Fatal donkey bite in children: a case report.

Although animal-inflicted injuries are a worldwide major public health problem, lethal donkey bites have very rarely been reported. We describe the case of a 21-month-old girl that was found dead in a farmyard next to a donkey that belonged to the family. Examination of the body showed bite marks on the right side of the neck and the upper part of the shoulder. Death was attributed to cervical trauma and spine injuries from a donkey attack.

Critical study of the initial medical certificates of occupational accident declaration.

The drafting of the initial medical certificate (IMC) is an innocuous act that can engage the responsibility of the certifier. AIM: To evaluate the quality of the IMC and their compliance with the legal provisions and to develop good practice recommendations for the drafting of the occupational accident certificate. METHOD: An epidemiological, descriptive and retrospective study was conducted in the University Hospital Center Farhat Hached (Tunisia) based on the occupational accident certificates completed by physicians during a period of 12 months. RESULTS: In our study, 241 certificates were collected. The number of the patient's ID card was mentioned in 12% of cases. The date of the accident was noted in almost all cases (99.6%). The date of certification was indicated in all the cases. The average number of days of permanent work incapacity was significantly higher among male patients (p = 0.015), married patients (p≤10⁻³), and night workers (p = 0.05) and significantly lower among doctors (p ≤ 10⁻³). CONCLUSION: Our study showed that the quality of the initial medical certificate drafting suffered from several inadequacies. This may be related to the lack of training of doctors in forensic practice, hence the importance of reminding the rules of good practice.

An Unusual Cervical Injury Caused by Accidental Electrical Burns.

High-voltage electrocution is mostly unintentional, and it is associated with significant morbidity and mortality due to severe tissue damages. The present report describes an atypical electrocution with multiple victims and a fatal outcome of a 48-year-old man due to unusual neck injuries caused by accidental electrical burns.

Patient information in radiology: medico-legal considerations.

Information constitutes a basic right of the patient and a legal obligation of the physicians. Radiological daily practice has evolved mainly by introducing the care rule of radiologists. This active rule is leading to add new medico-legal challenges. Patient Information is considered as a cornerstone of the valid consent to radiological investigations. A lack of information constitutes a fault against medical humanism being able to engage civil or administrative medical liability. Therefore, radiologists must be aware and familiar with their obligations towards patients, including the requirement to provide adequate information.

Sudden unexpected death due to Fournier gangrene.

Fournier gangrene is a rare fulminant necrotizing infection of the skin and soft tissue of the perineum that may result in rapid death. We describe the autopsy case of a 70-year-old female with uncontrolled diabetes mellitus who was found unexpectedly dead in her house where she lived with her dog. Examination of the body revelaed a deep necrotic ulceration of the perineum with exposure of the underlying deep muscles that was initially misinterpreted by police officers as post mortem animal predation. Medicolegal examination and histological and microbiological analyses eliminated this hypothesis and the diagnosis of septic multiorgan failure due to necrotizing fasciitis was retained as a cause of death.

[Nosocomial infections in the Intensive Care Unit: annual incidence rate and clinical aspects]. / Les infections nosocomiales en milieu de réanimation: incidence annuelle et aspects cliniques au Service de Réanimation Polyvalente, Kairouan, Tunisie, 2014.

Although the number of ICU beds is generally limited, the incidence rates of nosocomial infections is high. Managing infectious risk in ICU is a priority today; one of the strategic aims is the establishment of systems for epidemiological control. The aim of our study is to determine the incidence and the clinical aspects in order to identify the risk factors. We conducted a longitudinal descriptive impact assessment study enrolling patients hospedalized for more than 48 hours in general purpose Intensive Care Unit at the Ibn El JAZZAR Hospital, Kairouan over a period of 1 year, from 01/03/2013 to 28/02/2014. The study focused on 265 patients whose average age was 39±20 years (18-93 years) with a sex ratio(M/F) of 2.48. We identified 125 episodes of nosocomial infections in 81 patients corresponding to a total incidence of 30.6%. The incidence density rate was 55 infections per 1000 days of hospitalization. There was a clear predominance of pneumopathies, with an incidence of 27.73%, followed by urinary tract infections (9,73%), infections associated with central venous catheter (6.25%) and surgical site infections (2.34%). Mortality rate of patients was 28.7%, with a significant difference between infected patients (44.7% of cases) and non-infected patients (29.07%) (p < 10-3). Gram-negative bacteria were found in 80% of cases. Prevention must involve a global and multidisciplinary action.

A case of sudden death due to spontaneous right subclavian artery dissection.

Acute subclavian artery dissection (SAD) is a rare entity which is usually associated with several vascular abnormalities and traumatic events. Spontaneous SAD remains exceptional and often affects the left artery. We report the autopsy case of a 29-year-old female who died suddenly following a spontaneous dissection of the right subclavian artery.

Suicide in children and adolescents: a Tunisian perspective from 2009 to 2015.

This study presents the characteristics of child and adolescent suicides which occurred in Kairouan, Tunisia. Data were collected from autopsy records of the Forensic Department of the University Hospital Ibn El Jazzar of Kairouan. General characteristics of suicides among children and adolescents (under the age of 18) between 2009 and 2015 were retrospectively reviewed. A total of 49 cases, with a female predominance (61.2%) and a mean age of 15.4 ± 2.1, were registered. Most of the victims were from rural areas (93.1%). In most cases, suicide occurred in the victim's home or the surrounding area (73.4%). The identified precipitating factors were family problems in 55.1%, and school issues in 12.2%. The most common suicide method was hanging (69.38%) for both genders, followed by self-immolation for males and poisoning for females, the majority using pesticides. This study offers useful information to understand the risk factors in Tunisian child and adolescent suicides and provides a basis for the development of urgently needed preventive strategies.

[Organ and tissue harvesting in children: comparison of the legal framework in Tunisia and France]. / Le prélèvement d'organes et de tissus chez l'enfant : comparaison du cadre juridique en Tunisie et en France.

In Tunisia as in France, the legislator recognized the organ harvesting as of public health priority. To promote it, cells of coordination are created, and controlled by regulatory texts. There are differences in the strategy of organ harvesting in minor but whether he is alive or dead, he is well protected by law. Organ harvesting in alive child is prohibited in both Tunisia and France but the haematopoietic cells one is authorized. In the minor deceased organ harvesting obeys common principles, appearing in the bioethical law (France) and the law n°91-22 of March 25, 1991 (Tunisia) with a difference in the procedure of the assent of the legal guardian.