Erhan Kartal

Background: Delayed presentation after sexual assault reduces the probability of detecting injuries or recovering biological evidence. Evidence specific to anal-route allegations and physical findings is comparatively limited. Methods: We retrospectively reviewed 222 consecutive cases alleging anal-route sexual assault seen at a university forensic clinic in Türkiye (2010–2014). Examinations included standardized external anogenital inspection under magnification (colposcopy) and full-body assessment; anoscopy was not routinely available. The primary outcome was acute physical findings (composite of anal/perianal and, when present, parallel genital injuries, plus extragenital traumatic lesions). Bivariate associations used Pearson’s χ² (with df reported; Monte Carlo where appropriate). As a prespecified sensitivity analysis, a Random Forest classifier was trained using pre-examination demographics and incident-context variables with stratified 5-fold cross-validation, reporting ROC AUC, PR-AUC, accuracy, Brier score, and permutation feature importance. Results: Most victims were female (69.4%) and <18 years (60.8%). The probability of detecting acute findings was higher with earlier examination (e.g., ≤ 7 days vs. later: OR 6.13, χ² = 88.36, p < 0.001). The Random Forest showed moderate discrimination (CV ROC AUC 0.781 ± 0.077; PR-AUC 0.604 ± 0.119; accuracy 0.739 ± 0.079), with out-of-fold ROC AUC 0.762 (bootstrap 95% CI 0.692–0.827) and Brier 0.186. Assault-to-examination interval was the dominant contributor by permutation importance (group share 43.3%), followed by age metrics, prior anal intercourse count, and contextual factors. Findings were directionally similar when the outcome was any physical finding (genital or extragenital). Conclusions: Earlier examination markedly increases the likelihood of detecting physical findings in alleged anal sexual assaults. Negative examinations after delays are forensically compatible with the allegation and should be documented with precise timelines and standardized magnified imaging. Streamlined, trauma-informed pathways to facilitate timely reporting may improve evidentiary outcomes and reduce secondary victimization.

The pelvic inlet is one of the critical constraints within the relatively narrow birth canal for the passage of the fetal head. This study tested the hypothesis that the shape of the pelvic inlet differs between females and males, with the expectation that the female pelvic inlet is more elliptical than its male counterpart. Abdomino-pelvic computed tomography images from 600 cases, equally distributed by sex and age groups, were analyzed. Using 3D reconstruction, image processing, ellipse fitting, and a genetic algorithm, we evaluated whether the proposed measures of elliptical similarity in pelvic inlet shape varied by sex. Additionally, discriminant analysis was employed to assess the accuracy of sex determination based on these measures. The results demonstrated significant differences between the two sex groups for all proposed measures. Discriminant analysis achieved a maximum sex determination accuracy of 79.7%. These findings support the hypothesis that the female pelvic inlet has evolved to be more elliptical compared to the male pelvic inlet. If validated by future studies on diverse populations, this hypothesis may gain broader scientific acceptance.

Amaç: Dünya Sağlık Örgütü’nün 2023 tahminlerine göre, dünya genelinde 1,3 milyar kişi, diğer bir deyişle 6 kişiden 1’i veya toplam dünya nüfusunun %16’sı ciddi derecede fiziksel veya mental olarak engellidir. Değişen maluliyet, özürlülük, engellilik (MÖE) yönetmelik ve tüzükleri, aynı yaralanma için farklı olarak MÖE oranlarının çıkmasına neden olabilmektedir. Sunulan çalışma, herhangi bir yönetmelik/tüzük kapsamında değerlendirilmiş MÖE oranı tanımlanmış olguların bu oranlarının diğer yönetme-lik veya tüzükler kapsamında MÖE oranının değişip değişmediğinin, değişiyor ise bu değişimin hangi oranda olduğunun saptanması amaçlanmıştır. Materyal ve metod: Çalışmada iki farklı üniversitede 100 olgu üzerinde farklı yönetmelik ve tüzüklere göre hesaplanmış MÖE oranları, A,B,C ve D olarak dört gruba ayrılan farklı diğer yönetmelik ve tüzüklere göre de hesaplanarak, aralarındaki farklılıklar istatistiksel olarak hesaplanmıştır. Bulgular: Çalışmada 70 erkek ve 30 kadın olmak üzere, toplam 100 kişiye (ortalama yaş: 31,4±16,0) ait MÖE raporları değerlendirildi. Farklı diğer yönetmelik ve tüzüklere göre yapılan toplam altı karşılaştırmadan 5’inde istatistiksel olarak anlamlı farklılıklar saptandı. Sonuç: Tıp ve hukuk alanında ortak bilimsel toplantılar düzenlenerek MÖE hesaplamalarının uluslararası standartları ve kişinin mesleği, yaşı ve cinsiyeti gibi özellikleri de göz önüne alacak şekilde tek bir kılavuz altında toplanmasının hak kayıplarının olduğu kadar haksız kazançların da önüne geçeceği öngörüldü.

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.

Kronobiyoloji ve sirkadiyen ritmin adli tıp ile adli bilimler alanlarındaki kritik önemini inceleyen bu metinde; uyku-uyanıklık döngüsünü koordine eden sirkadiyen ritmin ölüm, intihar, kazalar ve suçlar gibi adli süreçlerdeki belirleyici rolü ele alınmaktadır. Doğal ölümlerin en büyük nedenini oluşturan kardiyovasküler hastalıklar, ani bebek ölümleri ve serebrovasküler tıkanmalar, sirkadiyen ritim doğrultusunda özellikle biyokimyasal ve trombosit aktivitelerinin değiştiği sabah saatlerinde yoğunlaşmaktadır. Küresel bir toplumsal sorun teşkil eden intihar eylemleri, psikiyatrik rahatsızlıklar ve sirkadiyen sistem bozukluklarının etkisiyle sabaha karşı en düşük seviyedeyken, genellikle 20:00-02:00 saatleri arasında zirveye ulaşmaktadır. Önemli bir halk sağlığı problemi olan trafik ve iş kazalarında ise uykusuzluk, yorgunluk ve vardiyalı çalışma düzeninin sirkadiyen ritmi bozması temel etkendir; nitekim gece saatlerinde ölümcül kaza riski 4 kat daha fazladır. Kriminolojik açıdan hırsızlık, soygun, cinsel saldırı suçları ile şizofreni gibi psikiyatrik olguların sergilediği şiddet eğilimleri de zamansal döngülerle doğrudan ilişkilidir. Sonuç olarak kronobiyolojik veriler; adli vakaların aydınlatılmasında, erken tanı-tedavi stratejilerinin geliştirilmesinde, ölümlerin önlenmesinde ve mortalite ile morbidite oranlarının düşürülmesinde hayati bir role sahiptir. The text examines the critical importance of chronobiology and circadian rhythm in forensic medicine and sciences, highlighting how the circadian rhythm, which coordinates the sleep-wake cycle, plays a guiding role in forensic events such as death, suicide, accidents, and crime. Cardiovascular diseases, the primary cause of natural deaths, along with sudden infant deaths and cerebrovascular events, are highly concentrated in the morning hours due to circadian shifts in biochemical and platelet activities. Suicide attempts, a major global issue influenced by psychiatric and circadian disruptions, reach their lowest levels in the morning but peak significantly between 20:00 and 02:00. Regarding traffic and occupational accidents, insomnia, fatigue, and shift work disrupt the circadian rhythm, acting as primary accident factors; notably, the risk of fatal accidents increases fourfold during the night. Criminologically, offenses such as burglary, robbery, sexual assault, and violent behaviors in patients with psychiatric conditions like schizophrenia correlate directly with specific temporal cycles. Consequently, chronobiological data holds a vital role in clarifying forensic cases, developing early diagnosis and treatment strategies, preventing deaths, and reducing mortality and morbidity rates.

The assessment of national suicide risks is considered critical in many countries for the establishment of suicide prevention initiatives aimed at considerably lowering suicide rates. The aim of this study is to identify at-risk suicide populations by reviewing the suicides in Turkey over a 25-year period. The Turkish Statistical Institute's suicide statistics for 1995-2019 in Turkey was retrospectively reviewed in current article. The data collected in the study was statistically analyzed using the MINITAB vn 14 software. Between 1995 and 2019, the total number of suicides in Turkey was 66,819, and suicide rates, especially in males, showed an increasing trend in this period. Males comprised 68.3% of the total cases, and most (27.2%) were aged 15-24 years. Suicides mostly occurred between May and July (27.7%), of individuals with a primary school level of education (51.7%) and who were married (6.0 per 100,000). Illness was most important risk factor for suicide (36.8%) and hanging (47.5%) was the leading suicide method in all age groups and in both genders. Despite the fact that Turkey's suicide rate is lower than many other countries, the growth in male suicide rates is concerning. Suicides are likely to become a severe problem in Turkey in the near future unless measures like education, psychiatric evaluations, the reactivation of psychological counseling service phone lines, and the establishment of youth counseling centers, as described in this paper, are taken.

The aims of this study were to compare the incidence of occupational accidents during one-year periods of the COVID-19 Pandemic and before the COVID-19 Pandemic, and to determine in which sectors occupational accidents occurred and what types of injuries were sustained in the population of Tokat, Turkey. A retrospective review was made of the records of Tokat State Hospital of patients injured in occupational accidents between 12.03.2019 and 11.03.2021. The patients injured in occupational accidents were classified according to age, gender, sector, accident type, trauma localization and type, time of the accident, and outcome of the injuries. Of 608 patients injured in occupational accidents, 384 (63.2%) were injured in the period before the pandemic and 224 (36.8%) were injured in the period during the pandemic (p < 0.001). Most work-related injuries occurred in the industry sector (n = 287; 47.2%; p < 0.001). Occupational accidents increased in the service sector (p < 0.001), but decreased in other sectors. The increase in occupational accidents in the health sector (p < 0.001) and transportation sector (p < 0.05) within the service sector caused a general increase despite the decrease in other service sectors (p > 0.05). In current study, the increase in the number of injuries in the transportation sector due to the increase of motor courier accidents, in health sector, and in pandemic quarantines were remarkable. It was evaluated that this narrow-scoped study pioneered comprehensive studies on the measures that can be taken to prevent occupational accidents in such pandemics in the future.