The Sydney Declaration - An unique opportunity for Africa

The Sydney Declaration (SD) has the inherent virtue of shifting the focus from the tools used in forensic science to the fundamental characteristics of appropriate forensic practice analysis of a situation and all related trace data for the purpose of resolving a case. Though several differences might be observed between countries regarding the technologies used, the fundamental principle of forensic logical reasoning are universally applicable to all contexts and environments and not only restricted to sophisticated, well-resourced, established forensic science laboratories based in countries that offer adequate resources, strong networks and legal frameworks. In Africa, several countries lack resources to train practitioners and to develop forensic science institutes, laboratories and other relevant institutions. The SD can serve as departure point to attain appropriate forensic science outcomes. Upholding its sound guidance can help forensic science practitioners remain faithful to their science, acknowledge their limits, give expert opinions based solely on facts and scientific analysis and interpretation, whilst also enhancing communication with their stakeholders. As forensic science develops in Africa, the SD presents a timely opportunity for us to proceed with a common understanding and a solid foundation through which our field can grow.

Risk factors of sudden cardiac death in women: A 10 years study in Tunisia

BACKGROUND

Sudden cardiac death (SCD) represents a frequent etiology of sudden death. It represents a major public health issue. Few data about SCD in women are available from the Arab world. Our work aimed to analyze the risk factors of sudden cardiac death in Tunisian women in comparison with men.

METHODS

A cross-sectional retrospective study including all sudden cardiac death cases, conducted in the Forensic Medicine Department of the main teaching hospital of Tunis, between January 2010 and December 2019.

RESULTS

We counted 417 cases of sudden cardiac death in women representing 17.5% of the total number of sudden cardiac deaths recorded during the study period. The average age was 60.03 ± 15.01 years with a predominance of urban married women. The most frequent cardiac risk factors were high blood pressure (50%), diabetes (36.2%), and cardiac disease history (34.2%). Predominately married women with a history of High blood pressure and diabetes, had a high predictive of sudden cardiac death.

CONCLUSION

Cardiac sudden death is no longer a male focused issue. As a matter of facts Rates of SCD in women are rising with a different pattern. We will highlight the importance of adopting specific preventive measures of SCD in female.

Patterns of Unnatural Deaths Among Children and Adolescents: Autopsy Study (2011-2018)

BACKGROUND AND AIMS

The problem of unnatural death in children is still relevant because of their vulnerability. This work aimed to describe the epidemiological profile and patterns of these medicolegal deaths in children and adolescents in northern Tunisia.

METHODS

We conducted a retrospective study from January 2011 to December 2018, within the Forensic Department of Charles Nicolle Hospital in Tunis. All children who died of unnatural causes were included (767 cases).

RESULTS

An overall male predominance was observed (sex ratio = 2.4). Accidental deaths represent the most common manner of death (81.4%) involving most frequently domestic accidents occurring in children aged between 1 and 4 years. In cases of suicide, the highest risk profile was a female child aged between 15 and 18 years. The suicide occurred most often in the victim's home with hanging representing the common means of suicide. For the criminal form, the most common means in those cases were stabbing and blunt injuries.

CONCLUSION

Our study delivered a broad picture of unnatural deaths among children in Tunisia. These deaths, largely absent from child survival initiatives presently on the global agenda, can be prevented if they are addressed strategically, as their injury prevention strategies differ from adults.

[Medical experimentation on prisoners (part 4): the dilemma of 'pros' and 'cons'.]

Given the long history of abuse of prisoners in medical experimentation, it is understandable that additional safeguards have been established to protect this social category. However, the debate between the detractors and the supporters of the medical experimentation in the prison environment is still going on. The present history note, the fourth in a series on medical experimentation on prisoners, intended to relate the main arguments of both sides: ie; the detractors and supporters of medical experimentation on prisoners.

Medical experimentation on prisoners (part 3): the main milestones of the evolving ethical' texts and codes

Ethical foundations related to the use of human beings in medical research, already existed in the oldest texts. The historical evolution of regulations (in terms of texts and codes) had always drawn its legitimacy and its logic from the historical context. The main aim of these regulations was to satisfy a need to restore moral or physical prejudices, by hoping by means of the law, that these abuses would not be repeated. Although they were the main victims of medical experimentation, prisoners were rarely specifically identified in these legislations. This history note, the third in a series on medical experimentation on prisoners, aims to describe the major founding texts of ethics in medical experimentation, drawing attention to the historical context as well as the issues that shaped these documents.

Sudden death due to a massive hydatid pulmonary embolism secondary to a cardiac cyst rupture

Cardiac echinococcosis is rare, and its clinical evolution is slow and asymptomatic until complications occur such as sudden death. Although more frequent in endemic countries, hydatid disease should be known by forensic specialists with regard to the migration flows of people from zones with high endemicity and who are likely to die from infection. We report an autopsy case of a 33-year-old male without any medical history who presented to the emergency room with shortness of breath, chest tightness, tingling all over the body and faintness without fever. He died suddenly before the medical examination. Autopsy showed no traumatic injuries or signs of violence. A cardiac 7 cm multivesicular hydatid cyst situated on the interventricular septum and the interatrial septum was observed. The cyst was ruptured with a massive hydatid pulmonary embolism. Hydatid cysts were also observed in the lungs. No signs of anaphylactic shock were found. The diagnosis of hydatid cyst was confirmed by histopathological examinations. Our case report highlights the mechanisms of occurrence of cardiac echinococcosis and hydatid pulmonary embolism as a complication, as well as the autopsy findings and the precautions needed by the forensic doctor.

[Medical experimentation on prisoners (part 5): ethical considerations]

Medical experimentation on prisoners is one of the most difficult ethical issues because it brings many principles into conflict with the reality of the practice. These ethical principles, which are universal and timeless, are accepted as elementary rights for every human being. However, in a detention setting, these principles are easily lost. Moreover, the scope of this problem goes far beyond the walls of the penitentiary to touch on conflicting issues of scientific publication, social discrimination, and even political decisions sometimes. The present history note, the fifth in a series on medical experimentation on prisoners, intended to discuss the main ethical considerations regarding prisoners, and to highlight the difficulty of their implementation.

Apport de la dixième révision de la Classification internationale des maladies dans le codage de la mortalité médico-légale

Contexte : les rapports de mortalité en Tunisie n’incluent pas les causes de décès médico-légaux. Objectif : établir les statistiques sur les causes de décès médico-légaux au nord de la Tunisie en 2015 en se basant sur la Dixième Révision de la Classification internationale des maladies (CIM-10). Méthodes : il s’agissait d’une étude transversale et descriptive portant sur tous les décès autopsiés au nord de la Tunisie en 2015. Les caractéristiques socio-démographiques ont été identifiées, ainsi que les formes médico-légales et les causes de décès. Celles-ci ont été codées selon la CIM-10. Résultats : notre échantillon était composé de 1957 cas. Il y avait une prédominance masculine avec un sex ratio de 3,5. L’âge moyen était de 47,2 (écart type [ET] 20,6) ans. Les morts violentes ont représenté 57,4 % de la mortalité globale, suivies du groupe des maladies de l’appareil circulatoire (24,5 %) et de celui des maladies de l’appareil respiratoire (6,5 %). Les causes de décès les plus fréquentes étaient les accidents de transport terrestre (33,7 %) et les cardiopathies ischémiques (17,9 %). Les accidents de la voie publique étaient à l’origine de 56,1 % des morts accidentelles. La pendaison était le mode suicidaire le plus fréquent (51,5 %). Les homicides étaient le plus souvent secondaires à des plaies par arme blanche (35,8 %). Conclusion : la CIM-10 a permis de mettre en avant la part de la mort violente et ses caractéristiques dans la mortalité médico-légale au nord de la Tunisie, ce qui témoigne de son efficacité dans la standardisation des conclusions des rapports d’autopsie.

Fatal coronary ectasia: An autopsy case report and review of literature

Coronary ectasia is a rare vessel defect that represents a pathological and incidental finding in routine coronary angiography performed for other coronary syndromes. This defect exposes to the risk of intra-coronary thrombosis by blood stasis due to the turbulent blood flow in those dilated areas that can lead to sudden death. We report an autopsy case of a male subject suddenly deceased. A medico-legal autopsy concluded an ischemic heart failure due to a vascular thrombosis by a blood clot in a coronary ectasia. Our case report aimed to discuss the mechanisms of sudden death attributed to coronary artery ectasia.

Pattern of homicidal burns in Northern Tunisia: An autopsy-based study over 15 years (2005-2019)

Data about homicidal burns remain scarce. Intentional burns are a challenging situation in the case of an individual found dead in a fire zone with no witness of the fatal act. This study aimed to analyze the victim profiles of homicidal burns in Northern Tunisia. It was a descriptive cross-sectional study with a retrospective data collection over 15 years (January 2005-December 2019). In total, 60 cases of homicidal burns were collected. The mean age was 40.22 ± 18.1 years (range 4-82 years). We noted a male predominance (sex ratio M/F = 1.3). Most of the victims were married (48.3%), unemployed (40%), and living in an urban area (63.3%). Homicidal burns occurred most frequently in private homes for female victims (80.8%) and in public places for male victims (31.4%) (p < 0.001). The reported motive varied according to the victim's sex; males were mostly assaulted by an acquaintance in an interpersonal conflict (47.1%), and females were mostly assaulted by an intimate partner while in a dispute (42.3%; p = 0.001). The median total body surface area (TBSA) that was burned was 60.4%, and burn injuries were observed mainly in the anterior part of the body. In 19 cases, the burns were associated with another type of trauma, from which the most common association was burning and stab wounds (12 cases). The identified pattern of homicidal burn casualties was similar to the reported data in Western countries and to homicides in general in Tunisia, suggesting that prevention measures should address those of intentional interpersonal violence.

Medico-legal aspects related to Telemedicine in Tunisia in the context of the covid-19 pandemic

Telemedicine has become a privileged mode of medical practice providing medical care while reducing the transmission of Covid-19 among patients, families, and clinicians. The law established in 2018 settled a legal framework for telemedicine in Tunisia. However, thelatterremains not sufficient in itself, as legal issues remain especially delimiting the precise conditions for this exercise and to expose the limits of responsibility of each party involved among its organizers, its health service providers, and its users. Several medico-legal issues may be generated by the practice of telemedicine in Tunisia. Our paper aimed to discuss these medico-legal issues relating to telemedicine in anticipation of its legislation.

Trends of infanticides in northern Tunisia: A 40 years study (1977-2016)

BACKGROUND

The Tunisian Penal Code defines infanticide as the murder committed by the mother on her child at birth or immediately after. There is a dearth of studies and official statistics on infanticide in the Arab region and North Africa.

OBJECTIVE

to analyze the infanticide trends in northern Tunisia between 1977 and 2016.

PARTICIPANTS AND SETTING

we included all cases of infanticides autopsied at the Legal Medicine Department of Charles Nicolle Hospital in Tunis, over a period of 40 years (1977-2016).

METHODS

A descriptive retrospective study.

RESULTS

We collected a total of 513 cases of infanticide over the study period. The general prevalence of infanticide was 0.42 per 100,000 live births per year. Infanticide often occurred during the week, in winter (31.5%) and in spring (30.9%). The newborn was often found on public roads (40.9%) and in urban areas (81.4%). The newborn was often full-term (73.6%), mature, without any congenital malformation, found completely naked (75.2%) and with an empty stomach (93.7%). The umbilical cord was often cut (71.5%), not ligated (82%) with an irregular edge (64%). There was often no putrefaction (54.4%). The hydrostatic test (81.8%) and histological examination (81.1%) showed that infants had breathed. Neglect was the most common cause of death (49.9%).

CONCLUSION

Northern Tunisia has a low prevalence of infanticide compared to most of the previous European and American studies. A better understanding of infanticide would allow us to adapt measures of prevention.

Evaluating a postgraduate teaching intervention among pathology trainees on medical liability

BACKGROUND

Pathology is a specialty of high malpractice risk. For that reason, we programmed a training session of the residents in Pathology with an association of traditional methods of learning and case-based brainstorming sessions.

OBJECTIVES

We aimed to train them about our national tort law and to make them aware of the different medicolegal errors that they have to avoid in their routine practice.

METHODS

Trainees completed a pre-test (3 multiple-choice questions (MCQ) and 4 medical malpractice cases involving pathologists), attended lectures covering standards in pathology, the legal responsibility of pathologists and the notion of medical malpractice error in pathology, brainstormed about legal cases (different than in the pre-test), participated in a conference covering telepathology, digital molecular pathology and social media and finally completed a post-test (same as the pre-test). We tried to assess the impact of the session using a questionnaire that different trainees ( who were present or absent in the training session) fulfilled one month after the training session. Analysis of variance (ANOVA) was conducted to determine whether there were significant differences between the scores among pathologists according to their level of training in the speciality.

RESULTS

The results indicated that performance on the post-test significantly improved on questions associated with 2 of the 4 cases.  Trainees were concordant with actual case verdicts at a rate of 38% for pre-test and 54% for post-test.  Most (76.5%) students felt they had an active role in the training and felt they achieved goals (94.1%).

CONCLUSION

The association of different methods of learning is helpful in training pathologists about medicolegal malpractice.

Workplace traumatic accidental death in Northen Tunisia

BACKGROUND

Workplace accidents represented a Global public health problem with about two millions persons dying from accidents at work or occupational diseases. In Tunisia, data on fatal traumatic workplace accidents remain scarce. Work-related accidents accounted for 0.4% of the employed population in 2014, with a prevalence of fatal accidents between 4 and 25 per 100,000 workers depending on the region and the field.

AIM

To describe the victim's profile of workplace traumatic accidents in Northern Tunisia.

METHODS

It was a retrospective cross-sectional study, including all cases of accidental workplace traumatic accidents autopsied at the Department of Forensic Medicine, Charles Nicolle Hospital in Tunis over a period of 12 years (2003- 2014).

RESULTS

We collected 741 cases, including 724 men. The median age was 38.5 years. Construction sector represented 70% and the industrial sector represented 12.6% of cases. Victims were workers in 91.4%. Falls from height was the most frequent accident type (43.5%), followed by objects falling (26.5%) and electrocutions (18.5%). Death occurred at the place of accidents in 58% cases.

CONCLUSION

Our study highlighted the need to reinforce and to adapt the prevention measures toward workers in the construction sector, in order to reduce the mortality from traumatic workplace accidents.

A controlled randomized trial about using a checklist-based critical appraisal

BACKGROUND

the critical appraisal of scientific publications is a mainstay step in the evidence-based-practice. This study aimed to assess the utility of using a checklist in implementing this practice.

METHODS

medical students in the third year that were performing a training period in a department of pathology were randomly assigned to two groups. A computerized random number allocation was used. The same manuscript was given to both groups. All the students spent the same period of training in the department and they received the same training session about critical appraisal of scientific publications. The intervention group (n=26) performed a critical appraisal of the article using the checklist of a Pubmed-indexed journal and the control group (n=25) performed a free critical appraisal. The individual critical appraisal forms were evaluated using a scoring-based-checklist. A one-way ANOVA test was used to compare the scores between both groups using SPSS software (version 11.0).

RESULTS

51 students were enrolled in this study. The mean score of the participants using free appraisal reached 16.5 in men and 13.25 in women. The mean scores in the intervention group reached 14.83 in men and 14.75 in women. The mean scores in the control group reached 13.65 and 14.42 in the intervention group (p=0.61).

CONCLUSION

these results highlighted the absence of significant difference in critical appraisal skills when using or not a checklist. This result has to be taken with caution because all the participants received the same training methods during the same period.

Evaluation and acceptability of concept maps as a learning tool in medical studies

BACKGROUND

the use of concept maps (CM) in medical studies has been largely reported in the literature. In our context, we used to promote case-based-teaching methods but students aren't used to construct CM.

AIM

To evaluate the acceptability of using CM by the students and the reproducibility of 2 methods of scoring, a holistic and an analytic one, associated to a master map in order to assess them.

METHODS

the authors supervised a 2-session-case-based-learning performed in a department of pathology. One case dealing with a real story about a colon cancer diagnosed in the musician Debussy (http://fr.wikipedia.org/wiki/Debussy) was adapted and presented to the students. At the end of the first session, the students were encouraged to construct collectively a concept map. At the end of the second session, the students were asked to fulfill a questionnaire about their acceptability of the learning process. Besides, two raters scored all the concept maps using 2 different scoring methods associated to a master map. The reproducibility of both scoring systems was evaluated using the kappa coefficient.

RESULTS

31 students were enrolled in this study with a mean age of 21 years. The raters evaluated 8 CM. The kappa coefficient reached a value of 1 in the holistic scoring and a value of 0.46 in the hierarchical scoring indicating respectively a very strong and a moderate agreement between evaluators. 15 students reported their satisfaction about the use of CM collectively. 10 students expressed their will to use CM individually, 17 students felt that using the CM collectively made them feel to belong to a group but without expressing their own knowledge and reflecting their progress.

CONCLUSIONS

our study highlighted the acceptability of using concept maps in medical studies and the possibility of reaching valid and reproducible scoring methods especially when associating a master map.

[Assessing violence against nurses at reception in hospital emergency departments in Tunis]

Violence against health professionals is a global public health problem. A study carried out of hospital emergency departments in Tunis sought to analyse assaults on nurses. It reveals high levels of violence, particularly at weekends and during night shifts. Under-reporting of such incidents is observed, revealing a sort of 'culture of silence' which, over time, can lead to suffering in the workplace and a deterioration in the quality of care.

Liquid Biopsy as Surrogate to Tissue in Lung Cancer for Molecular Profiling: A Meta-Analysis

Background:

The accurate microscopic diagnosis of lung cancer has become insufficient due to the concept of personalized medicine. Tissue samples are used not only for microscopic diagnosis but also for the assessment of the different targets. Biopsies are performed in 80% of the patients and they are not sufficient for molecular diagnosis in 30% of the cases. Liquid biopsy (LB) has been reported as a possible surrogate to tissue samples and has been introduced in the management scheme of the patients since 2014. We aimed to highlight the diagnostic value of liquid biopsy in assessing the molecular profile of non small cell carcinomas in comparison with tissue biopsy.

Methods:

We retracted eligible articles from PubMed, Embase and Cochrane databases. We calculated the pooled sensitivity (SEN), specificity (SPE), positive likelihood ratio (PLR), negative likelihood ratio (NLR) and diagnostic odds ratio (DOR). A summary receiver operating characteristic curve (SROC) and area under curve (AUC) were used to evaluate the overall diagnostic performance using the Meta-Disc software 5.1.32. The heterogeneity was assessed using I square statistics. A meta-regression was performed in case of heterogeneity. In case of absence of covariates, a sensitivity analysis was done in order to assess publications that induced a statistical bias.

Results:

39 eligible studies involving 4782 patients were included. The overall statistical studies showed heterogeneity in the SEN, SPE, PLR, NLR and DOR. No threshold effect was revealed. The meta-regression incorporating the ethnicity, the test, the technique used in tissue and plasma and the use of plasma or serum as covariates showed no impact of these factors. A sensitivity analysis allowed achieving the homogeneity in the SPE and DOR. The overall pooled SEN and SPE were 0.61 and 0.95 respectively. The PLR was 9.51, the NLR was 0.45 and DOR was 24.58. The SROC curve with AUC of 0,93 indicated that the liquid biopsy is capable of identifying wild type samples from mutated ones with a relatively high accuracy.

Conclusion:

This meta-analysis suggested that detection of molecular mutations by cfDNA is of adequate diagnostic accuracy in association to tissues. The high specificity and the moderate sensitivity highlight the value of LB as a screening test

Sex determination of a Tunisian population by CT scan analysis of the skull

It is widely accepted that the estimation of biological attributes in the human skeleton is more accurate when population-specific standards are applied. With the shortage of such data for contemporary North African populations, it is duly required to establish population-specific standards. We present here the first craniometric standards for sex determination of a contemporary Tunisian population. The aim of this study was to analyze the correlation between sex and metric parameters of the skull in this population using CT scan analysis and to generate proper reliable standards for sex determination of a complete or fragmented skull. The study sample comprised cranial multislice computed tomography scans of 510 individuals equally distributed by sex. ASIR^TM software in a General Electric^TM workstation was used to position 37 landmarks along the volume-rendered images and the multiplanar slices, defining 27 inter-landmark distances. Frontal and parietal bone thickness was also measured for each case. The data were analyzed using basic descriptive statistics and logistic regression with cross-validation of classification results. All of the measurements were sexually dimorphic with male values being higher than female values. A nine-variable model achieved the maximum classification accuracy of 90% with -2.9% sex bias and a six-variable model yielded 85.9% sexing accuracy with -0.97% sex bias. We conclude that the skull is highly dimorphic and represents a reliable bone for sex determination in contemporary Tunisian individuals.

Evaluation of the work satisfaction of the teaching physicians practicing in the hospitals of Tunis

BACKGROUND

Job satisfaction is a key element in managing human resources despite the scope of practice. It is intimately linked to motivation but acts independently.

AIM

To evaluate the degree of job satisfaction of the teaching physicians practicing in the hospitals of Tunis.

METHODS

It was a descriptive study including a sample of 75 teaching physicians practicing in Tunis hospitals, selected randomly and anonymously with a 1:20 scale with a matching based on the grade and the speciality. The evaluation was carried out by the Saphora-Job satisfaction questionnaire.

RESULTS

The 75 physicians who participated had a sex ratio (M / F) of 0.42. The Median seniority was of seven years. The majority of physicians who participated in the study had a professional experience of less than 10 years (72%) and were mostly Assistant Professors (57.3%). The overall job satisfaction rating of participants in the study was 3.13 ± 1.2. Indicators that were related to relatively high satisfaction were represented by the relationship between colleagues, the nature of work and the adequacy of work and personal life. Indicators that were linked to the lowest satisfaction were represented by knowledge and access to regulation, remuneration and knowledge of the organization of the institution.

CONCLUSION

Our study suggested the need for serious discussions between the different stakeholders about teaching physicians' salary ranges and opportunities for personal development as well as reward system for hospital-based physicians.

Legal responsibility of the pathologist in Tunisia

The role of the pathologist has been highlighted by the medias since the recent years and the Tunisian law system suffers from a huge and there are no rules or jury verdicts concerning the e responsability  of the doctors in general with emphasis on pathologists. One might think that the lack of laws benefits to the pathologist, on the other hand, we can consider this as dangerous either for the patients or the pathologists. This lack of laws makes the judge dependant on the expert view. Other countries like European ones and the United States, has available data furnished by the insurance bodies that enrich the jury verdicts and the different laws that are available. Our aim was to help the pathologists understand their legal responsibilities and the law system. The latter may seem as complex for the pathologist as a pathologic report for a judge.

Death certificate accuracy in a Tunisian Emergency Department

OBJECTIVE

Assess Death Certificates accuracy (DCs) issued by a teaching emergency department in Tunis.

METHODS

It is a descriptive study. We included all death certificates issued in the Emergency Department of a teaching Hospital in Tunis over 17 months period (October 2013 - March 2014). Twenty-one errors have been predefined and classified as "Editing errors" or "Medical analysis error" then as major or minor errors.

RESULTS

757 certificates were studied; all DCs had at least three errors with an average number of errors of 6.92±1.55.      The mechanism of death was inadequate in 20% of the DCs.  The cause of death was "unacceptable" in 21% of the DCs.

CONCLUSION

The results are similar to those reported in international literature. Therefore, it is urgent to start working on further and regular training on how to fulfil a death certificate for undergraduate and postgraduate medical students.

Organizational Ostracism: A Potential Framework in Order to Deal with It

Background

Organizational ostracism is defined as a violation of norms that we are suggested to acknowledge at the workplace. It results in the exclusion of one person or multiple persons, and causes damage to our innate need to belong. This kind of behaviorism can be engaged through a hierarchical or nonhierarchical relationship. Three elements interact in the framework of organizational ostracism: the actor, the target, and the institution. Our aim was to describe the different factors interacting with every element in order to produce recommendations targeting to prevent the occurrence of such behaviorism in an institution and to help targets of such a violence in order to handle this situation and go forward. As psychological impact of ostracism has frequently been studied in the literature, we focused on its impact on professional tasks.

Methods

We performed a questionnaire-based study about organizational ostracism. This questionnaire was established through an online platform (https://www.sondageonline.com) and made available through the following link: https://goo.gl/forms/KrkVXe3bMEc79cau2. A keyword was sent to all participants. We created a 23-interrogation questionnaire with open and short questions. Nonwritten consent was obtained from all participants.

Results

The actor of ostracism engaged in ostracism, in most of the cases, with other persons without a real purpose. The actor of ostracism had an antecedent of problematic relationship at work in 82.9% of the cases. Of the participants, 58.5% were of the view that ostracism aimed to cause hurt and isolate them. Professional isolation was observed in 58.5% of the cases; 51.2% of the participants tried to improve their work potential and explained their reaction by an intrinsic motivation. The organization atmosphere was judged to be bad in most of the cases.

Conclusion

Our study showed that ostracism was mainly observed in public practice.

Patterns of homicide in North Tunisia: a 10-year study (2005–2014)

Background

In Tunisia and in the Arab world, few data are available about homicide patterns. The aim of our study was to analyse the victims' profiles and the general pattern.

Methods

636 homicide victims were autopsied at the Legal Medicine Department of Charles Nicolle Hospital in Tunis, over a period of 10 years (2005–2014).

Results

Victims were males in 79.7% with a male-to-female ratio of 3.93 and the average age was 37.7 years. The victim was generally from an urban area (66.7%), single (55.7%) and semiskilled (50.2%). The most common methods of homicide were sharp force (51.7%) and blunt trauma (24.8%).

Conclusions

This study suggests applying urgent preventive measures targeting essentially young males and the importance of a national ‘Violence Repository’.

Impact of the Tunisian Revolution on homicide and suicide rates in Tunisia

OBJECTIVES

To analyze the impact of the Tunisian Revolution on suicide and homicide patterns in Tunisia.

METHODS

It is a retrospective, cross-sectional study, including all the cases of homicides and suicides that occurred during an 8-year period (2007-2014) in Northern Tunisia. We compared data before and after the revolution.

RESULTS

After the revolution, the number of suicides rose 1.7 times, with a prevalence rising from 1.8 to 3.12 suicides per 100,000 persons per year. Homicides rose 1.3 times after the revolution. For both manner of death, victims were mostly males, aged between 20 and 39 years, living in urban areas. Hanging and self-immolation rose, respectively, 1.8 and 3 times after 2011. We observed suicide cases most frequently occurred in public places and in front of public administration after 2011. Homicide victims' profile and circumstances showed a single variation which is an increase in number of cases happening in rural areas.

CONCLUSIONS

Our results proved a short-term impact of the transition period on homicides and suicides. Urgent preventive measures are needed especially to decrease the suicide rates.

Sudden death due to hydatid disease: a six-year study in the northern part of Tunisia

Human ecchinococcosis also known as hydatid disease is a zoonotic infection caused by the tapeworm Ecchinococcus with 2-3 Million cases worldwide. We hereby report a 6 years period study of Sudden death due to hydatidosis aiming to analyze the epidemiological criteria, death circumstances, and autopsy observations attributed to hydatid disease. During the past 6 years, 26 death cases were due to hydatid disease. Our analysis shows that the sex ratio (M/F) was 1.6, the mean age was 31-year old, and 65% of the subjects lived in rural places. In 17 cases, death occurred in the victim's place, five victims died after a heavy exercise, and in two cases, death occurred immediately after trauma. At autopsy, 91% of the cysts were found in the liver. In three cases, death followed a septic state, and in two cases, it followed an acute respiratory failure. Death was attributed to anaphylaxis in 17 cases.