Submersion cases in city of Aydin

Aydın'da 2004 ile 2009 yılları arasında sudan çıkarılan cesetlerin retrospektif olarak değerlendirilmesi, elde edilen verilerin literatür bilgileri ile karşılaştırılması, farklı unsurların belirlenmesi ve var ise farklılıkların tartışılması planlanmıştır. İl geneli için bu konuda daha önceden yapılmış çalışma bulunmamaktadır. Toplanan verilerin ülkemiz ve dünyadaki benzer çalışmalara katkı sağlayacağı düşünülmektedir. Gereç ve yöntem: 2004 ile 2009 yılları arasında Adnan Menderes Üniversitesi Tıp Fakültesi Adli Tıp Anabilim Dalı'nda görevli öğretim üyesi adli tıp uzmanlarınca yapılan tüm ölü muayenesi ve otopsi kayıtları, tutanak örnekleri incelendi. Sudan çıkarılmış olduğu anlaşılan olgulara ait dokümanlar ayrıntılı değerlendirme için ayrıldı. Bu tutanaklardan elde edilen veriler SPSS for Windows 13.0 programı yardımıyla işlenerek; zamansal açıdan rastlanma sıklığı, yaş, cinsiyet, uyruk gibi sosyodemografik veriler, cesedin çıkarıldığı suyun ve yerin özelliği (deniz, havuz, baraj, sulama kanalı, vs.), otopsi yapılma sıklığı, cesedin durumu ve adli muayene sonucunda saptanan bulgular, histopatolojik inceleme sonuçları, ölüm nedenleri, orijin açısından değerlendirildi. Bulgular: Çalışma kapsamındaki 6 yıllık dönem içerisinde toplam 1653 ölü muayenesi ve otopsi yapıldığı, bunlardan 125 (%7.56) olgunun sudan çıkarıldığı ve 104 (%6.29) olgunun ölümünde suda boğulmanın tek başına veya diğer nedenler ile birlikte etken olduğu saptandı. Olguların 104'ü (%83.2) erkek, 20'si (%16.0) kadındı. Mevsimsel olarak incelendiğinde yaz ayları (Haziran, Temmuz, Ağustos) olguların yarısından fazlasının görüldüğü dönemdi. Yaş ortalamasının 34.04±22.9 olduğu, olgular, dekadlar halinde yaş gruplarına ayrıldığında 26 (%20.8) olgu ile 21-30 yaş aralığının tepe noktası olduğu, 0-10 yaş grubunun 18 (%14.4) olgu ile ikinci sırada geldiği, ardından 17'şer olgu ile 11-20 ve 31-40 yaş grubunun takip ettiği saptandı. Olguların %44.8'i denizden, %37.6'sı göl, baraj, akarsu, sulama kanalı gibi normalde yüzmenin yasak olduğu yerlerden çıkarılmış ve 117'sine (%93.6) otopsi yapılmıştı. Cesedin bulunmasından, adli tıp uzmanınca değerlendirilmesine kadar geçen sürenin ortalama 10.47(±7.7) saat olduğu, çürümenin 10 (%8.0) olguda başlamış, 21 (%16.8) olguda ise ilerlemiş olduğu saptandı. Ölümünde suda boğulmanın etken olduğu 104 olgunun 42'sinde (%40.38) mantar köpüğü izlenmişti. İleri derecede çürüme olan 21 olgunun hiçbirinde mantar köpüğü bulgusu yoktu. 44 (%35.2) olguda herhangi bir dış travmatik bulgu yokken, geri kalan olgularda antemortem ve/veya postmortem oluşmuş çeşitli niteliklerde travmatik lezyonlar mevcuttu. Otopsi yapılan 117 olgunun 95'inde (%81.2) kişinin önemli miktarda sıvı aspire ettiğine işaret edecek akciğer bulguları belirlendiği, otopsi sonucunda (ıslak ya da kuru tip) suda boğulma sonucu öldüğü kanısına varılan 80 olgudan yalnızca 3 (%3.75)'ünde sıvı aspirasyonuna işaret edecek herhangi bir akciğer bulgusu yok iken, diğer nedenler ile suda boğulmanın ortak etkisi sonucunda öldüğü belirlenen 18 olgunun tamamında aspirasyon bulguları görüldüğü saptandı. Otopsilerin %88.0'inde (n=103) histopatolojik örnekleme yapılmamıştı. Çalışmamız sonucunda saptanan ölüm nedenlerine bakıldığında; 125 olgudan 86'sının (%68.8) suda boğulma, 18'inin (%14.4) suda boğulma ve diğer etkenlerin ortak etkisi sonucu öldüğü, 15 (%12.0) cesette ise sudan çıkarılmakla birlikte suda boğulma bulgusu olmadığı ve başka bir nedenle öldüğü kanaatine varıldığı belirlendi. Orijin olarak kazaların %79.2'lik bir oran (n=99) ile ilk sırada olduğu görüldü. Olguların %3.2'si (n=4) kendilerinde mevcut bir hastalık zemininde doğal nedenler ile öldükten sonra suya düşmüştü. 3 (%2.4) olguda cinayet, 1 (%0.8) olguda ise intihar orijin olarak belirlenmişti. Sonuç: Genel olarak adli tıp pratiğinde olduğu gibi, bölgemizde de, sudan çıkarılmış cesetler önemli bir yer tutmaktadır. Olguların çoğunluğunda ölüm nedeni suda boğulma, orijin kaza olmakla birlikte, diğer ölüm nedenleri ve orijinlerle de karşılaşma ihtimalinin her zaman bulunduğu dikkate alınmalıdır.Aim in this study is to examine the submersion cases which were found in the 6 years period 2004-2009 in Aydin, retrospectively and to discuss the differences with the studies that were done about this same subject in our country and worldwide. Material and method: Data was obtained from the archive of Adnan Menderes University Medical Faculty Department of Forensic Medicine. Distribution by time, social and demographic data like as age, gender, nationality, characteristics of the area and water supply that the bodies recovered from, autopsy rate, speciality of the death body, autopsy and histopathological findings, cause of death, origin were evaluated. Findings: There were a total of 125 submersion cases and 104 of them were drowned. These cases make up 7.56% and 6.29% of all forensic autopsies and death examinations, respectively. 83.2% of all the cases were male and 16.0% were female. Summer was the season that more than the half of the cases were seen. In the distribution of age groups; 21-30 age group was the highest with a rate of 20.8% and 0-10 age group was the second with 14.4%. 44.8% of all the cases were recovered from sea and 37.6% of them from lake, dam, river or irrigation canel. An autopsy by forensic medicine specialist was done in the 93.6% of all the cases. Putrefactive changes was advanced in 21 (16.8%) cases. External foam was determined in 40.38% of the drowned cases. According to autopsy data; there were not liquid aspiration finding in only 3.75% of the 80 cases that were died due to submersion (wet or dry drowning without any other factor). There was not histopathological examination in 88.0% of the autopsies. 86 (68.8%) cases were died due to drowning unaccompanied and 18 (14.4%) were died due to drowning and other factors together. In 15 (12.0%) cases, although recovered from water, there were no finding that point at they were drowned. According to origin of the cases; accident take the first place with a rate of 79.2%. Suicide was the origin in only 1 (0.8%) case. Conclusion: As in the world and different regions of our country submersion cases take an important place in Aydin also. Although the cause of death is drowning and the origin is accident in most cases, other causes and origins also must be beared in mind

Modafinil dependence: A case with attention-deficit/hyperactivity disorder

Modafinil is generally known as a drug with low addiction potential. There are few case reports in the literature demonstrating that Modafinil, stated being capable of diminishing symptoms of attention deficit/hyperactivity disorder (ADHD), causes addiction. In the present article a Modafinil addicted ADHD case, consuming usurious doses (5,000 mg/per day) of Modafinil is presented. The case presented to our psychiatry outpatient clinic due to: requirement of in taking high dose Modafinil in order to achieve the initial effects, difficulty in obtaining the drug, irritability, anxiousness, sleep irregularities, fatigue and unpleasant vivid dreams when he did not use the drug. It was realized that the patient, himself increased doses of Modafinil incrementally, in order to keep its effects on attention symptoms at the same level. It has to be kept in mind that ADHD patients can develop Modafinil addiction. It is necessary to carry out systemic studies on this subject. © 2018 Korean Neuropsychiatric Association

The impact of synapsin III gene on the neurometabolite level alterations after single-dose methylphenidate in attention-deficit hyperactivity disorder patients

Objective: To investigate the neurometabolite level changes according to synapsin III gene rs133945G.A and rs133946C.G polymorphisms by using magnetic resonance spectroscopy (MRS) in patients with attention-deficit hyperactivity disorder (ADHD). Methods: Fifty-seven adults diagnosed with ADHD were recruited for the study. The participants were examined by single-voxel1H MRS when medication naïve and 30 minutes after oral administration of 10 mg methylphenidate (Mph). Those who had been on a stimulant discontinued the medication 48 hours before MRS imaging. Spectra were taken from the anterior cingulate cortex, dorsolateral prefrontal cortex, striatum, and cerebellum, and N-acetylaspartate (NAA), choline, and creatine levels were examined. For genotyping of the synapsin III gene polymorphisms, DNA was isolated from peripheral blood leukocytes. The effects of age, sex, and ADHD subtypes were controlled in the analyses. Results: After a single dose of Mph, choline levels increased significantly in the striatum of rs133945G.A polymorphism-GG genotypes (P=0.020) and NAA levels rose in the anterior cingulate cortex of rs133946C.G polymorphism-CG genotypes (P=0.014). Both rs133945G.A and rs133946C.G polymorphisms were found to statistically significantly affect the alteration of NAA levels in response to Mph in dorsolateral prefrontal cortex with two-way repeated measure of analysis of variance. Post hoc comparisons revealed a significant difference between CG and GG genotypes of rs133946C.G polymorphisms after Bonferroni adjustment (P=0.016). Conclusion: Synapsin III gene polymorphisms may be affecting the changes in neurometabolite levels in response to Mph in adult ADHD patients. Future studies are needed to confirm our findings. © 2016 Başay et al

miR-181b-5p, miR-195-5p and miR-301a-3p are related with treatment resistance in schizophrenia

The aim of the study was to determine the differences between expression levels of certain miRNAs, as their association with schizophrenia has been well presented in the literature, and to investigate their relation to treatment resistance in schizophrenic patients. Three groups were formed: 1) treatment-resistant group, 2) treatment responsive group and 3) healthy control group. Expression levels of miRNAs from peripheric blood samples were determined by real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR). We investigated the roles of 29 schizophrenia-related miRNAs in schizophrenia treatment and their potentials to be considered as indicators. Among these miRNAs, only miR-181b-5p, miR-195-5p and miR-301a-3p expressions were found to be significantly different between the treatment-resistant group and the group responding well to the treatment. miRNAs may cause resistance by silencing the receptor genes of the drugs used for schizophrenia treatment. miR-181b-5p, miR-195-5p and miR-301a-3p may be candidate indicators that can be used to reveal resistance against schizophrenia treatment. © 2016 Elsevier Ireland Lt

Does the quality of life in autism spectrum disorder differ from other chronic disorders and healthy children?

Objective: Autism spectrum disorder (ASD) is characterized by deficits in social interaction, communication, re-stricted interests, and repetitive patterns of behavior. This study examined quality of life (QoL) and related clinical factors in children with ASD, compared to children with Attention Deficit Hyperactivity Disorder (ADHD), children with asthma, and healthy controls (HC). Methods: QoL was assessed by the Pediatric Quality of Life Inventory 4.0 (PedsQLTM 4.0). Additionally, parents of the children provided sociodemographic information and filled out an evaluation questionnaire, child behavior check list (CBCL), and Turgay DSM-IV Disruptive Behavior Disorders Rating Scale (T-DSM-IV-S). Results: The physical health, psychosocial health, social functioning, and scale total score of the ASD group were significantly lower than those of the three comparison groups. The school functioning score domain was lower in the ASD group than in the asthma and HC groups. In contrast, the emotional functioning domain assessments did not reveal statistically significant differences between the ASD group and the comparison groups. In the ASD group, the total problem score, inattention, and hyperactivity scores were significantly higher than both the asthma and HC groups, and the internalizing scores were higher than the healthy group. Conclusion: The poor QoL is most likely due to functional losses and problem behaviors related to ASD and may negatively affect not only children with ASD but also the whole life of the family. © 2016, Cukurova University, Faculty of Medicine. All rights reserved

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19314755PMCnul