayor que 170 cm, en comparación con cadáveres con la altura del cuerpo menor a 170 cm (p<0,05). Este estudio reveló que la longitud traqueal promedio en pueblo turco es menor que la longitud reportada en la literatura. Por otra parte, existe una diferencia considerable entre las diferentes razas con respecto a la longitud traqueal. La longitud traqueal puede variar con la altura del cuerpo.

Risk factors for violence against women by intimate partners in Sakarya, Turkey.

OBJECTIVES: Intimate partner violence (IPV) is an important public health problem in many countries including Turkey, with serious short- and long-term physical and mental health consequences, as well as significant social and public health costs. To understand the violence characteristics and the individual risk factors for both the married women victims and the perpetrator partners are the objectives of this study. METHODOLOGY: 243 married women, who have consulted to hospitals and village clinics between 2008 and 2009 with the mean age of 36.76 (SD = 11.59), accepted to participate in the study voluntarily. Participants were divided into two groups as "victimized" (58.8%, n = 143) and "non-victimized" (41.2%, n = 100) women. Victimized group consisted of women who have had any type of violence from their husbands during their life. A 61-item questionnaire was prepared that included items on demographics, IPV experience, attitudes about IPV and knowledge of legal rights. RESULTS: As compared to non-victimized group, women in victimized group mostly lived in villages than in town/city centers, were illiterate, had bride-price agreement and were younger when married. Place of accommodation, age and number of pregnancies were associated with the risk of victimization. CONCLUSIONS: In order to prevent IPV, further qualitative research is required to evaluate the involved risk factors and training programs on how to behave against violence in association with the legal rights should be designed for poorly educated women in their natural settings and hospitals.

Effects of some of the regional Turkish fermented foods and medications on respiratory alcohol levels.

BACKGROUND/AIM: Alcohols are used in many areas like medicine and industry. They may be naturally found in some fruits and vegetables secondary to fermentation. According to the traffic law in Turkey, professional drivers are prohibited from driving while they are under the influence of alcohol; nonprofessional drivers are allowed to drive vehicles with a blood alcohol level of up to 50 mg/dL. The aim of this research is to determine whether or not consumed medicine or fermented, nonalcoholic beverages cause false positive results in breathalyzer tests. MATERIALS AND METHODS: In this research, we used nonalcoholic fermented foods and 6 medicines. After the use of these materials, we measured breath alcohol level at 1, 3, 5, 15, and 30 min with a breathalyzer. RESULTS: False positive results were obtained only with Disinol and cologne. Other drugs and nutrients did not cause any false positivity in breathalyzer tests. CONCLUSION: At the end of the research, we observed that some substances caused false positive results, even if people did not use any alcohol. If there is any suspicion of the measured values, then measurements should be repeated. If a person cannot be sure of the reliability of the breathalyzer measurements, the person should consult other centers without losing time.

Child abuse and neglect in Turkey: professional, governmental and non-governmental achievements in improving the national child protection system.

Since ratification of the United Nations Convention on the Rights of the Child in 1995, significant efforts were made in Turkey to improve protection of children from abuse and neglect. The government took steps to amend relevant laws. Several state departments recognized the need for professional in-service training of relevant governmental agency staff. University hospitals established numerous hospital-based multidisciplinary child protection centres. The government established an Interministerial Higher Council, which has been overseeing the foundation of 13 child advocacy centres for a multidisciplinary and interagency response to child sexual abuse. In addition to undertaking research, non-governmental organizations contributed to this process by instituting professional and public education. These ground-breaking developments in the last decade give promise of even further improvement in the national child protection system from investigative, child protective and rehabilitative perspectives.

Histopathological differentiation of skin lesions caused by electrocution, flame burns and abrasion.

The aim of this study was to reveal histopathological features for differential diagnosis of skin lesions caused by electrocution, flames and abrasions. Based on the causes of the lesions, cases were assigned into three groups. Group 1 included 30 deaths from electric shock. Group 2 included 30 individuals with flame burns who died in the fires. Group 3 included 30 deaths from traffic accidents, from which the individuals had abrasions. Data from the crime scene investigations and macroscopic and microscopic findings from the autopsies allowed determination of the cause of death in all cases. The features of the lesions examined under the light microscope were intraepidermal separation, subepidermal (dermoepidermal) separation, coagulation necrosis in the epidermis, nuclear elongation in the epidermis, dark-staining epidermal nucleus, depth of homogenization in the dermis, and nuclear elongation in the epithelium of hair follicles. A significantly high rate of electrical lesions had intraepidermal separation. The rate of subepidermal separation was slightly more significant in flame burns. A significantly higher rate of electrical lesions had both intraepidermal and subepidermal separation. The rate of coagulation necrosis in the epidermis was significantly the highest in electrical lesions. Although the severity of nuclear elongation was the most significant in electrical lesions, varying degrees of nuclear elongation in the epidermis were present in all three groups. Dark staining of the epidermal nuclei was present in all lesions except for one electrical lesion, though the severity of staining was significant in the abrasion group. The depth of homogenization was slightly more significant in the abrasion group. The rate of nuclear elongation in the epithelium of the hair follicles was significantly lower in the abrasion group. The results of this study revealed that certain morphological changes determined under a light microscope could help the differential diagnoses of electrical lesions, flame burns and abrasions.

Intracranial sewing needle in a man with seizure: a case of child abuse?

Physical abuse in infancy can cause persistent neurological deficits. Although intracranial foreign bodies are generally secondary to penetrating trauma or surgical procedures, rarely they also occur as a result of child abuse. A 32-year-old man presented with the complaint of generalized tonic clonic seizures to the Neurology Department of Marmara, University Hospital. Computerized tomography (CT) scan revealed a sewing needle located within the temporal lobe. The location and the position of the needle suggested that it must have been introduced in infancy through the lamdoid suture before the closure of it, as an unsuccessful deliberate homicide attempt or accidental injury.

Deaths from drug overdose and toxicity in Turkey: 1997-2001.

Turkey is located on the main overland connection between Asia and Europe, making the country potentially vulnerable to drug trafficking and its associated harms. The aim of the present study is to explore the frequency of all deaths from drug overdose and toxicity in Turkey and to describe some of the characteristics of these deaths. We collected data on all deaths from drugs in Turkey between 1997 and 2001 using records from the Council of Forensic Medicine. Data obtained from autopsy reports were retrospectively analyzed. In the present study, 374 deaths from drugs were reported in Turkey, with a mortality rate of 0.17 per 100,000 population. Highest mortality rates were found in Istanbul (0.83) and Gaziantep (0.71). The mean age was 34.0, and most cases (71.7%) were below the age of 40. The proportion of female cases was 13.6%. Opiates were implicated in 91.5% of deaths and benzodiazepines in 25.9%. Two fifths (38.8%) of the cases involved use of more than 1 drug. In 36.6% of cases, the route of final drug administration was by injection. The most common location of death was at a home (33.7%). Interventions to reduce drug use nationally are urgently required. International cooperation in social-educational activities, scientific research, and security measures is essential for this war.