A case of suspected primary mediastinal large B-cell lymphoma: An uncommon cause of sudden death.

Primary mediastinal large B-cell lymphoma (PMLBCL) is an aggressive tumor originating from thymic B-cells. Clinically, it presents with general signs such as cough, chest pain and dyspnea. Although these symptoms are not specific, they are severe enough to reveal the disease. We report an autopsy case of a 25-year-old man, with a recent past history of cough and dyspnea, for which he consulted twice the emergency department and no diagnosis was made. He presented to the Emergency Unit, with a sudden onset of a dyspnea followed by a loss of consciousness. He was shortly declared dead after, a medico-legal autopsy was requested. On external examination, no traumatic lesions on the body were found, an important cyanosis of the face and ears, was, however, found. On autopsy, a mediastinal mass was found, measuring 19 cm × 25 cm and weighing 600 g, extending to the infra-hyoid region and to the thoracic cage and infiltrating the pericardium. Trachea had a necrotic mucosa with a partially obstructive lymph node mass. The diagnosis of a primary mediastinal large B-cell lymphoma was suspected based on pathological and immunohistochemical findings. The cause of death was finally attributed to respiratory failure due to this tumor.

Sudden death due to Takayasu arteritis complication associated with situs inversus totalis: A case discovered at autopsy.

Takayasu arteritis is a rare pathology that usually has general and atypical signs that make its diagnosis difficult. These characteristics can delay diagnosis, thus leading to complications and death. We, herein, report an autopsy case of a 25-year-old female patient with a history of multiple consultations for dyspnea. During these consultations, no diagnosis was made. She was found unconscious near her home and shortly after, she was declared dead. Forensic autopsy revealed superficial traumatic lesions. Internal examination revealed complete situs inversus. Multiple bilateral pleural adhesions and bilateral moderate effusion were found. The heart was heavy with thickening of the aortic wall (1.1cm), carotid arteries, and pulmonary trunk, associated with a large aortic valve and evidence of leakage. Histological examination of the aorta and its major branches showed features of panarteritis with segmental involvement. The vascular wall was thick with lymphoplasmacytic infiltrate and giant cells involving mainly the medio-adventitial junction. Disruption of the elastic lamina and reactive fibrosis in the intima were also noted. Diagnosis of large vessel vasculitis and particularly Takayasu arteritis was made. Death was therefore attributed to heart failure due to aortic insufficiency as a complication of Takayasu arteritis.

Cardiac rupture during acute myocardial infarction : Autopsy study (2004-2020).

INTRODUCTION: Cardiac rupture is a rare but critical complication of myocardial infarction with an incidence of 1 to 3% of cases. We aimed in this autopsy study to analyze the anatomical, epidemiological, cardiac, and coronary profiles of cardiac rupture in the Monastir region. METHODS: We conducted a descriptive study with retrospective data collection of all cases of myocardial infarction complicated by a cardiac rupture over seventeen years (2004-2020). RESULTS: Thirty-one cases were included in this study. The mean age of the cases was 67 years with a male predominance. Sixteen cases (57%) had cardiovascular risk factors. The most common symptomatology reported before death was acute chest pain in 57% of cases. Fourteen cases (45%) corresponded to the definition of sudden cardiac death. At autopsy, the heart had a mean weight of 452.78 grams. A large hemopericardium was associated in 90% of cases. Myocardial rupture involved the posterior wall of the left ventricle in 50% of cases. The myocardial rupture occurred at a site of acute myocardial infarction in 86% of cases and on a myocardial scar in 14% of cases. The coronary study showed double or triple vessel atherosclerotic coronary artery disease in 57% of cases with fresh thrombi at the infarct-related coronary in 11% of cases. CONCLUSIONS: Our analysis found that cardiac rupture mostly involved elderly subjects with underlying cardiovascular risk factors. Our findings sustain that age is a determining prognostic factor after acute coronary syndrome with the need for further education and awareness-raising efforts to speed up access to care for these patients.

Preservation of poultry meat using Tetraclinis articulata essential oil during refrigerated storage.

Current study aims to evaluate the effect of essential oil on the conservation of chicken fillets. Following a screening, Tetraclinis articulata was selected for its antimicrobial (Enterococcus feacalis ATCC 29212, MIC < 0.031 mg/mL) and antioxidant (IC50 = 1000 µg/mL) potentials with no cytotoxicity effect towards murine macrophage cells. The treatment of chicken fillets, especially with 200 ppm of T. articulata essential oil per 100 g of product reduced significantly (p < 0.05) lipid oxidation during 12 days of refrigerated storage. Microbial flora charges decreased significantly (p < 0.05) with a rate of 50.31% for 200 ppm of essential oil from the 6th day of storage. The acidity of treated fillets was lower than control samples (1.3 g/kg) from the 3rd day of storage. In addition, a clear effect was recorded by reducing water losses during cooking under the tested doses of essential oil. Withall, findings encouraged the use of T. articulata to extend poultry meat product shelf life.

A missed psoas abscess diagnosis: A forensic case report.

Psoas abscess is a rare pathology that usually presents with non-specific signs and rare clinical features. These characteristics can delay the diagnosis leading to complications and death. We report a forensic autopsy case of a 65-year-old male, alcoholic, smoker, with a history of hypertension, and urinary infection, who presented to the emergency room for anorexia and consciousness disorder. On physical examination, the patient was febrile and confused. Laboratory exams revealed leukocytosis and elevated C-reactive protein (CRP). Two days later, he died despite extensive resuscitation. Forensic autopsy revealed a large amount of green pus in the left psoas muscle extending to the muscles of the thigh of the same side with multiple cavities. The pus extended to the left kidney with destructive parenchyma and coralliform lithiasis. Histological examination showed destroyed renal tissue by lesions of chronic and acute pyelonephritis with dilatation of the pyelocaliceal cavities. Bacteriological analysis of the pus showed the presence of Escherichia coli. The psoas abscess was secondary to pyonephrosis favored by the immunodeficiency. Thus, death was attributed to a septic shock secondary to a psoas abscess complicating pyonephrosis.

Hydatid Disease, an Uncommon Etiology of Death in Forensic Practice.

ABSTRACT: In Tunisia, hydatid cyst is an endemic parasitic disease. The cyst may remain asymptomatic, discovered accidentally, or in case of a complication, the most serious of which is sudden death. We propose, in this article, to analyze the degree of involvement of the cyst in the mechanism of death, through the review of 25 cases. A total of 7932 autopsy cases were performed during the study period. Twenty-five cases of hydatid cyst discovered at autopsy were collected and death was attributed to hydatid cyst in 13 cases. The seat of the cyst was variable and death was due to anaphylaxis in 10 cases, to hydatious embolism in 2 cases and to cardiac arrhythmia, resulting from a cardiac localization of a large hydatid cyst, in 1 case.Although rare, echinococcosis can be a life-threatening disease. Its involvement in the death mechanism remains difficult in many cases.

Chemometric Profiling and Bioactivity of Verbena (Aloysia citrodora) Methanolic Extract from Four Localities in Tunisia.

This research aimed to study the chemical composition of Aloysia citrodora methanolic extract and its biological activities as an antioxidant, and its antibacterial, antifungal and anti-inflammatory activities based on four bioclimatic collection stages. The contents of total phenols, total flavonoids and total tannins were determined. Nine phenolic compounds were identified by LC-DAD-ESI-MS/MS. The major compound was acteoside, a phenylpropanoid which represented about 80% of the methanolic fraction in the various regions. The antioxidant activities of different locations were measured by different analytical assays, such as DPPH, ABTS and iron reducing power. The results showed that phenolic compounds and antioxidant activities varied with climatic and environmental factors. Moreover, there was a significant dependency between regions and biological activities. The use of a principal component analysis showed that there was a close relationship among phenylpropanoids, phenolic compounds and the studied biological activities.

Colorectal barotrauma following compressed air spray to the perineum.

Colorectal injuries caused by high-pressure air compressors are rare and reported especially among industrial workers. They may appear because of intended or accidental injury. In the present paper, we report a case of colorectal injuries due to air insufflation from a distance towards the anus with the clothes on, as a means of a practical joke. The patient presented one day after the trauma to the Emergency Department with complaints of severe abdominal pain and vomiting. On examination, he had signs of peritonitis. A computed tomography (CT) scan did not show any perforation. Emergency laparotomy was performed with the suspicion of pneumatic pressure-induced lesions. A total resection of the colon was made with enterostomy. The pathologic examination of the resected piece revealed multiple gangrenous areas without perforation associated to signs of peritonitis. Follow up was uneventful. A reversal of the enterostomy was scheduled.

Sudden death in the young adult: a Tunisian autopsy-based series.

BACKGROUND: We aim to study the profile, and pathological characteristics of sudden death in young in purpose of recommendations for prevention. METHODS: We performed a retrospective cohort study using autopsy data from the Department of Forensic Medicine of Monastir (Tunisia). A review of all autopsies performed for 28 years was done (August 1990 to December 2018). In each case, clinical information, and circumstances of death were obtained. A complete forensic autopsy and histological, and toxicological investigations were performed. We have included all sudden death in persons aged between 18 and 35 years. RESULTS: We collected 137 cases of sudden death during the studied period. The mean age of the studied population was 26.47 years. Almost 72% deaths were classified as cardiac death, and was due to ischemic heart disease in 32.32%. Sudden death was attributed to a pleuropulmonary cause in 7.4%, an abdominal cause in 6%, and from a neurological origin in 4.5%. The cause of sudden death in this group was not established by 9.5%. CONCLUSION: In this series, sudden death in young adults occurs mainly in a smoking male, aged between 18 and 24 years old, occurring at rest, in the morning, and early in the week. It is more common, especially in summer. Sudden death is most often the first manifestation of pathologies, especially unsuspected heart diseases. The predominance of cardiovascular causes is the common denominator of almost all studies reported in the literature. Our findings suggest that prevention of sudden death among young adults under the age of 35 years should also focus on evaluation for causes not associated with structural heart disease.

Tracheal agenesis clinical presentation in a preterm infant: Prenatal MRI difficulties and autopsy findings.

We describe, the clinical presentation of a rare case of Tracheal Agenesis in a preterm infant and we highlight magnetic imaging resonance (MRI) and autopsy findings to better characterize this anomaly. A 30-year-old female presented for acute polyhydramnios at 30 weeks gestation of a male foetus. Prenatal MRI was performed and excluded this diagnosis. After delivery, the neonate presented a respiratory distress. The laryngoscopy control of tube position concluded to an esophageal intubation. A second reading of antenatal MRI was made. An autopsy was performed. The internal examination of the organs revealed broncho-oesophageal fistula. The upper airways were obstructed at the larynx. Fetal MRI should be interpreted with caution when Tracheal Agenesis is highly suspected.

Natural colourants analysis and biological activities. Association to molecular markers to explore the biodiversity of Opuntia species.

INTRODUCTION: Synthetic colourants are subject to various allergies. As a result, the use of plant-based additives has proved promising. OBJECTIVE: It is in this perspective that our objective was undertaken to investigate natural colourants from edible cactus. Opuntia species populations were single-sequence repeat (SSR) fingerprinted, the analysis of betalains and phenolic compounds and the evaluation of their biological potentials were also characterised. RESULTS: Photometric quantification of betalains and phenols showed an interspecific variation across Opuntia species. Opuntia ficus indica fruits showed the highest betalain [betaxanthins; 843.67 and betacyanins; 1400 mg/100 g dry weight (DW)] and polyphenol contents. Reversed-phase high-performance liquid chromatography (RP-HPLC) analysis showed that the variation of individual phenols profile was influenced by interspecific and genetic factors. Isorhamnetin-O-(di-deoxyhexosyl-hexoside) was the major compound and its content varied according to Opuntia species, while catechol was the predominant phenolic compound in O. humifusa with 1.88 µg/g DW. Concerning cactus species, Opuntia colourants exhibited a potent antiradical activity [half maximal inhibitory concentration (IC50 ) up to 1 µg/mL]. Opuntia species were effective against Gram-positive and Gram-negative bacterial strains [inhibition zone (IZ) up to 27 mm]. A high genetic diversity within Opuntia genotypes based on SSR markers was revealed. UPGMA (unweighted pair group method with arithmetic mean) dendrogram and PCoA (principal coordinate analysis) based on natural pigments and antimicrobial profiles indicated significant variation. The correlation approach proved the presence of a probably metabolic relationship between genetic markers, pigments and their biological activities. CONCLUSION: A possible association between molecular approach and metabolic profile analysis of Opuntia allows tracing the relationship among species for its genetic conservation.

Sudden death due to left ventricular thrombosis: A report of two autopsy cases.

PURPOSE: In this paper, we report two rare cases of sudden death due to giant left ventricular thrombus revealed at autopsy and we discuss the manner and the cause of death. RESULTS: Cases presentation: The two cases reported are about two men aged 55 and 53 years respectively. In the two cases, no past cardiac history was found. Prior to the onset of complications and subsequent death, both patients presented to the emergency department with progressing asthenia, faintness and shortness of breath, were treated symptomatically. At autopsy, atherosclerosis of coronary arteries was found. In the first case, death was attributed to thrombosis of the pseudoaneurysm. In the second case, it was due to thrombosis complicating a myocardial infarction. The mechanism of death in the first case was explained by the hemodynamic shock caused by a total left ventricular pseudoaneurysm thrombosis secondary to old myocardial infraction. In the second case, death was the consequence of a cardiogenic shock secondary to thrombosis of the cardiac pseudoaneurysm complicating a myocardial infraction. CONCLUSION: Complications of myocardial infarction represent frequent causes of adult sudden death. Left ventricular thrombosis is a complication that is often fatal and its discovery during an autopsy remains rare. The first-line doctor must take these types of complications into consideration in order to detect them and thus ensure timely management.

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.

Age estimation at death by the study of chest plate radiographs: establishing a Tunisian male score.

We aim to establish a Tunisian score for age estimation through the study of chest plate's radiographs of a Tunisian male sample. We have focused on the study of 128 chest plate radiographs of Tunisian male individuals. We have established a score of eight criteria. The total score ranges from 8 to 32. Three observers scored double-blind the X-ray films. We studied the correlation of each criterion as well as the total score with chronological age for each observer. We also tested the reproducibility and the repeatability of criteria and total score. We calculated the estimated age for each score. We studied the relationship between the estimated age and the chronological age. The correlation between the total score and the chronological age has been good for the three observers (0.746, 0.756 and 0.742). The total score gives an estimation of age with a standard deviation of ± 5.88 years and a confidence interval of 95%, the interval's width increases gradually from 6.9 years to 23 years.

Sudden death and hydatid cyst: A medicolegal study.

The discovery of a hydatid cyst at autopsy poses the problem of its involvement in the mechanism of death. The aim of this study is to analyse the epidemiological and etiopathogenic characteristics of death attributed to hydatid disease, to discuss the mechanism of death and to propose preventive measures. This is a retrospective descriptive study of 26 cases of death with hydatid cyst autopsic discovered, collected at the forensic department of Fattouma Bourguiba University Hospital of Monastir (Tunisia) over a period of 27 years (from 1990 until 2017). In 26 cases, hydatid cyst was observed during autopsy of sudden death cases, which corresponds to 0.33% of the total of autopsies in this period. Of the 26 victims, 13 (50%) were men; the mean age was 43 years. Most victims were from rural zones (18 cases). In 20 cases, the complicated cyst was hepatic. It was cardiac in two cases. Of all cases, three cysts were cracked, and nine were broken. Of the 26 cases, only 15 were implicated in the death mechanism. Death was attributed to anaphylaxis in 12 cases, hydatid pulmonary embolism in 1 case, cardiac arythmia in one case and hemothorax in one case. Sudden death is the most dangerous complication of the hydatid cyst which can be discovered at autopsy. Several causes may explain its occurrence, the most common of which is anaphylactic shock.

Applicability of Willems methods and Demirjian's four teeth method for dental age estimation: Cross sectional study on Tunisian sub-adults.

This study aims to evaluate and compare the applicability of three dental methods for age estimation, including Demirjian's four teeth, Willems I, and Willems II methods in a sample of Tunisian children. Panoramic radiographs of 500 children (241 females, 259 males) aged between 5 and 15 years were examined. The mean absolute error (MAE) was performed to assess the accuracy of age estimation. Independent samples t-test was employed to compare the differences, the chronological age minus dental age (CA-DA), between sexes for the three methods. All of the three methods underestimated the chronological age on the average, and almost for all age groups. The discrepancy between the chronological age and the estimated age was most frequently observed for ages above 8 years for all methods. In our study, the Demirjian's four teeth method underestimated the chronological age by 0.45 years for males and 0.32 years for females, with no significant difference (p=0.124). Whereas the Willems I method is indicted for underestimating the chronological age by 0.40 years for males, and by 0.69 years for females. Willems II method underestimated age by 0.91, and 0.64 years for males and females, respectively. It is established that the Demirjian's four teeth method was more accurate in estimating the dental age than the Willems I and II methods, with a mean absolute error of 0.76 years for males and 0.79 years for females (MAE=1.10, and 0.98 years for the Willems I/1.02, and 0.92 years for the Willems II). According to the results, it is highly recommended that the Demirjian's four teeth method should be applied when estimating the dental age in Tunisian males and females. In forensic cases, when the sex is unknown or doubted, the Willems II method could be appropriate.

Cervical Injuries in Drowning Cases: A Case Report and a Review of Literature.

Discovery of bruises in the muscles of the neck and a fracture of the hyoid bone in a body recovered from water makes the diagnosis and the determination of the manner of death difficult.The aims of this work are to report a case of a drowned body with cervical injuries and to highlight the importance of interpreting these findings accurately.A 39-year-old woman was found dead face down in a 6-m deep well with a 3-m water level. She was mentally disturbed and had a history of suicide attempts. In fact, she had previously attempted to jump into that well in an attempt to put an end to her life. The autopsy revealed bruises in the muscles of the neck and a bruise associated with a fracture of the left horn of the hyoid bone.The mechanism for the origin of drowning-related neck injuries will be discussed.

Phenological stage effect on phenolic composition and repellent potential of Mentha pulegium against Tribolium castaneum and Lasioderma serricorne

Objective: To elucidate for the first time the phenological stage effect on polyphenol,flavonoid and proanthocyanidin contents of pennyroyal (Mentha pulegium) as well as their antioxidant capacities and insecticidal potentials against Tribolium castaneum and Lasioderma serricorne. Methods: Crude methanol extracts from pennyroyal (Mentha pulegium) aerial parts were evaluated for their antiradical, reducing power activities and repellent potentials against selected coleopteran insects during different phenological stages. Results: Phenolic contents of pennyroyal aerial parts and their antioxidant effects were significantly dependent on maturity stage of the plant. The maximum of phenol production was reached during the full flowering stage. Apigenin was the major phenol in Mentha pulegium with an amount of 6.01 mg/g of dry vegetable matter during this period. Nevertheless, at fructification stage,the highest antioxidant activity was not related to high phenolic content. The repulsive effect of pennyroyal extract showed that Lasioderma serricorne was more susceptible to pennyroyal extract than Tribolium castaneum with corresponding median repellent dose values of 0.124and 0.006 mg/mL respectively. Moreover, great differences in insect repulsion depending on extract concentrations, exposure time and developmental stage was observed. For the lowest concentration (0.125 mg/mL), the repellent effect against Tribolium reached its maximum (90％)during the fructification stage (after 24 h of exposure) while this repellent effect was 80％during the vegetative stage. Conclusions: Due to the strong insecticidal potential of pennyroyal extracts, this study highlights the therapeutic properties of this plant and encourages its use as a safer, environmental-friendly and efficient insecticide in food industry.

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.