Safa Çelik

The role of reactive oxygen species and oxidative stress in carbon monoxide toxicity: An in-depth analysis

Abstract The underlying mechanism of the central nervous system (CNS) injury after acute carbon monoxide (CO) poisoning is interlaced with multiple factors including apoptosis, abnormal inflammatory responses, hypoxia, and ischemia/reperfusion-like problems. One of the current hypotheses with regard to the molecular mechanism of CO poisoning is the oxidative injury induced by reactive oxygen species, free radicals, and neuronal nitric oxide. Up to now, the relevant mechanism of this injury remains poorly understood. The weakening of antioxidant systems and the increase of lipid peroxidation in the CNS have been implicated, however. Accordingly, in this review, we will highlight the relationship between oxidative stress and CO poisoning from the perspective of forensic toxicology and molecular toxicology.

Carbon monoxide-related deaths in Ankara between 2001 and 2011.

Abstract Objective: The aim of the present study was to describe the epidemiology of unintentional carbon monoxide (CO) poisonings (between 2001 and 2011) in Ankara, Turkey. Methods: Data were collected from the records of Ankara Branch of Council of Forensic Medicine and the licensed official institutes and hospitals for medico-legal autopsies. A total of 10 720 medico-legal autopsy reports were obtained and reviewed by the authors. Results: Among 622 fatal poisoning cases during the period, 380 deaths were due to unintentional CO poisoning. The mean CO saturation of the groups was 55.4 ± 13.4 (% saturation). The minimum and maximum levels of CO in blood was 3.6 and 86.5 (% saturation), respectively. Of all the fatal poisonings determined by Ankara Branch of Council of Forensic Medicine, CO poisoning was the most common mortality cause (61.1%). Among the cases, 301 (79.2%) were found to be death in their houses, 43 (11.3%) in hospitals, 15 (3.9%) in their workplaces and 11 (2.9%) in some public places such as park and garden. Most of the cases were from the capital city of Turkey, Ankara (n = 203, 53.4%). When we compared the cities according to their population, it was realized that the highest death rate due to CO poisoning was in Kirikkale (12.3/100 000), followed by Karabuk (8.3/100 000), Cankiri (7.8/100 000) and Kirsehir (5.0/100 000). Discussion and conclusion: These findings add new data to the pool of knowledge in terms of the need of safety, proper heating system instructions and more education on CO poisoning in Turkey.

Head Trauma-Related Deaths Among Preschool Children in Istanbul, Turkey.

ObjectiveHead trauma takes place among the leading causes of mortality in children. This study aimed to determine the risk factors of head trauma–related deaths among children younger than 5 years in Istanbul, Turkey. Material and MethodsThis study was conducted using the records of the Morgue Department of the Council of Forensic Medicine in Istanbul. The records of cases autopsied between 2008 and 2012 were retrospectively investigated. Of all preschool children deaths, 203 head trauma–related deaths were included in the study. ResultsOf all, 117 (57.6%) were males and 86 (42.4%) were females. Most cases (107, 52.70%) were between the ages of 12 and 36 months. The most common mechanism of injury was “fall from a height” with 97 cases (47.78%), followed by “traffic accidents” (67, 33%) and “hit by falling objects” (19, 9.35%). Skull fracture was detected in 176 cases (86.69%), of which 81 (46.02%) were characterized with linear fracture. Furthermore, skull fracture was accompanied by 1 or more skeletal bone fracture in 64 cases. Retinal hemorrhage was investigated in 5 cases of suspected physical abuse and only 2 of them showed retinal hemorrhage findings. ConclusionsObtained findings revealed that fall from a height was the leading cause of death among unnatural deaths in children younger than 5 years. Domestic accident was found to be a significant risk factor in childhood deaths. Traffic fatalities were among leading causes of death in childhood in our country, likewise in all around the world. Children were found to be more vulnerable to traumas when they start to move around with incomplete motor skills. Therefore, education of parents in terms of child supervision and installing safety precautions toward preschool children will be helpful in preventing such injuries. On the contrary to some findings in the literature, more severe lesions were also prominent even in case of short-range falls from a height.

A Study of Palmar Dermatoglyphic Pattern in Patients of Epilepsy

Dermatoglyphic is a scientific study of epidermal ridges and their configuration on the volar skin. Dermatoglyphic variations in epilepsy cases may be suggestive of an external imprint of genetic variation. The present study has been undertaken to find out the existence of any correlation between dermatoglyphics and idiopathic epilepsy. The material consisted of 100 patients (75 males and 25 females) and 100 controls (50 males and 50 females). Dermatoglyphics were obtained by printing method. Parameters studied were a-b, a-d ridge count, palmar angle - ‘atd’ angle, and total finger ridge count (TFRC). There is no significant difference in ‘atd’ angle in epileptic patients as compared to control group. Difference in the ‘atd’ angle between patients and controls was also not found to be significant. In this study a statistically (P value<0.01) reduced a-b ridge count is observed in patients as compared to control. Similarly total finger ridge count is reduced in epileptic patients as compared to controls. Significant differences have not been observed from these dermatoglyphics features for concluding the genetic predisposition of epilepsy.

New postmortem diagnostic biomarker for myocardial infarction: ischemia modified albumin

Abstract We investigated the change of IMA levels as biochemical markers, especially in the postmortem diagnosis of early MI. Also, histological investigation has been performed in cases of cardiac deaths and in non-cardiac cases. To the best of our knowledge, this is the first study to investigate the levels of IMA in the postmortem diagnosis of early MI. A series of medicolegal autopsy cases (n=139; 6–24 h postmortem, with a median of 16 h) were examined at our institute. The cases comprised 112 males and 27 females, between 16 and 89 years of age. Subjects were divided into six groups depending upon their final cause of death according to medical data, autopsy reports, biochemical and histological findings. The groups were as follows: cardiovascular disease, blunt trauma, asphyxia, pathological cerebral hemorrhage, bleeding due to a sharp object and gunshot injuries, and poisoning. IMA levels in the cardiovascular disease group were found to be significantly higher than the blunt trauma, asphyxia, pathological cerebral hemorrhage, and bleeding groups (p < 0.05). It is known that after MI, if less than 4–6 hours pass before death, the histopathology of the heart does not reveal significant findings. Our results demonstrated that IMA might be a valid biochemical marker, especially in the postmortem diagnosis of early MI.

Resuscitation artefact confirmed by postmortem angiography. Case report

Postmortem resuscitation artefacts are often encountered in the autopsy practice. During chest compression that is an essential component of resuscitation, thorax injuries including rib and sternum fractures and anterior mediastinal bleeding are often observed. Massive bleeding that develops as a result of a hepatic rupture is a rare complication of resuscitation. A 23 year-old woman attempted suicide by taking drug overdose in a hospital toilet. During autopsy we found fractures in the 1-6th left ribs and 3rd right rib in the midclavicular line, hemoperitoneum (1300 ml) and a rupture of 0.5 cm in depth and 8 cm in length in the left posterior lobe of the liver with an a hemorrhagic area of 4x2 cm in the left lobe neighbouring the diaphragm. A postmortem angiography found intraabdominal vessels to be intact and identified the source of the bleeding as being the liver rupture. The toxicological analysis identified drugs used in resuscitation and high levels of sotalol (4090 ng/mL) and flecainide (4350 ng/mL) in the blood. The underlying cause of death was considered to be drug intoxication. Liver rupture and bleeding caused by it is rarely seen as a complication of resuscitation. We consider that regional angiography will highly contribute to autopsies in which the source of bleeding is investigated, since it is easily implemented, inexpensive and practical.

Incidentally Detected Lithopedion in an 87-Year-Old Lady: An Autopsy Case Report.

A lithopedion is a rare complication of pregnancy that occurs when a fetus in an intraabdominal location dies, and it is too large to be reabsorbed by the body. The case was an 87-year-old woman, and she was transferred to the morgue department in April 2014 to determine the cause of death. During autopsy, an intraabdominally located calcified dead fetus and a 12-cm diameter calcified cyst in the right ovary were incidentally detected. It was aged 25 to 29 weeks (according to femur and humerus measurements) with a size of 12.5 × 8 × 5 cm and a weight of 227 g. According to investigation reports, her husband died in 1990, and she had 3 deliveries, the most recent of which was in 1946. Because the menopause age of the case was not exactly known, the retention time of the lithopedion was supposed to be 24 to 68 years according to the date of the most recent pregnancy and the date of her spouses death. It is the first case that has been incidentally detected and identified during an autopsy in Turkey and also one of the oldest cases in the literature.

Adli Otopsilerde Kemik İliğinde Yaşa Bağlı Sellülarite Değişiklikleri

SUMMARY Knowledge of the normal variations with aging of the bone marrow cellularity is essential for the interpretation of bone marrow features. We performed a histological study using biopsy samples of bone marrow obtained from medicolegal autopsies ranging from first to eighth decades. As a matter of increasing age, an increasing fat tissue fraction was observed.