Evaluation of human pineal gland acetylserotonin O-methyltransferase immunoreactivity in suicide: A preliminary study.

Disorders of the serotonergic system are especially known to be present in the neurobiology of suicidal behavior. Studies investigating melatonin levels show that changes in pineal gland functions may also play a role in the pathogenesis of suicide. However, to our knowledge, there are no studies evaluating the activity of pinealocytes responsible for melatonin synthesis in suicide. This preliminary study aimed to investigate the relationship among pinealocyte, acetylserotonin O-methyltransferase (ASMT) immunoreactivity, and suicide. Samples of pineal gland, cerebrospinal fluid, blood, and urine were obtained from 21 suicide and 21 non-suicide cases on which medicolegal autopsies were performed. Expression of ASMT in human pineal gland was evaluated by immunohistochemical methods. A scoring system was used to define the anti-ASMT-positive staining in the sections. Enzyme-linked immunosorbent assays were employed to assess serum and cerebrospinal fluid melatonin levels and blood and urine noradrenaline levels. The ASMT-immunopositive pinealocyte count was observed to be lower in suicide cases compared to the non-suicide cases. With the exception of two cases (with moderate staining), all graded scores were 3 (strong staining) in non-suicide group, whereas scores were 1 (mild staining) or 2 (moderate staining) in the suicide group. Melatonin levels in the blood were lower among the suicide victims. These results support decreased pineal gland activity in suicide. However, further studies are needed to assess whether these changes are related to a psychiatric disorder.

Assessment of the relation of violence and burnout among physicians working in the emergency departments in Turkey.

BACKGROUND: Violence and burnout are frequently seen among medical doctors; however, the relation is not clear. This study aimed to assess the violence and its possible effects on burnout in physicians working in emergency units. METHODS: This cross-sectional study targeted all physicians working in the emergency units of Pamukkale University Hospital, County and City Hospitals, 112 Emergency Services, and Private Hospitals in Denizli. Data were obtained by means of a self-administered questionnaire that consisted of questions on the demographics of the participants, Turkish version of the Maslach Burnout Inventory, and of the perpetrators of violence. What was also documented on the questionnaire was whether participants had been subjected to or had witnessed any verbal or physical violence during the previous one month of emergency physicians' certification program. RESULTS: A total of one hundred and seventy-four physicians were included into the study (85% of the targeted group). Many of the participants were between 24 and 59 years of age, with a mean age of 36.8±5.8 years. Married male doctors working in the City Hospital made up the majority. There were significant associations between emotional exhaustion and total violence (p=0.012) and verbal violence (p=0.016); depersonalization and total violence (p=0.021) and verbal violence (p=0.012). CONCLUSION: The results presented here indicated that there was a strong relation between burnout and violence experienced by physicians working in emergency units. Violence in the emergency department has a substantial effect on the physicians' well-being.

Anatomopathological findings in hangings: a retrospective autopsy study.

BACKGROUND: In this retrospective autopsy study, we aimed to review the anatomopathological findings observed in cases of hanging death for a five year period and to evaluate the role of contributing factors such as age, sex, type of hanging and localization of the ligature knot. METHODS: Autopsy reports of 102 hanging cases performed by the Department of Forensic Medicine, Faculty of Medicine of Pamukkale University, between January 2007 and September 2011, were retrospectively reviewed. RESULTS: In the 102 hanging cases 73 of the victims were males (71.6%) and 29 (28.4%) were females, with a mean age of 40.97 ± 17.41 years. All cases were suicidal hanging. Fifty four cases (52.9%) were typical hanging, with the ligature knot located posteriorly. There were petechial hemorrhage on the face and eye lids in 46 (45.1%), ecchymoses of the cervicale muscles in 43 (42.2%), and fractures of the neck structure(s) in 69 cases (67.6%). CONCLUSIONS: The incidence of neck structure fractures increased with age. In addition, there was no correlation between the incidence of neck structure fractures and sex or type of hanging.

Caspase 1, caspase 3, TNF-alpha, p53, and Hif1-alpha gene expression status of the brain tissues and hippocampal neuron loss in short-term dichlorvos exposed rats.

Dichlorvos (DDVP) is an organophosphate compound that causes neurotoxicity. Apoptosis plays an important role in neurotoxic cell death in the brain. The aim of this study was to examine caspase 1, caspase-3 and also cell apoptosis related genes as p53, Tumor Necrosis Factor-alpha, Hypoxia Inducible Factor 1-alpha expressions in hippocampus, cerebellum, cortex, and to estimate total hippocampal neuron number in DDVP treated rats. Ten female albino rats were divided into control (n:5) and dose (n:5) groups. In dose group, single dose of DDVP (25 mg/kg) was administered to the animals via oral gavage. A week later, brains were removed and total neuron number was estimated in the left hippocampus using by optical fractionator method. The right part of the brain was used for gene expression analysis. In dose group, total hippocampal neuron number was significantly decreased compared to control group (p = 0.008). Caspase 1 and TNF-alpha gene expression were increased in all brain tissues and p53 gene expression was decreased in only hippocampus tissue in dose group. Short-term exposure to dichlorvos leads to neuronal loss in hippocampus and TNF-alpha rapidly and potently induces apoptosis and also several caspases as possible participants in the apoptotic cascade.

Elderly deaths associated with balneotherapy in Denizli, Turkey province: three autopsy cases.

BACKGROUND: Turkey is one of the richest countries in the world in terms of balneotherapy resources. Thermomineral water baths are preferred by the elderly because of their positive beneficial effects over regulation of musculoskeletal system functions. However, existing cardiovascular and respiratory system diseases may constitute a risk and trigger ischemic changes in the heart. METHODS: In this study, 2 cases are presented who suffered sudden cardiac death while having a thermal bath and 1 drowning case that was precipitated by chronic myocardial infarction. While 1 case was 63 years old, 2 cases were above 65 years of age. Two (2) cases had atherosclerotic coronary artery disease, whereas 1 case had heart failure. RESULTS: The success of spa treatment, which is based on stimulation/harmonization therapy, restores bodily harmony and depends on the health of organs and functions playing a role in this process. CONCLUSIONS: In the elderly, some conditions, particularly limited pulmonary and cardiovascular functionality, should be taken into consideration while applying those treatments.

The relationship between adrenal gland morphometric changes and postmortem interval in rats: a stereological study.

The importance of determining time of death is crucial to forensic cases. The ability to use adrenal gland volume changes and adrenal medulla chromaffin cell counts to obtain the postmortem interval was examined in this study. A total of 15 rats were sacrificed by cervical dislocation and divided into three groups. The left adrenal glands were quickly excised in the first group at 0 h, in the second group at 12 h and in the third group at 24 h. Subsequently, the samples were fixed in 10% formalin solution and embedded in paraffin according to standard procedures. Ten to fifteen sections were obtained from each left adrenal gland by taking 30 µm thick sections; then, the sections were stained with hematoxylin-eosin (HE). The adrenal cortex and medullar volumes were calculated by Cavalieri's principle, which is a stereological method. The adrenal medullary chromaffin cell count was evaluated by the optical fractionator method. The total volume of the adrenal gland was determined as 4.82±1 mm(3) at 0 h, 6.32±0.28 mm(3) at 12 h and 8.35±1.73 mm(3) at 24 h. Increases in the adrenal cortex, adrenal medulla and the total volume of the adrenal gland at 12 and 24 h postmortem compared with at 0 h were statistically significant (p<0.05). The difference between the groups in terms of the total number chromaffin cells was statistically significant (p<0.05). In this preliminary study, we evaluated the total volume of the adrenal gland and the number of chromaffin cells of the adrenal medulla. We concluded that these parameters could be used reliably in determining the postmortem interval.

Hippocampal neuron loss due to electric injury in rats: a stereological study.

Electric injury may cause different changes from minimal damage (e.g. small burns) to severe complications up to death. Several morphological changes of the skin and the internal organs are used for the diagnosis of electrical injury. However, macroscopic findings and histological changes of the internal organs and the skin may be absent in many cases. Furthermore, neuropsychological changes including deficits of cognitive functions may be seen in survivor victims. The aim of the present study is to examine whether electric injury causes decreasing in the number of pyramidal neurons in the rat hippocampus and whether this decreasing can be demonstrated by stereological method. The rats were separated into three groups: first group, native control group; second group, the points of electrical contact were on the back skin in this group; third group, the points of electrical contact were on the temporal region in this group. The current was the usual city current (110V, 50Hz, 100A AC). On the third day, the rats were decapitated; the brains were removed, and sectioned horizontally through the hippocampus and samples chosen according to the systematic random sampling strategy. Afterwards the samples were stained by H&E and optical fractionator method, one of the unbiased stereological methods, was used to estimate the total pyramidal neuron number. The results showed that the total number of pyramidal neurons in three subdivision of the hippocampus (CA3-2 and CA1) was 242,141+/-31,167, 193,388+/-24,795 and 187,448+/-28,300 in the first, second and third groups, respectively. The differences between first and second-third groups were statistically significant (p<0.05). There was not any significant difference between the second and the third groups. In conclusion, electrocution causes loss of the pyramidal neuronal in CA3-2 and CA1 subdivisions of the rat hippocampus in this study.

[Frequency of skeletal chest injuries associated with cardiopulmonary resuscitation: forensic autopsy]. / Kardiyopulmoner resüsitasyona bagli gögüs kafesi hasarlanmalarinin sikligi: Adli otopsi sonuçlari.

BACKGROUND: Fractured ribs and sternum are frequent complications of thoracic compression during CPR (cardiopulmonary resuscitation) in adults. This study was conducted to determine the incidence of rib and sternal fractures after conventional closed-chest compression in the treatment of cardiac arrest. METHODS: We reviewed the forensic autopsy findings of 231 deaths referred to the Pamukkale University Department of Forensic Medicine over a 12-month period, 2004-2005. CPR-related chest injuries comprising rib and sternum fractures, ecchymosis and subcostal hemorrhage were compared retrospectively in 104 patients. RESULTS: Ninety-one (87.5%) of the 104 patients were adults, and 13 patients (12.5%) were children. The mean (SD) age in the pediatric group (5F/8M) was 5.48 (+/-5.96) and in the adult group (18F/73M) was 44.88 (+/-18.31). Forty-four (42.3%) of the 104 patients died of traumatic cause and 60 (57.7%) of non-traumatic cause. Ecchymosis was present in 26 (28.8%) patients, subcostal hemorrhage in 16 (17.6%) patients and fractures (sternal and costal) in 12 (13.2%) patients in adults. There were no significant differences between groups according to age, sex and traumatic-nontraumatic cause in terms of skeletal chest injuries associated with CPR in adult patients (p>0.05). CONCLUSION: This study shows a low incidence of rib and sternal fracture after closed-chest compression in the treatment of cardiac arrest in forensic autopsy cases.

Effects of postgraduate emergency training among general practitioners working in emergency units in Denizli, Turkey.

INTRODUCTION: Emergency medicine is characterised by rapid decision-making to help patients in life-threatening situations. For this purpose, special qualifications are necessary. The aim of our study was to evaluate the emergency medicine knowledge obtained during an obligatory postgraduate emergency medicine training programme that has been recently applied among Turkish physicians. METHODS: The training targeted all general practitioners (GPs) working in emergency units in the city hospitals, city-wide primary healthcare centres, public health offices, emergency services and private hospitals. Over an 8-month period between September 2004 and April 2005, seven individual groups of approximately 45 physicians were formed. Each group undertook an identical 5-day training programme and every participant completed identical pre-and post-training tests. RESULTS: Two-hundred and ninety-eight physicians participated in the training programme. The majority of participants were male (n=224, 75.2%), aged between 35 and 39 years (n=127, 42.6%), had been in the medical professional for 11 to 15 years (n=121, 40.7%), and were employed in city hospitals (n=102, 34.2%). Surprisingly, the majority of GPs had never participated in a postgraduate training programme before (n=166, 55.7%). Mean post-test scores of the participants were significantly higher than the pre-test scores (89.70%+/-12.41% vs 43.15%+/-10.47%, respectively; P<0.001). Mean pretest scores were significantly higher in the emergency services subgroup (51%, P=0.001) and in the subgroup of participants that had previously undertaken two or more postgraduate training courses (47.9%, P=0.004) compared with the mean pre-test scores of the other subgroups. However post-test scores were not statistically different between the groups. CONCLUSIONS: This postgraduate emergency medicine training programme appears to be effective in improving physicians' knowledge regarding emergencies. Any developing emergency medicine system in Turkey should include continuous, up-to-date, standardised educational programmes for emergency professionals. These may include postgraduate workshops to improve the knowledge and skill levels of emergency professionals.

Aggression and violence towards health care providers--a problem in Turkey?

Health care providers are increasingly concerned about the escalating incidence of verbal and physical abuse to healthcare staff. Factors, such as long wait in hospital areas, which lead to client frustration over an inability to obtain needed services promptly, are influencing these situations. Nonetheless, incidents of this nature can cause immense psychological harm as well as physical damage among medical employees. The current study aimed to ascertain from staff members aggressive experiences in the workplace, and the effects on the individual. The results of this study mirrored those of similar surveys in Turkey. Non-reporting was revealed as a major problem. Respondents believed they were treated less seriously than similar incidents involving private citizens. Accordingly, staff criticized hospital managers, the police, and the courts for their attitude about assaults towards hospital employees. They reported feeling vulnerable to abuse and there was a general desire for training in preventing and protection. These include teaching staff breakaway techniques, increasing the number of trained security officers on duty, issuing personal alarms, and encouraging staff to officially report all incidents.

Violence toward health care workers in emergency departments in Denizli, Turkey.

This study sought to determine the frequency and types of violence that occurred during the previous year against health care workers in emergency departments in Denizli, Turkey, and to discern the views of workers on the prevention of such aggressive behavior. This study was conducted from March 1 to April 15, 2003, and included a group of 79 health care workers from the emergency departments of 3 hospitals in Denizli, namely, the Hospital of Pamukkale University Medical Faculty, the City Hospital of Denizli, and the Hospital of the Social Insurance Foundation. Data were collected from a self-administered questionnaire. In all, 88.6% of participants had been subjected to or had witnessed verbal violence, and 49.4% of them had been subjected to or had witnessed physical violence during the previous year. The most frequent reason (31.4%) for violence was abuse of alcohol and drugs by perpetrators. The second most frequent reason (24.7%) was the long waiting times typical of emergency departments. The most common type of violence was loud shouting; swearing, threatening, and hitting were the next most frequent violent behaviors. In all, 36.1% of subjects who had experienced violence reported that they developed psychological problems after the incident. Most participants commented on the insufficiency of currently available security systems within emergency departments and on the need for further training about violence. All health care personnel within emergency departments should be aware of the risk of violence and should be prepared for unpredictable conditions and events; in addition, security systems should be updated so that violence within emergency departments can be prevented.

Using of atomic absorption spectrometry for diagnosis of electrical injuries (an experimental rat study).

The diagnosis of electrical injuries may be difficult and sometimes we should use some methods to support that. In this experimental rat study; electrical injuries were made in the dorsal skin of rats using 110 V, 100 A ac current. Swabs were taken from these injuries and investigated for iron and copper by using atomic absorption spectrometry. There was a great significance between study and control groups for copper (p<0.01). It was suggested that metallic deposition to skin in electrical injuries can be shown by atomic absorption spectrometry as quantitatively and can be used for improving the diagnostic sensitivity of electrical lesions.