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Abstract: Notch pathway plays a pivotal role in cell fate determination. There is much interest surrounding its therapeutic potential, in osteoarthritis, but the expression profile of Notch-related molecules, as well as their relation with cartilage pathological parameters, remains unclear. The purpose of our study is to analyze the expression pattern of Notch family members, type II and type I collagen, in normal (healthy) and osteoarthritic human knee cartilage. Osteoarthritic cartilages were obtained from 3 patients undergoing a total knee replacement. Macroscopically normal cartilage was dissected from 3 human knees at the time of autopsy or surgery. Immunohistochemical staining was performed using Notch1,2,3 and 4, Delta, Jagged, type II collagen and type I collagen antibodies. In healthy cartilage, type II collagen was abundantly expressed while type I was absent. This latter increased proportionally to the osteoarthritic grade. Type II collagen expression remained intense in osteoarthritic cartilage. In healthy cartilage as well as in cartilage with minor lesions, Notch family member''s proteins were not or just weakly expressed at the surface and in the cells. However, Notch molecules were over-expressed in osteoarthritic cartilage compared to healthy one. This expression pattern was different according to the cartilage zone and the severity of OA. Our data suggest that Notch signaling is activated in osteoarthritic cartilage, compared to healthy cartilage, with a much more abundant expression in the most damaged areas. [Copyright &y& Elsevier]

The aim of our study was to analyze the epidemiological characteristics for suicide methods and factors over a 12-year period among child suicides in Northern Tunisia and to compare juvenile and adolescent suicides. This is a cross-sectional study. We included all child and adolescent suicide cases that took place in the North of Tunisia over a 12 year period (2005–2016). Data were collected from medical records and judicial inquiries and were classified into three sections: sociodemographic data, the circumstances of suicide, and the autopsy findings. Data were then compared between the 'juvenile suicide group' and 'the adolescent suicide group', according to the WHO definition. Casualties were equally males and females, mostly adolescents (74.5%), aged 15 years old on average. Hanging was the most frequent suicidal method. A peak of frequency was observed in 2014. Our results suggested to focus, among other preventive measures, on the role of media coverage of child suicides. [ABSTRACT FROM AUTHOR]

La mort subite d'origine cardiaque demeure un problème majeur de santé publique. Certaines études épidémiologiques suggèrent une différence entre les deux sexes en termes de cause et des circonstances du décès. L'objectif de ce travail était d'étudier la différence entre les deux sexes et les spécificités féminines dans la mort subite en termes d'incidence, de cause et de circonstances de survenue. c'est une étude prospective et autopsique, portant sur les victimes de mort subite d'origine cardiaque survenues dans la région du nord de la Tunisie entre janvier 2013 et décembre 2019. Nous avons recueilli les données cliniques, anatomiques, les circonstances du décès, ainsi que la symptomatologie accusée par la victime au cours des 24 dernières heures précédant la mort. Une analyse de la variation circadienne, hebdomadaire et mensuelle des décès à été également effectuée. La population étudiée comprenait 1834 hommes et 468 femmes avec un âge moyen comparable (56,3 ± 13,8 ans chez les hommes et de 57,2 ± 15,8 ans chez les femmes p : 0,26). Les facteurs de risque cardiovasculaire traditionnels et une dyspnée isolée précédant le décès étaient plus fréquemment constatés chez les femmes (15,6 % versus 8,1 %, p < 0,001). Par ailleurs, le décès était survenu plus fréquemment à domicile chez les femmes et dans un lieu publique ou en milieu du travail chez les hommes. Les cardiopathies ischémiques étaient les causes de décès les plus fréquentes chez les hommes et une autopsie blanche avec un cœur structurellement normal à l'examen était plus fréquente chez les femmes (34 % versus 23,6 %, p < 0,001). Un excès de mortalité nocturne chez les femmes a été enregistré entre minuit et 6 heures du matin (43,8 % contre 34,1 % chez les hommes, p < 0,001), en revanche la distribution hebdomadaire et mensuelle des décès était comparable avec en particulier un pic de mortalité hivernale enregistré dans les deux sexes. Il existe une spécificité féminine dans le domaine de la mort subite, avec une mortalité coronarienne moins importante et un taux d'autopsie blanche plus élevé chez cette population. Le décès survenait plus fréquemment à domicile avec une surmortalité nocturne par rapport aux hommes. 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. 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. 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. Women had considerably more cardiovascular risk factors and more commonly negative macroscopic autopsy. Death occurred indoors and during night more often than in men. [ABSTRACT FROM AUTHOR]

Objective: To analyze the victims profile related to death among homeless people. Study design: A descriptive, retrospective, and cross-sectional study. Methods: We included all deaths among homeless people that occurred during a 10-year period (2005-2014) that were autopsied in the Department of Legal Medicine of the Charles Nicolle Hospital of Tunis. Causes of death were classified according to the International Statistical Classification of Diseases and Related Health Problems 10th Revision. Data were classified in three sections: sociodemographic data, circumstances of death, and autopsy findings. A univariate data analysis was performed. Results: The sex ratio (M/F) was of 7.45. The average age was of 59 years. The majority of deaths (80.9%) occurred in the metropolis of Tunis with a significant occurrence of cases in other governorates after the 2011 revolution (P = 0.002). Deaths occurred more often during winter (34.8%). The bodies were frequently discovered in public places (36.0%) and private locations (34.0%). The deaths of 55.3% of cases were attributed to natural causes, significantly affecting the elderly, whereas the accidental causes (25.7%) were more frequent before the age of 49 years, followed by suicides (3.9%) and homicides (3.3%). Conclusions: Our study highlighted a phenomenon not yet studied in Tunisia. Our results highlight an urgent need for preventive measures focused on the improvement of healthcare measures among homeless people. [ABSTRACT FROM AUTHOR]

Several studies have suggested a circadian and septadian pattern of incidence of sudden cardiac death with a morning peak and a Monday peak. To analyze the circadian and septadian pattern of occurrence of sudden cardiac death in the eight northern Tunisian governorates. 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. 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). 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. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To develop profile of the victims and to study circumstances, causes of death and autopsy findings. Methods: Retrospective study of cases of sudden death in sport activity whose autopsy was performed in forensic department of Tunis, between January 2005 and December 2009. Results: During study period, 32 cases of SD in sport activity were recorded. These are amateur athletes predominantly male (84% of cases). Victims are aged between 15 and 79years with an average age of about 33.16years. Young subjects whose age is less than 35years representing 68.7% of cases. 9.3% of victims had a family history of SD and 18.7% of cases had a known cardiac history. The sports most involved are running (40.6% of cases), football (31.3% of cases) and dance (12.5% of cases). Sixty-nine percent of victims died during sports activities. Presence of witnesses was noted in all cases; however, none of these witnesses has begun resuscitation. Cause of death was cardiac in 84.4% of cases. In young athletes, hypertrophic cardiomyopathy is the leading cause (nine cases), followed by arrhythmogenic right ventricular dysplasia (three cases). Among other causes, there is the myocardial bridge, congenital anomalies of the coronary arteries, aortic dissection and dilated cardiomyopathy. Beyond 35years, coronary artery diseases represent the cause of death (nine cases). Only case of death secondary to non-cardiac disease occurred after a severe asthma attack. In four cases (12.5%), no cause of death was identified after a complete autopsy accompanied by further investigations. The cause of the death was imputed to a rhythmic pathology. Conclusion: This is the first study dealing with autopsy in SD in sport have provided a specific profile of victims. Other studies on larger samples and using standardized autopsy protocols are needed. [Copyright &y& Elsevier]

Abstract: Objective: The aim of our work was to study cardiac sequelae of penetrating cardiac injuries. Material and methods: It is a retrospective study including nine patients (eight men and one woman with an average age of 26.6±7.4 years) hospitalised between January 1st, 1988 and December 31, 2002 in cardiovascular surgery department of Tunis Rabta hospital for heart wounds. Results: It was stab wounds in all patients. Heart lesions concerned primarily the right ventricle. In admission, two patients had cardiac tamponade and seven were in shock. Beating heart surgery without cardiopulmonary bypass in all patients performed surgical repair and it consisted in simple suture. Functional symptoms were observed in five patients at late outcome. Five patients had heart sequelae. It consisted of conduction abnormalities (right bundle branch block) in five patients. One patient had a small ventricular septal defect. Finally, partial permanent disability rates were less than 10%. Conclusion: Cardiac sequelae of penetrating cardiac wounds have good prognosis with the exception of a small partial permanent disability rate. Their prevention must be based on the fight against the urban violence and on the good initial management. [Copyright &y& Elsevier]