Child Death Due To Sink Fracture: a Case Report

Çocukluk çağı yaralanmaları ve buna bağlı ölümler çok sık rastlanan olaylardır. Merdiven ya da banyoda kayma şeklindeki düşmelerin yaralanmalara yol açtığı ama ölümün ender olarak meydana geldiği görülmektedir. Bu olguda dosya tetkikinde 6 yaşında erkek çocuk olduğu, anaokulunda lavabo kısmında öğretmenin çocuğu yerde kırık lavabo parçalarının yanında kanlar içinde yatar vaziyette görmesi üzerine, hastaneye kaldırıldığı ve hastaneye eks olarak kabul edildiğinin kayıtlı olduğu tespit edildi. Otopside dış muayenede sol kulağın 3 cm altından başlayarak boyunda yatay seyirle larinks çıkıntısı üzerinde sonlanan 9 cm uzunluğunda kesik vasıfta yara görüldü. İç muayenede boyunda sol vena jugularis internada 1.5 cm lik damar lümeni ile iştirakli yarım kat kesi, arteria karotis communis sinistra da tam kat kesilme olduğu, kesi kenarlarının düzgün olduğu görüldü. Boyun organları dışında tüm organların yüzey ve kesitlerinde ileri derecede solukluk dışında başkaca makroskobik patolojik özellik görülmedi. Kanda ve idrarda alkol, uyutucu ve uyuşturucu madde saptanmadı. Ölümünün penetran cisim kesisine bağlı büyük damar kesilmesinden gelişen dış kanama sonucu meydana gelmiş olduğu kanaatine varıldı. Böyle kazalara bağlı ölümlerin nadir görülmesi nedeniyle bu çalışmada çocukların gittiği okullardaki eşya ve mekanın onların kullanımına uygun yapılması ve düzenli kontrol edilmesinin önemini vurgulanması amaçlandı.Childhood injuries and deaths due to these injuries are not rare. Falling from stairs or slipping in the bathroom may lead to injury however death rarely occurs. In this case study, a six-year old boy was found lying on the ground in blood next to the broken sink fragments in the bathroom of the kindergarten. The child was taken to hospital, but accepted to hospital as an ex. During autopsy, external examination showed a 9 cm of incision extending from 3 mm under the left ear to protrusion of the larynx. Internal examination demostrated a 1.5 cm half layer cut in the internal jugular vein of the neck and a complete cut in the left common carotid arteria. The incision edges were smooth. The surface and the sections of all organs were macroscopically not pathologic except for severe pallor. Alcohol, opiates and narcotics were not detected in blood and urine. The death was thought to be the result of external bleeding from large vessel cut due to penetrating object. In this case study, we aimed to emphasize the importance of suitability of furniture and environment for children in kindergarten or school

Transparent Development of the WHO Rapid Advice Guidelines

Emerging health problems require rapid advice. We describe the development and pilot testing of a systematic, transparent approach used by the World Health Organization (WHO) to develop rapid advice guidelines in response to requests from member states confronted with uncertainty about the pharmacological management of avian influenza A (H5N1) virus infection. We first searched for systematic reviews of randomized trials of treatment and prevention of seasonal influenza and for non-trial evidence on H5N1 infection, including case reports and animal and in vitro studies. A panel of clinical experts, clinicians with experience in treating patients with H5N1, influenza researchers, and methodologists was convened for a two-day meeting. Panel members reviewed the evidence prior to the meeting and agreed on the process. It took one month to put together a team to prepare the evidence profiles (i.e., summaries of the evidence on important clinical and policy questions), and it took the team only five weeks to prepare and revise the evidence profiles and to prepare draft guidelines prior to the panel meeting. A draft manuscript for publication was prepared within 10 days following the panel meeting. Strengths of the process include its transparency and the short amount of time used to prepare these WHO guidelines. The process could be improved by shortening the time required to commission evidence profiles. Further development is needed to facilitate stakeholder involvement, and evaluate and ensure the guideline's usefulness

The limits of the Russian-Iranian strategic alliance: its history and geopolitics, and the nuclear issue

The Russian and Iranian governments define their relations as "very close" and "strategic" in many areas. The frontiers of this cooperation, in geopolitical terms, include the south Caucasus, central Asia, Afghanistan, and the oil- and natural gas-rich Caspian basin, while, at the issue level, the cooperation includes the nuclear issue, disarmament, the struggle against terrorism, the Iraqi quagmire, the Palestinian problem, and the U.S. military expansion into Eurasia. The signs of cooperation in these areas are, among others, regular political dialogue and similar attitudes in refusing to include the Lebanese Hizballah oil terrorist lists, pursuing political relations with Hamas, maintaining a pro-Arab position on the Arab-Israeli question, objecting to foreign military engagement in Eurasia, and having a common voice during the Israeli-Lebanese conflict in 2006. However, we need to discover the nature of these relations in order to decide whether the close Russian-Iranian relations can be described as a strategic alliance. What is the strategic depth of Russian-Iranian relations? Do the relations consist merely of the conjectural necessities of the post-Cold War period? What are the "red lines" in RUssian-Iranian relations? This article analyzes the relations between these two Countries from a broader perspective, to examine the meaning of the relations in bilateral, regional and international contexts.Publisher's Versio

Dances with wolves: Russia, Iran and the nuclear issue

The Iran-Iraq War, combined with escalating tension with the United States, paved the way in Iranian security circles to new ideas on obtaining nuclear weapons to defend Iran in a hostile regional and international environment. Whether for peaceful nuclear purposes or for producing nuclear weapons, there was a desperate need for external support to pursue a nuclear program. Russian experts spent an initial three months at the site planning how to finish the nuclear plant and placing new reactors in it.3 Under this deal, Russia agreed to educate 20 to 30 Iranian experts in nuclear science at Russian institutes and promised to provide technological and scientific assistance and supply three light-water reactors (1000 MW each) to the nuclear plant.Publisher's Versio

Polish-Russian relations: history, geography and geopolitics

[No abstract available]Publisher's Versio

Turkish-Armenian relations : will football diplomacy work?

Bülent Aras; Fatih Özba

Kompleks İntihar Olgusunda Kan Lekesi Model Analizi İle Olay Yerinin Yeniden Yapılandırılması

İki veya daha fazla yöntemin eş zamanlı ya da peşi sıra uygulanması kompleks intihar olarak adlandırılmaktadır. Tek başına kullanıldığında da sonuca ulaşılabilecek iki farklı yöntemin intihar amaçlı kullanılması ölme güdülenmesindeki kararlılığı göstermektedir. 40 yaşındaki erkek olgumuz kurusıkıdan dönüştürülmüş bir silah ile kalbine ateş etmiş ve bu sırada kendini asmıştır. Otopside elde edilen bulgular, olay yeri inceleme raporundan alınan bilgiler, vücuttaki ve olay yerindeki kan lekeleri olay orijininin intihar olduğunu düşündürmüştür. Kompleks intihar olgularında olayın orijinini ortaya çıkarma çalışmaları otopsi masasına geldikten sonra değil, olay yeri incelemesinde, hatta ceset ilk görüldüğü andan itibaren başlamalıdır. Olay yerinin multidisipliner olarak ele alınması, ortamda bulunabilecek her nesnenin/ delilin olayın çözümünde yardımının olabileceğinin akılda tutulması orijin tayininin kolaylıkla yapılmasını sağlayacaktır. Benzer şekilde otopsi yapılacak olan bir cesedin, varsa elbiseleri üzerindeki, yoksa vücudu üzerindeki kan lekelerinin kan lekesi model analizi yöntemleri ile dikkatli bir şekilde incelenmesi ve belgelendirilmesi de orijin tayininde faydalı bilgiler verebilmektedir

Misplacements Of Central Venous Catheters: Internal Jugular Versus Subclavian Access In Critical Care Patients

Aim; In central venous catheterization (CVC), misplacement is not a rare complication since this is a blinded procedure. The aim of this study was to compare the misplacement risks of the access of internal jugular vein with that of subclavian vein catheterizations. Methods; The records of a total of 1092 patients in whom central venous catheters were placed between 2002 and 2006 in Anesthesiology Intensive Care Unit and the location of the tips was confirmed radiologically were retrospectively evaluated. Neck and infraclavicular region were cleaned by antiseptic solution after routine monitorization. CVC were easily inserted with Seldinger’s technique after blood aspiration through internal jugular vein or subclavian vein. Results; In adult patients, six internal jugular catheter misplacements were seen (0.80%); among them five were kinking and one was intrapleural location of the catheter tip. Six subclavian misplacements (2.02 %) were detected, five of them were located in contralateral subclavian vein, and one was located in ipsilateral internal jugular vein. In children, two subclavian misplacements were seen as crossing to contraleteral subclavian vein, and there were no internal jugular misplacement. There was no statistically difference for misplacement between the access sites (in adult p= 0.110, in children p=0.501). Conclusion; We have concluded that experience of operator should be taken into account for choice of catheterization site