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.

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.

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.

Contribution of dual-energy computed tomography in the differentiation of illicit drugs.

INTRODUCTION: The objective of this study was to compare the dual-energy behaviour of the main illicit substances as well as their cutting agents in order to be able to differentiate them. MATERIAL AND METHODS: Cocaine, heroin, MDMA, and cannabis as well as 3 adulterants, 2 diluents, and water were scanned at 90 kV and then at 140 kV on a single X-ray tube computed tomography (CT) scanner. The data acquired enabled a mapping of the attenuation values to 90 and 140 kVp as well as a resulting dual-energy index (DEI) mapping. RESULTS: Drugs, cocaine, MDMA (pill), and cannabis had a positive DEI (0.014-0.008), while heroin and MDMA (powder) had a negative DEI (-0.016 and -0.013). The DEI of water was -0.01 and that of taurine was -0.018. Adulterants had negative DEI, while diluents had a positive DEI. All DEI were significantly different (p < 0.01). CONCLUSIONS: Cocaine and heroin can be clearly differentiated using DEI.

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.