[Medico-legal issues of the practice of ritual circumcision by nurses in Tunisia]. / Enjeux médico-légaux de la pratique de la circoncision rituelle par les infirmiers en Tunisie.

Circumcision is the most performed surgical procedure in the world. This removal of the foreskin answers most often to an obligatory ritual practice in the Jewish and Muslim religions. In Tunisia, this act, formerly practiced by customary circumcisers, is mainly performed by nurses. In case of complications, the responsibility of the latter remains unclear, in the absence of regulations specific to this ancestral practice, with the exception of two ministerial circulars.

The Causality Nexus Between the Tako-tsubo Syndrome and an Assault: A Forensic Case Report.

"Tako-tsubo" cardiomyopathy, also known as "broken heart syndrome," is one of the rarest types of stress-induced cardiomyopathy. It frequently mimics acute coronary syndrome, characterized by transient left ventricular dysfunction, electrocardiographic changes, and release of myocardial enzymes. After treatment, the patients are cured in most cases without sequelae. Tako-tsubo syndrome is rarely considered as a reason for consultation in the forensic department.Herein, we report a case of a 68-year-old woman who was assaulted by her police officer neighbor. The latter punched her in the arms and kneed her in the gut without causing any intrathoracic or abdominal injury. The victim was urgently hospitalized in the cardiology department for chest pain and dyspnea accompanied by ST-segment elevation and high troponin level.Tako-tsubo cardiomyopathy diagnosis was based on clinical findings, echocardiography, coronary angiography, and magnetic resonance imaging findings. A forensic medicine consult was initially solicited for the drafting of an initial medical certificate and for evaluating the total transitory disability rate. A second consultation was then sought to evaluate the permanent partial disability.We report this work to discuss the conduct of the forensic pathologist and to prove the causality relationship between the assault and the physical injuries.

Managing mass disasters linked to the sinking of illegal migrant boats: experiences of the Sfax forensic medicine service.

Background: The sinking of illegal migrant boats has been unpredictable. It has resulted in mass disasters that cause deaths and attracts huge media attention, thus making it a medico-social emergency. Aims: This paper reports activities of the forensic medicine service in Sfax, Tunisia and describes the forensic management of mass disasters related to the sinking of illegal migrant boats as well as the main challenges. Methods: This is a retrospective, descriptive study that includes all cases of drowning deaths examined at the forensic department of Habib Bourguiba Hospital, Sfax, following the sinking of illegal migrant boats over a four-year period (October 2017 to September 2021). Results: During the study period, we received 539 corpses following the sinking of illegal migrant boats. The median number of deaths was 93 per year. There was a significant decrease in the number of victims in 2019 (13 victims), followed by a significant increase in 2020 (115) and 2021 (271). We noted two frequency peak periods in June and July, 31.4% and 20.8%, respectively. The victims were mostly male (67.5%) with a sex ratio of 2.08. Minors aged under 18 years were 5.8% and pregnant women were 2.4%. The majority (63.1%) of the victims were of sub-Saharan origin and there has been an increase in the number of victims from this region over the past two years. Samples were systematically collected for genetic investigation and 146 (27.1%) victims were identified. Conclusion: There have been significant advances in the identification of the victims of migrant boat sinking around the Tunisian coast, however, there are several challenges in providing information rapidly to the families of the victims to clarify the uncertainty about the fate of their missing loved ones.

Homicide by unusual-edged weapons: Forensic considerations of two cases.

Homicide by stab wound is common worldwide. However, the use of unusual edged weapons is rarely reported in the forensic literature. Here, we report two cases of homicide involving a Japanese sword, or katana, and a sickle. Both of these weapons can create either stab or incised wounds with some particularities. In our cases, characteristics of the external wounds, internal injuries, and the depth of penetration raised the possibility of an unusual weapon. Meticulous forensic examination of these injuries (morphological characteristics, depth of penetration, trajectories, and cut marks in the bone) may allow the forensic expert to determine the type of weapon used.

Professional accountability in a sternal bone marrow aspiration: a forensic case report.

An aortic injury with concomitant pericardial tamponade caused by sternal bone marrow aspiration is rare. We report a case of fatal sternal bone marrow aspiration performed to a 73 year old man for the purpose of confirming the diagnosis of multiple myeloma. This puncture was followed by an injury in the aorta causing a pericardial tamponade and the death of the patient immediately after the aspiration. This paper stresses the precautions to be taken, by the operator, in certain particular situations that make the sternal bone marrow aspiration difficult and risky, and discusses the different types of operator´s liability that can be involved and their foundations.

Criminal medical liability in the context of Covid-19 pandemic.

The COVID-19 infection causes to medical community many difficulties worldwide. In addition to its therapeutic problems, it can generate situations with high medico-legal risk to doctor who can see his criminal medical liability engaged. In fact, in Tunisia, this new infection imposes many specific legal obligations. Some of these obligations have recently been introduced, therefore still little or not known by doctors, despite the need for them to comply with. In this paper, we propose to analyse the circumstances of medical practice in Covid-19 pandemic period , which risk to engage the doctor's criminal medical liability, and to set out the sanctions incurred, in order to protect health professionals against the specific legal risk of this emerging disease.