ADLİ TIP BÜLTENİ

Number 20(1), 2015

1
Editorial
Authors: halis Dokgoz

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The Bulletin of Legal Medicine has been continuously published with the double-blind referee system since 1996. We are celebrating our 20th year anniversary together with the issue you are holding. The Bulletin of Legal Medicine, being monitored by international scientific indexes, has gained an international journal quality, within a short time. We hope to give the good news of the new scientific indexes in near future. From the very next issue every paper will have DOI (Digital Object Identifier) number. DOI is a character string that uniquely identify a digital object that facilitate accession to it, and accepted papers that given DOI number will accessed as article in press. We would like to underline that from the very first issue of 2015 the journal will be published with more original, case reports, and review papers. The journal’s editorial board, national and international advisory board have been updated and activated in a short period. The Bulletin of Legal Medicine experience innovation, starting from 2015 issues, without compromising its scientific way, and without departing from tradition. We are going to change the journal’s cover and page design in the new issue. We present the journal with both its scientific content and design. We would like to thank distinguished forensic scientists who contribute our journal as authors and reviewers. Hope to meet you in higher quality issues with your increasing criticism and interest... Sincerely...

1
Letters to the Editor
Authors: M. hakan Özdemir

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Derginizde Hülya Öztürk, Cezmi Karasu tarafından kaleme alınan “Mekteb-i Tıbbiye-i Adliye-i Şahane'nin kurucusu Charles Ambroisse Bernard'ın eserleri ve Osmanlı'ya etkileri üzerine bir değerlendirme” başlıklı yazıyı büyük bir keyifle okudum. Dr. Charles Ambroisse Bernard'ın 6 yıl gibi bir sürede yaptıkları karşısında şaşırmamak, ona saygı duymamak elde değil. Yazıyı okuduğumda ilk aklıma gelen ve yıllardır düşündüğüm “Mekteb'i Tıbbiye'i Adliye'i Şahane” acaba nasıl bir mekandı? sorusu aklıma yine takıldı. 1839 tarihinde Linardi Sokağında (Bugünkü Eski Çiçekçi sokağı) açılan Mekteb-i Tıbbiye-i Adliye-i Şahane, maalesef 11 Ekim 1848 günü çıkan bir yangın sonucu yok olmuştur. Merakımı özel bir koleksiyonda bulunup yayınlanan Mekteb-i Tıbbiye-i Adliye-i Şahane'nin resmi ve verdiği diplomayı görünce giderdim. Bu yazıyı okuyunca resimleri dergi okuyucuları ile paylaşmak istedim. Bu yazının dergide yayınlanmasını sağlayan editöryal kurul üyelerinin ve kaleme alan Hülya Öztürk, Cezmi Karasu'ya bir kez daha teşekkürler.

1-6
Special Education Right and The Disability Features of Psychiatric Disabled Children Who at Risk for Child Abuse
Authors: Ahsen Kaya, Orhan Meral, Hülya Güler, Ekin Özgür Aktaş

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Aim: Disabled children are a risky group for child abuse, while they mostly cannot predict the outcomes of the results of their behaviors and also they are insufficient in directing their behaviors, and cannot sift and know right from wrong. In this study, it was aimed to draw attention to the causes of disability and the disability ratios of the children with psychiatric disabilities who are at risk for child abuse. Materials and methods: With this regard, 2839 reports belong to children under 18, those were prepared between 01 January, 2011 and 30 June, 2013 by Disabilities Health Board of the Hospital, were examined and 2103 of them included children with psychiatric disabilities were analyzed retrospectively. Data were evaluated with SPSS (version 18.0) statistical program. Results: 1432 (68.1%) of the subjects were male, 671 (31.9%) were female, and the mean age was 6.7±4.3. The most common diagnosis for the subjects (n=911) was mild mental retardation. The first mostly stated cause of application in the reports was to have special education (95.3%). Conclusion: Special education right, which is one of the most important social rights for children with psychiatric disabilities, is offered free of charge with his/her disability report. The state providing this right free of charge is an important step towards the protection of the children from abuse. Moreover, special education right being ranked as the first among the reasons for application to Disability Report shows that families are contributing to the protect their children from abuse -intentionally or unintentionally-. Keywords: Child, disability, neglect, abuse, special education, mental retardation.

7-13
Importance of Biochemical Analysis of Postmortem Intraocular Fluid Regarding to Time and Cause of Death
Authors: Muharrem Teyin, Yasemin Balcı, Sema Uslu, Kenan Karbeyaz, Kazım Özdamar

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Aim: The time of the death has been one of the questions frequently inquired by courts to the forensic medicine experts. In this study, it is aimed to investigate the relationship between cause of death and postmortem interval with can easily be detected in postmortem intraocular fluid samples and routine biochemical tests. Materials and Methods: A total of 100 cases autopsied at the Eskisehir Osmangazi University whose exact times of the death were known has been included in the study. Cases were divided into 3 groups as 10 hour and below postmortem interval, 10-20 hours and upon 20 hours. The cause of death was divided into two groups as traumatic and non-traumatic. Results: In this study the significant relationship was determined between potassium and uric acid levels and postmortem interval. It is determined that the mean level of Sodium and Chlorine sow difference in patients died because of traumatic and non-traumatic reasons. Key words: Postmortem biochemistry, Vitreous humor, Time since death, Cause of death.

14-20
Medicolegal Approach to Post-Injection Neuropathy Cases
Authors: Volkan Ünal, Esra Özgün Ünal, Abdurrahman Emir, Yusuf Özer, Sadi Çağdır

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Objective: Redundant injections, false administration techniques and the injections applied by unqualified personnel can cause injection neuropathy. The purpose of this study is to characterize the post-injection neuropathy cases, to identify the active ingredients used for injection and, knowing the fact that the a number of sciatic nerve injuries are secondary to medical intervention, to discuss if post-injection neuropathy can be considered as malpractice. Materials and methods: A retrospective study was conducted based on the analysis of 121 cases which were sent to the Council of Forensic Medicine from the courts with a post-injection neuropathy claim in 2008-2010. All patients were evaluated for the agent injected, indication for injection and person who injected the drug and the severity of neurodeficit. Results: It was found that 107 (88.4 %) of 121 cases sent to Council of Forensic medicine were male, 14 (11.6%) of them were female. Majority (n=93, %76.8) of the injections were applied by a nurse or health officer. Diclofenac sodium is the major injection agent. While 47 (38.8%) of the cases had only diclofenac sodium injection, with combined treatments 58 of the cases had diclofenac sodium injected. On the other hand, 10 (8.3%) of the cases were injected with analgesics, whose active ingredients couldn’t be determined from the medical records. In one case the doctor and the nurse was found responsible for the post-injection neuropathy. Conclusions: Animal testing shows that the injection neuropathy can happen because of the toxic effects of the injection agent. Even if the injection done properly, there may happen various neurological sequels, but being careful while choosing injection agent and educating medical staff should lower the rates of unwanted complications. Keywords: Injection Neuropathy, Intramuscular Injection, Malpractice

21-26
Investigation of Narcotic Substance Use Among Individuals Who were under Probation in The City of Antalya
Authors: Burak Kulaksızoğlu, Sibel Kulaksızoğlu, Hamit Yaşar Ellidağ, Necat Yılmaz, Selen Bozkurt

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Objective: The aim of this study is to retrospectively analyze the substance use specifications and sociodemographic data of individuals who were brought to the Clinic of Psychiatry of the Antalya Education and Research Hospital. Methods: The recorded files of the individuals in the archives of the probation unit who were referred to our hospital by the Branch Office of the Probation and Help Center (BOPHC) were retrospectively analyzed and the data obtained were recorded in the data form. Results: When the substance use among the individuals presenting to the Antalya Education and Research Hospital in between 2012 and 2014 were analyzed, substance use had increased 82% and 76% between the years 2013 and 2014, respectively. Ninety-seven percent of substance users were male with a 118% and 102% increase in marijuana use in 2013 and 2014, respectively. Morphine use increased by 43% and 42%, respectively. The frequency of substance use in females increased by 52% and 131%, respectively. The mean age of the substance users has decreased in the last three years. Fifty eight percent of the substance users in the year 2014 were single, 74% of them graduated from the secondary school, and 65% were self-employed. Conclusion: Narcotic substance use increased markedly in the last three years in the Antalya region, according to the data obtained in this study. The rate of substance use was higher when compared to the other cities. The most commonly used substance was marijuana. Substance use increased among women. The mean age of the substance users decrease. Only 14% of the substance users desired to be treated. Key Words: drug addiction, probation, Antalya, cannabis

27-33
Psychiatric Disorders and Sociodemographic Characteristics of Sexually Abused Children and Adolescents
Authors: Uğur Koçak, Ahmet Hamdi Alpaslan

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Aim: In this study, it was aimed to determine socio-demographic characteristics and psychiatric diagnoses of sexually abused children and adolescents. Materials and Methods: The data of the sexually abused children and adolescents (n=158) who were referred to the Department of Child and Adolescent Psychiatry for a forensic report between October 2012 and May 2014 were examined retrospectively. The socio-demographic characteristics, psychiatric diagnoses, mental statuses, juridical requests, and abuser-victim relationships of the forensic cases were collected from the outpatient medical records. The cases were diagnosed using DSM-IV TR criteria. Results: Of the 158 cases included in the study, 17.7% (n=28) was male and 82.3% (n=130) was female. Their age varied between 6 and 18 years, with a mean of 13.94 (sd±2.56) years. Vaginal penetration was the most reported type of abuse with a rate of 32.5%, followed by sexual touching (29.9%), anal penetration (22.3%) and the others. When the psychiatric diagnoses of the cases were analyzed, post traumatic stress disorder (PTSD) was the most common diagnosis with a rate of 24.1%, followed by depressive disorder (20.9%), and acute stress disorder (19.0%) respectively, 36.1% of the cases had no psychiatric diagnosis. Conclusion: The incidence rate of child sexual abuse is increasing alarmingly in our country such as in the world. Our findings suggest that broader interdisciplinary research is needed to reveal child and adolescent sexual abuse. Keywords: child, adolescent, sexual abuse, sociodemographic characteristics.

34-37
The Change of Preference Priorities on Examination for Specialty in Medicine by Years of High Risky Medical Branches in Medical Malpractice
Authors: Hüseyin Kasap, Taner Akar, Birol Demirel, Ahmet Zahit Dursun, Serhat Sarı, Alper Özkök, Önder Aydemir

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Objective: Malpractice is defined as the illness going out of its normal course, delayed healing, death of a patient because of physicians unlawful and/or defective medical practice and treatment. The increase in the both criminal and compensation cases claiming malpractice have led the physicians to practice defensive medicine. Defensive medicine’s reflection to the "Examination for Specialty in Medicine" is that specialties withlower risk are preferred priorly. Materials and Methods: In this research it is aimed to demonstrate the change of preference priorities of specialties by physicians after the risk groups were determined relying on the ’Compulsory Liability Insurance Related to Medical Malpractice’, entered into force in 2010. According to this insurance, the group with the highest risk is 4th and the group with the lowest risk is the 1st. The base points of specialties according to 2009-2013 Examination for Specialty in Medicine (TUS) placement results were included to the research. Results: From 2009 to 2013 it was determined that second group’s base points increased gradually, third group remained stable and the fourth group decreased significantly. Conclusion: We believe that, the reason of the change of the priority of physicians is not only the rise of the violence of which the physicians are subjected to, but also, in spite of the increased number of claims braught and the amount of indemnity due to the higher risk of the medical application faults compared to other groups, the almost steady income of the physicians compared with that risks that take. While it is being discussed that defensive medicine is practiced more often each day, we demonstrated in this research that this situation is even reflected to the preferences of specialist candidates. Keywords: Medical malpractice, Defensive medicine, Examination for specialty in medicine.

38-42
The Difficulties Sexually Abused Hearing Impaired Children in the Judicial Process A Case Series
Authors: Hatice Ünver, Nesligül Nihal Olgun, Şahika Gülen Şişmanlar, Ayşen Coşkun, Ümit Biçer

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Introduction: Sexual abuse means to meet sexual needs and desires of an adult with using children or adolescent. Sexual abuse was not detected in any sociodemographic groups and can be seen in every socioeconomic level. Diagnosis of sexual abuse is usually made with a history which taken from the child. Because of verbal communication is very important of evaluation in the diagnosis of sexual abuse; hearing impaired children are more abuse than other children and their inability to express themselves fell them in more risky situations. Method: In this case series; it is considering that sociodemographic characteristics and difficulties in the diagnosis and assessment process of 3 hearing impaired children who sexually abused and evaluation process will be discussed of these children. Results: Sexual abuse of children is an important public health problem that leads to long-term negative results. Therefore the training and raising awareness of professionals in the judicial process will help to evaluate more comfortable and accurate in the system of these children. Key words: Sexual abuse, Hearing impaired, Child and adolescent

43-48
Forensic Reporting Process of Injured Cases as a Result of Security Forces Intervention to Protest Demonstrations Case Series
Authors: İlker Koçar, Ökkeş Koçyatağı, Hakan Kar, Nursel Gamsız Bilgin, Halis Dokgöz

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Many injuries, even deaths can be seen as a result of the intervention of the security forces to protest demonstration or social events in our country. The right of individual application to medical facilities for their health status and treatment is ensured by constitutional law and international legal regulations. Despite this assurance many problems can occur during forensic reporting process concerned with both medical facilities and judicial authorities. Key words: Social event; Protest demonstration; Injury; Individual application Forensic report.

49-52
Investigation of Handwriting Changes of a Subject Who Committed Suicide by Drinking Antifreeze
Authors: İlhami Kömür, Esat Şahin, Ersen Saltı, Çetin Seçkin, Ferruh Baklacıoğlu, Işıl Özbay, Hüseyin Bülent Üner

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Although forensic autopsy was performed on the subject, who was found dead in his car, the reason of dead could not be identified. The body was found in his car with an antifreeze bottle near to him and with a suicide note telling that the subject committed suicide by drinking the antifreeze. In order to confirm the reason origin of the dead, prosecution office want to determine whether the suicide note was in fact written by the subject. The handwriting samples and the diary obtained from the scene were sent to The Council of Forensic Medicine Forensic Document Examination Laboratory for comparison. In this study, we aim to present a subject who committed suicide by drinking antifreeze (ethylene glycol) and noted what he feels until he looses his conscious. By investigating the impact of ethylene glycol intake on handwriting changes, we would like to show the contribution of forensic document examination to determination of reason of dead. Keywords: Ethylene glycol. Suicide, Handwriting, Questioned Document

53-55
Eosinophilie Arteritis Related Spontaneous Coronary Artery Dissection A Case Report
Authors: Gülden Çengel, Esra Gürlek Olgun, Semih Alper Kureş, Cafer Uysal, Mehmet Ali Çakmak, İsmail Özgür Can

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Spontaneous dissection of coronary arteries is accepted as one of the rare reasons of myocardial infarction. Spontaneous non-traumatic coronary artery dissection occurs rarely. Eosinophilic periarteritis of coronary artery may cause coronary artery dissection. Coronary eosinophilic periarteritis is put forward as predisposing factor of intimai impairment and dissection. In the literature; 1/3 of women with eosinophilic periarteritis is pregnant or in postpartum stage. In our case, 35 aged postpartum woman, who was deteriorated at home is brought hospital as dead. In the histopathological examination of tissue samples taken by the autopsy, made in The Council of Forensic Medicine, dissection in the left descending branch of coronary artery related to eosinophilic periarteritis and thyroiditis in the thyroid tissue samples is observed. In the literature, there is a few death case, related eosinophilic periarteritis with, autoimmune thyroiditis. It is found important because of that it i s one of the pathologies, which must come to mind firstly in postpartum period women deaths. Keywords: Postpartum, Arteritis, Eosinophilic, Coronary, Dissection.

56-59
Use of Microbiological Methods in Postmortem Interval Estimation
Authors: Mahmut Şerif Yıldırım, Sinan Sevinç, Ramazan Akçan, Aysun Balseven Odabaşı, Ali Rıza Tümer

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Postmortem interval estimation is one of the most important issues of postmortem investigation. Although there are several methods utilized in postmortem interval estimation, most of these are far from providing accurate interval. Thus, there is a strong need for novel methods or improvement of conventional ones. Among these, the place, role and efficiency of microbiological methods in postmortem interval estimation are still controversial. This paper aims to attract attention to the use of microbiology in postmortem interval estimation and discuss its role in the light of the related literature. Keywords: Microbiology, Postmortem interval, Forensic pathology

60-70
All Aspects of Pedophilia
Authors: Oğuz Polat

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Pedophilia is a deviant sexual behavior which is a sub-category of paraphilias. If acted out, pedophilia is legally defined as sexual child abuse. Pedophilia includes fondling a child's genitals, intercourse, rape, sodomy, exhibitionism, and commercial exploitation of children through prostitution or the production of pornographic materials. Pedophiles who have sexually abused children require intense psychological and pharmacological therapy prior to release into the community because of the high rate of repeat offenders. The incidence of pedophilia has been markedly underestimated. It is often discussed whether sexual offenders of children are pedophiles or child molesters. It depends on exact definition and operationalizational categorization .Practical question from forensic point of view is whether there are any differences between the group of 'pedophiles', who have sexually offended child and the group of child molesters, who do not meet criteria for pedophilia. It confirms the opinion that not all of child sexual offenders are pedophiles. Regarding pedophilia remains the problem of its definition in conditions of practical acceptance. Keywords: Pedophilia, Child sexual abuse, paraphilia
http://oaji.net/journal-archive-stats.html?number=1436&year=2015&issue=4146

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ADLİ TIP BÜLTENİ

Number 20(1), 2015