Çağlar Özdemir

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/μl), 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.

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 ≤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.

Homicidal poisoning by injection of methidathion: The first ever report

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.

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.

Deaths During Sport and Recreational Activities in Istanbul

Abstract Sudden deaths can be simply explained as the rapid loss of heart functions of the individuals and recently an increase in sports-related sudden deaths is observed in forensic practice in Turkey. Reported here are six cases of sports-related sudden deaths to emphasize the pathological mechanisms with optimal screening strategies where a detailed postmortem examination were carried out for all. Except for one case, all cases occurred while playing soccer where coronary artery disease was established as the cause of death in four cases and as arrthymogenic right ventricular dysplasia in the other case. Toxicological analyses revealed 60 ng/ml benzodiazepine concentrations in one case. Sports activities should be undertaken cautiously, particularly in the presence of risk factors. Beside professionals, screening of the recreational athletes is also important. By this way, early diagnosis of most cardiovascular abnormalities can be provided.

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.

Assessment of Sociodemographic Data, Self Mutilation, Suicide Attempt and Psychiatric Disorders in Children and Adolescents who Abused Sexually

Objective: It is now generally known that undergoing a sexual abuse may lead to self-destruction, suicide, post-traumatic stress disorder (PTSD), depression and dissociative disorders. Our study aims at determining the rate of self-destruction and suicide among children who had experienced sexual abuse and determining the rates of depression, PTSD and dissociative disorders and their relationships each other.Materials and Methods: The children aged 0-18 who had undergone sexual abuse and sent to Prevention of Child Abuse, Application and Research Center at Erciyes University between 01.01.2011-31.12.2011 to have a judicial report were analyzed retrospectively with regard to their age, sex, frequency of abuse, psychiatric diagnosis according to DSM IV-TR and leaving home or suicide behaviors. The children were made to complete Depression Scale for Children (CDI), Child Post-Traumatic Stress Reaction Index (RPTS-CS) and Dissociation Questionnaire (DIS-Q).Results: 556 cases were included in our research. There was suicide attempt in 24(4,3%) of them, 15 (2,7%) had the behavior of self-mutilation, 6 (1,1%) of them had the idea to commit suicide. In the scales, RPTS-CS was found significant for 33 (5,6%) cases. The score of the DIS-Q was found significant for 8 (1,6%) cases (>2,5). The mean score of the CDI was found significant for 42 (7,3%) cases (>19).Conclusion: It is not only important to follow up closely the children who had experienced sexual abuse and to protect their mental health, but also it is very important to keep them away from being a victim again and prevent to commit suicide and self-mutilation behaviors.

Aspiration Deaths Among Adults in Istanbul

Massive aspiration of food is rare, but most common in people under the influence of alcohol or a drug and comatose patients who have impaired functioning of the central nervous system. The finding of small amounts of food material in the airway at autopsy does not indicate the true vital aspiration because of agonal or even early post-mortem overspills. Occlusion of the small airways, mainly the membranous and respiratory bronchioles, partial or total filling of bronchiolar lumen and the alveolar spaces with food or gastric content were typical morphologic findings. In our 10 year retrospective study we presented the data of 21 male and 4 female cases with a final diagnosis of fatal aspiration in age from 23 to 78 years (45.43±14.61) from the records of Morgue Specialization Department of the Council of Forensic Medicine. 13 cases found death at the scene without an eyewitness. All deaths were accidental in manner except one homicide. Toxicological analysis revealed blood alcohol concentration levels between 161 and 339 mg/dL in 7 cases. Morphine metabolites, benzodiazepine and barbituric acid derivatives, toluene and acetone were detected in 5 subjects. Aspirated materials were food in 14 cases, chewing gum in 3 cases, gastric content in 7 cases and a fabric gag in one case. The history, other evidence of external vomit on the clothing or immediate surroundings and toxicological analysis are by no means as significant as autopsy findings especially in cases of aspiration. Key words : adult; aspiration; death; autopsy