Dengue is the fastest spreading arboviral infection in the world. It is responsible for about 50 to 200 million infections annually. Turkey is accepted in the World Health Organization European region and dengue is now endemic in all World Health Organization regions except for the European region, but people can travel anywhere in the world and they can catch a disease easily. Approximately 2.5 billion people live in dengue endemic countries; therefore, it may be endemic in Europe as well in the near future. It might be seen with increasing frequency in forensic mortuaries soon. In such a situation, the autopsy staff have to keep dengue virus infections in mind to protect themselves from contamination and to detect the cause of death. A case of a 65-year old Thailand citizen male who died in Turkey is presented. He had skin rashes all over the body. His internal examination revealed, 1900 ml, 1700 ml and 80 ml sero-hemorrhagic fluid in the right chest, left chest and pericardial cavities respectively. The sectional cuts of the lungs showed hemorrhagic fluid leakage. Ecchymosis due to intubation was found in the upper tracheal region. Mesocolon transversum showed hemorrhage as well. Blood test results showed Dengue Virus Immunoglobulin G (IFA) and Immunoglobulin M (IFA) positive, Japanese encephalitis virus Immunoglobulin M (IFA) negative and Immunoglobulin G (IFA) positive.
Colchicine is a drug which has a very narrow therapeutic range. This drug has been commonly used for Familial Mediterranean Fever (FMF), Behçet's disease, gout arthritis and acute pseudo gout attacks. In this study, the investigation reports and autopsy reports written by the Council of Forensic Medicine of Ankara between the years 2010-2014 were retrospectively analyzed to find out presence in the cases related to colchicine. Six cases were identified as colchicine intoxication, while three of them used colchicine for medical purpose. In four cases, colchicine was found to have been used for suicidal purpose. Among these four cases, two used colchicine for treatment. In all of our cases, colchicine was detected in bile specimen. Alveolar pulmonary edema and petechial hemorrhage were observed in the lung in all cases. Colchicine was detected in blood in four of the cases. In two cases, the concentration was found to be in therapeutic ranges (0,012 mg/L and 0,018 mg/L), while the other two, in lethal levels (0.099 mg/L and 0,264 mg/L). The most frequent histopathological finding is alveolar pulmonary edema in colchicine intoxication autopsies. Colchicine is widely used alkaloid drugs with narrow therapeutic ranges. More than 0.8 mg / kg in the acute high dose has usually fatal effects. The deaths resulted from colchicine intoxication are mainly suicide-oriented. Similar to other suicides with medicines, they are common among women. In our cases, colchicine was used for intention of suicide in four incidents (66, 66%).
Cinsel saldırı veya cinsel istismara bağlı ortaya çıkan suç kavramı, insan ırkının karşılaştığı en ağır suç şekillerinden birisi olarak kabul edilmektedir. Bu çalışmada, çevre il ve ilçelerden ilimize gönderilen adli boyutlu cinsel suç mağduru olguların başta so syodemografik dağılım özelliklerinin belirlenebilmesinin yanı sıra genital muayene ve adli psikiyatrik değerlendirme sürecinde yaşanan sorunların ortaya konulabilmesi amaçlanmıştır. Bu amaçla, 1 Ocak 2010 ile 31 Aralık 2011 tarihleri arasında, Diyarbakır Adli Tıp Şube Müdürlüğünde canlı olguların muayenesi sonucunda düzenlenmiş 16.953 adli rapor ve buna ait adli tahkikat evrakı (ulaşılabilen olgularda) geriye dönük olarak incelendi. Olgular; çocukluk ve erişkin yaş grupları olarak sınıflandırıldı. Bulgular: Raporların 165'i (%0,97) cinsel suç mağduru adli olgulara ait olup, çalışmaya dahil edildi. Olguların 121'i (%73,3) kadm, 44'ü (%26,7) erkek cinsiyette olup, en küçüğünün 3, en büyüğünün 57 yaşında olduğu saptandı. Ortalama yaş 14,98 ± 7,22 bulundu. Oluların yaş ortalaması; erkek (12,95 ± 8,36) cinsiyetinde, kadın (15,72 ± 6,65) cinsiyetine kıyasla daha düşük değerde bulundu (p:0,029). Olguların 116’sı (%70,3) olaydan 72 saat sonra, 49'u (%29,7) ise 72 saatten önceki bir zaman dilimi içerisinde adli muayeneye gönderilmişti. Genital muayenesi çıplak gözle yapılan olguların, sadece 13'ünde (%9,2) akut dönem, 29'unda (%20,6) kronik dönem genital bulgu saptandı. Adli psikiyatrik yönden değerlendirilen 77 olgu (%82,8) 18 yaşını tamamlamamış olup, 16 olgunun (% 17,2) 19 yaş üzerinde olduğu hesaplandı. Şüpheli konumundaki kişilerden 76'smın (%46) tanıdık birisi, 31'inin (% 18,8) ise aile içi ya da yakın akrabadan olduğu görüldü. Cinsel suç mağduru olguların, gerek genital, gerekse psikiyatrik yönden adli tıbbi değerlendirilme sürecinin daha dinamik, yeterince ayrıntılı ve disipliner bir yaklaşım gerektirdiğini düşünmekteyiz. Süreçteki güncel sorunlarımızın, klinik adli tıp alanında ülkemizde mevcut farkındalığın daha da geliştirilip, derinleştirilmesi ile azaltılabileceği inancındayız.Anahtar kelimeler: Cinsel istismar, cinsel saldırı, cinsel suç, genital muayene, klinik adli tıp
Aim: Abusive head trauma (AHT) is the most common cause of death as the result of child abuse. A task force is planned to provide training on AHT to professionals in different disciplines on clinical presentation, diagnostic workup, and organization of multidisciplinary evaluation at the hospital and community levels. This study reports on the preliminary findings of the pre-intervention phase of a larger study. Materials and Methods:This is a descriptive, retrospective study exploring the rates of documentation of relevant data in charts, including risk factors for abuse, family demographics, completeness of diagnostic workup, and case finding.Results: Overall, 345 cases were found in hospital databases that were eligible for the retrospective study from 10 participating hospitals. In total, 305 cases (88.4%) were younger than 2 years of age. The most common documented risk factors were low parental education level in 82 families (23.8%), more than three children under 7 years of age in 76 families (22.0%), and bad child temper in 16 families (4.6%), among others. The rate of complete diagnostic workup in hospitals with a multidisciplinary team (MDT) (25.7%) was statistically significantly higher than in hospitals without an MDT (2.9%) (p=0.001). Etiology was identified as inflicted in 78 cases (22.6%), possibly inflicted in 24 (7.0%), undetermined in 79 (22.9%), and accidental in 164 (47.5%) by the researchers, compared to only three cases (0.8%) diagnosed as inflicted by the treating physicians (p<0.0001). In two of the three cases, the perpetrator was convicted; in one, the prosecutor closed the case without a trial on the basis of "no confession" despite the death of the child and medical evidence. Conclusion:Clinicians' knowledge of the diagnosis of AHT should be increased to improve case finding, which will allow determination of more accurate incidence/prevalence. This can be accomplished via the establishment of an MDT in teaching hospitals as well as staff training on how to recognize suspicious cases, how to utilize MDT services, and how to report and manage cases on a community level multidisciplinary basis. (Eurasian J Emerg Med 2016; 15: 24-9)
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