Deaths from drug overdose and toxicity in Turkey: 1997-2001

Turkey is located on the main overland connection between Asia and Europe, making the country potentially vulnerable to drug trafficking and its associated harms. The aim of the present study is to explore the frequency of all deaths from drug overdose and toxicity in Turkey and to describe some of the characteristics of these deaths. We collected data on all deaths from drugs in Turkey between 1997 and 2001 using records from the Council of Forensic Medicine. Data obtained from autopsy reports were retrospectively analyzed. In the present study, 374 deaths from drugs were reported in Turkey, with a mortality rate of 0.17 per 100,000 population. Highest mortality rates were found in Istanbul (0.83) and Gaziantep (0.71). The mean age was 34.0, and most cases (71.7%) were below the age of 40. The proportion of female cases was 13.6%. Opiates were implicated in 91.5% of deaths and benzodiazepines in 25.9%. Two fifths (38.8%) of the cases involved use of more than 1 drug. In 36.6% of cases, the route of final drug administration was by injection. The most common location of death was at a home (33.7%). Interventions to reduce drug use nationally are urgently required. International cooperation in social-educational activities, scientific research, and security measures is essential for this war.     

Histological and immunohistochemical study of Wischnewsky spots in fatal hypothermia

Wischnewsky spots in the gastric mucosa are considered an important finding for the diagnosis of hypothermia-related deaths. In the present prospective histological and immunohistochemical investigation, 14 cases of fatal hypothermia presenting Wischnewsky spots at autopsy were studied. Macromorphologically, the lesions, varying in diameter from 0.1 to 0.4 cm, had a blackish-brownish color and appeared partly lofty, especially on the apex of gastric folds. Histologically, no erosions or ulcers were observed in the gastric mucosa. In some cases, hemorrhages in conjunction with infarctions of the mucosa were observed in the mucosal glands. Those regions, however, did not represent the lesions visible as Wischnewsky spots at the macroscopical level. Immunohistochemical stains were done with a specific antibody against hemoglobin (Dako, Glostrup, Denmark). Wischnewsky spots expressed immunopositivity with antihemoglobin. Concerning the pathogenesis and underlying pathophysiologic mechanisms contributing to the development of Wischnewsky spots, we hypothesize that cooling of the body in the setting of cold ambient temperatures primarily leads to circumscribed hemorrhages of the gastric glands in vivo or in the agonal period, respectively. Subsequently, due to autolysis, erythrocytes are destroyed and hemoglobin is released. Following exposure to gastric acid, hemoglobin is hematinized, leading to the typical blackish-brownish appearance of Wischnewsky spots seen at gross examination. Wischnewsky spots are not equivalent to erosions in terms of histopathological diagnosis but rather represent epiphenomena generated in vivo or in the agonal period of fatal hypothermia.     

The use of mitochondrial cytochrome oxidase I gene (COI) to differentiate two UK blowfly species -- Calliphora vicina and Calliphora vomitoria

Traditionally identification of forensically important insects has been carried out based upon morphological differences between species. However insect evidence found at a crime scene may on occasion be difficult to distinguish by morphological techniques and under these circumstances another method of accurate identification is required. This work utilises a cytochrome oxidase I partial mitochondrial gene region (COI) to distinguish the two of the main UK blowfly species -- Calliphora vicina (Robineau Desvoidy) and Calliphora vomitoria (Linnaeus) (Diptera:Calliphoridae). Seventeen interspecific differences in COI sequence were located. Use of the restriction enzyme SfcI on this gene region provides a simple method for distinguishing between C. vicina and C. vomitoria.     

Analysis of artificially degraded DNA using STRs and SNPs--results of a collaborative European (EDNAP) exercise

Recently, there has been much debate about what kinds of genetic markers should be implemented as new core loci that constitute national DNA databases. The choices lie between conventional STRs, ranging in size from 100 to 450 bp; mini-STRs, with amplicon sizes less than 200 bp; and single nucleotide polymorphisms (SNPs). There is general agreement by the European DNA Profiling Group (EDNAP) and the European Network of Forensic Science Institutes (ENFSI) that the reason to implement new markers is to increase the chance of amplifying highly degraded DNA rather than to increase the discriminating power of the current techniques. A collaborative study between nine European and US laboratories was organised under the auspices of EDNAP. Each laboratory was supplied with a SNP multiplex kit (Foren-SNPs) provided by the Forensic Science Service, two mini-STR kits provided by the National Institute of Standards and Technology (NIST) and a set of degraded DNA stains (blood and saliva). Laboratories tested all three multiplex kits, along with their own existing DNA profiling technique, on the same sets of degraded samples. Results were collated and analysed and, in general, mini-STR systems were shown to be the most effective. Accordingly, the EDNAP and ENFSI working groups have recommended that existing STR loci are reengineered to provide smaller amplicons, and the adoption of three new European core loci has been agreed.     

Results of hair analyses for drugs of abuse and comparison with self-reports and urine tests

Urine as well as head and pubic hair samples from drug abusers were analysed for opiates, cocaine and its metabolites, amphetamines, methadone and cannabinoids. Urine immunoassay results and the results of hair tests by means of gas chromatography-mass spectrometry were compared to the self-reported data of the patients in an interview protocol. With regard to the study group, opiate abuse was claimed from the majority in self-reports (89%), followed by cannabinoids (55%), cocaine (38%), and methadone (32%). Except for opiates the comparison between self-reported drug use and urinalysis at admission showed a low correlation. In contrast to urinalysis, hair tests revealed consumption in more cases. There was also a good agreement between self-reports of patients taking part in an official methadone maintenance program and urine test results concerning methadone. However, hair test results demonstrated that methadone abuse in general was under-reported by people who did not participate in a substitution program. Comparing self-reports and the results of hair analyses drug use was dramatically under-reported, especially cocaine. Cocaine hair tests appeared to be highly sensitive and specific in identifying past cocaine use even in settings of negative urine tests. In contrast to cocaine, hair lacks sensitivity as a detection agent for cannabinoids and a proof of cannabis use by means of hair analysis should include the sensitive detection of the metabolite THC carboxylic acid in the lower picogram range.     

Fatal intoxication with amisulpride and presentation of organ distribution

Amisulpride is a substituted benzamide used as an atypical antipsychotic drug. It antagonizes dopamine D2 and D3 receptor-mediated effects with greater affinity for the limbic system suggesting better neurological tolerance than classical neuroleptics. However, occasionally amisulpride intoxications associated with seizures, comatose conditions and agitation, hyperthermia, tachycardia, prolongation of the QT interval and extrapyramidal features have been described. A 27-year-old female with a medical history of psychosis and amisulpride therapy was found dead at home. By means of high performance liquid chromatography coupled with mass spectrometry (LC/MS) an amisulpride concentration of 13.4 mg/l was found in the peripheral blood. A lower concentration in the brain and an extremely high concentration in bile can be explained by the polarity and hydrophobic character of the substance. After macroscopic and histological exclusion of other causes of death the results of the toxicological analysis were consistent with the assumption of a fatal amisulpride overdose.     

Naming oneself criminal: gender difference in offenders' identity negotiation

This qualitative research examines gender differences in offenders'ability to negotiate a positive identity once the pejorative labels of criminal, prostitute, drug dealer, and incompetent parents have been imputed onto them. In-depth semi-structured focused interviews were conducted with a purposeful information-rich sample of eight male and eight female offenders. Content analysis reveals that males were much more adept than female offenders at juggling with conventional and street norms to justify and/or resist stigmatizing labels in order to construct a favorable identity. Appeal to such personal strengths as know-how, competence, loyalty, and a code of honor allowed male offenders to challenge the boundaries between conventional and delinquent worlds. Concomitantly such an appeal gave rise to a sense of efficacy perception and an optimistic explanatory style. In contrast, even though female offenders were able to justify the labels of drug dealer, prostitute, and thief by appeal to higher loyalties and reject that of insane, all their justifications collapsed when having to negotiate the identity of incompetent mother. Female offenders' negative internal attributions and deprivation of the normative center-motherhood resulted in apathy, anomie, and lack of confidence in their ability to do something worthwhile. Rehabilitation guidelines would build female offenders' personal strengths while redirecting those exhibited by male offenders into lawful enterprises.     

Nonviolent offenders' and college students' attachment and social support behaviors: implications for counseling

This study examines the relationships between adult attachment orientations and the ability to seek social support as factors in mediating behavior. Data were collected on non violent offenders (n = 57) and college students (n = 89). The results indicated the non-normative group of nonviolent offenders reported being more securely attached and having more satisfaction with their social supports than the normative group of college students. Fewer college students reported being securely attached than the nonviolent offenders but had a larger number of social supports. In the insecure categories, nonviolent offenders reported being more dismissively attached whereas college students reported being preoccupied in their attachment orientation. The study suggests that attachment and social-support-seeking behaviors across different populations may be potential factors in designing counseling services that are used for risk classification and needs assessment.     

Fostering Juror Comfort: Effects of an Orientation Videotape

The purpose of the present study is to assess the impact of a juror orientation videotape on juror knowledge of the legal system and comfort levels regarding jury service. Juror knowledge and comfort were measured using the Juror Knowledge and Comfort Scale (JKCS). It was hypothesized that jurors exposed to the orientation videotape would be significantly more knowledgeable about the legal system and significantly more comfortable with their role as jurors. It was further hypothesized that there would be a significant correlation between the knowledge scale and comfort scale of the JKCS. Results indicate that jurors exposed to the orientation videotape scored significantly higher on both the knowledge scale and comfort scale than jurors not exposed to the orientation videotape. There is also a significant correlation between the juror knowledge and comfort components of the JKCS. The implications of the findings and directions for future research are discussed.