Demographic and clinical characteristics of patients with serum sickness-like reaction.

In this study, we aimed to review the demographic, clinical, and laboratory characteristics of patients who were followed up and treated with the diagnosis of serum sickness-like reactions (SSLR) in our pediatric rheumatology clinic retrospectively and emphasize the importance of early diagnosis and treatment. The files of 29 patients who were hospitalized in the pediatric rheumatology clinic between September 2016 and March 2017 with the diagnosis of type 3 hypersensitivity reaction were reviewed retrospectively. Patient records including C-reactive protein, erythrocyte sedimentation rate, serum electrolytes, blood glucose, urea, and liver function were recorded by using the computerized patient database. The gender, age, length of hospital stay, accompanying clinical findings, family history of atopy, preceding infection, and drug usage data were obtained from the files of the patients. Twenty-nine patients with the diagnosis of type 3 hypersensitivity reaction were evaluated. Fifteen (51.7%) of the patients were male and 14 (48.3%) were female. The male to female ratio was 1.07. The age distribution of patients ranged from 18 to 192 months (mean ± SD 100.66 ± 53.75 months). The hospitalization duration was 3-16 days (mean ± SD 5.14 ± 3.20 days). The use of many drugs, especially antibiotics, has increased even in the treatment of viral upper air way infections. As a result, side effects have also increased. The most important of these is SSLR. However, this disease is not well recognized by clinicians.

Use of Autopsy to Determine Live or Stillbirth: New Approaches in Decision-support Systems.

Fetal deaths are important cases for forensic medicine, as well as for criminal and civil law. From a legal perspective, the determination of whether a deceased infant was stillborn is a difficult process. Such a determination is generally made during autopsy; however, no standardized procedures for this determination exist. Therefore, new facilitative approaches are needed. In this study, three new support systems based on 10 autopsy parameters were tested for their ability to correctly determine whether deceased infants were alive or stillborn. Performances were analyzed and compared with one another. The artificial neural networks and radial basis function network models had 90% accuracy (the highest among the models tested), 100% sensitivity, and 83.3% specificity. Thus, the models presented here provide additional insights for future studies concerning infant autopsies.

[Secondary victimization of traffic accident victims: getting buried without the declaration of forensic case and without having performed autopsy]. / Trafik kazasina maruz kalan olgularda ikincil magduriyet: Adli olgu bildirimi yapilmadan veya otopsi uygulanmadan defnedilme.

BACKGROUND: In this study, it was aimed to analyze the cases of traffic accident related deaths, buried without performing autopsy, in order to increase awareness of the physicians about declaration liability of forensic cases and also emphasize the declaration of the forensic case and autopsy importance. METHODS: In the First Specialization Board of Council of Forensic Medicine, 542 cases of death, reported between the years 2004-2008, who were involved in traffic accidents and buried without an autopsy performed, were evaluated retrospectively. RESULTS: It was found that 69.4% of the cases (n=376) were males, whereas %30.6 (n=166) were females; mean age was 58.5±20.9 (range, 3-98 years). Age 61 and above was the most frequent age group with 301 cases (55.5%). Of the cases, 336 (62.0%) had died in hospital, 241 (44.5%) had died in 1-12 months following the accident and medico-legal corpse examination was performed only in 123 (22.9%) cases. Three hundred fourty-four (63.5%) of the cases were not reported as forensic cases and death certificate was signed by any physician other than medical examiner without being declared as a legal case. According to the decisions of Board, since an autopsy was not duly performed, the cause of death could not be determined for 95 cases (17.5%) and for 57 cases (10.5%), it was not possible to determine whether there was causality between the accident and death. DISCUSSION: Our findings emphasize the importance of declaration of forensic cases and performing autopsy in time in traffic accident victims.

An evaluation of childhood deaths in Turkey due to yellow phosphorus in firecrackers.

Yellow phosphorus (YP) is a powerful protoplasmic poison used in the manufacturing of matches, pest poisons, firecrackers, firework cracker, lights for watches, military ammunition, and agriculture fertilizer. YP is extremely flammable and toxic and easily absorbed from the gastrointestinal tract. In this study, we examined childhood deaths from 1997 to 2012 resulting from the ingestion of firecrackers. The patients ranged from 2 to 15 years of age and were admitted to the hospital with a variety of symptoms. Those that presented with nausea, vomiting, and hypotension rapidly deteriorated and entered a coma. An autopsy was performed in all but one of the 16 cases reviewed. Macroscopically, the livers had a yellowish discoloration with petechial bleeding. Histopathologic examination revealed acute toxic hepatitis. In conclusion, these firecrackers are found in corner shops throughout Turkey, may cause death in children with little warning, and should be banned to prevent further deaths.

Evaluation of social and demographic characteristics of incest cases in a university hospital in Turkey.

BACKGROUND: Incest is defined as any sexual activity between close blood relatives including step relatives and family members who are forbidden by law to marry. It is a problem that can be seen in all the social classes in developed and undeveloped societies. The World Health Organization classifies this problem as a silent health emergency. Father-daughter incest is reported to be the most common incest type followed by the other types like brother-sister, sister-sister and mother-son incest. MATERIAL AND METHODS: Subjects for this study were recruited from a sample of incest cases referred to Forensic Medicine Department of Gaziosmanpasa University Medical Faculty Hospital between 2008 and 2012. Data involved social and demographic characteristics and clinical features of victims, perpetrators and the families. The ethical committee of the faculty of medicine approved the study. RESULTS: The study sample consisted of 43 incest cases (36 females and 7 males) with an age rage 4-40 years. Two third of the victims were under 18 years old. All perpetrators were males. Father - daughter incest (34.9%) was found to be most common incest type followed by brother - sister incest (14%). 75% of the perpetrators were family members and relatives with consanguinity while 25% of them were not consanguineous but faithful and intimate relatives to victims. CONCLUSIONS: Increasing awareness about incest and its damaging effects is so important and clinicians should keep in mind sexual abuse or incest when examining the risky population. Multidisciplinary approach is necessary for determining short term or long term results and preventing the negative consequences of incest.

Autopsy evaluation of coal mining deaths in the city of Zonguldak, Turkey.

BACKGROUND: In this study, our aim was to evaluate the fatal occupational accidents that occurred in Zonguldak coal mines between the years 2005-2008. MATERIAL AND METHODS: We retrospectively evaluated 42 fatal coal mine occupational accidents in Zonguldak (Turkey) between the years 2005-2008. The forensic records of autopsies referred to the chief prosecutors' office during 2005-2008 were reviewed retrospectively. There were 42 cases. The cases were evaluated with respect to age, mechanism of injury, body region of wound, cause of death, and legality of the mine. RESULTS: Ages of the deceased ranged between 17 and 52 (median: 32.9 yrs). Deaths were mostly in the 21-30 (35.8%), and 31-40 (30.9%) age groups. Only 1 case was younger than 18 years of age. Review of occupational fatalities has revealed that fatal accidents occurred mostly (76.2%) in the private, and fewer (23.8%) in the public mining enterprises. Crime scene investigation findings have demonstrated that of all occupational deaths (total n=42), 27 (64.3%) were due to subsidence, followed by methane gas poisoning (n=6, 14.2%), tram crash (n=3, 7.1%), log falls (n=2, 4.8%), electrocution (n=2, 4.8%), and methane explosion (n=2, 4.8%). CONCLUSIONS: Despite laws and regulations concerning mining and because of problems in their implementation, Turkey leads the world in work-related accidents, occupational injuries, and deaths. Evaluation of autopsy findings of deaths in fatal occupational accidents occurring in coal mines is quite important in planning to decrease rates of occupational fatalities.

Suicide of elderly persons: towards a framework for prevention.

Suicide is an act of intentionally terminating one's own life. Although suicide rates vary across demographic categories, they have increased by approximately 60% in the last 50 years. Many studies of adolescent suicidal behavior have noted impulsivity to be a common feature in the younger age group, while with older people there is evidence of planning and a strong intent to die. In fact, older people are most successful as an age group with approximately one in four attempts resulting in death. While very comprehensive statistics are available on many aspects of this problem for the Turkish population as a whole, this data does not include physical factors like illnesses, legal domiciles like nursing homes, economic standards and history of attempted suicides. This necessary data would add greatly to the available data and accuracy of research in this area. Whereas Turkish national risk factor procedures are available, precaution procedures and suicide attempt data is not. There is no way of knowing how many deceased had a history of repetitions. It is suggested that this could be attributed to routine failure to observe and mitigate risk factors. The size of this problem is being demonstrated with this presented case report about a planned complex suicide with multiple sharp forced injuries and substance intoxication; a completed suicide that was potentially preventable with timely detection and intervention. In accordance, suicidal risk factors in the old age population, precautions, along with the characteristics of this suicidal case, are evaluated within existing published work.

Postmortem findings after anaphylactic reactions to drugs in Turkey.

AIMS: To determine the frequency of anaphylactic deaths at autopsies performed in Turkey between January 2001 and June 2006 and to review the circumstances of death and autopsy findings. METHODS: The Council of Forensic Medicine database in Istanbul was searched for anaphylactic deaths. Postmortem reports and medical records were reviewed to determine the circumstances of death. Data about basic demographics, medical history, drugs responsible for allergic reactions, and pathologic findings at autopsy were collected. RESULTS: A total of 36 anaphylactic deaths from drugs were identified for the study period. Death was due to antibiotics in 26 cases, analgesics in 7 cases, an intraoperative drug in 1 case, an H2 receptor in 1 case, and intravenous contrast medium in 1 case. Out of 36 cases, 19 were male and 17 female. They were aged between 1 and 74 years with the median age of 26.7 years. Death occurred within 1 hour of the onset of anaphylaxis in 27 cases. Findings at autopsy included nonspecific pulmonary edema and congestion, upper airway edema, cerebral hypoxia, and cutaneous edema. Serum tryptase levels were not measured in all cases. CONCLUSION: Anaphylactic reaction is an uncommon cause of sudden death. In many cases, no specific macroscopic or microscopic findings were detected at autopsy. When serum tryptase levels cannot be determined, in the presence of typical clinical records, eye witness reports and autopsy findings can be useful diagnostic aids.

Handmade guns in Trabzon, Turkey.

A wide variety of handmade firearms have been involved in criminal cases in the city of Trabzon, Turkey. Although they are often very similar to commercially manufactured firearms in terms of design, loading and locking mechanisms, and cocking and firing arrangements, these guns are constructed from cheap materials and are not safe for firing. Handmade firearms manufactured in the Black Sea region of Turkey, particularly in the city of Trabzon, are similar to pistols manufactured by Browning, Luger, Star, Smith and Wesson, Berretta, and MAB. A total of 201 handmade guns referred to the Criminal Police Laboratories for examination from 2003 to 2005 were evaluated with respect to type, number of barrels, size and caliber, rifling, design, mechanism, operability, legality, and similarity to commercial models. We found that most of these handmade guns resembled commercial models in several aspects.

Mole guns in Turkey in 2003-2005.

This study describes the frequency of mole guns in Turkey by examining the cases sent to the Council of Forensic Medicine of Turkey between 2003 and 2005. In total, 11 mole guns were examined. Mole guns are manufactured to be used as a trap against detrimental animals. Although they are not meant to be used as a firearm, they are able to cause death. Mole guns appearing in regular casework were evaluated in terms of type of the gun, number of barrels, size and caliber, rifling, design, mechanism, fitness for use, legality, and geographical distribution. Ninety-one percent of the guns were 12 gauge. Most commonly they originate from Inner Anatolia. Mole guns are typically handmade. Some examples of injuries and deaths caused by mole guns are also offered.

Pen guns in Turkey.

This study describes the frequency and type of pen guns in Turkey by examining the cases sent to the Council of Forensic Medicine of Turkey between 2000 and 2004. In total, 32 cases and 61 pen guns were examined. These guns were evaluated in respect of the type of the gun, size and caliber, rifling, design, mechanism, fitness for use, legality, and geographical distribution. Fifty-nine percent of the guns were 22-gauge. Most commonly, they originate from South Eastern Anatolia. It is suggested that the guns are handmade.

Cardiac myxoma: an unusual cause of sudden death in childhood.

Primary tumors of the heart and pericardium are rare in autopsy series. Considering all age groups, the most common cardiac tumor is the myxoma. They may arise in any of the four chambers or, rarely, on the heart valves. About 90% are located in the atria, with the left-to-right ratio of 4:1. The majority of patients are usually in the age group of 30-60 years. Female predominance has been reported. In this report, we describe a six-year-old boy with right atrial myxoma. A 5x4x3 cm, polypoid, smooth-surfaced, brown-colored tumor was found in the right atrium. It was attached by the stalk to the atrial septum. Microscopically, the tumor had the typical appearance of a myxoma with spindle cells widely spaced by abundant myxoid matrix. The diagnosis was based on histopathological and immunohistochemical findings. Sudden death may occur in patients with atrial myxoma. Death is caused by coronary or systemic embolization or by obstruction of blood flow at the mitral or tricuspid valve.