Nursel Gamsız Bilgin

Demographical, aetiological and clinical characteristics of poisonings in Mersin, Turkey

Background: As acute poisoning continues to be an important public health problem, and represents a frequent cause of admission in emergency departments, there is a constant need to have up to date information about it. The aim of this retrospective study was to evaluate the demographical, aetiological and clinical characteristics of acute poisonings who were admitted to a university hospital in the south part of Turkey. Methods: The data of 195 acute poisoning patients who were admitted to the Emergency Department of Mersin University were retrospectively studied. Results: Most poisonings occurred in the age range 0–6 years (57.5%) for children and 17–25 year (46.7%) for adults. The overall female to male ratio was 1.26. Drugs were the most common cause of poisonings (55.4%). Among the drug poisonings, psychotropics (41.7%) were the most frequent agent, followed by analgesics (20.4%). 67.7% of the cases presented to the emergency department within 3 hours of poisoning and the procedures for elimination of poison were performed in most of them. The clinical status of the patients on arrival was generally good. 69.2% of the patients were hospitalized. The mean duration of hospitalization was 2.49±2.8 days. 41.8% of the suicidal cases had a history of psychiatric disorders; 92.8% of the patients were discharged home after toxicological treatment; 2.6% of the cases died. Conclusion: Further studies are necessary to collect more data and these data will be helpful not only for determining risk factors of acute poisonings but also for developing education and prevention programmes.

The usefulness of trauma scores in determining the life threatening condition of trauma victims for writing medical-legal reports

Objectives: In the Turkish legal system the severity of the victim’s injury determines the severity of the criminal penalty, and the life threatening condition stated in the medical-legal report is one of the main determinants for injury severity. The aim of this study is to investigate the effectiveness and usefulness of the trauma scores in determining the life threatening condition of trauma victims from the forensic aspect in order to write accurate medical-legal reports. Methods: Data of 296 forensic cases with blunt and penetrating trauma were obtained. The life threatening condition of patients stated in the medical-legal reports according to the criteria based on traditional forensic opinion were examined. For each case, Injury Severity Score (ISS), Revised Trauma Score (RTS), and Trauma and Injury Severity Score (TRISS) were calculated. The ROC curve analysis was used to investigate the success of the trauma scores in distinguishing patients with/without life threatening conditions. Logistic regression analysis was performed to measure the association between trauma scores and life threatening conditions. Results: The relations between all scores and groups (with and without life threatening risk) were found statistically significant. ISS was the most successful method in distinguishing traumatised patients both in a life threatening or non life threatening condition. Conclusions: Trauma scores can be used for making more objective, standardised, and accurate judgement on whether the injury was a life threatening one or not. These advantages of using trauma scores in such situations will also be helpful for the conclusion of the lawsuits shortly, but further studies are needed to confirm these findings.

Evaluation of the effects of disabilities due to traffic accidents on the quality of life using SF-36 health survey

OBJECTIVE The purpose of this study was to investigate the impact of disabilities caused by traffic accidents on quality of life using the SF-36 health survey. METHODS The study group included 168 patients (30 females and 138 males) injured in traffic accidents referred to the Department of Forensic Medicine to obtain health reports indicating their degree of disability. One hundred twenty-two cases comprised the control group. The degree of disability for the injured body parts was determined based on the related section of the Disability Regulation for patients regarded as recovered based on examination and consultation. Quality of life was calculated using the SF-36 survey. Patients were additionally evaluated using the physical and mental component summary PCS/MCS) scores. RESULTS A statistically significant difference was observed between the groups in terms of the injured body parts. The femur, tibia and/or fibula, vertebrae, radius and/or ulna and the humerus were the most frequently fractured bones. The degree of disability in the patient group was 19.22 ± 17.73. Together with the scores of the eight subscales of SF-36, the PCS and MCS score in the patient group were significantly lower when compared to the control group (p<0.05). CONCLUSION An update is required in the Disability Regulation, including the addition of items on deterioration in the quality of life and pain, and the use of the SF-36 scale may be beneficial in this regard.

Evaluation of poisoning deaths in the Cukurova Region, Turkey, 2007-2011

Complications of substances detected in poisoning deaths are important in order to observe changes in poisoning patterns and to monitor effects of preventive work. The aim of the present study was to describe the characteristics of substances investigated and detected in poisoning deaths by Adana Group Authority of the Council of Forensic Medicine, Department of Forensic Chemistry, Cukurova, Turkey, between 2007 and 2011 retrospectively. A total of 7681 examinations were performed, of which, 7% (n = 564) determined positive for at least one compound investigated. Ages of the cases ranged from 1 to 97 years (mean ± SD: 36.10 ±19.16). Carbon monoxide (CO) poisonings were found most frequently with an incidence of 27.0%, followed by prescription medications with 25.0%. Illegal drug poisonings were present in 20.0% of blood and urine samples analyzed. Pesticides, mostly endosulfan, were found in 13.0% of the 564 cases investigated. In the blood samples analyzed, methyl and ethyl alcohol were detected in 14.0% and volatile substances in 1.0%. Overall, this study has managed to contribute substantial additional information regarding the epidemiology of poisoning in Cukurova region, Southern Turkey. The results confirm other epidemiological data that indicate CO as the major cause of poisoning deaths in Turkey.

Beyin Ölümü Gerçekleşmiş Adli Olgularda Organ Transplantasyonunda Adli Tıp Uzmanlarının İnisiyatifi

We aimed to discuss organ transplantation of brain death legal cases due to high benefits of patient with forensic and legal points of view. Case: 16 years old, entubated male patient who was intoxicated from inhalation of bottled gas with unconsciousness, bilateral fix-dilated pupils and GCS:3 was admitted to Mersin University Faculty of Medicine and hospitalized in intensive care unit. Subarachnoidal hemarrogie and brain edema were detected in Computerized Cerebral Tomograpy and given medical teraphy. But there was no answer to the treathment and the family was given consent of organ transplantation. Brain death was occured in 04.18.2007 and the case is consulted with our Department of Forensic Medicine. After discussing the case with public attorney we concluded that the organs which was planned to be transplantated had no influence on cause of death and the medicolegal autopsy can performed after transplantation operation. The public attorney approved the procedure and the medicolegal autopsy was performed after operation. There are serious problems in organ transplantation for legal cases. Sheduling of legal notification and pastmortem examination is not clear in such cases. It’s not obvious that these procedures must before or after transplantation operation. The article 11 of the law code numbered 2238 describes the priority of urgent transplantation for patient survive due to the principle of high benefits of the patient. The legal cases who becomes doneur for organ tranplantation must be consulted and evaluated with Forensic Medicine Departments.Key words: Brain death, organ transplantation, legal case

Hekimlerin Defin Ruhsatı Düzenlerken Karşılaştıkları Sorunlar Bir Anket Çalışması

Olum raporlari ve defin ruhsatlarinda yer alan bilgiler saglik istatistikleri icin veri tabani olarak kullanilmaktadir. Bu calismada hekimlerin defin ruhsati duzenlerken karsilastiklari sorunlari belirlemek, cozum onerileri getirmek, mezuniyet oncesi ve sonrasi egitim programlari icinde konunun onemini vurgulamak amaclandi. Mersin Universitesi Tip Fakultesi Hastanesi’nde calisan hekimlerin ondort acik uclu sorudan olusan anketi cevaplandirmalari istendi. Anket verilen 200 hekimin %87’si (n= 174) anketi cevaplandirdi. Anketi cevaplayanlarin %89.1’i (n=155) gomme izni verilmesi icin defin ruhsati duzenlenmesi gerektigini belirtti. %70.7’si defin ruhsatinin olumu tespit eden hekim tarafindan duzenlenmesi gerektigini dusunmekteydi, %71.84’u defin ruhsati duzenlerken sikintilari oldugunu belirtti. Hekimlerin %51.1’i olum sebebi olarak, olume neden olan asil taninin yazilmasi gerektigini dusunmekteydi, %86.8’i Uluslararasi Hastalik Siniflama (UHS) listesini kullanmiyordu. Hekimlerin %93.1’i adli tip egitimi almisti. Saglikta dogru istatistiksel veriler elde etmek icin defin ruhsati duzenlerken Uluslararasi Hastalik Siniflama Listesi’ne gore olume neden olan asil taninin yazilmasinin ve mezuniyet oncesi ve sonrasi egitim programlarinda olum sonrasi islemlere yonelik konularin da yer almasinin onemli oldugu sonucuna varildi.Anahtar kelimeler: Defin ruhsati, adli tip egitimi, saglik istatistikleri