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Pregabalin (PGB) has been commonly subjected to diversion, from being a prescription drug to a recreational drug. In this study, pregabalin use (which is one of the substances subject to control in Turkey) and the concomitant use of other substances in cases admitted to the Izmir Forensic Medicine Institute was evaluated. Samples from 15,259 cases were screened, between June 2017 and December 2018, for the presence of PGB, and PGB positive cases were further analyzed. Of all cases screened, PGB was detected in 3.2% (n = 487). The mean age of PGB positive cases was 29.24 ± 10.34 years old (min: 14, max: 84), and 94% of them were male. Cannabis metabolite THC-COOH was the most common substance detected in the blood samples following PGB. Overall, 8 other substances were commonly used along with PGB. These substances were cannabis, morphine, hydromorphone, codeine, hydrocodone, heroin, paracetamol, and naproxen. Finally, we observed similar results in urine analysis. This research provides systematic data for PGB use in forensic cases in Turkey. The study findings indicate that PGB and multiple drug use increased over time, and providers should be particularly careful when prescribing PGB.

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Using postmortem toxicological analyses, we aimed to determine the origin and cause of death and type of substance used in substance use-related deaths. A total of 7475 autopsies were performed between January 2015 and December 2017 in Izmir, Turkey. In our retrospective analysis, substance use was detected in 449 (6.0%) autopsies. The majority (96.4%) were male. The most frequent deaths (18.5%) occurred in the 25-29 age group. Of the 55.2% of the cases that died of unnatural causes, accident-related events (22.9%) were most frequent. Trauma/injury caused death in 37.0% of cases and substance intoxication in 24.7%. Cannabis use was detected in 34.3% of the samples, and multiple substance use in 25.4%. Accordingly, It is thought that a multidisciplinary approach can be successful in preventing substance use and related problems.

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Mitochondria appeared to be a major target for paracetamol (PAR)-induced hepatotoxicity. Studies suggested that microsomal CYPs catalyse bioactivation of PAR to N-acetyl-p-benzoquinone imine (NAPQI), which alkylates mitochondrial proteins, and causes transmission of death signal from mitochondria to nucleus. We hypothesised that local formation of NAPQI within mitochondria seems more likely compared to the translocation of NAPQI. We therefore tested whether the formation of NAPQI may be catalysed by mitochondrial CYPs. Cellular fractions were isolated from human liver and kidney to compare the metabolic capacities. Liver and kidney mitochondria are capable to generate NAPQI. Mitochondrial CYP2E1 and CYP3A4 activities were comparable to the microsomal counterparts in both organs. Previously reported higher kidney microsomal CYP2E1 activity in men compared women were observed in mitochondrial CYP2E1 as well in the present study. On the other hand, no correlation between kidney CYP2E1 activity and quantity of NAPQI formation, as well as no induction on mitochondrial permeability transition pore (mPTP) opening by PAR in kidney mitochondria strongly suggested a different toxicity mechanism in this organ.

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Izmir is a city in Turkey where both tourists and refugees concentrate, making it home to many foreign nationals. In recent years, many refugees have tried to reach Europe via Izmir and the Aegean Sea. In this study, we examine autopsy reports on foreigners who died in Izmir between 2015 and 2020, and we compare the data with relevant international studies. This study analysed the autopsy reports of foreign nationals in Izmir, in terms of demographic data, date of death, place of death, manner of death, source of death, histopathology and toxicology results and exact cause of death. A total of 9951 autopsies were performed between 2015 and 2020 in Izmir, of which 538 (5.4%) were on foreign nationals. Of the autopsy cases in our study, 55.4% were performed on males and 44.6% were performed on females; 32.5% of the cases died between the ages of 0 and 10 years. Syrian nationals comprise 29.7% of the total cases. Of the autopsies of Syrian nationals, 80% died between the ages of 0 and 10. The cause of death was determined to be drowning in 42.4% of all cases. Information gathered from autopsies performed on foreign nationals can contribute to an understanding of the common problems of refugees, which can aid in the alleviation of some migration issues by drawing attention to the mass deaths of refugees in the Aegean Sea, the health problems experienced by children during their journey, and the deaths of refugee children.

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INTRODUCTION: and Objective: Falling from a height is one of the main causes of blunt force trauma. Frequently seen in accidents or for the purpose of suicide, it can result in disability or death. The aim of this study is to investigate the characteristics of fatalities due to falling from a height. MATERIALS AND METHODS: This study retrospectively examines 213 cases of fatal falls from a height that had occurred in and around Elazig province between January 2005 and December 2016. All the victims' autopsies were performed. The cases were reviewed in terms of such variables as gender, age, the month and season in which the incident took place, the cause of the fall, the location of the fall, the height of the fall, the injury site and the cause of death. RESULTS: It was determined that the falls were caused by: Accident in 171 (80.3%) cases, suicide in 41 (19.2%) cases and homicide in 1 (0.5%) case. Of these cases, 144 (67.6%) were men and 69 (32.4%) were women. In our study, the youngest case was aged 9 months while the eldest was 91 years, the average age being 43.6 ±â€¯27.4 years. It was determined that 60.6% of the cases had fallen in their homes. CONCLUSION: In conclusion, it was observed that fatalities from height are mainly the result of an accident and thus preventable. Since fatalities were more common in the aged and in children, it was thought that protective measures should be implemented specifically for these groups such as appropriate planning and family education.

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INTRODUCTION AND OBJECTIVE: Tractor is regarded as a key equipment in agriculture, and it is also used for transportation and transfer purposes in addition to its agricultural use. Accidents resulting in death in farmlands are frequently encountered. Tractor-related fatalities are the most common ones among the deaths after farm accidents. This study aimed to evaluate the characteristics of tractor-related deaths and to discuss the measures that could be taken to prevent these deaths. METHODS: In this study, 42 cases who underwent postmortem examination and/or autopsy because of tractor fatalities in the province of Elazig between January 2005 and December 2016 were examined retrospectively with such variables as sex, age, month and season of incident, cause of incident, location of incident, position of case, and injured region. RESULTS: Of the cases, 36 (85.7%) were male, and 6 (14.3%) were female. The youngest case was 2 years old, and the oldest case was 83 years old; the mean age was 43.3 ± 25.0 years. Examining the deaths regarding the cause of incident showed that tractor rollover was the most common cause (42.9%). This was followed by being run over by the tractor (19.0%). Of the cases, 24 (57.1%) were drivers, 10 (23.8%) were passengers, and 8 (19.0%) were pedestrians. CONCLUSIONS: Tractor-related fatalities due to tractor rollover are most often seen. To reduce the deaths caused by this reason, drivers should have special training and technical support, use helmets and seatbelts in the tractor, and have a health check at certain intervals (especially the drivers at advanced age).

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Pleomorphic adenoma is a slow-growing salivary gland tumor frequently arising from the parotid gland. In this study, we investigated the role of the insulin-like growth factor I-II receptor (IGFI-IIR) levels on the development of parotid gland pleomorphic adenomas. The study included 20 males and 20 females who had superficial parotidectomy with a histopathological diagnosis of pleomorphic adenoma in Firat University Otorhinolaryngology Clinic between 2000 and 2011. The ages of the patients ranged between 20 and 50 years. The control tissues were obtained unilaterally from the parotid glands of five female and five male cadavers during autopsy, and consisted of 0.5 × 0.5 cm sized normal parotid gland tissues. The expression of IGFI-IIR were measured in both tumor and tumor-free normal parotid tissue in the study group while only the normal parotid tissues were studied in the cadavers. Primary polyclonal antibodies against IGFI-IIR were used with "Streptavidin-Biotin Complex" method for immunohistochemical staining of both the study and the control groups' tissue sections. In this study, the IGFI-IIR levels were found significantly higher in the pleomorphic adenoma tissue (p < 0.05). In addition, IGFI-IIR expression was greater in normal parotid tissues of the study group when compared to the normal parotid tissues of the cadavers. However, the difference was not statistically significant (p > 0.017). Greater expression for IGFI-IIR in pleomorphic adenoma when compared to normal parotid tissues of the patients and the cadavers suggests that IGFI-II may be important factors in the development of pleomorphic adenoma.

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The allelic frequency distribution and statistical genetic parameters of forensic relevance for 15 STR loci (D8S1179, D21S11, D7S820, CSF1PO, D3S1358, TH01, D13S317, D16S539, D2S1338, D19S433, vWA, TPOX, D18S51, D5S818 and FGA) in a population sample of 802 unrelated individuals in Eastern Turkey. The expected performance of these loci for personal identification and paternity testing in this population was estimated. Eastern Turkey and other 12 country population data were compared using allele frequencies.

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A 19-year-old male patient who wounded himself with a gun in the cranial region had a Glasgow coma scale of 3E. At posttraumatic day 7, locked-in syndrome was considered upon detection of vertical eye movements, meaningful winks, and quadriplegia. Apart from the classical view, computed tomography (CT) and postmortem examination of the brain showed an infarct area in the cerebellum. However, vertebrobasilar artery system was normal. In this case report, we would like to present that unlike cases with ischemia, specific CT findings may not be evident in posttraumatic cases and ischemia may occur in the cerebellum as a result of the pressure exerted by a sound gun.

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BACKGROUND: The aim of the study was to investigate if there was a difference in injury in intra-abdominal viscera due to blunt abdominal trauma sustained by rats with empty or full stomach and to examine which viscera is affected most, based on the direction of the trauma. METHODS: Since there is no data in the literature on the force of trauma, a pilot study was carried out before commencing the experimental study. An apparatus was built to determine the trauma force that would not cause sudden death, and rats were allowed free fall from a height of 40 and 45 cm so that they would land on their abdomen. The most appropriate force of trauma (F=69.978 N) and absorbed energy (E=½mv2=0.979 Joules) were obtained in rats weighing 250 g that fell from a height of 40 cm. RESULTS: Thirty six rats were included in the study and separated into six groups. Any statistically significant differences between groups with regard to the stomach being empty or full during trauma and its direction were examined (anterior, right/left sided). CONCLUSION: It was observed that there were differences in injuries sustained by the internal organs depending on the fullness or emptiness of the stomach and the direction of the trauma.

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Suicide is a form of behavior brought about by a combination of biological, psychological, and social factors and the adverse effects of those factors on individuals, their surroundings, society, and subsequent generations. In this study, attention is focused on the increase in adolescent suicides in Elazig and the surrounding province. The probable suicide cases among adolescent deaths that occurred in Eastern Turkey between 2001 and 2012 were examined retrospectively. A total of 67 cases were evaluated in terms of age, sex, method of death, death location, and the time of the year at which death occurred. Of the 67 study cases, 40 were female (59.70%) and 27 were male (40.29%). When the methods of suicide were analyzed, it was found that hanging came in first place with 34 cases (50.74%), followed by death using a firearm with 27 cases (40.29%). Other types of death were self-poisoning in four cases (5.97%) and jumping from a height in two cases (2.98%). According to this study, there are common risk factors both for suicidal thoughts and suicide attempts. Defining the prevalence of suicidal thoughts leading to suicide attempts, determining the risk factors, and evaluating the relationship between those factors and mental disorders will enable society to develop new approaches to suicidal behavior.

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OBJECTIVES: Sudden deaths occur within 24 hours after symptoms' onset and are caused by cardiac, neurological and pulmonary diseases. Autopsy is the gold standard in determining cause of death. In this study, death's etiology was evaluated in cases applied to our department that underwent autopsy with sudden death indication. METHODS: This study included cases aged 18 or older with sudden, suspected, non-traumatic death applying to our department between 2008 and 2012. Patients' age, sex, death time, co-morbid diseases, initial signs, cardiac rhythm, and autopsy findings were recorded after reviewing patient charts. RESULTS: The study included 46 patients. Mean age was 45.73±19.6. Of the cases, 84.78% applied to emergency with cardiopulmonary arrest. Thirty-two cases (69.6%) were male. The most frequent cause of death was cardiovascular diseases (52.2%), followed by central nervous system disorders (21.7%), intoxications (15.2%), and respiratory diseases (10.9%). The most common diseases were myocardial infarction (45.7%), subarachnoid hemorrhage (8.7%), and chronic obstructive pulmonary disease. There were three drug ingestions, three carbon monoxide intoxications, and one corrosive material ingestion among the intoxication cases. CONCLUSIONS: Sudden deaths are rarely encountered. Emergency clinicians should consider cause in differential diagnosis and provide appropriate approaches at first evaluation.

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BACKGROUND: This study was designed to determine depression in women in the postmenopausal stage in Elazig city, located in Eastern Turkey, and determine the factors affecting depressive status. MATERIAL/METHODS: The sample included 546 women and of these, 519 could be contacted. A questionnaire was conducted with the women who were included in the study. This included demographic properties, which are thought to affect depression. Subjects were given the Beck Depression Inventory (BDI). RESULTS: In total, 97.7% of women reported that they experienced a problem or had complaints during menopause, while 54.9% reported that they experienced problems in their sexual lives. The mean BDI score of women was 17.01+/-8.75. The ratio of women whose total scores were higher than the breakpoint of 17 was 42.2%. Single, widowed, and divorced women had higher ratios than married women; primary school or lower education women had higher ratios than high school or lower education graduate women; the women who reported that they had problems in their sexual lives had higher ratios than the other women within the survey; the women who were subject to violence at any time during their lives had higher ratios than the women who had not experienced violence (P<.05). CONCLUSIONS: The frequency of depression symptoms in women living in Elazig is high. The information and services that the local women receive about menopause are inadequate.

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BACKGROUND: Traumatic brain injury is the leading cause of death of people in motor vehicle (MV) accidents, which have been increasing in number in developing countries. A retrospective study was undertaken to evaluate all cases admitted to the emergency department of the authors' institution with suspected injury after involvement in a MV-related accident between January 2000 and January 2005. MATERIAL/METHODS: During the study period a total of 2014 cases were admitted: 1258 were occupants of motor vehicles and 756 were pedestrians. Cases with traumatic brain injury were evaluated with respect to gender, age, Glasgow Coma Scales (GCS), and death. RESULTS: Five hundred thirty-two of the cases (386 male, 146 female, mean age: 26.8+/-20.3 years) involved in MV accidents experienced traumatic brain injuries, of which 299 were MV occupants and 233 were pedestrians. The pediatric (< or =16 years: 65.4%) and elderly (> or =65 years: 64.7%) groups were frequently involved as pedestrians in MV accidents; adults 17-64 years of age were involved as pedestrians at a lower rate (25.4%, p<0.001). The GCS values of the pedestrian victims were significantly lower than those of the MV occupants on admission (p<0.001). CONCLUSIONS: The results show that improvements in car safety have reduced life-threatening conditions for occupants of motor vehicles, but this does not include pedestrian safety. There is great need for practical strategies to reduce or prevent MV accident-related injuries among pedestrians, especially for the pediatric and elderly groups who are most exposed to these injuries.

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AIMS: To determine the type, extent and effects of workplace violence among residents during postgraduate speciality training in various departments of medical schools in Turkey. METHODS: A cross-sectional survey was conducted in seven medical schools representing all geographical regions of Turkey. All physicians in speciality training in the selected medical schools were asked to complete a semi-structured 'violence questionnaire' addressing the type (emotional, physical and sexual) and extent of violence experienced, the perpetrators of the violence and the victim's reactions to the experience. RESULTS: A total of 1712 residents out of 2442 completed the questionnaire. In all, 68% indicated they had experienced some form of workplace violence, 67% had experienced verbal violence, 16% had experienced physical violence and 3% had experienced sexual violence. The victims' most prevalent reactions to violence included being deeply disturbed but feeling they had to cope with it for the sake of their career (39%), being distressed (26%) but considering that such events are common in all occupations and discounting it and being confused and bewildered and unsure how to respond (19%). The most frequently named perpetrators of verbal violence were relatives/friends of patients (36%) and academic staff (36%), followed by other residents/senior residents (21%), patients (20%), heads of department (13%) and non-medical hospital staff (6%). CONCLUSIONS: Physicians in speciality training in medical schools in Turkey are subject to significant verbal, physical or sexual violence. Precautions to prevent such exposure are urgently needed.

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This study was carried out to determine the prevalence and risk factors for domestic violence victimization of women during pregnancy by intimate partner throughout marriage in a Turkish community. Pregnant women living in the servicing area of selected health centers in Elazig were considered for the study and data were obtained through a questionnaire. A total of 249 pregnant women, mean age 26.8 +/- 5.2 years and the mean gravidity 2.6 +/- 1.7, were involved. Of the 249 women, 28.9% were exposed to at least one case of physical violence throughout matrimony, 12.4% being abused during the previous year and 4.8% during the current pregnancy, 30.5% were exposed to verbal insult and 4.4% exposed to sexual abuse during the current pregnancy. In addition, 25.7% were exposed to one or more types of domestic violence during previous pregnancies. There was a significant correlation between the rate of violent victimization and number of children, and the partner's alcohol habits and socioeconomical status of the families (p < 0.05). Results from the self-report of the receiving end of violent behaviors indicate that the rates of any type of intimate partner violence were very high among pregnant women in this studied Turkish population. Efforts to reduce the incidence of this women's rights and public health problem should be given high priority.

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PURPOSE: To report an uneventful sudden death because of a periorbital pellet injury. METHOD: Review of autopsy findings. RESULTS: A 20-year-old hunter was shot accidentally during hunting. At autopsy, the body showed no significant injuries or deformity except for the pellet injuries and ecchymosis on the medial side of the left lower eyelid. Skull roentgenography located a pellet in the base of the cranium. Upon craniotomy, the cause of death was diagnosed as subarachnoidal haemorrhage due to incomplete basilar artery injury. The pellet entered through the medial cantus, passed through the inferior orbital fissure than the sphenooccipital junction and basilar artery and lodged in the pons. CONCLUSION: A-high index of suspicion is required in order to detect an intracranial extension in periorbital injuries.

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Family is one of the most important factors in the social and psychological progress of an adolescent. Social behavior disorders in childhood have been reported to be caused by many factors that may lead children to commit a crime. Our study included a total of 106 convicted adolescents from Eastern Turkey in a reformatory and 126 unconvicted adolescents with a similar socio-economic status. A survey form was completed during a face-to-face interview and a review of official records was undertaken. The role of family disruption, education levels of parents, the rate of imprisonment among first- and second-degree relatives, migration as a family from their place of birth, and the number of delinquent children in the family were evaluated. There was a significant difference between the conditions in the families of convicted and unconvicted adolescents. Family factors play an important role in the development of adolescent delinquency. To prevent or decrease this rate of childhood or adolescent delinquency, there needs to be an improvement in the socio-cultural conditions of families.

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Multiple entrance gunshot wounds can give useful information in forensic evaluation of deaths from homicide and suicide. Although the presence of multiple entrance gunshot wounds does not absolutely exclude the possibility of suicide, they are important to the forensic investigators and pathologists in cases of assault, attempted homicide and suicide as they provide important clues for determination of number of shots fired and direction of firing. We present a case of 16 years of young woman who was shot to death by her husband. External examination revealed an entrance wound with semi-lunar shot residue at the dorsal side of her left hand at 5th metacarpus, and exit wound on the hypothenar muscle. There was also a second wound entrance located on her left zygoma. Direction of the bullet was downward traveling from left-to-right. Initially it was thought that there were two close shots, but when her left hand was placed over the malar area her face, it was determined that the gunshot powder tattoos were completing the nature of a single shot from a close distance. Crime scene investigation revealed only one cartridge casing. The autopsy and radiography findings showed that the bullet was entered from dorsal site of the left hand exiting from the palm and re-entering from the zygomatic region, hit the base of the skull, and remained in the soft tissue of the right mandible after passing the soft palate. The bullet was caused an incomplete laceration of the right internal arteria carotid and she died of internal and external bleeding. Detailed investigation of gunshot residues can provide important information for clarification of close distance gunshot wounding. We present this case due to its interesting nature, and to highlight the importance of detailed investigation of the gun powder residues in cases with multiple entry wounds.

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OBJECTIVE: The polymerase chain reaction (PCR) - based DNA amplification fingerprinting (DAF) or randomly amplified polymorphic DNA (RAPD) is based on a strategy using a single arbitrary oligonucleotide primer to generate anonymous amplification of genomic DNA. On this basic strategy, in this study, we aimed to test individual differences and usefulness of 2 basic primers (5'-CGCGCCGG-3' and 5'-TGCCGAGCTG-3') and examined whether there is a positive effect on results of 10 x PCR buffer with ammonium sulfate. METHODS: A new approach in DNA fingerprinting, 10 x PCR buffer with ammonium sulfate, is presented in the study. Primers with single 8 and 10 nucleotides in length and 2 different PCR buffers with or without ammonium sulfate were used to identify 135 volunteers with no blood relationship. This study was carried out at the Pharmacology Laboratory, University of Gaziantep, School of Medicine, Turkey between 1999 and 2000. RESULTS: An average of 10 major bands representing 500-1500 base pair (bp) in length was determined as amplified DNA products on standard agarose gels for these volunteers. The use of ammonium sulfate in 10 x PCR buffers has increased to 92% success ratio of individual difference obtained from the 8 nucleotides primer. CONCLUSION: With this study, more reliable results can be obtained by using ammonium sulfate in 10 x PCR buffers.

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