Search

In this study, bodily injuries related to chest compression were examined in non-traumatic death cases that underwent autopsy. This study aimed to evaluate factors that can affect these injuries. Data were collected retrospectively, and injuries related to chest compression during cardiopulmonary resuscitation were determined over a 10-year period. Age, gender and cause of death were determined, and when cardiopulmonary resuscitation was performed, cardiopulmonary resuscitation duration, intubation and the injury that occurred due to chest compression were also determined. The study included data from 203 cases. The most frequent injuries were a single fracture in the left ribs (19.7%). Only the duration of cardiopulmonary resuscitation was determined to be associated with injuries. Ventricle rupture in 1 case and liver laceration in 2 cases were the most significant injuries. It has been shown that during cardiopulmonary resuscitation, severe injuries can occur due to thoracic compression. Only a positive correlation with the duration of cardiopulmonary resuscitation was found in our study.

Subject: Sleep disorders are common problems in post-traumatic stress disorder (PTSD) patients. The main symptoms associated with sleep disorders were reported as a reduction in total sleep time, prolonged sleep latency, increase in the number wakefulness, low sleep efficiency and a reduction in the percentage of deep sleep stages. A relation between sleep disorders and increased levels of aggression was determined. In this study, we aimed to examine the relationship between the quality of sleep and the level of aggression in patients with Post Traumatic Stress Disorder. Method: The study was included 48 patients with a diagnosis of PTSD who were hospitalized. Data were collected using post-traumatic stress disorder questionnaire scale, Pittsburgh sleep quality scale and the Buss-Perry Aggression Scale applied by the clinician. Data analysis was made using SPSS 15.0 package program. Descriptive statistics and Pearson's correlation test were used in statistical analysis. Results: The average age of the cases was 32.33 +/- 7.93, the average of the symptoms of post-traumatic stress disorder was 56.23 +/- 11.14, the average of sleep quality was 22.08 +/- 6.67 and the average of aggression levels was 51.67 +/- 7.48. There was a high level deterioration in sleep quality and aggression levels were medium/medium-high levels. It was determined that Buss-Perry Aggression Scale scores were positively correlated with Pittsburgh sleep quality and posttraumatic stress disorder total and hyper arousal subscale scores. Conclusion: In this study, it is stated that increase in overstimulation symptoms and degradation of sleep in PTSD patients cause increase in agression levels. Degradation of sleep is determined as an indicator of agression that is observed in TSSB patients. Associatively, in PTSD patients, use of interventions to improve the quality of sleep oriented agressive behaviours gain value [TAF Prev Med Bull 2015; 14(6.000): 433-437]

Aim: To evaluate the relationship between pre-biopsy PSA levels, International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), prostate volume and positive core numbers of histologically proved chronic prostatitis in the patients whom underwent transrectal ultrasound guided biopsy for elevated prostate specific antigen (PSA) levels. Material and Method: Between January 2012 and 2014, 152 patients underwent TRUS biopsy. Their medical records are examined retrospectively. The mean age of the patients were 62 (45-75). The pathologic specimens were evaluated for the number of cores with chronic prostatitis and percentage of prostatitis. Pre-biopsy levels of PSA, IPSS, maximum urinary flow rate, prostate volume are compared with the number positive cores for chronic prostatitis and their percentages. These variables also compared in the non-chronic prostatitis patients. Results: There was no statistically significant correlation between the positive number of cores for chronic prostatitis and age (P=0.5, r=0.055), a positive correlation was observed between IPSS (P

An overdose of acetaminophen (APAP) produces acute tubular necrosis. The aim of this study was to observe the effects of hyperbaric oxygen (HBO) only and combined with N-acetylcysteine (NAC) on inflammatory cytokines in kidney. Thirty-two male Sprague-Dawley rats were divided into four groups: sham, control (APAP), NAC, and NAC + HBO. In the APAP, NAC, and NAC + HBO groups, renal injury was induced by oral administration of 1 g/kg APAP. The NAC group received NAC (100 mg/kg/day). NAC + HBO group received NAC (100 mg/kg/day) intraperitoneally and HBO underwent at 2.8 ATA pressure with 100 % oxygen inhalation for 90 min every 12 h for 5 days. Rats in the sham group received distilled water only by gastric tube. All animals were killed on 6 days after APAP or distilled water administration. Creatinine, urea, neopterin, tumor necrosis factor-α (TNF-α), and interleukin (IL)-6 levels were measured in sera. There was a significant increase in serum creatinine and urea levels in the control group compared to the sham group (in both, p = 0.001). NAC and NAC + HBO significantly decreased serum neopterin, TNF-α, and IL-6 levels compared to control group. APAP administration caused tubular necrosis in the renal. NAC and NAC + HBO treatments significantly reduced APAP-induced renal damage. The results of this study showed that renal dysfunction in APAP toxicity was attenuated by the use of HBO and NAC treatments. The combination of NAC and HBO treatments might be recommended as an effective treatment modality for APAP-induced nephrotoxicity.

Acetaminophen (APAP) is an analgesic and antipyretic agent. In overdoses, it is associated with nephrotoxicity. We examined the potential protective effects of N-acetylcysteine (NAC) and NAC + ozone therapy (OT) combination against APAP-induced nephrotoxicity.Thirty-two male Sprague-Dawley rats were divided into four groups: sham, control (APAP), NAC, and NAC + OT. In the APAP, NAC, and NAC + OT groups, kidney injury was induced by oral administration of 1 g/kg APAP. The NAC group received NAC (100 mg/kg/day). NAC + OT group received NAC (100 mg/kg/day) and ozone/oxygen mixture (0.7 mg/kg/day) intraperitoneally for 5 days immediately after APAP administration. All animals were killed at 5 days after APAP administration. Renal tissues and blood samples were obtained for biochemical and histopathological analyses. Neopterin, tumor necrosis factor-α (TNF-α), interleukin (IL)-6 and IL-10 levels were measured in sera. Malondialdehyde (MDA) levels and glutathione peroxidase (GPx) activities were determined in renal homogenates.NAC and NAC + OT significantly decreased MDA and TNF-α levels and increased IL-10 levels and GPx activities. Serum neopterin and IL-6 levels were not different among all groups. APAP administration caused tubular necrosis in the kidney. The degrees of renal necrosis of the APAP group were higher than the other groups. Renal injury in rats treated with combination of NAC and OT were found to be significantly less than the other groups.Our results showed that NAC and OT prevented renal injury in rats and reduced inflammation. These findings suggest that combination of NAC and OT might improve renal damages because of both oxidative stress and inflammation.

BACKGROUND: Firearm injuries (FI) are the most common cause of death among military personnel. In this study, postmortem examination and autopsy records of deaths resulting from firearm injuries recorded in the Department of Forensic Medicine of Gulhane Military Medical Academy between 1993-2010 were examined retrospectively. METHODS: We evaluated the characteristics of 153 firearm deaths accounting for 36.6% of all medical-legal autopsies. The cases included 152 men (99.3%) and 1 woman (0.7%). RESULTS: The mean age of the cases was 23.1 years (±4.7; range, 20-43 years). The manner of death was determined in all cases with 41.8% of cases identified as suicide and 39.9% as homicide. The most common sites of firearm entrance wounds were the head and neck region (n=109, 71.2%), the chest (n=26, 17%), or the abdomen (n=14, 9.2%). The type of firearm was not clear in most cases. CONCLUSION: In conclusion, complete forensic and medical records will facilitate the rapid and accurate conclusion of the legal process and will enhance future retrospective studies. Language: en

Military personnel deployed abroad could be exposed to more risk factors that adversely affect quality of life. In this study, we examined psychiatric symptoms and quality of life in Turkish Armed Forces deployed to Afghanistan.A total of 289 Turkish military personnel working in Afghanistan enrolled in this study. They completed two surveys containing questions about socio-demographic characteristics. Data were collected and analyzed from 258 of the participants.The general symptom scores (GSI) were above 1 in 20.8 Percent (n=54) of the participants. The lowest SF-36 scores by the sub-groups were mental health (59.14 ± 18.56) and vitality (59.25 ± 21.17). The highest score was in the physical function subscale (84.42 ± 19.53). All Quality of Life Questionnaire Short Form (SF-36)subscale scores were lower in the GSI above 1 group than the GSI below 1 group. In the GSI above 1 group: education level and depression affected SF-36 physical functioning; paranoid ideation and somatization affected SF-36 role limitations due to physical health; age and somatization affected SF-36 pain; age affected SF-36 general health; phobic anxiety affected SF-36 vitality; age, tenure of occupation, tenure abroad; and phobic anxiety affected SF-36 mental health.The negative effects of psychiatric symptoms on the quality of life were similar to those in the general population and in specific disease groups. These results should be considered when evaluating the mental health of military personnel deployed abroad.

Introduction In this study student suicides are classified as a distinct group in Eskisehir-a city located in the western part of our country and famous as a student city. The study aims at describing demographic and suicide specification of cases and compare some important issues between males and females. Method All the judicially deaths in Eskisehir in a 12 year period between 2004 and 2015 have been evaluated. 75 cases that were deemed as suicide cases as a result of criminal investigation have been included in the study. Results It was determined that hanging method was the most frequently used method and the number of male was more. It was determined that the majority of them were the students living away from their families. Definite or possible psychiatric disorder was identified as the most important risk factor. It was observed that there were significant differences in terms of risk factors between male and female students. Males have been found as more prominent in case of definite or possible psychiatric disorders, alcohol and substance abuse, love and romantic tangles; females have been found as more prominent in case of family problems and social pressure, and repeated suicide attempts. Discussion Compared to the general population love and romantic problems are more prevalent in this group. It is observed that university students left suicide notes more than the general population. Sharing this study with the university administrations could be helpful in undertaking the necessary precautions.

Paraquat (PQ) is a widely used herbicide. Exposure to PQ at toxic doses can result in fatal acute lung injury. Inhibition of the poly-(ADP-ribose) polymerase (PARP) enzyme alleviates inflammation and necrosis in various pathologies. Here we aimed to evaluate the effects of PARP inhibition on PQ-induced lung damage in a rat experimental model. Female Sprague-Dawley rats (n = 24) were allocated into three groups: sham, PQ and PQ + 3-aminobenzamide (3-AB) that is a PARP inhibitor, groups. Experimental lung injury was induced by administration of 15 mg/kg PQ intraperitoneally in PQ and PQ + 3-AB groups. 3-AB (10 mg/kg twice per day) was administered to the PQ + 3-AB group for four consecutive days. The animals were killed on the fifth day following PQ administration. Lung tissue and blood samples were collected and stored until analysis. Serum lactate dehydrogenase (LDH) and neopterin levels, tissue oxidative stress parameters, transforming growth factor-beta1 (TGF-β) levels and histological injury scores in the PQ + 3-AB group were significantly lower than in the PQ group (P

a b s t r a c t Objectives: Acetaminophen (APAP) overdose may cause acute liver injury. Ozone therapy (OT) is shown to reduce inflammation and necrosis in several entities. Thus, we have designed this study to evaluate the efficacy of OT in a rat model of APAP-induced liver injury. Methods: Twenty-seven Sprague-Dawley rats were divided into three groups: sham, APAP and APAP+OT groups. In the APAP and the APAP+OT groups, liver injury was induced by oral administration of 1 g/kg APAP. The APAP+OT group received a single dose ozone/oxygen mixture (0.7 mg/kg) intraperitoneally 1 h after APAP administration. All animals were killed at 24 hour after APAP administration. Blood samples and liver tissues were harvested to determine liver injury and oxidative stress parameters. Liver tissues and blood samples were obtained for biochemical and histopathological analyses. Results: APAP administration caused necrosis in the liver after 24 h. The degrees of liver necrosis of the APAP group were higher than the other groups (in both p < 0.05, respectively). In the APAP+OT group, liver antioxidant enzymes activities were significantly higher than the APAP group (p < 0.05), but were lower than the sham group (p < 0.05). In the sham group, serum neopterin, a marker of cell-mediated immunity, concentrations (4.8 ± 1.2 nmol/L) were lower than the APAP (14.7 ± 1.4 nmol/L) and APAP+OT groups (7.5 ± 2.4 nmol/L) (in both p < 0.05, respectively). Conclusion: Our results showed that OT prevented liver necrosis in rats and reduced neopterin levels. These findings suggest that the use of OT as an adjuvant therapy which might improve the outcome in APAP induced liver injury.

Snakebites are common in people living or working in rural area. Military personnel are among the risk groups for viper envenomation. In this study, we presented seven cases of vipera snakebites in military personnel and discussed how to minimize functional loss and maximize the outcome. All of the bites were located in extremities and 5 were at hands. All patients were admitted at the day of snake bite which is an indicator of good triage. Hematological complications were the most common systemic complications. Antivenom therapy was performed according to the severity of the envenomation. Local wound care, grafts and flaps were used for wound coverage. Pit viper envenomation can cause serious morbidity in military personnel especially at hot climates. A suspicion of snake bite must be managed properly. Triage is the most important step to reduce the morbidity. Almost all snake bites occur in extremities, thus protective measurement must be taken especially for hands. [TAF Prev Med Bull 2012; 11(2.000): 127-130]

Objective: This study was made in order to determine the methods of overcoming with stress of the specialist physicians. Material-Method: Our study is a descriptive study. In the study, the scale of overcoming with stress was applied to the 100 specialist physicians who working in 5 different health care institutions in and around the Istanbul in 2009. Results: The scores that the participants takes from sub-categories of scales of overcoming with stress types were measured respectively as; 22.4±3.5 point for self-confident approach, 16.3± 3.6 point for helpless, 14.4± 2.6 point for optimistic, 10.8±2.6 point for submissive, 9.9±2.1 point for seeking social support. It is determined that the self-confident approach method was the most used method among the participants in methods of overcoming with stres. It is determined that the submissive method was the least used method. No statistical significant differences were determined between the men and women, marrieds and singles, subgroup and total score, categories composed according to the age range and institutons. (p>0.05) [TAF Prev Med Bull 2012; 11(2.000): 211-218]

Physicians have to write reports in accordance with the relevant laws, statutes and regulations when requested by the administrations for distribution of monetary donations and allowances. The Statutes for Distribution of Monetary Donations and Allowances show the conditions requiring monetary support, the people who need monetary donations and the types of making monetary donations in cases of disabilities and injuries. We retrospectively reviewed the reports written in accordance with the Statutes for Distribution of Monetary Donations and Allowances in the Department of Forensic Medicine of Gulhane Military Medical Academy between 1st January 2005 and 31st December 2006. There were 87 reports written in accordance with the Statutes for Distribution of Monetary Donations and Allowances. The mean age of the cases was 25.93 ±5.8 years (20-43 years). The most frequent condition requiring monetary support was gun shot wounds (42.6%). The most frequent location of the wounds was the head (31%) and there was an increase in the duration of work leave caused by disabilities (p

Serum neuron-specific enolase (NSE) and S-100β levels are considered novel biochemical markers of neuronal cell injury. In this study, the initial and post-treatment levels of NSE and S-100β were compared in carbon monoxide (CO) poisoning patients, who received normorbaric oxygen (NBO) or hyperbaric oxygen (HBO) therapy. Forty consecutive patients with acute CO poisoning were enrolled in this prospective, observational study. According to their clinical symptoms and observations, twenty patients were treated with NBO, and the other twenty with HBO. Serum S-100β and NSE levels were measured both at time of admission and 6 h later (post-treatment). Serum NSE and S-100β values decreased significantly in both of the therapeutic modalities. The initial and post-treatment values of NSE and S-100β in NBO or HBO patients were comparable. A clear negative correlation was observed between the decrease of NSE and S-100β levels and initial blood carboxyhemoglobin levels. In conclusion, the present results suggested the use of serum S-100β and NSE levels as indicators for brain injury. Due to the significant increase of their values with oxygen therapy, they may also be useful as prognostic follow-up markers. However, the current findings reflected no difference between the efficacy of NBO or HBO therapy.

The analysis of autopsy reports plays an important role in the evaluation of trauma care quality. The objective of this study was to determine the rate of preventable deaths and medical errors in regard to the autopsy reports as an indicator of trauma care quality in traumatic deaths.A retrospective review of traumatic autopsy reports kept between 2011 and 2012 in Eskişehir, Turkey was conducted. Demographic data of the cases, injury type, injury mechanism, injury location, ISS values, and cause and place of death were recorded. Deaths were judged in three groups including preventable deaths, potentially preventable deaths and non-preventable deaths. In the definiton of preventability, the criteria of American College of Surgeons Committee on Trauma were used. A commission composed of two forensic medicine specialists and one emergency medicine specialist reviewed preventability and defined medical errors.A total of five hundred and ninety-two autopsy reports were examined in the study period. Trauma was defined as the cause in 65.2% (n=386) of the cases. 81.9% (n=316) of the cases were observed to have suffered blunt injury and 18.1% (n=70) penetrating injury. Death occurred at the scene of trauma in 56.7% (n=219) of the cases, in the pre-hospital period in 11.7% (n=45), and in hospital in 31.6% (n=122). In preventability analysis, it was decided that 4.1% (n=16) of the cases had the properties of being preventable, 14.5% (n=56) potentially preventable and 81.3% (n=314) non-preventable. Suboptimal care was determined in 65.3% (n=47) of the total cases, delayed intervention in 58.3% (n=42), error in the medical method decision in 8.3% (n=6), delayed or wrong diagnosis in 1.4% (n=1), and inappropriate or incorrect medical application in 1.4% (n=1).High rates of preventable deaths in the pre-hospital period, in cases of penetrating injuries, and particularly in cases of chest trauma were evaluated as noteworthy findings. Integrated working of pre-hospital emergency healthcare services with trauma centres would enable the development of trauma care and reduce the rates of preventable deaths.

Burn injuries are an important public health problem resulting in high morbidity and mortality. Mortality in burn patients is associated with age, the extent of the burn surface, and the presence of concurrent chronic diseases. Studies have revealed differences between antemortem clinical diagnoses and postmortem findings in burn-related deaths.In the present study, postmortem examination reports and autopsy reports issued by the Department of Forensic Medicine in Gülhane Military Medical Academy between 1 January 1994 and 30 May 2013 were retrospectively reviewed together with patient charts in an attempt to compare postmortem findings and antemortem clinical findings in burn-related deaths.In a period of approximately 20 years, thirty-one (6.9%) of the deaths among 450 cases were burn-related. Of the injuries, 90.3% were caused by flame burns. Mean burn percentage was 70.52%, and the survival of these cases was found to decrease significantly with increasing burn percentage (r=-0.491, p=0.005). According to autopsy findings, pneumonia was the most frequently overlooked antemortem clinical diagnosis, and mortality was associated with systemic organ failures.Burn-related deaths are an important cause of mortality among soldiers. We believe that postmortem findings revealed by autopsies could significantly contribute to the treatment of burn cases, and that interdisciplinary data sharing would be important in this respect.

BACKGROUND: The analysis of autopsy reports plays an important role in the evaluation of trauma care quality. The objective of this study was to determine the rate of preventable deaths and medical errors in regard to the autopsy reports as an indicator of trauma care quality in traumatic deaths. METHODS: A retrospective review of traumatic autopsy reports kept between 2011 and 2012 in Eskisehir, Turkey was conducted. Demographic data of the cases, injury type, injury mechanism, injury location, ISS values, and cause and place of death were recorded. Deaths were judged in three groups including preventable deaths, potentially preventable deaths and non-preventable deaths. In the definiton of preventability, the criteria of American College of Surgeons Committee on Trauma were used. A commission composed of two forensic medicine specialists and one emergency medicine specialist reviewed preventability and defined medical errors. RESULTS: A total of five hundred and ninety-two autopsy reports were examined in the study period. Trauma was defined as the cause in 65.2% (n=386) of the cases. 81.9% (n=316) of the cases were observed to have suffered blunt injury and 18.1% (n=70) penetrating injury. Death occurred at the scene of trauma in 56.7% (n=219) of the cases, in the pre-hospital period in 11.7% (n=45), and in hospital in 31.6% (n=122). In preventability analysis, it was decided that 4.1% (n=16) of the cases had the properties of being preventable, 14.5% (n=56) potentially preventable and 81.3% (n=314) non-preventable. Suboptimal care was determined in 65.3% (n=47) of the total cases, delayed intervention in 58.3% (n=42), error in the medical method decision in 8.3% (n=6), delayed or wrong diagnosis in 1.4% (n=1), and inappropriate or incorrect medical application in 1.4% (n=1). CONCLUSION: High rates of preventable deaths in the pre-hospital period, in cases of penetrating injuries, and particularly in cases of chest trauma were evaluated as noteworthy findings. Integrated working of pre-hospital emergency healthcare services with trauma centres would enable the development of trauma care and reduce the rates of preventable deaths. Language: en

Physicians have responsibilities to prepare forensic and expertise reports besides their role in treatment, diagnosis and preventive medicine. A physician who engaged in treatment should have sufficient knowledge and experience to prepare the requested forensic or medical expertise reports. These expertise reports are usually requested either by criminal law or civil law courts, besides, calculation of the physical disabilities should be demanded at the basis of Armed Forces Pension Fund (OYAK) Law and monetary compensation. New Turkish Penal Code highlights the new implementations about severity of injuries caused by trauma. According to the interpretation of Military Supreme Court, the severity of injuries caused by trauma in Military Penal Code is evaluated under the light of Turkish Penal Code. Determination of the rate of disabilities in general body functions and loss of daily activity have been often requested for reports concerning the civil law. Different legislations have been used for reports at the basis of monetary compensation. The purpose of this study is to scrutinize the problems encountered while preparing forensic and medical expertise reports and implementing the relevant and appropriate legal procedure and to emphasize the important points to be considered during the preparation of these expertise reports. [TAF Prev Med Bull 2006; 5(6.000): 466-475]

The production of androgens (mostly testosterone) during the early fetal stage is essential for the differentiation of the male brain. Some authors have suggested a relationship between androgen exposure during the prenatal period and schizophrenia. These two separate relationships suggest that digit length ratios are associated with schizophrenia in males. The study was performed in a university hospital between October 2012 and May 2013. One hundred and three male patients diagnosed with schizophrenia according to DSM-IV using SCID-I, and 100 matched healthy males, were admitted to the study. Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms (SANS) and Brief Psychiatric Rating Scale (BPRS) were used to assess schizophrenia symptoms. The second digit (2D) and fourth digit (4D) asymmetry index (AI), and the right- and left-hand 2D:4D ratios were calculated. All parametric data in the groups were compared using an independent t-test. The predictive power of the AI was estimated by receiver operating characteristics analysis. The 2D:4D AI was statistically significantly lower in the patient group than the healthy control comparison group. There were significant differences between the schizophrenia and the control groups in respect of left 2D:4D and right 2D:4D. There was no correlation between AI, left, or right 2D:4D, BPRS, or SAPS in the schizophrenia group. However, there was a negative correlation between left 2nd digit (L2D):4D and the SANS score. Our findings support the view that the 2D:4D AI can be used as a moderate indicator of schizophrenia. Even more simply, the right or left 2D:4D can be used as an indicator. L2D:4D could indicate the severity of negative symptoms.

Paraquat (PQ) overdose can cause acute lung injury and death. Ozone therapy (OT) was previously demonstrated to alleviate inflammation and necrosis in various pathologies. We therefore hypothesized that OT has ameliorative and preventive effects on PQ-induced lung damage due to anti-inflammatory and antioxidants properties. Sprague-Dawley rats ( n = 24) were separated into three groups: sham, PQ, and PQ+OT groups. 15 mg/kg PQ was administered intraperitoneally in PQ and PQ+OT groups to induce experimental lung injury. One hour after PQ treatment, PQ+OT group was administered a single dose of ozone–oxygen mixture (1 mg/kg/day) by intraperitoneal route for four consecutive days. The animals were sacrificed on fifth day after PQ administration. Blood samples and lung tissues were collected to evaluate the inflammatory processes, antioxidant defense and pulmonary damage. Serum lactate dehydrogenase (LDH) and neopterin levels, tissue oxidative stress parameters, total TGF-β1 levels, and histological injury scores in PQ+OT group were significantly lower than PQ group ( P

Paraquat (PQ) is a well-known quaternary nitrogen herbicide. The major target organ in PQ poisoning is the lung. Reactive oxygen species (ROS) and inflammation play a crucial role in the development of PQ-induced pulmonary injury. Neopterin is synthesized in macrophage by interferon γ and other cytokines. We aimed to evaluate the utility of neopterin as a diagnostic marker in PQ-induced lung toxicity. Sprague Dawley rats were randomly divided into two groups (sham and PQ), administered intraperitoneally 1 mL saline and PQ (15 mg/kg/mL) respectively. Blood samples and lungs were collected for analyses. Lung injury and fibrosis were seen in the PQ group. Serum total antioxidant capacity, lactate dehydrogenase (LDH), and lung transforming growth factor-1β (TGF-1β) levels were significantly higher than the sham group (in all, p < 0.001). In addition, in the PQ group, serum neopterin and lung malondialdehyde (MDA) levels were also significantly higher than the sham group (in all, p = 0.001). Serum neopterin levels were correlated with LDH activities, lung MDA, lung TGF-1β levels, and the degree of lung injury. These findings demonstrated that oxidative stress, reduction of antioxidant capacity, and inflammation play a crucial role in the PQ-induced lung injury. Elevated serum neopterin levels may be a prognostic parameter to determine extends of PQ-induced lung toxicity. Further studies may be performed to clarify the role of neopterin by different doses of PQ.

An overdose of acetaminophen (APAP) produces centrilobular hepatocellular necrosis. We aimed to investigate the hepatoprotective effects of N-acetylcysteine (NAC) only and hyperbaric oxygen (O2) treatment (HBOT) combined with NAC, and their anti-inflammatory properties in liver tissue. In the current study, a total of 32 male Sprague Dawley rats were divided into 4 groups: sham, APAP, NAC, and NAC + HBOT. In the APAP, NAC, and NAC + HBOT groups, liver injury was induced by oral administration of 1 g/kg APAP. The NAC group received 100 mg/kg NAC per day. NAC + HBOT group received intraperitoneal injection of 100 mg/kg/day NAC and were given HBOT at 2.8 ATA pressure with 100% O2inhalation for 90 min every 12 h for 5 days. Rats in the sham group received distilled water only by gastric tube. All animals were killed on day 6 after APAP or distilled water administration. Serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) activities, hepatic neopterin, tumor necrosis factor-α (TNF-α), and interleukin 6 (IL-6) levels were measured. There was a significant increase in serum AST and ALT activities in the APAP group compared with the sham group (in both p = 0.001). NAC and NAC + HBOT groups had significant decreases in hepatic neopterin, TNF-α, and IL-6 levels compared with the APAP group. APAP administration caused extensive hepatic necrosis. NAC and NAC + HBO treatments significantly reduced APAP-induced liver injury. Our results showed that the liver damage in APAP toxicity was attenuated by NAC and NAC + HBO treatments. NAC + HBOT exhibit hepatoprotective activity against APAP-induced liver injury in rats.

We have read the article by Xia et.al. entitled as "L-carnitine ameliorated fatty liver in high-calorie diet/STZ induced type 2 diabetic mice by improving mitochondrial function" with great interest. In this article, the authors concluded that L-carnitine might be an effective liver cell protector for delaying the progression of type 2 diabetes mellitus complications. They supported this conclusion by using biochemical and morphological differences between control and L-carnitine-treated groups. However, we have some reservations the terms they used throughout the article: Firstly, the term of "mitochondrial function" has a very broad meaning and might be a little bit confusing as well. As known, mitochondria basically have three biochemical systems: i) beta-oxidation, ii) tricarboxylic acid cycle (TCA cycle) and iii) electron transport chain. Although all these systems are interconnected and coexist in mitochondria at the same time, only dysfunctions of electron transport chain are enumerated among the mitochondrial diseases. In this article, we understand that the mitochondrial complex activities were not measured at all. Therefore, we think that the conclusion saying "L-carnitine stimulates fat metabolism" is acceptable. But, using the term of "improvement of mitochondrial function" in this context is not scientifically very appropriate. Secondly, the authors did not describe the method(s) they used in "morphological assessment of hepatic tissue" in detail. They said that tissue samples have been fixed in 4% paraformaldehyde in the third page of the paper. But, as far as we know, oil red O staining works only with fresh frozen tissues. Besides, the red dots in figure 2 were presented as lipid droplets. If these are lipid droplets, then the other unstained vacuoles in the same figure were remained to be identified. We think that the tissues stained with oil red O must be fresh-frozen samples, and at least some of that unstained vacuoles were actually freezing artifacts. Discrimination between freezing artifacts and lipid vacuoles are important because the authors assumed that L-carnitine was decreasing "lipid area percentage" in hepatic tissue.

The external branch of the superior laryngeal nerve gives off many branches above the upper pole of the thyroid gland. Differentiating the branch innervating the cricothyroid muscle from the others may be important during surgery. Therefore, we aimed to demonstrate the branching pattern of this nerve in detail. In 34 human cadavers (59 sides), branches of the nerve were exposed and measurements related to them and neighboring structures were made. A cricothyroidal branch was present on all sides. This branch pierced the inferior pharyngeal constrictor muscle 3.9–17.6 mm above, 3.1–9.9 mm below, or at the level of the upper pole of the thyroid gland. On all sides, the nerve provided one or two thyroidal branches. The thyroidal branch was generally thinner than the cricothyroidal branch. But they were equal in size on three (5%) sides. The external laryngeal nerve provided two or three pharyngeal branches on all sides. These branches arose from the nerve 3.5–12.7 mm from the upper pole of the thyroid gland. Although the branch was generally thinner than the cricothyroidal branch, both branches were equal on four (6.7%) sides. Two cardiac branches were observed on two (3.3%) left sides. In conclusion, the cricothyroidal branch was generally thicker than the other branches. But on seven (11.8%) sides, thyroidal or pharyngeal branches and the cricothyroidal branch were equal in size. These data may be important during surgery as the surgeon may confuse the cricothyroidal branch with other branches of the external laryngeal nerve. Clin. Anat. 25:32–39, 2012. © 2011 Wiley-Liss, Inc.

In this study, we aimed to investigate preventable deaths due to trauma among cases in whom autopsy and postmortem examinations were performed in Diyarbakir Council of Forensic Medicine.In this study, which was planned as retrospectively descriptive, demographic data, type of injury, cause of injury, locations of injuries, cause of death, and scene of death data were withdrawn through the reports of deaths due to trauma in Diyarbakir Council of Forensic Medicine between 1 January 2008 and 31 December 2008. Medical errors in these deaths and preventable deaths were analyzed with this data. The criteria of American College of Surgeons Committee on Trauma was used for definition-classification of errors and compose of preventability criteria.It was concluded that of the 747 cases taken into consideration, 4.15% (n=31) were preventable, 16.20% (n=121) were potentially preventable and 79.65% (n=595) were unpreventable. Suboptimal care in 49.34% (n=75), delay in treatment in 41.45% (n=63), missed diagnosis in 10.53% (n=16), clinical judgment error in 10.53% (n=16), missed medical administration in 7.23% (n=11), and other mistakes in 3.95% (n=6) of the cases were determined.When the results were compared with the studies performed in the areas in which modern trauma care and trauma centers are located, the preventable death ratio was found high. As a result, it has been determined that development of a modern trauma system and trauma centers have significant roles in decreasing preventable death ratios.

Distinguishing between injuries resulted from electrical current versus thermal energy is not only a difficult, but also a controversial issue in forensic medicine practice.In this study, an electrical current and a cautery were applied to dorsal skins of 10 rats and biopsies were taken from the injured sites as well as normal skin. In the histologic sections; some planimetric variables such as the perimeter, area, diameter equivalent circle, minimum feret, maximum feret, and the circular form factor of the nuclei located in normal and injured epidermis were measured with the aid of the computer-assisted image analysis.When compared with normal skin, all of the variables -nuclear area, perimeter, diameter equivalent circle, minimum feret, maximum feret, and circular form factor seemed to be decreased both in the electrical current- and cautery-applied skin samples.The differences between the variables measured in normal skin and in electrical- or cautery-applied skin samples were statistically significant (P < 0.05). However none of the variables showed any meaningful differences between the electrical- and cautery-applied areas.It was concluded that the nuclear changes due to electrical current and thermal injury are identical and morphometric analysis seems not to make any further contributions in the differentiating from each other. Therefore, conventional and more established methods for detection of metallization would be more effective.

Çocukluk çağında en sık görülen yanıklar, sıcak bir obje veya sıcak sıvı ile temas sonucu meydana gelmektedir. Çocukluk çağı yanık olgularında etiyoloji genellikle kaza olup, ihmale bağlı yanık olguları %6-20 oranında görülmektedir. İhmale bağlı yanıkların en sık nedeni haşlanma yanıklarıdır. Haşlanma yanıkları vücudun sıcak sıvıya dalması veya sıcak sıvının vücuda sıçraması ile oluşmaktadır. Bu çalışmada, Gülhane Askeri Tıp Akademisi Yanık Merkezinde, 2002-2006 yılları arasında yatırılarak tedavi edilen, 0-15 yaş arası, 82 olgunun hasta dosyaları retrospektif olarak incelendi. Olguların yaş, cinsiyet, yanık nedeni, yanık derecesi, yanık yüzdesi, hastanede yatış süresi, mortalité ve morbidité özellikleri değerlendirildi. Olguların, %72’sinin haşlanma yanığı, %19’unun alev ve aleve bağlı inhalasyon yanığı, %5’inin elektrik yanığı ve %4’ünün temas yanığı olduğu saptandı. Olguların vücut yanık yüzde oranının %20.71, mortalité oranının ise %17.1 olduğu tespit edildi. Sözlü olarak ifade etme becerileri tam gelişmemiş, küçük yaştaki çocuklarda ihmalin saptanması zordur ve bu olgular kolaylıkla kaza şeklinde yorumlanabilmektedir. Yanığın loka-lizasyonu, biçimi, yaralanmanın oluş şekli ile yanığın karakteristiği arasındaki ilişki değerlendirilerek, yaralanmanın kaza veya ihmal sonucu meydana gelip gelmediği saptanabilir. Çocuk ihmaline ait kanıtların fark edilmesi ile sağlık personelinin sorumluluğu artmakta ve olguların adli makamlara bildiriminin yapılması gerekmektedir.Anahtar kelimeler: Çocuk, yanık, ihmal

ÖZET KISMI IZLENIMLI MARKOV KARAR YÖNTEMLERİNE SİNİRSEL-BULANIK BİR YAKLAŞIM Yapay Zeka alanında, belirsizlik altında rasyonel davranabilmek, en zor ve en önemli problemlerden biridir. Belirsiz durumlar, olasılık içeren ortamlar ve mekanik problemler ana sorunları meydana getirir. Günümüzde, belirsiz ortamları bir perfor mans kriteri ile beraber modelleyen Kısmi Izlenimli Markov Karar Yöntemleri (POMDP), bu probleme tatmin edici tek modeli getirmektedir. Bu yüzden, POMDP modeller ine çözümler bulabilmek yapay zeka alanındaki en ümit vaad edici konulardan biri haline gelmiştir. Olası çözümler, robot yönlendirme, hata saptama ve karar verme gibi sayısız alanlara da uygulanabilirler. Ne yazık ki, POMDP'lerin konvansiyonel tekniklerle çözülmeleri, çok ufak problemler için bile. çok zordur. POMDP'ler için en uygun çözümleri bulma yöntemlerinin hepsi NP-Zor olarak bilinmektedir. Konvansiy onel teknikler olarak genelde numaralandırma algoritmaları kullanılmaktadır, ancak genellemeden uzak olmaları sebebiyle, bunların üstel zaman ve yer karmaşıklıklarına sahip olacakları kesindir. Ayrıca, üretecekleri çözümlerin kontrol edilebilmelerinin zor olması bir yana anlaşılabilmeleri bile mümkün olmayabilir. Bu tez, sinirsel ağ yapılarının, bulanık mantık karar verme ve Q-Öğrenme mekaniz malarının bir kombinasyonunu kullanarak, POMDP olarak modellenmiş problemlere hızlı, dayanıklı ve kolay anlaşılabilir çözümler elde edebilmek için alışılmışın dışında bir sinirsel-bulanık teknik sunmaktadır. IV ABSTRACT A NEURO-FUZZY APPROACH TO PARTIALLY OBSERVABLE MARKOV DECISION PROBLEMS In the field of Artificial Intelligence, behaving rationally under uncertainty is one of the hardest and most important problems. Uncertain cases, probabilistic environ ments and mechanical problems are the main obstacles. Today, Partially Observable Markov Decision Processes (POMDPs) which model uncertain environments with per formance criteria, deliver the only satisfactory solution for these problems. So, finding solutions to POMDP models is one of the most promising issues in the field. Possible solutions apply to numerous areas including robot navigation, fault detection, decision making, etc. Unfortunately, POMDPs are also very hard to solve by conventional tech niques even for very small problems. Finding optimal solutions to POMDP problems is known to be NP-hard. Mostly enumeration algorithms are used as the conventional approach, but lacking generalization, these are guaranteed to have exponential time and space complexities. Moreover, their solutions are not much understandable if not intractable. This dissertation presents a novel neuro-fuzzy approach to obtain fast, robust and easily interpreted solutions to POMDPs by utilizing a combination of several learning techniques including neural networks, fuzzy decision-making and Q-Learning. 157

The mental health of the person must be healthy for being responsible for the crime committed. In this study, socio-demographic and clinical characteristics as well as assessments about criminal responsibilities of the patients who were under forensic observation for crimes committed in the military environment was evaluated. Medical records of the 1,482 patients who were referred with the aim of forensic observation within a period of five years were studied retrospectively. The average age of the patients was 26.6 ± 8.2 years and education levels were 8.6 ± 2.2 years. Fifty-seven percent had a history of substance abuse, drug addiction rate was 1.2%. 22.3% of the cases were evaluated within the 32nd article of Turkish Penal Code (TPC). Diagnoses of patients assessed under 32nd article of TPC was psychotic disorder (61.9%), mental retardation (13.3%) and bipolar disorder (13%), respectively. 19.23% of the cases had previous criminal histories. Level of education of patients with a previous criminal history was lower (7.73 ± 1.36 years). There was also significant difference between groups with and without previous criminal history in terms of diagnosis of antisocial personality disorder and substance abuse history (p

Deaths due to rupture of hydatid cysts caused by Echinococcus granulosus encountered rarely, mostly in endemic areas. We report a 29-year-old man who died suddenly. A forensic autopsy was performed. The postmortem examination confirmed a ruptured cyst in the liver and a decision was made that death must have been caused by the anaphylactic shock due to rupture of this cyst. This case was presented in order to emphasize the medico-legal issues related to the diagnoses and treatments of the entities which cause sudden death encountered in primary health care services, and to document of the postmortem findings of a sudden death case due to a ruptured hydatid cyst which is rarely occured.

AIM: High levels of anger and aggression in post-traumatic stress disorder lead to unfavorable social, legal, physical and economic results to family members and the other social layers as much as patients. In this study, it is aimed to investigate the relation between both alcohol-cigarette consumption ratios and anger levels, characteristics of aggressive behaviors and the judicial outcome in cases diagnosed post-traumatic stress disorder due to armed conflict. METHODS: 38 cases diagnosed as post-traumatic stress disorder were included to the study. Pre- and post-traumatic alcohol/cigarette consumption amounts and aggressive behaviors are determined. Impact of Events Scale (Revised) (IES-R) was used for evaluating post-traumatic stress disorder symptom patterns and severity, Buss Perry Aggression Questionnaire was used for measuring anger and aggression levels, and Taylor and #8217;s Violence Rating Scale was used for evaluating the judicial outcome of aggression. RESULTS: 23 of cases (60.6%) were married with children, 13 of cases (34.25) were single and 2 of cases (5.2%) were divorced.18 of cases (47.4%) were graduate. IES-R total score was 66,9 +/- 12,7, Buss Perry total score was 111,3 +/- 20,5, and Taylor and #8217;s Violence Rate was 2,5 +/- 1,0. When the pre- and post-traumatic aggressive behaviors were compared; physical violence to the partner was increased more than ten times, Physical and verbal violence to social individuals were increased more than four and seven times, respectively. And also it is observed that inflicting damage to property was increased 17 times, reckless driving was increased 11 times, and self-mutilation was increased 5 times. Alcohol consumption was determined as 0 (0 - 126) g/day for pre-trauma cases and 16.5 (0 - 294) g/day for post-trauma cases. Cigarette smoking was determined as 5 (0 and #8211; 40) cigarette/day for pre-trauma cases and 30 (0 -60) cigarette/day for post-trauma cases. CONCLUSION: Post-traumatic stress disorder associated with high levels of anger and aggression and alcohol can cause familial-marital problems, breaking up a family, increase in judicial problems and arrest, increase in ratios of self-mutilation and severe bodily injuries, physical violence to patterns and children, progressing of post-traumatic stress disorder, severe mental situations such as depression and suicide. For these reasons, careful detecting of alcohol-drug abuse and overstimulation symptoms as anger/aggression in post-traumatic stress disorder, and rapid target-driven psychopharmacologic and psychotherapeutic interventions Become more of an issue. [TAF Prev Med Bull 2014; 13(4.000): 301-306]

ÖZET Robot yönlendirme alanında, belirsizlik en önemli problemlerden biridir. Biz, mantıklı davranan robotlara ihtiyaç duyuyoruz. Fakat, belirsiz durumlar, olasılık içeren ortamlar ve mekanik problemler önümüzde durun ana engellerdir. Bugün, `Partially Observable Markov Decision Process (POMDP)`ler bu problemler için tatmin edici tek çözüm olarak görünmektedir. POMDP'ler `Markov Decision Process (MDP)`lerden kismi gözlemlenebilme özelliği eklenerek elde edilmiş bir kümedir. POMDP'ler yardımıyla bir robot, labirent benzeri bir ortamda yolunu kaybetme problemini çözümleyebilir. Yani bu konuda mantıklı hareket edebilir. Bu tez boyunca POMDP'lerin robotlar üzerinde uygulanmaları, bunları içeren problemler ve bu problemlere uygun çözümler incelenmiştir. Buna ek olarak POMDP problemleri için hazırlanmış bazı algoritmalar hayata geçirilmiştir. Bu algoritmalar bu tür problemler üzerinde çalıştırılmış ve sonuçlar toplanmıştır. Bu çalışmada hayata geçirilen algoritmalar, Cheng algoritması, SPOVA algoritması, SPOVA- RL algoritması ve Value Iteration algoritmasıdır. Bunların herbiri kendine has özelliklere sahiptir ve herbiri bir çözüme ulaşabilmek için değişik yöntemler kullanır. Aslında, bu dört algoritma POMDP algoritmalarının başka başka katagorilerinin örnekleridir. Özet olarak, bu tez iki ana bölüme ayrılabilir; birinci bölümde POMDP'lerin teorisi açıklanmıştır, ikinci bölümde ise pratikte nasıl çalıştıkları gösterilmiştir. IV ABSTRACT In robot navigation field, uncertainty is one of the most important problems. We need robots, which are behaving rationally. But, uncertain cases, probabilistic environments and mechanical problems are the main obstacles in front of us. Today, `Partially Observable Markov Decision Processes (POMDPs)` seem to be the only satisfactory solution for these problems. POMDPs are elements of a set generated from Markov Decision Processes (MDPs) where partial observability is taken into account. By the help of POMDP structures, the robot can find a way around the problem of loosing its position in a maze-like environment. That means it can behave rationally. Throughout this Thesis, we have examined the POMDP usage in the field of robotics, problems concerning POMDPs and solutions that are suitable to them. In addition to these, to see the things working, we have implemented a bunch of algorithms, which are designed to attack POMDP problems. They are run on such problems and results are collected. The algorithms, which are implemented in this study, are Cheng's algorithm, SPOVA algorithm, SPOVA-RL algorithm and Value Iteration algorithm. Each of them has its own characteristics and every one of them uses different ways to obtain a solution to a POMDP problem. Actually, these four algorithms are examples from different categories of POMDP algorithms. So, in brief this Thesis is divided into two separate parts; the first part presents POMDPs in theory and the second part presents them at work. 109

Among the available chemical warfare agents, sulfur mustard (SM), also known as mustard gas, has been widely used chemical weapon. In our laboratory, we have shown that, acute toxicity of SM is related to reactive oxygen and nitrogen species, DNA damage, poly(ADP-ribose) polymerase activation and energy depletion within the affected cell. In spite of the knowledge about acute SM-induced cellular toxicity, unfortunately, it is not clear how mustard gas causes severe multi-organ damage years after even a single exposure. A variety of treatment modalities including antioxidants, anti-inflammatory drugs and others have resulted no promising results. We, therefore, made an attempt whether epigenetic aberrations may contribute to pathogenesis of mustard poisoning. The term epigenetic describes the study of inheritable alterations in gene expression that occur in the absence of changes in genome sequence. Therefore, epigenetic gene regulation requires molecular mechanisms that encode information in addition to the DNA base sequence and can be propagated through mitosis and meiosis. Our current understanding of epigenetic regulation of gene expression involves basically two classes of molecular mechanisms: histone modifications and DNA methylation. Preliminary evidence obtained from our laboratory reveals that exposure to mustards may not only cause nitro-oxidative stress and DNA (genetic) damage, but epigenetic perturbations as well. Epigenetic therapy is a new and rapidly developing field in pharmacology. Epigenetic drugs alone or in combination with conventional drugs may prove to be a significant advance over the conventional drugs used to treat both acute and delayed SM toxicity. Future studies are urgently needed to clarify the mechanism of delayed SM-induced toxicity and novel treatment modalities. [TAF Prev Med Bull 2012; 11(2.000): 231-236]

The incidence of firearm related non-fatal and fatal accidents has increased worldwide. Most of firearm accidents result often due to human errors included extreme carelessness while handling, carrying or storing a loaded firearm. Most of the unintentional or intentional nonfatal gunshot injuries involve an extremity. Most gunshot injuries to the hand are result of low-velocity handguns. While low-energy firearm injuries are caused by small calibre hand guns, BB (ball bearing) guns and zip guns, high energy firearm injuries are caused by high calibre handguns or assault rifles. Gun-cleaning accidents occur rarely. All firearms are being cleaned periodically and gun-cleaning mistakes can cause accidents and even fatalities. The most dangerous type of gun-cleaning mistake is forgetting to check whether it is loaded or not, before attempting to clean the gun. The MG3 is a German general-purpose machine gun and is a short recoil-operated, belt-fed, heavy-barreled, air-cooled machine gun suitable for bursts and sustained fire. The weapon and its derivatives have also been acquired by the armed forces of over 30 countries. We report a case with gunshot wound to the hand caused by ignition of a bullet while the cleaning a MG3 barrel with gun cleaning rod. In this study, the circumstances accompanying these injuries, and preventive measures are discussed. These injuries are preventable, and therefore, some basic measures may reduce the incidence of accidental injury during gun cleaning procedure.

Incest can be traditionally described as sexual intercourse between family members. Determination of incest cases is quite difficult due to the inability of applying contemporary interview techniques with the child and the resistance of the family members to collaborate with physicians due to the nature of the event. In such cases, diagnostic physical findings are not often observed and criminal investigations to reach a conclusion become harder. Many cases of incest can be recognized when pregnancy occurs. In the present case, an incestuous relationship between a male and female sibling younger than 15 years resulting in pregnancy has been examined. Fragmented family, lack of education, and socio-cultural characteristics have been considered as contributing factors. The location of the case has low socioeconomic status. Education about puberty and sexuality of children in such places can be problematic. Adding fragmented families into the equation makes this more dramatic as it can be observed in our case. In these cases it is important that physicians, other healthcare professionals and teachers should be alert and be ready to take appropriate measures in their area. In addition, the introduction of a state policy of education about sexuality is extremely effective in the prevention of such events.