Fatma Yücel Beyaztaş

Establishment of interdisciplinary child protection teams in Turkey 2002–2006: Identifying the strongest link can make a difference!

OBJECTIVESnThe University of Iowa Child Protection Program collaborated with Turkish professionals to develop a training program on child abuse and neglect during 2002-2006 with the goals of increasing professional awareness and number of multidisciplinary teams (MDT), regional collaborations, and assessed cases. This paper summarizes the 5-year outcome.nnnMETHODSnA team of instructors evaluated needs and held training activities in Turkey annually, and provided consultation when needed. Descriptive analysis was done via Excel and SPSS software.nnnRESULTSnEighteen training activities were held with 3,570 attendees. Over the study period, the number of MDTs increased from 4 to 14. The MDTs got involved in organizing training activities in their institutions and communities. The number of medical curriculum lectures taught by MDTs to medical students/residents, conferences organized by the MDTs, and lectures to non-medical professional audiences increased significantly (R(2)=91.4%, 83.8%, and 69.2%, respectively). The number of abuse cases assessed by the MDTs increased by five times compared to pre-training period.nnnCONCLUSIONSnA culturally competent training program had a positive impact on professional attitudes and behaviors toward recognition and management of child abuse and neglect in Turkey. The need to partner with policy makers to revise current law in favor of a greater human services orientation became clear.nnnPRACTICE IMPLICATIONSnPioneers in developing countries may benefit from collaborating with culturally competent instructors from countries with more developed child protection systems to develop training programs so that professional development can improve recognition and management of child abuse and neglect.

SRY and AZF gene variation in male infertility: a cytogenetic and molecular approach

AimThe aim of this study was to identify the genetic effects of Y chromosome and azoospermia factor (AZF) gene variation in men with infertility and to elucidate the molecular mechanism responsible for the identified point mutation.MethodsChromosome analysis was performed according to standard methods on lymphocyte cultured cells and genomic DNA was extracted from the peripheral blood. Three sets of primers were used encompassing the AZFb, AZFc and SRY14 gene regions. Products were genotyped with single-strand comformational polymorphisim (SSCP) analysis.ResultsThe profiles of the mutated genes were detected in five of three azoospermic and two oligoasthenozoospermic infertile males. The SSCP variability of the AZFc gene was detected in all of the cases, while sex-determining region Y (SRY) gene variation was detected in two of the current cases. Three cases with oligoasthenozoospermia showed mutated SSCP profiles in both their SRY and AZFc gene regions. No AZFb variation was detected in the presented cases.ConclusionThe AZF locus is assumed to contain the genes responsible for spermatogenesis in human. Deletions in these genes are thought to be involved in male infertility associated with azoospermia, oligozoospermia and/or both. AZF microdeletions and variations that are seen in infertile males suggest the need for molecular screening of such cases. Advance studies are also needed to detect of these variations and their relevance to male infertility before using assisted reproduction techniques in such cases.

Evalution of Femicide Cases Committed Between the Years 1996–2005 in Antalya

Criminal death incidence of women varies between developed and developing countries, and it has become a common public problem in almost every country. We do not have any data about femicide cases published in Turkey until today. In our study, we tried to call attention to femicide cases. In our study, we evaluated 141 cases of female homicides with an interval of 10 years between January 1996 and May 2005, retrospectively. Data retrieved were statistically evaluated using chi-square test. Most of the cases were between 21 and 35 years of age. Spouse murders are usually witnessed during the process of divorce. Establishment of institutions which will ensure the security of women during this period is of paramount importance. If we protect women during divorce and separation proceedings, we can prevent femicide cases. We also think that laws may be strengthened for protecting women who are vulnerable at such times.

The Role of Forensic Medicine Durıng Organ Extraction Process on the Judicial Cases

When medico-legal cases occurred brain death are potential donor candidates for organ transplantation, various problems concerning forensic medicine, judicial needs and ethics are confronted. In this paper, the problems encountered during organ extraction process in a judicial death case are reported.In the emergency service, physical examination of a case with attempted suicide to the head by firearm, revealed visible brain parenchyma through a bone defect on the right fronto-temporal region, a wound defect on the left frontal region, multiple cranium fractures and brain hemorrhage. The case immediately underwent operation, the bone defects were closed and the wounds were sutured. Approximately one day after the operation, a diagnosis of brain death was made in the intensive case unit. As the case is a potential donor candidate for organ transplantation, an interview with his family members was made, resulting in agreement for organ donation. When the public prosecutor asked to the Forensic Medicine Department for the acceptability of organ extraction, after the evaluation of judiciary and medical records, we decided that the organ extraction would not preclude the determination of the cause of death in this case. After the approval of the public prosecutor, an external examination was made just before organ extraction. Thereafter, the case immediately underwent operation for organ extraction. The autopsy was performed on the deceased, after the operation. In conclusion, it is obvious that, when medico-legal cases occurred brain death are potential donor candidates for organ transplantation, the collaboration of public prosecutors with forensic medicine experts would be beneficial for both the organ extraction and the judicial processes.Key Words: Judicial case; brain death; organ transplantation; autopsy; forensic medicine.When medico-legal cases occurred brain death are potential donor candidates for organ transplantation, various problems concerning forensic medicine, judicial needs and ethics are confronted. In this paper, the problems encountered during organ extraction process in a judicial death case are reported. In the emergency service, physical examination of a case with attempted suicide to the head by firearm, revealed visible brain parenchyma through a bone defect on the right fronto-temporal region, a wound defect on the left frontal region, multiple cranium fractures and brain hemorrhage. The case immediately underwent operation, the bone defects were closed and the wounds were sutured. Approximately one day after the operation, a diagnosis of brain death was made in the intensive case unit. As the case is a potential donor candidate for organ transplantation, an interview with his family members was made, resulting in agreement for organ donation. When the public prosecutor asked to the Forensic Medicine Department for the acceptability of organ

A Case of Suden Death due to Rupture of Dissecting Aortic Aneursym

Aortic dissection of the aorta is the most common fatal disease requires urgent diagnosis and treatment. The most important step in the diagnosis of aortic dissection which is characterized by sudden onset of chest pain in predatory manner is the clinical suspicion. Especially in patients who present with atypical symptoms is difficult to diagnose. The mortality rate is increasing by 1-2% every hour if left untreated. In this study we presented a fifty-two-year-old female case with atypic symptoms, such as nausea and vomiting, admitted to the emergency room. The patient admitted to the emergency department with only nausea and vomiting complaints and at the end of the examination it was decided that there were no cardiac pathology. Six hours later, the overall situation has deteriorated, and the patient died. In the autopsy we revealed two pericardial rupture in the front pericardial area, also there was 8.5 cm long identified ruptured aortic dissection beginning from the ascending aorta to the root of aorta, which was the cause of death. Delays in diagnosis of aortic dissection can lead to death, also the physicians can face with important legal issues. Early diagnosis of patients, who died suddenly and unexpected, can avoid unnecessary judicial proceedings.

The School Bullying in Sivas-Questionnaire Study -

Violence among bullying, although not a new concept has increased steadily in the last period. This study, 9 and 10 in the grade of 1200 students applied to study through a survey of school violence prevention and inter-flow prevention was intended to put forward proposals for the solution in the center of Sivas. In determining the number of students included in the study stratified sampling method used and the selection of students was done with simple random sampling method. Questionnaire; sociodemographic characteristics and violence against the approach consists of containing the problem. Data SPSS (Ver: 10.0) were evaluated using the khi-square test. 722 of students (60.2%) men, 478 (39.8%) and girls, ages between 14-18 years and mean age 15.75 ± 0.85. Between gender differences in terms of violence and brute force is significant (p

Çocuk İstismarı Tanısında Görüntüleme Yöntemlerinin Değeri

Child abuse and neglect that caused serious injuries and even deaths, being a major public health problem, present medical, legal, and social aspects. Due to difficulties in diagnosing child abuse because of various narrations of the abusive event(s), controversial testimonies, and consultations to different health care centers each time, maintenance of high degree of suspicion has been advocated. In suspected cases of child abuse, and neglect, as emphasized in our case report, use of proper imaging modalities is crucial in order to recognize, and document the signs of abusive act. X-rays of all skeleton to evaluate bony structures, and computerized tomography (CT), magnetic resonance imaging (MRI), and ultrasound to detect visceral organ injuries should be preferred. Nowadays, imaging techniques of nuclear medicine have been introduced for the diagnosis of child abuse. In cases with child abuse accurate diagnosis should be established using objective medical evidence. Failure in diagnosis of child abuse causes the child to reside in the environment of abusive acts which consequently leads to more serious health problems or even death of the child. Misdiagnosis of child abuse will lead to unnecessary and unfair accusation of an innocent individual. In both conditions, legal, and ethical obligations, and responsibilities of the physicians will be interrogated. Establishment of accurate diagnosis using objective evidence in cases with child abuse is important with respect to proper treatment, and from the perspectives of ethical, and legal obligations. In conclusion, every possible medical opportunity should be used in order to diagnose child abuse, and clarify the judicial case. Guidelines and algorithms are available within the frame of good medical practice. The important benefits provided by imaging techniques as documentation, legal protection, and if deemed necessary, reevaluation of relevant information, and findings in cases with child abuse should not be forgotten.Key words: Child abuse, radiology, imaging techniques, virtopsy, forensic medicine.

Av tüfeği ile intihar eden olgudan otopsi sırasında “müdahale” ile silahın çıkarılması

Ozet Atesli silahlarla yaralanma ve olum olgulariyla siklikla karsilasilir. Atis mesafeleri; bitisik, yakin ve uzak atis olarak siniflandirilmaktadir. Bitisik atislarda namlu agzi deriye tamamen temas halinde ise tam bitisik, deri ile namlu arasinda 3cm’ye kadar mesafe varsa bitisige yakin olarak tanimlanir. Bu calismada, av tufegi ile ksifoid alt bolgesine bitisik mesafeden gerceklestirilen atis nedeniyle olen ve hastaneye namlu ucu deri altina girmis durumda getirilen olgudaki atis mesafesine ait bulgular tartisildi. Ayrica olgunun uzerindeki silahin guvenlik tedbirleri alinarak cikarilmasinin onemi vurgulandi. Anahtar sozcukler: Av tufegi, atis mesafesi, bitisik atis, intihar, adli tip Abstract Injury or death cases often occur with firearms. The discharge distances are classified as adjacent, close and distant. In adjacent discharges; it is defined full adjacent if the mouth of gun barrel is completely in contact with skin, it is defined near adjacent distance if there is up to 3 cm. distance between skin and gun barrel. In this study, this case died in adjacent discharge to the bottom of xiphoideus with shotgun and was brought together with shotgun, whose gun barrel settling in the subcutaneous soft tissue, used during the event to the hospital morgue. They were also pointed out the findings concerning the discharge distance on the case and the importance of removal the shotgun in the body of the case by the safety measures. Keywords: Shotgun, discharge distance, adjacent discharge, suicide, forensic medicine