Anatomy and anatomical variations of adrenal veins and its application to adrenal venous sampling

PURPOSE

Our aim was to study the anatomy of the left and right main adrenal veins (LAV and RAV) and to identify their anatomical variations in order to see the practical application of these findings to adrenal venous sampling (AVS).

METHODS

Our work is based on dissection of 80 adrenal glands from fresh corpses in the forensic medicine department. We studied the number, the drainage, the direction and the level of termination of the main adrenal veins.

RESULTS

The average length of the LAV was 21 mm. It ended in 100% of cases at the upper edge of the left renal vein with a mean connection angle of 70° and after an anastomosis with the lower phrenic vein in 36 cases(90%). The average length of the RAV was 9 mm. It ended in 100% of cases at the level of the retro hepatic inferior vena cava (IVC) mainly on its posterior face in 21 cases (53%) and on its right lateral border in 18 cases (45%). The mean angle of the RAV in relation to the vertical axis of the IVC was 40°, with extremes ranging from 15° to 90°.

CONCLUSIONS

AVS seems to be easier on the left than on the right side because of the greater length of the adrenal vein (21 mm vs. 9 mm) and a greater angle of connection (70° with the left renal vein vs. 40° with the IVC), which explains the lower success rate of cannulation and the more frequent occurrence of blood sample contamination on the right side.

A cadaveric anatomical study of the adrenals: vascular relationship

The adrenal gland is a retroperitoneal organ with intimate relationships with neighboring organs but also with the large retroperitoneal vessels. Our aim was to study the vascular relationships of the adrenal gland with the large abdominal vessels. Our work is an anatomical dissection of 80 fresh cadaveric adrenals. The subjects didn't have a history of retroperitoneal surgery. Dissection conditions were similar to those in the living. All measurements were made in situ. On the right side, the average distance between the adrenal gland and the renal vein (DR) was 13 mm (0-20). In one case, the adrenal gland laid directly on the right renal vein (DR = 0). The average length L, over which the right adrenal gland entered behind the inferior vena cava (IVC), was 8 mm (0-12). In 4 cases, the right adrenal was lateral to the IVC and in 6 cases the length L exceeded 10 mm. On the left side, the mean distance DL, separating the adrenal gland from the left renal vein was 8 mm with extremes ranging from 0 mm to 18 mm. In eleven cases, the adrenal gland laid directly on the left renal vein. The right adrenal gland has a close relationship with the IVC and is often located behind it. This close relationship helps to explain the increased incidence of IVC lesions during surgery. The left adrenal gland has an intimate relationship with the left renal vein and often lies on top of it. This explains the risk of injury to the left renal pedicle during left adrenal surgery.

Management of blunt renal trauma on pre-existing diseased kidneys: a cross-sectional study

Pathological kidney trauma is a special entity. Congenital or acquired lesions may interfere with clinical presentation, radiological imaging, and the therapeutic approach.

Objective

Our objective was to determine the clinical, radiological, and therapeutic features of this entity.

Materials and methods

The medical records of 37 observations were retrospectively collected from January 1992 to February 2022. All cases were explored by a kidney ultrasound and/or a computed tomography scan, and classified according to the American Association of Surgery of Trauma. Pre-existing renal abnormalities were found in 37 patients among 203 (18.2%). The most common underlying lesion were urolithiasis (37.8%) followed by pyelo-ureteral junction syndrome (32.4%). Surgical abstention was decided in 11 cases, four nephrectomies were performed as a matter of urgency, and seven nephrectomies were performed remotely. The cure of uropathy was performed after an average delay of 3 months.

Conclusion

Kidneys with underlying pathology are habitually more susceptible to trauma. Contusions are often benign contrasting with a high nephrectomy rate.

A comparative study of the injury pattern between suicidal and accidental falls from height in Northern Tunisia

BACKGROUND

Falls from height are a common cause of marbidity and mortality. The aim of this study is to examine the characteristics of the victims, the circumstances of the fall and distribution of the injuries of accidental and suicidal falls from height.

MATERIALS AND METHODS

It was a retrospective cross-sectional study, based on autopsies performed over 16 years (January 2005 to December 2020). The recorded variables included demographic data of the victim, height of fall, death scene findings, length of hospital stay, autopsy findings, and toxicological results.

RESULTS

Of the 753 victims of fall from height, 607 were fallers and 146 were jumpers. We found that male victims were predominant in the accidental group (86.8% vs. 69.2%). The mean age at death was 43.6 ± 17.9 years. Suicidal falls occurred in a private house in the majority of cases (70.5%), while accidental falls occurred most frequently at workplace (43.8%). Suicidal falls were higher than accidental falls (10.4 ± 7.3 m vs. 7.1 ± 5.7 m). Injuries in the thorax, abdomen, pelvis, upper and lower extremities were more frequentl in the suicidal falls group. Pelvic fractures were 2.1 times more likely to occur in the suicidal falls. Head injuries were more frequent in the accidental falls group. The survival delay was shorter in the suicidal falls group.

CONCLUSIONS

our study highlights the differences in the profile of the victims and in the pattern of injuries caused by falls from height, depending on the victim's intention to fall.

[Circadian and septadian variation in sudden cardiac death : Autopsy registry of the Tunisian North]

INTRODUCTION

Several studies have suggested a circadian and septadian pattern of incidence of sudden cardiac death with a morning peak and a Monday peak.

OBJECTIVE

To analyze the circadian and septadian pattern of occurrence of sudden cardiac death in the eight northern Tunisian governorates.

METHODS

We prospectively collected epidemiological and autopsy data of sudden cardiac death victims occurring in the northern region of Tunisia between January 2013 and December 2019.

RESULTS

The population included 1834 men (79.6%) and 468 women (20.4%) with a mean age of 56.5 ± 14 years. Smoking (53.9%) was the most prevalent cardiovascular risk factor. One-fifth (20.9%) of victims had known heart disease, and 3% had a family history of sudden death. ischemic heart disease was the leading cause of sudden death (46.8% of cases). One- fourth (25.7%) of autopsies were negative. Analysis of the circadian pattern of occurrence of sudden cardiac death identified a peak (36.1%, p < 0.001) between midnight and 6 am. This nocturnal excess mortality was significant (p < 0.001) and independent of sex (34.1 % in men and 43.8 % in women) and cause of death (39.3 % of cases of sudden ischemic death and 33.3 % of cases of nonischemic death). Moreover, there was a significant septadian variability in the occurrence of sudden death (p: 0.0015), with a peak on Friday (15.8 %, p: 0.042).

CONCLUSION

This study showed a peak of sudden death between midnight and 6 am, and on Fridays, confirming the modification of the classic circadian and septadian pattern of sudden death occurrence. These results may help optimize the deployment of emergency mobile teams and structures during the most vulnerable periods.

Ordinal disciplinary responsibility of the certifying physician

NTRODUCTION

Writing medical certificates is part of the doctor's daily practice.

AIM

To analyze the complaints related to medical certificates filed to the Regional Council of the Order of Doctors (RCOD) of Tunis and to identify the predictive factors of disciplinary sanctions.

METHODS

We collected the complaints filed to the RCOD of Tunis between 01/01/2017 and 31/12/2017, in relation to a problem with the establishment and/or the issuance of medical certificates by registered certifying doctors at RCOD, Tunis.

RESULTS

We collected 32 complaints, the reason for which was a certificate of convenience in 88% of cases, a drafting error in 9% of cases and a fee problem in 3% of cases. The decision of the RCOD was a closing of the file in 56% of cases, a call to order in 28% of cases and a temporary ban on practicing medicine in 16% of cases.The multivariate analysis with logistic regression identified one independent predictor of a call to order or a sanction from the RCOD, namely the fact that the doctor did not bring the file of the patient(s) having been the subject of the complaint, at the time of his invitation to RCOD Tunis (p=0.037, OR=22.66).

CONCLUSION

The doctor must always keep a medical form or a patient file, which will allow him to justify himself in the event of a complaint against him, for the reason of a certificate of convenience.

Ecotoxicity of chrysene and phenanthrene on meiobenthic nematodes with a case study of Terschellingia longicaudata: Taxonomics, toxicokinetics, and molecular interactions modelling

Polycyclic aromatic hydrocarbons (PAHs) are toxic for humans and marine fauna alike. The current study assessed the impact of PAHs on the migratory behaviour of meiobenthic nematodes collected from the Bizerte lagoon, Tunisia. The experiment lasted for 15 days and was carried in open microcosms, which comprised a lower, contaminated and an upper, uncontaminated compartment. Three treatments were used, for each of them an untreated control was set up: sediment contaminated with chrysene (116 ng g^-1 dry weight (DW), with phenanthrene (116 ng g^-1 DW) and a mixture of both. The results showed a significant decrease in diversty and abundance in the lower, contaminated compartments compared to the upper zones. The results also highlighted that under an increased stress some species progressively increased in number, these were considered PAH-tolerant species such as Odontophora villoti, some others had an occasionally increased in number were considered as opportunistic species, such as Paracomesoma dubium and the species that showed a progressive decreased in number, such as Metoncholaimus pristiurus and Steineria sp., Terschellingia. longicaudata, and Oncholaimellus sp. were classified as PAH-sensitive. Moreover, an increase in the activity of biochemical biomarkers was observed following the exposure of males and gravid females of T. longicaudata to 29, 58 and 87 ng g^-1 DW of chrysene and phenanthrene paralleled by a higher vulnerability of the latter demographic category. Besides, a significant decrease in fertility of females and an increase in pharyngeal sucking power were observed for both types of PAHs considered. The sex ratio was also significantly imbalanced in the favor of males, which suggest that chrysene and phenanthrene affect also the hormone system of T. longicaudata. The high affinities of these PAHs and their molecular interactions with both germ line development protein 3 (GLD-3) and sex-determining protein (SDP) may justify these results and explain the toxicokinetic attributes.

A 13-Year Study of Fatal Falls From Height in Northern Tunisia

INTRODUCTION

Falls from height are a major cause of unintentional injury death, resulting in high disability and mortality. We investigated the characteristics of fatal falls and their relationship with intentionality, injury patterns, and death on impact.

MATERIALS AND METHODS

In this retrospective study, we examined 545 cases of fatal falls from height that underwent autopsy in the forensic department of the Charles Nicolle hospital of Tunis (Tunisia) between January 2008 and December 2020. Cases were reviewed in terms of demographics, fall characteristics, and autopsy findings.

RESULTS

The population was predominately male (86.6%). Four hundred twenty-one (77.3%) originated from accidents, 120 (22%) were found to be suicidal, with 4 homicide cases. A notable decline in cases was noticed following the Jasmine revolution, 2011 (R squared = 0.8). The mean height of falls was 8 m. Higher falls were associated with a set of organ-specific injuries. Organ injury pattern did not differ based on intentionality. Female victims were 2.4 times more likely to sustain pelvic injuries than males. The majority of victims deceased before reaching health care structures. Death on impact was strongly associated with higher falls, cranial impact, and organ-specific injuries, including cardiac, pulmonary, and skull injuries.Falls from height are in many cases preventable. A clearly defined fall safety policy, strict implementation of evidence-based interventions, efficient allocation of resources, and raising safety awareness must to be urgently implemented.

CONCLUSION

Understanding patterns of injury and the factors that influence death on impact may be of further interest in the prevention and management of survivors in the acute period.

The response of meiobenthinc sediment-dwelling nematodes to pyrene: Results from open microcosms, toxicokinetics and in silico molecular interactions

An experiment conducted with 'open microcosm' made by connected sedimentary compartments with different qualities was for 30 days to evaluate the migratory behaviour of nematodes as induced by exposure to pyrene. The nematofauna was collected along with sediment from a reference site in Bizerte lagoon. Following one week acclimatization period, the populated sediments were topped with azoic sediments, with a pyrene concentration of 150 μg kg^-1. The concentration of pyrene from sediments was measured on a weekly basis. A stable status of nematode assemblages was reached between the upper and lower compartments in each microcosm, whatever the treatment type. An upward exploratory phase was observed during the first two weeks within the assemblages, possibly induced by the repellent chemodetection of pyrene. This observation was confirmed by the toxicokinetic properties and molecular interactions of pyrene with the germ-line development Protein 3 and sex-determining protein of Caenorhabditis elegans as nematode model.

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.

The exposure to polyvinyl chloride microplastics and chrysene induces multiple changes in the structure and functionality of marine meiobenthic communities

The effects of microplastics and sorbed polycyclic aromatic hydrocarbons at community levels were rarely assessed in laboratory experiments, despite their obvious advantage in reflecting better the natural conditions compared to traditionally single species-focused toxicological experiments. In the current study, the multifaceted effects of polyvinyl chloride and chrysene, acting alone or combined, on general marine meiobenthos, but with a special focus on free-living marine nematode communities were tested in a laboratory experiment carried in microcosms. The meiobenthos was exposed to two polyvinyl chloride (5 and 10 mg.kg^-1 Dry Weight 'DW') and chrysene (37.5 and 75 ng.g^-1 DW) concentrations, respectively, as well as to a mixture of both compounds, for 30 days. The results highlighted a significant decrease in the abundance of all meiobenthic generic groups, including nematodes, directly with increasing dosages of these compounds when added alone. The addition of chrysene adheres to microplastics, making the sediment matrix glueyer, hence inducing greater mortality among generic meiobenthic groups. Moreover, the nematofauna went through a strong restructuring phase following the exposure to both compounds when added alone, leading to the disappearance of sensitive nematodes and their replacement with tolerant taxa. However, the similarity in nematofauna composition between control and polyvinyl chloride and chrysene mixtures suggests that the toxicity of the latter could be attenuated by its physical bonding to the former pollutant. Other changes in the functional traits within the nematode communities were a decline in the fertility of females and an increase of the pharyngeal pumping power following exposure to both pollutants for the dominant species. The latter results were also supported by additional toxicokinetics analyses and in silico modeling.

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.

Molecular interactions of polyvinyl chloride microplastics and beta-blockers (Diltiazem and Bisoprolol) and their effects on marine meiofauna: Combined in vivo and modeling study

The ecotoxicological effects of beta-blockers (i.e. Diltiazem and Bisoprolol) and their interactions with the microplastic polyvinyl chloride on marine meiofauna were tested in laboratory microcosms. An experimental factorial design was applied, using meiobenthic fauna collected from the Old Harbor of Bizerte (NE Tunisia), but with a main focus on the nematode communities. The meiobenthic invertebrates were exposed to two concentrations of Diltiazem and Bisoprolol, of 1.8 µg.L^-1 and 1.8 mg.L^-1, respectively, and one concentration of polyvinyl chloride (i.e. 20 mg.kg^-1), separately and mixed. The overall meiofauna abundance was significantly reduced in all treatments, mainly that of polychaetes and amphipods. Moreover, the juveniles-gravid female ratios of the nematode communities were the lowest in the 1.8 µg.L^-1 Bisoprolol treatment and for the 1.8 mg.L^-1 mixture of Diltiazem and microplastics, suggesting that different dosages influence the maturity status of the examined species. The demographic results were also supported by in silico approach. The simulation of molecular interactions revealed acceptable binding affinities (up to -8.1 kcal/mol) and interactions with key residues in the germ line development protein 3 and sex-determining protein from Coenorhabditis elegans. Overall, the experimental outcome strongly indicates synergistic interactions among the beta-blockers Diltiazem and Bisoprolol and the microplastic polyvinyl chloride on marine nematode communities.

Molecular autopsy and clinical family screening in a case of sudden cardiac death reveals ACTN2 mutation related to hypertrophic/dilated cardiomyopathy and a novel LZTR1 variant associated with Noonan syndrome

Background

Genetic cardiac diseases are the main trigger of sudden cardiac death (SCD) in young adults. Hypertrophic cardiomyopathy (HCM) is the most prevalent cardiomyopathy and accounts for 0.5 to 1% of SCD cases per year.

Methods

Herein, we report a family with a marked history of SCD focusing on one SCD young adult case and one pediatric case with HCM.

Results

For the deceased young adult, postmortem whole‐exome sequencing (WES) revealed a missense variant in the ACTN2 gene: c.355G > A; p.(Ala119Thr) confirming the mixed hypertrophic/dilated cardiomyopathy phenotype detected in the autopsy. For the pediatric case, WES allowed us the identification of a novel frameshift variant in the LZTR1 gene: c.1745delT; p.(Val582Glyfs*10) which confirms a clinical suspicion of HCM related to Noonan syndrome.

Conclusion

The present study adds further evidence on the pathogenicity of ACTN2: p. Ala119Thr variant in SCD and expands the mutational spectrum of the LZTR1 gene related to Noonan syndrome.

Effects of the antidepressant paroxetine on migratory behaviour of meiobenthic nematodes: Computational and open experimental microcosm approach

An open experimental setup was established in order to explore the toxic effects of the antidepressant paroxetine on meiobenthic nematodes. Three types of microcosms made from polyvinyl chloride tubes, each comprising two sediments compartments (upper and lower), were used in a laboratory experiment for 15 days. The experimental setup targeted the migratory behaviour of the nematofauna from the above compartments, which were exposed to paroxetine (0.4 and 40 μg.l^-1), towards below compartments. The univariate indices significantly decrease in the contaminated compartments compared to controls. Multivariate analyses revealed also significant taxonomic dissimilarities between contaminated and uncontaminated compartments. Furthermore, SIMPER functional outcomes highlighted a significant decrease in 2A feeding groups, 'co' tail shape, 1-2 mm interval length, 'cr' amphid shape, and c-p2 life history in contaminated compartments. Computational approach showed that paroxetine bound GLD-3 and SDP with high affinities, which together with molecular interactions and toxicokinetics satisfactorily explain the experimental results.

A cadaveric anatomical study: anatomy and anatomical variations of left adrenal vein

PURPOSE

Control of adrenal vein is the key of adrenal surgery. Its anatomy can present variations. Our aim was to study the anatomy of the main left adrenal vein (LAV) and its anatomical variations.

METHODS

Our work is based on dissection of 40 cadavers. We studied the number of LAV and the drainage of the main adrenal vein as well as its level of termination. We measured its length, its width and the distance between its termination level and the termination level of the gonadal vein (GV).

RESULTS

The average length of the LAV was 21 mm its mean width was 5 mm. It ended in 100% of cases at the upper edge of the left renal vein after an anastomosis with the lower phrenic vein in 36 cases (90%) and without anastomosis with the lower phrenic vein in four cases (10%). The left adrenal vein ended at the upper edge of the left renal vein either at the same level as the termination of the left GV in 14 cases (35%) or within the termination of the left GV in 26 cases (65%) by an average of 8 mm. The LAV was unique central vein in 22 cases (55%) and in 12 cases (30%), a major central adrenal vein with several small veins was found.

CONCLUSIONS

The LAV is usually unique but there are variations in number. There are also variations in the level of its termination in the left renal vein as well as its anastomosis. During surgery, in case of difficulty, the left GV and the adrenal-diaphragmatic venous trunk could be used as benchmarks.

Diuron environmental levels effects on marine nematodes: Assessment of ecological indices, taxonomic diversity, and functional traits

Coastal marine systems are the most sensitive zones to emerging pollutants. The present study aims to investigate the effect of Diuron on the meiofaunal assemblages, collected from the Bizerte channel (Tunisia). Microcosm experiments were set up using four increasing Diuron concentrations [D1 (10 ng g^-1 dry weight (DW)), D2 (50 ng g^-1 DW), D3 (250 ng g^-1 DW) and (1250 ng g^-1 DW)] compared to non-contaminated sediments (controls) and all plots were incubated for 30 days. Our results show that Diuron-supplemented sediments provoked the significant decrease of meiofaunal abundance as well as a change in nematodes' diversity and structure composition. All univariate indices, as well as the cumulative k-dominance, were lower in the Diuron than the control plot. Additionally, the ordination of treatments according to the two-dimensional nMDS plots analysis showed a clear structural separation of the Diuron treated replicates from the controls based on the functional groups lists. These current data emphasize the utility of the use of biological traits in the detection of disturbances in the aquatic biotope.

Sudden death related to the gastrointestinal system in Tunisia: A 13 year autopsy study

Sudden gastrointestinal (GI) death is an unexpected death due to digestive system causes mainly found after autopsy. The literature is rich in articles that studied sudden death due to cardiac causes while sudden GI deaths remain less well-documented. We retrospectively investigated all cases of gastrointestinal death at the Department of Forensic Medicine in Tunis, over 13 years (January 1, 2006 to December 31, 2018). Two hundred and eight cases were collected. The mean age of our series was 51.06 ± 20.99 years. No history of digestive disorders was reported in 78.4%, and no family history of sudden death was found in any cases. A male predominance was found in most epidemiological characteristics of the sample with a significant statistical rate in some features. Non-specific abdominal pain was the most described symptom (n = 92). Perforation of GI tract was the common mechanism involved in the death of 55 cases, of which 44 were related to ulcer perforation. These ulcer perforations were statistically more reported in smokers and people suffering from schizophrenia. Intestinal obstruction was the second commonest cause of death, mainly found in the elderly. Sudden death in children was most frequently caused by acute intussusception. This study highlights that systematic study of sudden death due to GI causes might provide opportunities to identify avenues for overall health improvement.

Child homicide in northern Tunisia: a retrospective study of forensic autopsy cases

Background

As far as we know, no previous research has investigated child homicide in Tunisia. In this context, our study was carried out to analyze the epidemiological and medico-legal characteristics of child homicide occurring in northern Tunisia over a 17-year period.

Results

Eighty-seven cases were collected, with a male-to-female ratio of 2.4. The mean age of the victims was 12.6 years for both sexes. We found that 56.3% of the cases were aged between 15 and 18 years. The majority of deaths under 15 years of age occurred at home as a result of intrafamilial homicide. Victims aged more than 15 years were more likely to be assaulted outside the home by a non-family member.

The most frequent method of homicide was sharp force (39%) affecting mostly the heart and the lung, followed by blunt trauma (25%), which affected mainly the head. Sexual assault was diagnosed at autopsy in six victims (6.9%).

Conclusions

The study offers available data concerning the patterns of child homicide in northern Tunisia and may help to implement preventive measures against this kind of crime.

Meiobenthic nematode Oncholaimus campylocercoides as a model in laboratory studies: selection, culture, and fluorescence microscopy after exposure to phenanthrene and chrysene

Numerous studies have focused on the response of meiofauna after exposure to polycyclic aromatic hydrocarbons (PAHs), but none has been devoted to their uptake into nematode body compartments. The present study monitored PAH uptake by Oncholaimus campylocercoides which was selected after 40 days in the laboratory through original protocols from natural sediments collected in the Old Harbor of Bizerte, Tunisia. To achieve the mono-species level, a grain size magnification was applied by gradually adding a biosubstrate made from either the crushed shells of Mytilus galloprovincialis or minced leaves of Posidonia oceanica. After selection, O. campylocercoides was cultured and fed with earthworm powder (560 mg.l-1). Thereafter, it was exposed for 3 weeks to phenanthrene and chrysene (38, 116, and 348 ppb). Fluorescence microscopy revealed higher intensities of PAHs at the spicules, mouths, and pharynges compared with the other organs considered. Moreover, the buccal fluorescence showed a significant correlation with that measured in the biosubstrate made with shells of M. galloprovincialis.

Using meiobenthic taxa, nematofauna biological traits, and bacterial abundance to assess the effects of the polybrominated diphenyl ethers compound: Case study of tetrabromo diphenyl ether BDE-47

Trophic web structuring in aquatic sediments is dependent on the biological interactions between metazoans and microbial communities. The presence of pollutants in these biotas can therefore impact the meiofauna structure via the modification of the microbial communities. The current study examined in a laboratory bioassay the response of meiobenthic communities, particularly marine nematode taxa from the Bizerte Lagoon to the effect of the most detected polybrominated diphenyl ether in this aquatic environment, BDE-47. Four doses [D1 (2.5 ppb Dry weight (DW)), D2 (25 ppb DW), D3 (50 ppb DW), and D4 (100 ppb DW)] were gradually applied and sediment microcosms were incubated for 30 days in the presence or absence of meiofauna. Our results show that BDE-47-enriched sediments decreased the meiofaunal taxa and bacterial abundance. A lower taxonomic diversity of the nematodes' general structure was observed with all doses used. The numerical analysis of the two dimensional (2D) non-metric multidimensional scaling (nMDS) plots and the evolution of the relative abundances of each functional group of nematode genus assemblages revealed that the abundance of all biological traits was modified. Nevertheless, only three of the functional traits, adult length, feeding group, and amphid shape, showed a clear difference between the control and the treated microcosms. The similarity percentage analysis (SIMPER) revealed that the average dissimilarity between nematode genera communities and biological traits increased with BDE-47-enriched sediments. The nMDS second-stage ordination of inter-matrix rank correlations for matrices including genera and biological traits showed that the amphid shape was the functional trait closest to the generic distribution. Finally, the Principal Component Analysis (PCA) for the nematode biological traits and bacteria indicated a positive correlation of these microbes with the functional groups [1A, Cr, and ef], and a negative correlation only with the "cla"-type tail shape.

Ecotoxicity of polybrominated diphenyl ether (BDE-47) on a meiobenthic community with special emphasis on nematodes: Taxonomic and trophic diversity assessment

The response taxonomic and trophic of meiobenthic organisms, especially marine nematodes to polybrominated diphenyl ether (BDE-47) was studied using a community from Bizerte lagoon (Nord-East Tunisia). Four concentrations of BDE-47 [D1 (2.5 μg/kg dw), D2 (25 μg/kg dw), D3 (50 μg/kg dw), and D4 (100 μg/kg dw)] were applied, and responses were determined 30 days after exposure. Species abundance and all univariate indices were significantly affected in all treated microcosms compared to the control. The non-parametric cluster based on species abundance separated the nematode population into two groups: control + all treated microcosms. After grouping nematode species according to their trophic diversity, their abundance showed differential responses. The non-metric multi-dimensional scaling analysis and cumulative k-dominance based on the abundance of trophic groups abundances reflected significant separation between the control microcosm and each treatment condition. The correspondence analysis 2D plot generated from nematode species and trophic groups abundance showed the control microcosm was dominated by microvores, represented by two species of Terschellingia. However, when treated with the highest concentration of BDE-47, the community was occupied by the resistant trophic groups of facultative predators and epigrowth feeders represented by Metoncholaimus pristiurus and Paracomesoma dubium, respectively.

Do presence of gray shrimp Crangon crangon larvae influence meiobenthic features? Assessment with a focus on traits of nematodes

In this study, a microcosm experiment was conducted for 30 days to assess the impact of the presence of juvenile gray shrimp Crangon crangon on meiofauna. The results suggested that juvenile shrimp had a significant negative impact on the abundance of nematodes and copepods, but no effect on polychaetes. Moreover, nematodes showed a significant decline in individual weight. The collected nematodes were taxonomically identified and assigned to five functional traits: shapes of the tail and amphid, life history, feeding types, and adult length. The nematode traits were affected by the number of shrimp introduced, and descriptors followed normal or inversed bell-shaped curves. When no shrimp were present, the nematofauna had a higher species richness compared with treatments of 4, 8, and 12 shrimp. Bell-shaped curve patterns were common in relation to the two phases of feeding for C. crangon. During the first phase, C. crangon consumed the nematode species Oncholaimus campylocercoides; thereafter, shrimp fed mostly on the nematode Anticoma eberthi and copepods.

Experimental selection of Marylynnia puncticaudata (Cyatholaimidae, Nematoda) and effects of organic enrichment

Meiobenthic nematodes are well-known bioindicators in aquatic ecosystem health programs. However, the explored taxa are still limited and practically devoted to the community level. The present study provided a new method of experimental isolation of a species from a pristine nematofauna. In our method, the nematofauna faced two types of sediment, namely, the leaves of Posidonia oceanica and shells of Mytilus galloprovincialis, under controlled laboratory conditions, and several changes in species composition occurred through gradual selection of the most adaptable nematode taxa to the new environments, which were previously defaunated. We used the selected nematode taxon, Marylynnia puncticaudata (Cyatholaimidae), to examine the possible effects of organic enrichment, and the results clearly showed that the body size of the nematodes significantly increased and they became fat when after enrichment using a powder made of marine agar (1200 mg l^-1) and cuticles of Crangon crangon (900 mg l^-1), but their relative body growth showed no discernible changes.

How to establish a medico-legal obstacle on the Medical Certificate of Death

Indicating a medico-legal obstacle to burial is not always evident for the pratician. In the absence of specific legal references and scientific Tunisian guidelines, we propose in this paper a practical guide to orientate the pratician on when and how to establish a medico-legal obstacle on the Medical Certificate of Death.

Evaluation médico-légale des certificats médicaux initiaux

Le certificat médical initial est un document médico-légal descriptif dont finalité est de prouver l´existence du dommage et de permettre à la victime d´obtenir ce que de droit. L´objectif de notre étude était d'étudier le contenu et d'évaluer la qualité de rédaction des certificats médicaux initiaux. Il s´agissait d´une étude rétrospective et descriptive sur une période de 18 mois allant de janvier 2015 à juin 2016. Nous avons colligé 450 certificats médicaux initiaux parvenus au service de médecine légale du centre hospitalier universitaire de Charles Nicolle à Tunis. La qualité des certificats médicaux initiaux a été évaluée grâce à un canevas qui a permis de leur attribuer une note sur 30. Les certificats médicaux initiaux évalués étaient majoritairement moyens. Les scores obtenus à partir du canevas que nous avons élaboré oscillaient entre 9,5 et 27,5/30 avec une moyenne de 18,59/30. Les médecins généralistes, les médecins ayant une spécialité d´organe comme les ophtalmologistes ou encore les neurochirurgiens et les médecins qui ont utilisé le support du ministère de la santé ont rédigé de meilleurs certificats. De même nous avons noté une qualité de rédaction meilleure lorsqu´il s´agit de coups et blessures volontaires. Notre étude a montré que la majorité des certificats médicaux initiaux ne sont pas conformes aux recommandations de rédaction. Ces insuffisances sont probablement liées au fait que les médecins n´ont jamais bénéficié d´une formation médico-légale adéquate.

Restructuring of a meiobenthic assemblage after sediment contamination with an antibacterial compound: Case study of ciprofloxacin

A microcosm experiment was conducted to evaluate the impacts of the fluoroquinolone antibiotic ciprofloxacin on meiobenthic taxa abundance, nematode genus structure, and functional trait parameters. Sediment samples were experimentally enriched with four different doses of ciprofloxacin [D1 (50 ppm Dry weight 'DW'), D2 (100 ppm DW), D3 (200 ppm DW), and D4 (500 ppm DW)] and were then compared with non-enriched sediments (controls). After one month of exposure, the data showed that ciprofloxacin had altered the meiofaunal taxa abundance. A change in the structure of nematofaunal genera was observed, particularly with the highest dose (D4), which was characterized by the lowest taxonomic diversity. The SIMPER analysis revealed that the average dissimilarity between nematode communities increased with increasing doses of ciprofloxacin. Two dimensional (2D) non-metric multidimensional scaling (nMDS) plots and relative abundances of functional groups of nematode genus assemblages revealed that all functional trait abundances were affected, particularly with the highest dose. However, only the amphid shape and feeding group functions showed a clear distribution separation between the control and ciprofloxacin treatments. The nMDS second-stage ordination of inter-matrix rank correlations for matrices including genus and functional traits showed that the tail shape was the closest functional trait to the generic distribution. Thus, only the curves of cumulative dominance related to the tail shape mirrored discernibly the sedimentary concentrations in ciprofloxacin.

Nematodes trophic groups changing via reducing of bacterial population density after sediment enrichment to ciprofloxacin antibiotic: Case study of Marine Mediterranean community

An experiment was carried out using microcosms to evaluate the impact of the fluoroquinolone antibiotic on nematode trophic groups structure and bacterial abundance. Sediment samples were experimentally enriched with four increasing doses of ciprofloxacin [D1 (50 ppm), D2 (100 ppm), D3 (200 ppm) and D4 (500 ppm)] and compared to non-enriched sediments (used as control). Ciprofloxacin changed the trophic composition of nematodes taxa where the relative abundance of microvores (M), epigrowth feeders (EF) and ciliate consumers (CF), raised in a control microcosm, was highly affected and significantly decreased in response to the increasing doses. Nevertheless, the abundance of deposit feeders (DF), optional predators (FP) and exclusive predators (Pr) showed a significant increase. Results from the multivariate analysis showed a clear impact of this antibiotic on nematode trophic assemblages. Microcosms treated with the three highest doses [D2, D3 and D4] were different from the control. The exceptions were those treated with the lowest dose, D1, and which were grouped with the control. The SIMPER analysis results showed that the average dissimilarity continuously increased in the treated microcosms compared to the control. Furthermore, our results have shown that ciprofloxacin also leads to a significant decrease in bacterial density with the highest dose, which could explain the results obtained for nematode trophic groups distribution. Thus, the bacteriophages nematodes only use bacteria as a nutrition source and the lack or presence in small quantity of this food could induce a decrease in their abundance as well as changing of nematodes groups repartition. Our work demonstrates that the nematode responses were dependent on sediment enrichment with ciprofloxacin and opens new perspectives on the potential impact of antibiotics on functional nematode diversity.

The individual and combined effects of cadmium, polyvinyl chloride (PVC) microplastics and their polyalkylamines modified forms on meiobenthic features in a microcosm

A microcosm experiment was carried out to study the ecotoxicity and interactions between heavy metals and polyvinyl chloride microplastics. Fifteen treatments were tested and results were examined after one month. In details, this work aims to study the ecotoxicological effects of cadmium (10 and 20 mg kg^-1 Dry Weight DW), polyvinyl chloride (PVC) and its modified forms; PVC-DETA (PD) and PVC-TETA (PT) (20 and 40 mg kg^-1 DW), separately and in mixtures, on meiofauna from Bizerte lagoon (NE Tunisia) with focus on nematode features. The results obtained showed that individual treatments were toxic for meiofauna and particularly for free-living nematodes. No clear trends characterized the numerical responses but significant reductions were observed for diversity indices. Moreover, the binary combinations of contaminants have a lesser toxic effect compared to their individual effects. This effect could be related to the high-capacity chelating ability of PVC and its polymers against cadmium.

[Sudden cardiac death in women, data from the northern Tunisian sudden cardiac-death registry]

BACKGROUND

Sudden cardiac death is a major public health problem. Epidemiological and clinical differences according to gender have been described in sudden cardiac death. The aim of this study was to examine the gender differences between autopsy findings and circumstance of occurrence associated with sudden cardiac death.

METHODS

We prospectively collected epidemiological and autopsy data of victims of sudden cardiac death occurring in the northern governorates of Tunisia between January 2013 and December 2019. Symptoms preceding death, circadian, weekly and seasonal variations of sudden death were also analyzed.

RESULTS

The study population included 1834 men and 468 women with a mean age of 56.5±14.2 years. All cardiovascular risk factors except smoking were significantly more frequent among women but ischemic heart disease was the most common cause of death in men (51.3 %, versus 28 %, P<0.001). Women were more likely to have a negative macroscopic autopsy than men (34 % versus 23.6 %, P<0.001). Chest pain preceding sudden death was more frequent in male (24 % versus 13.2 %, P<0.001). In contrast, women were more likely to have dyspnea (8.1 % versus 15.6 %, P<0.001). Sudden death in women occurred indoors more often than in men (63.9 % versus 54.5 %, P<0.001) and also more often during night (midnight to 6 am). We also recorded an excess cardiac mortality in winter in both sexes.

CONCLUSIONS

Women had considerably more cardiovascular risk factors and more commonly negative macroscopic autopsy. Death occurred indoors and during night more often than in men.

A cadaveric anatomical study of the adrenals: Relationship with the posterior abdominal wall muscles revisited

AIM OF THE STUDY

The main difficulties during retroperitoneal laparoscopic adrenalectomies are due to its location. Our objective was to define the relationship of the adrenals with the diaphragm and the psoas muscle.

METHODS

Our work is an anatomical dissection of 80 fresh cadavers' adrenals. To study the right adrenal, we performed a right nephrectomy and adrenal remained attached to the Inferior vena cava by its main vein. On the left, the edges of the adrenal have been identified by needles and the adrenal was reclined to study its projection on the posterior muscular wall.

RESULTS

The right adrenal is located higher, 13mm [4-20mm] above the medial arcuate ligament (MAL) in 16 cases (40%). Its lower border was at the same level as the MAL in 18 cases (45%) and 11mm [10-17mm] below the MAL in 6 cases (15%). The posterior support of the right adrenal was the right crus of the diaphragm (Right-CD) in 34 cases (85%) and straddling the Right-CD and the psoas in 6 cases (15%). The study of the relationships of the left adrenal with the MAL showed that the lower edge of the gland was at its same level in 16 cases (40%) and below in 24 cases (60%) by 14mm [8-24mm]. The posterior support of the left adrenal was the left crus of the diaphragm (Left-CD) in 16 cases (40%) and straddling the Left-CD and the psoas in 24 cases (60%).

CONCLUSIONS

Our results showed that the right adrenal is higher. The MAL is an important posterior element to the adrenal gland that could serve as an anatomical landmark to identify the adrenal during laparoscopic adrenalectomy.

New protocols for the selection and rearing of Metoncholaimus pristiurus and the first evaluation of oxidative stress biomarkers in meiobenthic nematodes

Meiobenthic nematodes have been designated as sensitive global models in the development of biomonitoring and ecotoxicology monitoring programs howbeit the sensitivity of these organisms against oxidative stress biomarkers have never been addressed. The present study aimed to decipher this research axis after selecting and culturing a single nematode species from an entire community through original laboratory protocols. The purpose of this investigation was to change the grain size of the sediment into the immediate environment of nematodes by progressively adding a biosubstrate made from Sepia officinalis endoskeletton. At the end of the experiment, Metoncholaimus pristiurus became the unique component of the nematode species when the sediment was enriched with 80% of S. officinalis powder. After the mono-species level had been achieved, the selected species was fed on an another biosubstrate made from bodies of Porcellio scaber under the identical laboratory controlled conditions of light and temperature adopted during the selection process. Accordingly, the bioassay protocol this study layed new foundations for the study of meiobenthic nematodes in the biomarker field. Our results revealed that, in case of M. pritiurus, discernible oxidative stress responses are valid for catalase and gluthatione S-transferase. Indeed, for both enzymes, a clear increase in the activity was recorded, and the response was more reinforced when zinc and permethrin were administrated in combination. The relevance of the protocols proposed in this work parallels their global applicability to reach and maintain the monospecific level in laboratory by using biosubstrates made from animals widely distributed. It is true also that our data provided the first results in terms of biochemical biomarkers for meiobenthic nematodes and showed that the selected taxa, M. pristiurus, could be one of the first marine taxa responding early to the tested stressors, zinc and permethrin, even at very low concentrations.

Ecotoxic response of nematodes to ivermectin, a potential anti-COVID-19 drug treatment

At the end of March 2020, ivermectin was confirmed as a drug for COVID-19 treatment. A significant amount of ivermectin could deposit into sediments of the semi-closed Mediterranean Sea, where three European COVID-19 epicenters are located: Italy, Spain, and France. Meiobenthic nematodes were exposed to three ivermectin doses (1.8 ng.g^-1, 9 ng.g^-1, and 18 ng.g^-1) for 10 days. Ivermectin caused a great reduction in abundance. However, the diversity indices decreased only at high doses. Ivermectin disadvantaged the 1B-Cr-Id functional type (non-selective deposit feeders and nematodes with circular or indistinct amphids) and benefited the 2A-REL-Sp type (epistrate feeders and nematodes with rounded or elongated loop amphids). Thus, Trophic Diversity and Amphideal Diversity index values increased with sedimentary ivermectin enrichment. Large amphideal foveas were more efficient for 2A-REL-Sp nematodes to avoid ivermectin. The responses of the functional type 2A-REL-Sp and corresponding taxa predict post-COVID-19 environmental concerns and the bioaccumulation of ivermectin in seafoods.

Laboratory bioassay exploring the effects of anti-aging skincare products on free-living marine nematodes: a case study of collagen

Organic enrichment due to human impact is one of the major threats that affect benthic communities in semi-enclosed marine ecosystems, such as the Mediterranean Sea. However, many emerging sources of organic pollutants, such as those released to nature through human practices related to esthetics and cosmetics, remain underestimated, despite being an increasingly important source of organic matter input following a decade of expansion by the cosmetic industry. Therefore, an experiment was designed to explore the influence of collagen, the main component of commercialized skin anti-aging products, on a Mediterranean community of free-living marine nematodes from a beach in Rimel, northeast Tunisia. The effects of exposure for 30 days to a control treatment and three test treatments, corresponding to three levels of sedimentary enrichment with collagen (3, 6, and 12 ppm dry weight (DW)), were examined using a microcosm approach. Reductions in abundance and diversity were noted with an increase in collagen enrichment, together with a slight increase in individual weight. The presence of three species characteristic of control microcosms, Ptycholaimellus ponticus, Theristus modicus, and Kraspedonema reflectans, was clearly affected at the lowest dose; these were therefore classified as "collagen-sensitive." In contrast, the numbers of "collagen-tolerant" species, including Sigmophoranema rufum, Lauratonema hospitum, Enoploides spiculohamatus, and Trichotheristus mirabilis, increased significantly in the treated microcosms.

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.

Peptides derived from the dependence receptor ALK are proapoptotic for ALK-positive tumors

ALK is a receptor tyrosine kinase with an oncogenic role in various types of human malignancies. Despite constitutive activation of the kinase through gene alterations, such as chromosomal translocation, gene amplification or mutation, treatments with kinase inhibitors invariably lead to the development of resistance. Aiming to develop new tools for ALK targeting, we took advantage of our previous demonstration identifying ALK as a dependence receptor, implying that in the absence of ligand the kinase-inactive ALK triggers or enhances apoptosis. Here, we synthesized peptides mimicking the proapoptotic domain of ALK and investigated their biological effects on tumor cells. We found that an ALK-derived peptide of 36 amino acids (P36) was cytotoxic for ALK-positive anaplastic large-cell lymphoma and neuroblastoma cell lines. In contrast, ALK-negative tumor cells and normal peripheral blood mononuclear cells were insensitive to P36. The cytotoxic effect was due to caspase-dependent apoptosis and required N-myristoylation of the peptide. Two P36-derived shorter peptides as well as a cyclic peptide also induced apoptosis. Surface plasmon resonance and mass spectrometry analysis of P36-interacting proteins from two responsive cell lines, Cost lymphoma and SH-SY5Y neuroblastoma, uncovered partners that could involve p53-dependent signaling and pre-mRNA splicing. Furthermore, siRNA-mediated knockdown of p53 rescued these cells from P36-induced apoptosis. Finally, we observed that a treatment combining P36 with the ALK-specific inhibitor crizotinib resulted in additive cytotoxicity. Therefore, ALK-derived peptides could represent a novel targeted therapy for ALK-positive tumors.

Anatomical variations of renal venous vascularisation. A study of 71 three-dimensional kidney endocasts

BACKGROUND

A better understanding of the anatomy of the renal vein and its relationship with the arterial and excretory systems can prevent intra operative complications.

METHODS

Three-dimensional endocasts of intrarenal vessels and renal collecting systems were obtained from fresh cadavers, by injecting a polyester resin coloured with different pigments. A total of 71 endocasts were studied: 37 right kidneys and 34 left kidneys.

RESULTS

Renal vein was unique in 88% of cases and double in 11% of cases. It was formed in 52% of cases by 3 trunks. Intrarenal veins anastomosed together to form 2 levels of arcades in 28% of cases and 3 levels in 71% of cases. The venous drainage of the upper pole was provided by two anterior and posterior plexus in 38% of cases, and by a single anterior plexus in 61% of cases. In 22% of cases, the venous drainage of the lower pole was provided by both an anterior and a posterior plexus, and in 77% of cases, there was only an anterior plexus. Renal artery was posterior to the vein in 66% of cases. It was anterior to the vein in 29% of cases, and located directly above it in 4% of cases. In 60% of cases, we noted a close relationship between the anterior surface of the ureteropelvic junction and the lower branch of the renal vein.

CONCLUSION

Venous vascularisation of the kidney appears to be variable and its relationship with the arterial and the excretory systems may be complex.

[Relation entre la température ambiante, l'humidité et la mort subite cardiaque au nord de la Tunisie]

BACKGROUND

Several studies have suggested a relationship between weather parameters and the occurrence of sudden cardiac death.

AIM

The aim of this work was to study the impact of changes in temperature and humidity level on the occurrence of sudden cardiac death in the north of Tunisia.

METHODS

it's an autopsic study that included all victims of sudden cardiac death occurring in northern Tunisia between October 2010 and September 2012. The minimum, maximum and average of daily temperatures and humidity during the study period were recorded and compared with the monthly variation in the occurrence of sudden death.

RESULTS

The study population included 392 men and 108 women with a mean age of 52.2 + / - 15.8 years.The highest rate of sudden death (37%) was observed at ambient temperatures below 15 degrees and only 4.2% of deaths occurred at temperatures above 30 degrees ambient temperatures (p <0.001). Among the population aged over 60 years, the highest mortality rate (47.3%) were recorded at temperatures below 15 degrees, while 35.5% of young patients under 40 years died during periods with temperatures between 20 and 30 degrees and 56.8% of deaths occurred in the humidity levels between 60 and 78% .

CONCLUSION

In the north of Tunisia where the climate is temperate, a temperature drop below 15 degrees was significantly associated with a sudden cardiac death. This excess winter cardiac mortality was more pronounced in the elderly.

Sudden death due to pulmonary embolism in north Tunisia: 37 cases study

AIM

To determine frequency of pulmonary embolism as the cause of sudden death and to study clinical, epidemiological characteristics and risk factors.

METHODS

Prospective study of cases of sudden death secondary to pulmonary embolism, whose autopsy was performed in the forensic department of Tunis, between October 2009 and of September, 2011.

RESULTS

During study period, 37 cases of pulmonary embolism were recorded. They represented 6.8 % of all cases of sudden cardiovascular deaths. Victims were male in most cases (65 %). Victims were aged between 21 and 87 years with an average age of about 52 years. Pathological histories were noted in 9 cases: three cases of recent surgery, four cases of pelvic trauma, a case of ovarian tumor and a case of which the PE arose in post-partum. Concerning other risk factors of pulmonary embolism, confinement to bed was noted in 24 cases (64.8 %), obesity in 12 cases (32.4 %), an arterial high blood pressure in 4 cases. Histories of psychiatric pathology were noted in 5 cases (13.5 %). Symptomatology preceding death was dominated by sudden death (35 %) followed by dyspnoea (30 %) and thoracic pains (16 %). In 8 cases , victims consulted emergencies within 48 hours preceding death, for a varied symptomatology without diagnosis of pulmonary embolism is suspected. At autopsy, in 30 cases embolism was massive. In 29 % of the cases, a deep venous thrombosis was revealing in particular at the primitive iliac veins.

CONCLUSION

Pulmonary embolism is an affection that still kills a lot. It can benefit from prevention and from an effective treatment. This testifies the major importance of clinical diagnosis of pulmonary embolism as well as the technical means for the diagnosis.