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Purpose: This study aims to analyze the pattern of deaths in detention in Northern Tunisia as well as the causes of death. Design/methodology/approach: The authors conducted a cross-sectional retrospective study including all the casualties of death in detention examined in the legal medicine Department in the main teaching hospital from 2005 to 2019. The department covers 10 out of the 11 governorates of Northern Tunisia and 13 prisons. Findings: Of a total of 197 casualties, only 2 were females. The mean age was 45.39 ± 14.43 years. A known medical history was reported in 63.5%, mainly cardiovascular disease, mental health disorders and diabetes. Half of the deaths occurred at the hospital. A total of 53 victims spent less than one year in custody before their death. Most deaths occurred due to disease-related causes (78.7%; n = 155); among these, 69 victims died from cardiovascular disease. Suicide accounted for 3.6% of the casualties and homicides for four cases. Research limitations/implications: Several missing data regarding the details of the detention circumstances as well as the absence in some cases of the toxicological and histopathology analysis results, which could bias the study findings. Practical implications: Death in detention in Northern Tunisia involved mainly males between their 30s and their 50s who died mainly from cardiovascular or pulmonary disease. These results underscore the importance of empowering the penitentiary health system. Originality/value: To the best of the authors' knowledge, this study is one of largest studies with regard to the number of decedents and the number of prisons from the Arab countries allowing to draw a pattern of casualties of death in prison. [ABSTRACT FROM AUTHOR]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.forsciint.2008.09.017 Byline: Fatma Gloulou, Mohamed Allouche, Mehdi Ben Khelil, Olfa Bekir, Ahmed Banasr, Mongi Zhioua, Moncef Hamdoun Keywords: Forensic science; Suicide; Band saw; Power tools; Schizophrenia Abstract: Suicides or suicide attempts with power saws (band, circular or chain saws) are rather rare events and only a few case reports exist in the forensic literature. The use of a band saw, in particular, has been extremely rare in cases of suicide. We report two cases of suicide that occurred in the same suburban area, three years apart. In each case, the victim was a carpenter and had a history of psychiatric disorder and/or of prior suicide attempts. We summarize the findings of the death scene investigations, the pertinent autopsy findings, and also summarize the world literature pertaining to suicide committed with power saws. Author Affiliation: Service de Medecine Legale de Tunis, HA[acute accent]pital Charles Nicolle, 138 Boulevard du 9 avril 1938, Tunis 1006, Tunisia Article History: Received 5 June 2007; Accepted 23 September 2008

Post-traumatic anterior pituitary insufficiency (PTAPI) is a rare but established disease caused by ischemic lesions after severe cranial trauma. This case study aims to highlight the criteria for imputability of PTAPI to a cranial trauma as well as the specific principles of legal redress in relation to this disease. We conducted a forensic study of a patient with diagnosed PTAPI followed up in the Division of Endocrinology and Legal Medicine at the University Hospital, Sousse (Tunisia). The patient included in the study was a 45-year old woman with no particular past medical history. (6 gynaecological procedures, 4 parities and 2 abortions) having regular menstrual cycles, without a history of hemorrhagic childbirth, who had been involved in a road accident (pedestrian got hit by a car) causing occipital trauma without initial knowledge loss. She developed hypothyroidism three years after the accident. The hormonal assessment showed the involvement of all the other axes. Neuroradiological examination objectified pituitary gland and pituitary stalk integrity. The definitive diagnosis of PTAPI was made. Medical examination (performed 4 years after the accident) concluded that PTAPI was imputable to the accident. Permanent partial disability rate according to ordinary law has been assessed at 25%. PTAPI diagnosis is made by elimination. The evaluation of physical injury should be based on residual symptoms, on therapeutic constraints and on its impact on daily and professional activity. Patient's evolution under hormone replacement therapy is often favorable, however, complications may occur, hence the necessity to establish these complications in order to preserve the right of the patient to underwent new treatments.

Aim: To determine frequency of pulmonary embolism as the cause of sudden death and to study clinical, epidemiological characteristics and risk factors., Methods: Prospective study of cases of sudden death secondary to pulmonary embolism, whose autopsy was performed in the forensic department of Tunis, between October 2009 and of September, 2011., Results: During study period, 37 cases of pulmonary embolism were recorded. They represented 6.8 % of all cases of sudden cardiovascular deaths. Victims were male in most cases (65 %). Victims were aged between 21 and 87 years with an average age of about 52 years. Pathological histories were noted in 9 cases: three cases of recent surgery, four cases of pelvic trauma, a case of ovarian tumor and a case of which the PE arose in post-partum. Concerning other risk factors of pulmonary embolism, confinement to bed was noted in 24 cases (64.8 %), obesity in 12 cases (32.4 %), an arterial high blood pressure in 4 cases. Histories of psychiatric pathology were noted in 5 cases (13.5 %). Symptomatology preceding death was dominated by sudden death (35 %) followed by dyspnoea (30 %) and thoracic pains (16 %). In 8 cases , victims consulted emergencies within 48 hours preceding death, for a varied symptomatology without diagnosis of pulmonary embolism is suspected. At autopsy, in 30 cases embolism was massive. In 29 % of the cases, a deep venous thrombosis was revealing in particular at the primitive iliac veins., Conclusion: Pulmonary embolism is an affection that still kills a lot. It can benefit from prevention and from an effective treatment. This testifies the major importance of clinical diagnosis of pulmonary embolism as well as the technical means for the diagnosis.

We report the case of a collective intoxication by ingestion of a mushroom "Lepiota brunneoincarnata" at the origin of the death of four members of the same family aged between 3 and 15 year old. We discuss the physiopathology and the prognosis factors of such intoxications through these four observations which highlight the clinical signs, biological disturbances due to the intoxication, autopsy and histology findings. The first observation concerns a six year old girl. She presented an abdominal pain with vomiting and aqueous diarrhea. She died during the early phase of the intoxication (seven hour after the ingestion of the mushroom), death was secondary to an acute dehydration. The three other observations concern children aged between three and fifteen year old. They presented typical phalloïdian syndrome symptoms evolution with first gastro-intestinal and then hepatic signs. They died after a period varying between three and eleven days without being able to profit from a hepatic transplantation. The autopsy findings showed the presence of an important cerebral edema and hemorrhagic zones of the liver in all the cases, the presence of hemorrhagic complications in two cases. Histology investigations showed the presence of a diffuse centrilobular and periportals necrosis.