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Abstract Background Comprehending the toxic effects of substances co-detected in bodily fluids presents a formidable challenge. The combined toxic effect of carbon monoxide and methamphetamine remains a rarely discussed issue within the realm of scholarly literature. The main objective of this research is to delve into the potential intricacies of death mechanisms, unraveling the profound impact of both CO and methamphetamine on the heart. Case presentation The cause and mechanism of death of a young man with toxic levels of CO–Hb and low-dose methamphetamine in his bloodstream were discussed in conjunction with the literature in this study. Methamphetamine levels of 30 ng/mL (0.03 mg/L) and 25.8% CO–Hb were detected in the blood of a 25-year-old individual who was found dead and without any disease. Conclusions Although the amounts of methamphetamine and CO–Hb in the blood were not in the deadly range, it was determined that death occurred as a result of the combined action of these substances. In the present case, it was considered that death occurred as a result due to the combined cardiac effect of methamphetamine and CO, before the lethal blood CO level was reached.

Background:Autopsy rates are significantly lower that what they should be worldwide. Additionally, autopsy practices vary between countries.Aims:To examine the autopsy rates, the distribution and temporal changes of forensic autopsy cases, so as to identify the areas in the death investigation system that require improvement in Türkiye.Study Design:Cross-sectional study.Methods:“Forensic Death Examination Statistics” of the Council of Forensic Medicine (CFM) and “Death Statistics” of the Turkish Statistical Institute were compared and analyzed for the years 2013-2022 in Türkiye.Results:The number of forensic death cases sent to the CFM has increased over time. For all causes of deaths, the autopsy rate is approximately 3.6-4.8%. The cause-specific mortality rates for deaths due to sharp instrument trauma, blunt trauma, occupational accident, undetermined, and poisoning have increased over the years. “The percentage of “undetermined” deaths, which are important to demonstrate negative autopsies, was 14.2% in 2021.Conclusion:Although the autopsy rates have slightly increased in a volatile trend over time in Türkiye, they are still not at the desired level. Thus, it is essential to further raise awareness among all professionals involved in death investigations about the importance of autopsies.

Abstract Background It is difficult to pinpoint the manner of death in cases of death due to sharp force injuries where injury patterns resemble one another. Other issues that might arise include physical mobility and survival time after injury. Within the scope of this case, a 53-year-old male suicide with findings suggestive of homicide is presented, along with research on the nature of sharp neck injuries, survival time, and movement after injury. Case presentation Thanks to the surveillance camera video that captured a significant portion of the occurrence, it was determined that the incident in the case that was presented, which had two perforations of the larynx, was suicide. At first appearance, this case could be assumed to be homicidal. Due to the injury, the victim could only walk around 300–350 m. The victim had a 4-h average survival time. Conclusions In general terms, the survival time according to the injury sites in the neck can be listed for a person (if the wound sizes are close to each other) as follows: injury causing vagal stimulation < arterial injury with severe blood loss < venous injury with blood loss < airway injury causing aspiration and respiratory failure.

Objective:It is aimed to determine the causes of supreme court reversal in the field of forensic psychiatry on Juvenile Delinquents and identifying to issues be considered while preparing a report in terms of compliance with the law.Methods:From website of the Supreme Court https://karararama.yargitay.gov.tr/YargitayBilgiBankasiIstemciWeb/, 691 reversal decisions on forensic psychiatric issues regarding juvenile delinquents were examined by using the words: “child psychiatry”, “child and adolescent mental health”, “child at the age of discretion”, “mental health, child”, “perceiving the legal meaning and consequences, directing their behaviour” and “the child delinquent”.Results:It was determined that the most common reason for reversal in the evaluation of criminal responsibility by age in children (n=208, 36.3%) was the absence of social examination report or forensic psychiatric report, used of reports prepared for past crimes in the trial process, the second most common reason (n=169, 29.5%) was the reports which weren’t prepared duly and found insufficient in terms of content. In the evaluation of criminal responsibility due to mental illness, it was seen that the most common reason for reversal (n=154, 40.5%) was that although mental illness was stated in the history of psychiatric illness, insufficient investigation was carried out on this subject, and that the second most common reason for reversal was (n=130, 34.2%) the decision was made before delegation report was received.Conclusion:The attached template, which is prepared considering the Supreme Court Reversal Decisions, can help to ensure standardization in the prepared reports.It is important for the prepared reports to contain complete, reasoned and clear opinions, to prevent grievances due to the judicial process, and to protect the best interests of the child.

Echinococcosis generally remains asymptomatic for many years, but it can also be fatal if complications like cyst rupture or superinfection occur. It is highly uncommon for a macroscopically non-ruptured cyst to cause death, and its exact mechanism is unknown. In the literature, there are several cases with identical characteristics diagnosed by autopsy. This autopsy case has illustrated the death due to a micro ruptured hydatid cyst. The deceased's lung underwent microscopic inspection, and it revealed broad intraalveolar hemorrhage, edema, severe hyperemia, neutrophil stasis in the interstitial capillary lumens, and a large number of parasites in the capillary lumen. Anaphylaxis against cyst contents that leaked into the bloodstream from liver cysts and non-thrombotic pulmonary embolization were shown to be the causes of mortality. In countries where echinococcosis is endemic, echinococcosis should be considered in all cases of anaphylaxis and sudden death.

As a result of persistent weakening or loss of function of one of the senses or organs, which are stated in articles 87, 89 and 95 of the Turkish Penal Code, penalty increases are applied at varying rates depending on whether the act was committed by negligence, willful or torture. The need for a separate guide has become more evident today, as there are deficiencies in the guide used for the evaluation of these situations, and the existing debates about the charts used to determine the financial compensation recommended to be used to support the guide. The existing problems in the evaluation of the function of the senses and organs also bring the problem of fair distribution of justice. Considering the problems in practice, a separate guide is needed for the evaluation of sensory and organ function, which can be considered as a second-line forensic medical evaluation. Since the definition of organ is evaluated differently in the Turkish Penal Code and in the medical literature, first of all, it will be important to ensure a common language unity in practice, to define all the body parts that will be included in the concept of organ in forensic medicine practices. Including studies in the literature in the guide will provide a more reassuring approach in updating the guide. What are the concepts of organs and senses from a forensic medicine perspective? What should be considered in the forensic medical examination in the evaluation of their functions? In our study, the concepts of permanent weakening/loss of the function of one of the senses or organs will be discussed in terms of legal and forensic medicine and solutions will be discussed by revealing the problems experienced in practice.

Abstract Background It is not straightforward to objectively evaluate the olfactory dysfunction that occurs following forensic incidents. The olfactory event-related potentials method, based on electrophysiological records, may provide objective data in the evaluation of posttraumatic anosmia cases from the medicolegal perspective. This study, where a quantitative evaluation of the cases with the complaints of olfactory sensation disorder was performed using the olfactory event-related potentials test, aims to identify the factors that should be considered in the evaluation of olfactory dysfunction from the medicolegal perspective. Results This study first evaluated the complaints of 98 patients admitted because of posttraumatic impaired smell and then administered electrophysiological odor tests on the patients. Because of this, the relationship between the EEG responses of the cases and the olfactory disorder was examined. Of the 98 cases that participated in the study, 68 (69.4%) were male and 30 (30.6%) were female. Of all cases, 53 (54.1%) had complaints of not being able to smell at all, 14 (14.3%) had complaints of reduced smell, whereas, in addition to the existing complaints of olfactory dysfunction, 44 (44.9%) of them had complaints of taste perception and 18 (18.3%) reported having vision disorders. 21 of 37 cases who reported being unable to smell during the test turned out to be anosmic. Furthermore, 16 cases stated that, though having had a response in the odor test, they had no sense of smell following the test. Conclusions Although it seems possible to prove that there is a relationship between the olfactory event-related potential test and the diagnosis of anosmia, there is still ongoing research on its use in clinical practice. Performing both subjective and electrophysiological tests together to detect olfactory dysfunctions that occur after a forensic incident enable provide more reliable results in diagnosis.

Article 87/3 of the Turkish Penal Code (TPC) indicates that if a deliberate injury causes bone fracture/dislocation in the body, it leads to penalty increase regarding its effects on the victim’s life functions. This study intends to discuss the concept of “the effects of bone fracture/dislocation on a person’s life functions”, considering both the legal and medical dimensions, and it provides solutions to the potential problems by addressing this issue regarding the Supreme Court’s decisions. The effects of bone fracture/dislocation in the legal literature focus on to what extent the fracture influences the victim’s daily life, whether the victim maintains his/her everyday life, whether he/she is able to do his/her job. However, in The Guideline of Evaluating Bodily Injury Offences in the TPC from Forensics Perspective, the effects of bone fracture/dislocation on life functions reflects the severity of fracture/dislocation and trauma. Although the guideline facilitates the standardization in this issue, it has noticeable limitations in legal principle of equality. There emerges a need for scale to provide objective and scientific data about the effects of fracture/dislocation. This research presents several validated and reliable scales to be used in Forensics and offers a method of calculating more than one fracture.

Objective:As a result of using different scales while preparing disability reports, different rates are determined for the same person. Comparing the disability rates measured by the Scales in the annex of “Capacity to Work and Vocational Permanent Disability Rates Detection Operations Regulations (CVPR)” and the Scale in the annex of “Regulation on Disability Criteria on Classification and Health Board Reports to Be Issued to the Disabled (RDC)”, this research aims at identifying differences between the scales, thereby indicating various hardships experts encounter.Methods:The cases’ gender, occupation and trauma history as well as the request letters, the injuries related to the event and the examination findings were recorded forms. After calculating each case’s profit loss rate in profession and disability rate, the components that led to different rates were evaluated.Results:It was found that following trauma, tibial, fibula and vertebral injuries occurred at most. The most frequent sequelas (52%) were a limitation of movement at a joint and a gait disorder. Since the disorders of almost half of the cases (48.1%) identified with sequela in CVPR do not appear in the A Scale, the discretionary power was enacted. Within the scope of RDC, the discreationary power was employed in 5 cases (3.1%). Average disability ratio of the cases (9.01%) appeared to be significantly lesser (p

Son yıllarda ani kardiyak ölüm oranlarında artış görülmektedir. Günümüzde, implante edilebilir kardiyoverter defibrilatör (implantable cardioverter defibrilator, ICD) ani kardiyak ölümleri önlemede kullanılan bir cihazdır. Travma sonucunda cihazda birtakım problemler meydana gelebilmektedir. Kablo kırığı bu problemlerden biridir. Literatürde, künt travmaya bağlı ICD komplikasyonlarının, özellikle kablo kırığının oldukça nadir görüldüğü belirtilmektedir. Bu olgu sunumunda; eski eşi tarafından sol kolu çekilerek künt travmaya maruz kalan ve oluşan kablo kırığı nedeniyle uygunsuz şoklara maruz kalan kadın olgu medikolegal açıdan değerlendirildi. Olguda, göğse direkt bir travma olmadan, sol kolun çekilmesine bağlı olarak lead kırığı meydana gelmiştir. Hafif şiddetteki bir travmanın bile, yaşamsal tehlike oluşturabilecek, ciddi klinik sonuçlara neden olabileceğine dikkat çekmek amaçlandı.

Konjenital perikardiyal kistler çok nadirdir ve birçok vakada tesadüfen saptanmasına karşın nadiren yaşamı tehdit edici semptomlara neden olabilir. 23 yaşındaki postpartum dönemdeki kadın olgunun yapılan otopsisinde saptanan perikardiyal kistin ve atrioventriküler (AV) nodda yağlanmaya bağlı değişikliklerin kişinin ölümü üzerindeki etkisini tartışmayı amaçladık. Adli tahkikatta; emzirme döneminde olan kadının bir süredir göğüs ağrısı şikâyeti olduğu yazılıydı. Yapılan otopsisinde; perikardın dış yüzüne asılı halde, sol akciğer üst loba komşu 7,5x7,5x4 cm boyutunda, oval yapıda, unilokuler, intakt, içerisinde berrak sıvı bulunan kistik yapı görüldü. Histopatolojik incelemede; AV nodda yağlanmaya bağlı değişiklikler izlendi. Olgumuzda mediastendeki kistin yer kaplayıcı etkisi sonrası gelişen aritmi, sağ ventrikül çıkış yolu tıkanıklığı, kardiyak bası gibi komplikasyonların ve AV nodda yağlanmaya bağlı değişikliklerin ölümüne sebebiyet verdiği değerlendirildi.

Amaç: Trafik kazaları hem ceza hukuku hem de tazminat hukuku açısından sorumluluk doğurabilmektedir. Kalıcı sekellerin ve bu sekellere bağlı maluliyet oranlarının değerlendirilmesinde, Adli Tıp uzmanlarına büyük görevler düşmektedir. Bu araştırmada; trafik kazalarına bağlı maluliyet raporları hakkında Yargıtay’ın bozma kararları incelenerek, göz önünde bulundurulması gereken hususların değerlendirilmesini amaçladık. Gereç ve Yöntem: Trafik kazası sonucu meydana gelen maluliyet oranı hesaplamalarında kullanılan yasal mevzuat ve “trafik kazası” kavramları anahtar kelime olarak kullanılarak, “https://karararama.yargitay.gov.tr/YargitayBilgiBankasiIstemciWeb/” adresinden ulaşılan kararlar tarandı. Yargıtay’ın trafik kazasına bağlı maluliyet oranı raporlarında, ilk derece mahkemelerince alınan kararları bozma nedenleri araştırıldı. Bulgular: Yargıtay 17. Hukuk Dairesi’nin 376 bozma kararına ulaşıldı. Haksız fiilin gerçekleştiği tarihte yürürlükte olmayan tüzüğe/yönetmeliğe göre rapor düzenlenmesinin en sık (n=262, %69,7) bozma nedeni olduğu görüldü. Bunu sırasıyla; alınan raporlar arasında çelişkili oranlar olması, hangi tüzüğün/yönetmeliğin esas alındığının belli olmaması/anlaşılamaması, yazım hatası olması, hükme esas alınacak maluliyet raporu alınmaması ve illiyet bağı ile ilgili sorunların izlediği saptandı. Sonuç: Maluliyet raporlarının; anlaşılır, gerekçeli ve ilgili mevzuata uygun olarak düzenlenmesi esas olmalıdır. Yürürlükteki mevzuata uygun olarak düzenlenmemiş, uygun şekilde gerekçelendirilmemiş, illiyet bağı konusuna dikkat edilmemiş, çelişki bulunan ve denetime elverişli olmayan raporlar hak kayıplarına, yargılama sürecinin uzamasına neden olabilmektedir.

Objective: The aim of this study is to investigate the publication rate of Forensic Medicine specialty theses in national and international journals. Materials and Methods: The Thesis Center database of Council on Higher Education was searched for medical specialty theses written between 1983-2016. Another screening was done using the resident and mentor names as well as thesis title on Ulakbim, Türk Medline, Google Scholar, Web of Science, PubMed databases. The years in which the theses were done and the articles were published, database of the journal, resident’s order among the authors, type of research, thesis subjects were recorded. Results: It was found that 77 (32.6%) out of a total of 236 theses written between 1983-2016 were published. Fifteen-point two percent of these theses were published in Science Citation Index-Expanded/Social Sciences Citation Index, 11.9% were published in international, and 5.5% in national indexed journals. The mean publication time was 2.95±2.49 years. It was also found that the resident was the first author in 85.7% of the articles, and 53.2% of the published theses were prospective studies. Most frequently article subjects were in the fields of Forensic Pathology (26%) and Forensic Psychiatry (23.4%). Conclusion: Publishing rate of theses in Forensic Medicine was similar to the data regarding publication rates of theses in different medical specialty fields in our country and abroad; however, it is below the level desired. It is of utmost importance to generate solutions to facilitate the process including but not limited to mentors that are encouraging and instructive,...

Divalproex sodium/valproic acid (VPA) is an antiepileptic drug which is frequently prescribed in neurology and psychiatric clinics. Common side effects of VPA are side effects of the digestive system, weight gain, tremor, sedation, hematologic side effects and hair loss. Valproate-induced hyperammonemia is almost seen in 50% of patients treated with VPA, some of which may develop encephalopathy. Valproate-induced hyperammonemic encephalopathy (NE) is a well-known subject and there are numerous publications in the current literature. Although there is substantial evidence for this side effect in patients with neurological disorders, the data in the psychiatric area are limited. When we look at publications, it seems that VHE is seen more often because it starts earlier in psychiatric patients, but we think that it is often missed. Here, we presented five cases in which we followed up and treated with VHE diagnosis in our clinic within one year and other reports published previously in a table.

Supplier selection is very important for a company to be successful in a globalized competitive environment. The aims at choosing the optimal supplier; to increase customer satisfaction, improve the competitive ability and continue to exist at minimal cost. This study was intended to choose the most suitable raw material supplier in a company engaged in the production of agricultural tires. In the study Analytical Hierarchy Process (AHP) and Promethee I-II methods were applied in order to select the most optimal supplier to a company. In conclusion, AHP and Promethee I-II methods used by the company to determine the suppliers with the optimal supplier and brought several recommendations.

Amaç: Çalışmamızda; trafik kazası sonucu meydana gelen kemik kırıklarına uygulanan tedavilerin başarıları ile bu tedavi sonucunda kalan sekellere ait meslekte kazanma gücü kaybı ve özürlülük oranlarının hesaplanarak kıyaslanması amaçlanmıştır. Gereç ve Yöntem:01 Şubat 2016 – 01 Şubat 2017 tarihleri arasında travma sonucuEge Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji Anabilim Dalında tedavi uygulanmış ve Ege Üniversitesi Tıp Fakültesi Adli Tıp Anabilim Dalımıza sekel oranının hesaplanması için başvuru yapılması istenmiş tek taraflı ekstremite kırığı olan 142 olgu değerlendirildi. Bulgular:En sık kırık saptanan ilk üç kemik olan tibia, femur, tibia+fibula kırıklarının anlamlı olarak motosiklet kazalarında daha fazla gözlendiği saptandı. Alçı-atel tedavisi ile plak vida ve intramedüller çivi tedavileri arasında sekel oranları yönünden anlamlı fark olduğu saptanmıştır (p

Erektil disfonksiyon, cinsel ilişki için yeterli ereksiyonun elde edilememesi veya sürdürülememesidir. Bu olgu sunumunda; trafik kazasına bağlı multitravmalı olguda gelişen erektil disfonksiyonu adli-tıbbi açıdan değerlendirmek ve yaralama suçlarının adli tıp açısından değerlendirilmesi amacıyla kullanılan kılavuza katkıda bulunmak amaçlandı. Tıbbi evrakta; olaya bağlı pelvik kırıklar, mesane ve üretra rüptürü ve diğer yaralanmaları olduğu kayıtlıydı. Olgunun Anabilim Dalımıza başvurusu sonrası istenen Üroloji konsültasyonu sonucunda; mevcut bulgularla ereksiyonu gerçekleştirmek için organik açıdan yeterli olmadığı anlaşıldı. Travmanın erektil disfonksiyona yol açtığı belirlenen olguda, yaralanmanın ürolojik açıdan kişinin organlarından birinin işlevinin sürekli yitirilmesine yol açtığı sonucuna varıldı.Erektil disfonksiyonun, cinsel fonksiyon bozuklukları başlığı altında ilgili kılavuzda yer almasının, adli rapor düzenleme sürecine yardımcı olacağı düşünülmektedir.

Essential hypertension is one of the most emphasized psychosomatic disorders. Age, sexuality, excessive salt and alcohol consumption, lower activity level, fatigue, personality traits, emotional factors and stress are some of the risk factors for essential hypertension. The presence of emotional factors in the etiology of the essential hypertension and the emergence of psychiatric symptoms in the course of the illness has driven considerable attention from mental health workers on the disease for a long time. Some of the personality traits that make a person vulnerable to hypertension are being over controlled, being submissive, and hardworking. Hypertension is accepted to be a reaction against suppressed emotions and an adaptive and defense mechanism of the body. Among persons who are prone to hypertension, sympathetic nerve system is affected as a response to emotional stress and hypertension appears as a result of vasoconstriction and other autonomous responses. All at once, it was also shown that vasoconstrictor response continues much longer in hypertensive individuals than in normotensive patients. Autonomic response to stress almost always displays itself as hypertension in individuals who are prone to hypertension. Moreover, normotensive children of hypertensive parents also have elevation in blood pressures as a response to emotional stress almost without exception. The increase in sympathetic stimulus, re-modulation of bar receptors by structural and functional changes are the main features of the most commonly valid hypothesis in essential hypertension, currently. According to this hypothesis: as a result of emotional stress, inhibition over vasomotor center decreases and output of stimulus increases; epigenetic changes in endothelial structure of carotid sinus and/or aortic arch and/or vasomotor centers occurs; and finally stress increases sympathetic stimulus output. This situation leads to neurohormonal excitation; increases in systemic vessel resistance; and in turn increase in the secretion of vasoconstrictor compounds from endothelial cells of over-resistant vessels. Hypertension develops as a result of vasoconstriction. In the previous studies, emotional factors and particular personality traits are consistently confirmed for being predisposing factors in hypertensive individuals. In this article, we focused on the association between essential hypertension and psychological factors, and discussed the common pathophysiological mechanisms.