Trends in MDMA‐related mortality across four countries

Findings: A total of 1400 MDMA-related deaths were identified in Turkey, 507 in Australia, 100 in Finland and 45 in Portugal. The median age ranged from 24 to 27.5 years, and males represented between 81 and 94% of the deaths across countries. Standardized mortality rates significantly increased across all four countries from 2011 to 2017 during a period of increased purity and availability of MDMA. The underlying cause of death was predominantly due to drug toxicity in Australia (n = 309, 61%), Finland (n = 70, 70%) and Turkey (n = 840, 60%) and other causes in Portugal (n = 25, 56%). Minorities of all deaths across the countries were due to MDMA toxicity alone (13-25%). These deaths had a significantly higher blood MDMA concentration than multiple drug toxicity deaths in Australia, Finland and Turkey. Drugs other than MDMA commonly detected were stimulants (including cocaine, amphetamine and methamphetamine) (Australia 52% and Finland 61%) and alcohol (Australia 46% and Portugal 49%). In addition to MDMA toxicity, benzodiazepines (81%) and opioids (64%) were commonly identified in these deaths in Finland. In comparison, synthetic cannabinoids (15%) and cannabis (33%) were present in a minority of deaths in Turkey.info:eu-repo/semantics/acceptedVersio

Trends in MDMA-related mortality across four countries

Aims To determine trends in 3,4 methylenedioxymethamphetamine (MDMA)-related death rates across Australia, Finland, Portugal and Turkey and to analyse the toxicology and causes of death across countries. Design Analysis of MDMA-related deaths extracted from a national coronial database in Australia (2001-19) and national forensic toxicology databases in Finland (2001-17), Portugal (2008-19) and Turkey (2007-17). Presentation of MDMA use and seizure data (market indicators). Setting Australia, Finland, Portugal and Turkey. Cases All deaths in which MDMA was considered by the forensic pathologist to be contributory to death. Measurements Information collected on cause and circumstances of death, demographics and toxicology. Findings A total of 1400 MDMA-related deaths were identified in Turkey, 507 in Australia, 100 in Finland and 45 in Portugal. The median age ranged from 24 to 27.5 years, and males represented between 81 and 94% of the deaths across countries. Standardized mortality rates significantly increased across all four countries from 2011 to 2017 during a period of increased purity and availability of MDMA. The underlying cause of death was predominantly due to drug toxicity in Australia (n = 309, 61%), Finland (n = 70, 70%) and Turkey (n = 840, 60%) and other causes in Portugal (n = 25, 56%). Minorities of all deaths across the countries were due to MDMA toxicity alone (13-25%). These deaths had a significantly higher blood MDMA concentration than multiple drug toxicity deaths in Australia, Finland and Turkey. Drugs other than MDMA commonly detected were stimulants (including cocaine, amphetamine and methamphetamine) (Australia 52% and Finland 61%) and alcohol (Australia 46% and Portugal 49%). In addition to MDMA toxicity, benzodiazepines (81%) and opioids (64%) were commonly identified in these deaths in Finland. In comparison, synthetic cannabinoids (15%) and cannabis (33%) were present in a minority of deaths in Turkey. Conclusions Deaths related to 3,4 methylenedioxymethamphetamine (MDMA) increased in Australia, Finland, Portugal and Turkey between 2011 and 2017. Findings show MDMA toxicity alone can be fatal, but multiple drug toxicity remains more prevalent.Peer reviewe

The Challenges in Autopsy Cases Exposed to Animal Attack

Discrimination between antemortem and postmortem lesions inflicted by animals from other traumas, and contribution of these injuries to the cause of death which is often encountered in forensic autopsies may cause some difficulties. Detailed identification, and, evaluation of bite marks which has the depth and shape of the teeth and jaw of the animal interfering to the cadaver, tissue losses, paw and tooth marks nd vital signs must be performed during autopsy. Current autopsy reports filed in the Morgue Department of Council of Forensic Medicine between the years of 1996 and 2001 had been retrospectively screened and various cases inflicted by animals during antemortem, perimortem and postmortem periods had been included in the study in order to determine emerging problems in autopsy cases with signs of animal attack and develop recommendations for points to be considered in these cases. Location of animal attack, severity of injury, typical wound characteristics, differential diagnosis among other lesions, the cause of death and effects on identification of the victim and consequences in terms of forensic medicine were evaluated based on autopsy reports of 130 cases. Postmortem (n=129 cases) and antemortem (n=1) signs of animal attack were detected. Lesions were commonly caused by marine animals, and observed on the head region. The identity of the victims, and cause of death couldn't be determined in 22, and 48 % of the cases, respectively. When we consider the problems encountered during phases of determination of the cause and type of death and identification of the signs of postmortem animal scavening, the importance of forensic medicine approach in crime scene investigation on antemortem and/or postmortem animal attacks, identifying the profile of the offending animal and the challenging autopsy procedure becomes much more clear. [Med-Science 2014; 3(2.000): 1209-23

Evaluation of fatal diving accidents in Turkey

In any kind of diving there is a risk of accidents, as the move from the topside environment to underwater can affect a diver's physiological and psychological condition. It is important to investigate dive accidents to clarify the causative factors and determine preventive measures

Psychoactive Drug Related Traumatic Deaths in Istanbul between 1990-2000

The objective of this study was to identify characteristics of drug related traumatic deaths in Istanbul between 1990 and 2000. This retrospective descriptive study was set in the Council of Forensic Medicine, Ministry of Justice. During the period studied 143 people (86 % males, 14 % females) who took a drug died after traumatic events. The mean age was 37.7 +/- 13.6 years. The most common causes of deaths were asphyxia and blunt force injury. Benzodiazepines, cannabis and heroin were the most commonly used drugs. While benzodiazepines are common in self-directed violence cases such as suicide by asphyxia, cannabis was frequent among interpersonal violence cases as homicide by shooting. Heroin was approximately equally seen in all traumatic deaths. Benzodiazepine and heroin use are especially frequent among non-violence deaths (road traffic accidents)

The Selective Odontoidectomy: Endoscopic Endonasal Approach to the Craniocervical Junction

Objective: The resection of the odontoid process via an extended endoscopic endonasal approach has been recently proposed as an alternative to the microscopic transoral method. We aimed to delineate a minimally invasive endoscopic transnasal odontoidectomy and to describe the endoscopic anatomy of the anterior craniovertebral junction (CVJ)

Microsurgical and endoscopic anatomy of Liliequist's membrane and the prepontine membranes: cadaveric study and clinical implications

Liliequist's membrane is mostly described as having a diencephalic leaf, mesencephalic leaf, and diencephalic-mesencephalic leaves in the literature. Also different descriptions of the prepontine membranes were reported. In this study, we visualized the regular structural forms of membranes without disturbing any attachments and defined infrachiasmatic and prepontine safety zones. We discussed the clinical significance of these structures

Prevalence of sacrococcygeal pilonidal sinus as a silent disease

The aim of this research was to determine the prevalence of sacrococcygeal pilonidal sinus disease (SPSD) based on clinical examination and histopathological evaluation