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The pulmonary alveolocapillary dysplasia (ACD) with pulmonary vein misalignment (PVM) is a rare condition characterized by a congenital anomaly of the development of the pulmonary parenchyma. We present a case of an 8-month-old infant who died quickly from acute respiratory failure complicating an unknown ACD. We also describe its epidemiological characteristics in infants and we discuss the diagnosis's difficulties. In this case, a pulmonary arterial hypertension was decompensated by an infection. A medico-legal autopsy was performed. As for the Histological examination, it showed the features of ACD/PVM.

Summary Introduction The hyoid bone is of great importance in forensic medicine and it has been studied for various forensic purposes. However, there have been few studies dealing with age and sex estimation using the hyoid bone, especially the radiographic methods. Objective To analyze the relationship between age, sex and metric parameters of hyoid bone in Tunisian population sample, using CT scan. Materiel and methods A prospective study was conducted in the department of Forensic Medicine of Fattouma Bourguiba Hospital of Monastir-Tunisia during 4 years. A total of 240 samples of hyoid bone were studied. The age of cases ranged from 18 days to 81 years. The specimens were collected only from the deceased of known age. Once dried, each hyoid bone was scanned using CT scan. For each specimen, 10 measurements were taken using a computer program. The measurements consisted of 6 lengths and 4 widths. A regression analysis was used to estimate the relationship between age, sex and different measurements. For age estimation, a multiple logistic regression was carried out for samples ≤ 35 years. For sex determination, ROC curve was performed. Discriminant value finally retained was based on the best specificity with the best sensitivity. Results The correlation between real age and estimated age was good (r2 = 0.72) for samples aged 35 years or less. The unstandardized canonical function equation was estimated using three variables: maximum length of the right greater cornua, length from the middle of the left joint space to the middle of the right joint space and perpendicular length from the center point of a line between the distal ends of the right and left greater cornua to the center point of the anterior view of the body of the hyoid bone. For sex determination, the ROC curve analysis reveals that the area under curve was at 81.8%. Discriminant value was 0.451 with a specificity of 73% and sensibility of 79%. The equation function was estimated based on two variables: maximum length of the greater cornua and maximum length of the hyoid bone. Conclusion The findings of the current study suggest that metric analysis of the hyoid bone may predict the age ≤ 35 years. Sex estimation seems to be more reliable. Further studies dealing with the fusion of the hyoid bone and the current study could help to achieve more accurate age estimation rates.

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.

Resume La mort subite a un âge jeune est vecue comme un phenomene dramatique necessitant la connaissance de son incidence. Notre etude a pour objectifs de decrire les particularites epidemiologiques de la mort subite cardiaque d’origine ischemique chez le sujet jeune dans la population d’etude et de discuter son implication dans la survenue du deces. Dans ce travail, le sujet jeune a ete defini comme toute personne âgee de 1 an a 35 ans pour les sujets de sexe masculin, et jusqu’a 45 ans pour les sujets de sexe feminin. Il s’agit d’une etude descriptive, retrospective, exhaustive, concernant 312 cas de mort subite chez le sujet jeune colliges au service de medecine legale de l’hopital universitaire Fattouma Bourguiba de Monastir-Tunisie, durant une periode de 23 ans. Les donnees recueillies ont ete saisies et traitees a l’aide du logiciel SPSS 20. Le taux de significativite a ete fixe a 0,05. Trente-deux cas de mort subite cardiaque d’origine ischemique ont ete recenses. L’infarctus du myocarde (IDM) representait la deuxieme cause de mort subite du sujet jeune apres la cardiomyopathie hypertrophique. La predominance masculine etait nette. La tranche d’âge la plus touchee etait celle entre 25–45 ans. La mortalite par IDM est survenue plus frequemment au repos. Une coronaropathie a ete objectivee dans vingt-quatre cas (75 %). L’IDM est survenu sur des arteres coronaires saines dans huit cas. Une anomalie du trajet, en particulier le pont myocardique, a ete trouvee dans huit cas (25 %). Le « screening » toxicologique etait negatif dans tous les cas. La prevention doit interesser toute la population avec une education sur les moyens des mesures generales d’hygiene de vie et de prevention des facteurs de risques cardiovasculaires a long terme, ainsi que le depistage clinique oriente au moindre signe d’appel.

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.

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.

Background: The diffuse large-B-cell lymphoma (DLBCL) is known as one of the most neoplasm that occurs in AIDS patients. In rare cases, this tumor is manifested with acute liver failure. Case presentation: We report a case of patient who was presented with jaundice and hepatomegaly due to an acute liver failure. A blood exposure accident helped the operator to discover the seropositive statue of the deceased. The results confirmed the presence of HIV antibodies in patient’s serum. Macroscopic examination of the spleen showed a well-defined subcapsular nodule. It had a micronodular appearance. Immunohistochemistry was also performed. Conclusion: The diagnosis of DLBCL related to HIV associated to an Epstein-Barr infection was established in postmortem.

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.

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.

Background: We aim to study the epidemiological and pathological characteristics of sudden death in young, to determine the etiology of death and to purpose recommendations for prevention. Methods: we performed a retrospective cohort study using autopsy data from the Department of Forensic Medicine of Monastir. A review of all autopsies performed during 28 years was done. In each case, clinical information and circumstances of death were obtained and a complete forensic autopsy and histological and toxicological investigations were performed. We have included all sudden death in persons aged between 18 years and 35 years.Results: we collected 137 cases of sudden death during studied period. The mean age of the studied population was 26.47 years. In 72.6% death was 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 in 9.5%.Conclusion: there are several potential causes of sudden unexplained death such as structural abnormalities, ion channels abnormalities. Unexplained deaths, presumed to result from sudden primary arrhythmogenic causes, occur in young adult with structurally normal hearts. That underlying disease-causing genetic defects may be involved has clinical implications for family members. 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.

This chapter looks at cronyism as a pillar of Morocco’s political economy and studies its manifestation and impact in the manufacturing sector. Cronyism and patronage have helped the Makhzen to strengthen its control on Moroccan society and prevent any countervailing power from taking root, especially in the economic sphere. After Morocco became independent, the state–business nexus was consolidated through “Moroccanization,” import-substitution strategy, and privatization. The network of cronyism and patronage was reinforced and extended during the liberalization era. This chapter uses a unique database to identify politically connected firms and measure their performance in comparison with non-connected ones. Political privileges are granted to connected firms through preferential access to finance, protection from foreign competition, and discriminatory implementation of rules and regulations. This chapter also provides some illustrative evidence showing that political connectedness tends to impede firms’ dynamics and innovation.

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.

This chapter illustrates how the Soulaliyate movement was able to gain limited official recognition of their right to collective land. We draw mainly on the Advocacy Coalition Framework (ACF) to analyze the process of land policy change. The social movement framework provided additional insights into coalition formation and strategies. Our methodology is based on desk and media reviews, as well as interviews with civil society actors. The analysis supported the ACF’s hypothesis on policy change.

This paper assesses the water privatization dynamics in Casablanca from a socio-economic and political perspective. It presents three main findings. First, the privatization of public water and sanitation in Casablanca took place under the tight control of the central government (the makhzen). While the delegated management was intended to improve water delivery, the outcomes after ten years are disappointing. Second, the public accountability of local elected officials came under strain due mainly to the power imbalances between a weak local delegating authority and a delegate with global power. Third, Casablanca's inhabitants have resorted to social protests to make their voice heard and claim their human right to water.