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Background: The common methods of suicide are hanging and poisoning. Suicidal electrocution using a homemade device is very rare. Victims usually possess knowledge of electrical circuits. Here, we report two cases of suicide by electrocution using a homemade device., Case Presentation: Case 1: A retired electrical technician was found unresponsive in his bedroom, with two bare copper wires; one encircling the index finger of the left hand, and the other placed in the mouth. The other ends of the wires were connected to a wall plug supplying 220 V current. Forensic autopsy and microscopic findings attributed death to suicidal electrocution. Case 2: A 51-year-old-man was found dead in the bathroom with bare copper wires encircling both wrists and connected to a wall plug carrying 220 V current. Death scene investigation, necropsy, histological tests and toxicological screening indicated suicide by electrocution., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Spontaneous splenic rupture is a rare life-threatening finding with a challenging diagnosis which is largely ignored in the literature. Hematological disorders such as afibrinogenemia are reported to cause bleeding disorders mostly cerebral hemorrhage. Despite being a life-threatening condition, data about spontaneous splenic rupture in patients with Afibrinogenemia remain scarce. Such fatal incidents should warrant diligent efforts to establish and adopt prevention measures in this particularly vulnerable population. We report two new cases of spontaneous splenic rupture in two siblings, diagnosed with congenital afibrinogenemia since early childhood. In addition, we report the results of a systematic review of the literature of cases that have reported the occurrence of splenic rupture in afibrinogenemia, with the aim of filling the gap in the clinical course of such an uncommon event., Methods: We conduced a systematic review of English and French language publications cataloged in Pubmed, and Google Scholar up to December 2022. We opted to include articles written in other languages if an English language abstract was available and contained the information needed for our report. The following MeSH (medical subject heading) search criteria were used: ''splenic rupture'' AND ''afibrinogenemia.'' The above search strategy was further combined with a supplementary strategy that included the MeSH terms ''spleen'', AND ''rupture'' AND ''Afibrinogenemia''. In order to reduce the selection bias in searching on the Google Scholar database, we searched for articles containing these MeSH terms in their titles., Results: We reported two cases of splenic rupture in two family members who were diagnosed with afibrinogenemia at the age of 1 year. The splenic rupture was misdiagnosed by clinicians in the brother's case, resulting in his death and presenting as a forensic case. However, the sister underwent a splenectomy one week before her brother's death following the onset of asthenia and acute abdominal pain. Then we conducted a literature review of relevant studies of spontaneous splenic rupture in Afibrinogenemia. A selection of 13 relevant studies was included in the final review, describing a total of 25 cases of spontaneous splenic rupture in Afibrinogenemia. One paper was an international cross-sectional study across 25 different countries involving 211 patients with fibrinogen disorders, showing that 11 patients with afibrinogenemia had developed spontaneous splenic rupture. The remaining 12 articles were case reports or case series, describing a total of 14 cases of atraumatic splenic rupture in afibrinogenemia, ranging from 0 to 28 years old, with a median age of 14.5 years, where the majority were infants (age inferior to 18) with the most cases occurred in the age group of 10-15 years old., Conclusion: Congenital afibrinogenemia is a rare disease with a wide range of clinical symptoms and with challenging management. While the most common presenting symptoms are bleeding and thrombosis, spontaneous spleen rupture is rare and probably underdiagnosed which consequently may lead to death. Studies about the topic remain scarce, hence, further studies are needed to ascertain this risk and establish target preventive measures for this vulnerable population., Competing Interests: Declaration of competing interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2025 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)

Objectives: The aim of the present work is to develop a novel method for predicting age in individuals over 50 years old, utilizing regression models., Methods: The conducted study is of an analytical cross-sectional nature, involving a sample of 44 young subjects and 107 elderly subjects. The necessary data for this research were extracted from "The New Mexico Decedent Image Database." Based on the phenomenon of height shrinkage with age, we created models for young subjects and applied them to elderly subjects, allowing us to extract the variables., Results: We obtained highly encouraging results with an R 2 of 0.73, a mean absolute error of 3.94, and stable cross-validation. We used a Student's t-test, which demonstrated no significant difference between predicted and actual values (p-value >0.05). We also conducted a learning curve analysis and examined residuals against predicted values. This suggests that the forecasts are accurate, with no significant bias in predictions., Conclusion: This work has allowed us to conclude that it is possible to reliably estimate the age of subjects over 50, taking into account age-related physiological and pathological changes., (Copyright © 2024 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)

The mastoid bone, situated at the base of the skull and characterized by its compact structure in the petrous portion, being among the slowest-growing bones, has gained recognition as a valuable anthropological tool for sex determination. Thus, we have proposed to assess the reliability of the mastoid process in sex determination in a Tunisian population using CT-scan analysis. A cross-sectional study was conducted. CT scans forming the mastoid triangle were analyzed using a General Electric Bright Speed scanner. Nine measurements were taken by a single observer, ensuring reliability through intra- and inter-observer assessments. Normalization and statistical analyses, including logistic regression, were applied to identify sex-discriminating variables. The model's performance was evaluated using learning curves, cross-validation, and various metrics. The resulting logistic regression equation, coefficients, and intercept provided a predictive tool for sex determination. A total of 256 cranial CT scans (126 males, 130 females) were analyzed. Our study revealed that the mastoid region approach achieved an overall accuracy of 80.8 % in sex identification within the examined population. The method demonstrated a sensitivity of 78.9 % and specificity of 81.8 %. All investigated variables (AP, PM, AM, CMH, TMH, OSDmax, OCDmax, MA) exhibited discriminatory capabilities for sex determination, except for AIA. Notably, the most effective discriminators were AP, CMH, and OSDmax. Utilizing an ROC curve analysis to optimize mastoid variables for maximum sensitivity and specificity, we obtained excellent results, with an area under the curve reaching 91 %., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Since the 1950 s, several studies have reported that patients using first generation and/or second-generation antipsychotics had increased risk of venous thromboembolism events. These events include deep vein thrombosis and/or pulmonary embolism (PE). However, data about fatal PE in patients on antipsychotics (APs) remain scarce. Thus, the current study aimed to investigate sociodemographic, clinical and pharmacological characteristics related to psychiatric patients on APs and who died from a fatal PE. We reported a case-series, then conducted a literature review of relevant studies and performed a meta-analysis of studies with usable data. The main outcome of the study suggested a significantly high risk of fatal PE in patients using APs compared to nonusers (Odds Ratio=6.68, with 95% confidence interval 1.43-31.11). Clozapine was the most incriminated drug. Low potency first generation APs were the second most exhibited medication. Studies about the topic remain scarce with a high heterogeneity and a high probability of bias. Further studies are needed to ascertain this risk and to establish target preventive measures in this particularly vulnerable population., (Copyright © 2022 Elsevier B.V. All rights reserved.)

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., Competing Interests: The authors report no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

In eastern countries, Muslim females wear the Hijab, all the time, conforming to a moral standard of modesty and privacy. Worn in workplaces, the Hijab can causes accidents leading to death. In this context, we report three fatal work accidents related to the Hijab. In two cases, death occurred instantaneously. In all cases, death was attributed to mechanical asphyxiation., Competing Interests: Conflict of interest None., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Ventricular non-compaction (VNC) is a rare myocardium disorder, which can be both genetic and sporadic. A poor wall compaction process or an excessive trabeculae formation may be at the genesis of myocardial hypertrabeculation with multiple recesses. It is often complicated by ventricular dysfunction, arrhythmias and cardiac embolism. Herein we report a case of a 20-year-old male patient with no particular past medical history who was followed up at the cardiology department for dyspnea. Echocardiography showed reduced ejection fraction of the left ventricle with potential hypertrabeculation in the right ventricle, confirmed by cardiac MRI. The patient was not put under medication and was later lost to follow-up. He died few months later without a clear cause explaining death. A forensic autopsy was performed that attributed death to acute ventricle arrhythmia secondary to VNC, emphasizing the major role of an early and specific treatment to avoid such a fatal outcome., Competing Interests: No competing interests were disclosed., (Copyright: © 2020 Mannoubi S et al.)

Postobstructive pulmonary edema is a life-threatening complication that occurs after the removal of severe upper airway obstruction. Development of postobstructive pulmonary edema has been described after several cases of upper airway obstruction. However, postobstructive pulmonary edema developing after non-lethal hanging has not been reported widely in the literature. Herein, we describe a fatal case of postobstructive pulmonary edema in a 10-year-old girl, which was brought to the hospital with history of attempted suicide by hanging. At presentation, the girl was breathing laboriously. The oxygen saturation was of 82% and pulmonary auscultation revealed bilateral and diffuse crepitations. The chest computed tomographic scan showed bilateral diffuse infiltrates consistent with pulmonary edema. After 3 days of hospitalization, the respiratory state of the girl worsened leading to death despite intensive care. An autopsy was conducted and confirmed the diffuse pulmonary edema. Hence, this case confirms that delayed death in near hanging may occur. Pulmonary edema which develops subsequently in such patients is an uncommon mechanism of death that physicians should consider in emergency room., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2020.)

Echinococcosis, also known as hydatid disease, is a common parasitic human infestation found in sheep-breeding areas. It is caused by the larvae stage of Echinococcus granulosus , and cysts develop mostly in the lungs and the liver. Cardiac involvement is unusual and silent until acute complications or a fatal outcome occurs. Herein, we report an autopsy case of a young healthy adult who died suddenly. The autopsy revealed an external bulging on the right heart ventricle outlet with a fluid-filled cystic cavity discovered on sectioning. Dissection of other organs did not reveal other cyst locations. Histological examination ascertained the diagnosis of hydatid cyst, and death was attributed to cardiac arrhythmias. Pathologists should keep in mind that hydatid cysts can develop anywhere in the body. Solitary cardiac cyst is rare and can simulate a "silent bomb". Unfortunately, sudden death remains the frequent manner of revelation of this disease in endemic areas., Competing Interests: No competing interests were disclosed., (Copyright: © 2020 Mesrati MA et al.)

Chronic calcific constrictive pericarditis is a rare condition. It can cause severe morbidity and even mortality. The diagnosis may be difficult to establish due to its variable clinical signs. We report an autopsy case of a 54-year-old male with a past medical history of well treated hypertension, diabetes and dyspnea present of 2 weeks, who was discovered dead in his bed. The postmortem examination showed a large band of calcification of the pericardium with obliteration of the pericardial space. Both pericardium and epicardium were thickened with bread-and-butter appearance. Microscopic examination showed thickened pericadium which is formed by a fibrous paucicellular tissue containing extensive basophilic calcifications.

The diagnosis of aortic dissection is often difficult because the symptoms are usually non-specific. AD should be considered in the differential diagnosis of all cases of idiopathic retrosternal pain. Misdiagnosis of AD is a common cause of legal suits in medical practice. Prevention requires a complete and thorough evaluation., Competing Interests: None declared.

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.

The spread of the disease of HIV has been decreased since the promotion and protection of human rights. In Tunisian law, patient infected by HIV, as every citizen, enjoys of all his rights without any discrimination, including the right to life and dignity, the right to care access, the free choice of doctor, the right to be informed and consent before any health care and specially the right to medical confidentiality. The Code of patients rights and the law no° 2007-12 of 12 February 2007 supplementing the law no° 92-71 of 27 July 1992 related to transmitted diseases ensure the protection and the respect of these rights. However, law requires a great sense of responsibility from patients and obliges them to avoid any unconscious behavior that can risk transmission of the disease. But, the application of these laws raises always many ethical problems that need reflexions.

The spontaneous subcapsular hematoma of the liver is very rare. There are only a few reported cases in the literature.Most reported cases of liver hematoma often occur during pregnancy as part of the hemolysis, elevated liver enzymes, and low platelet count syndrome. The other causes may be due to amylosis, rupture of hepatocellular carcinoma, adenoma, focal nodular hyperplasia, hemorrhagic cyst, or hemopathy. Idiopathic spontaneous subscapular hematoma is a rare and often fatal condition.We report a case of a 43-year-old woman having Steinert disease who died because of a fatal spontaneous liver hemorrhage occurring without any traumatism. We did not find any apparent cause that could explain this hemorrhage even after a histological study of the liver.

Aims of the Study: To describe epidemiological aspects of sudden cardiovascular death and to specify the etiopathogenic characteristics., Patients and Method: Our study is retrospective and descriptive. It included 361 cases of sudden cardiovascular death, which underwent autopsy in forensic medicine department of Monastir during eight years, from 1st January 2004 to 31st December 2011., Results: The incidence of sudden cardiovascular death was 9 per 100,000 person. A marked male predominance was noted. The mean age was 55.75 years. In our series, myocardial infarction represents the leading cause of sudden cardiovascular death, 57.8% of cases. Other etiologies were hypertrophic cardiomyopathy (4.7%), heart failure (1.9%), arrhythmogenic right ventricular dysplasia (2.8%), valvular disease (2%), cardio-myo-pericarditis (1.9%), hydatid cyst of the heart (0.8%), ruptured aneurysm (2.5%), pulmonary embolism (1.9%) and aortic dissection (1.3%). A sudden cardiovascular death at work was found in 25 cases. These cases pose essentially a problem of imputability., Conclusion: Sudden cardiac death is usually the complication of underlying heart disease, sometimes overlooked. Several risk factors are involved. Sudden cardiac death in healthy heart or death caused by arrhythmia is an important entity seeking the intervention of several actors (forensic doctor, cardiologist, geneticist, media…) for prevention., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Introduction: Textiloma is a mass composed of retained surgical textile foreign body. It is a rare iatrogenic complication that can engage the doctor's responsibility. The aim of this manuscript is to report an unusual case of breast Textiloma mimicking a recurrent tumor and to highlight its medico-legal implications., Presentation of Case: A 47-year-old lady, without past medical history, was diagnosed with a breast infiltring intraductal carcinoma. She was treated with mastectomy. Four years later, the patient consulted her surgeon for a subcutaneous mass in the operative site. Both medical and radiological investigations concluded to recurrent tumor. Histological examination confirmed the diagnosis of Textiloma., Discussion: Retained foreign bodies in the operative site are infrequent but serious iatrogenic complications. Clinical manifestations of Textiloma are variable and non-specific. It should be suspected in any postoperative case with unresolved or unusual problems. It can mimic other conditions such as tumor. Textiloma is a frequently injurious situation that can lead to medico-legal implications. It is considered to be a sample of medical negligence that involves the surgeon responsibility., Conclusion: Textiloma is a preventable condition and it can be avoidable by maintaining standard recommendations., (Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Arrhythmogenic right ventricular dysplasia (ARVD) is cardiomyopathy where normal myocardial tissue is replaced with fibrofatty tissue. Histological examination performed on myocardial biopsy or on autopsy samples are used to confirm the diagnosis. However, in many cases, the diagnosis cannot be made on a simple macroscopic and histological study and requires genetic analysis and molecular biology. In this work, we propose to describe the main macroscopic and histological findings of ARVD through the study of an autopsy series. We report 12 autopsy cases of sudden death in ARVD collected in the Department of Forensic Medicine of the University Hospital Fattouma Bourguiba Monastir (Tunisia) during a period of 20years. Microscopic examination was performed on 5microns thick histological sections. All slides were reviewed by two operators in a double blind (physician pathologist, pathologist) and in each, the percentage of adipose tissue, fibrosis and infarction in the right ventricle, left ventricle and interventricular septum, the presence or absence of inflammatory infiltrate, the presence or absence of signs of degeneration of myocytes were noticed. ARVD was found in 12 cases (1.8% of sudden cardiac death). The age ranged between 13 and 67years (mean age: 45.3years). The death occurred in half of the cases during exercise. Macroscopic examination of the RV showed the presence of a wall thinning (thickness<3mm) in 9 cases. Histological study highlight RV adipose infiltration in all cases with a percentage between 15% and 60%, fibrotic lesions were observed in only 9 cases with an average percentage of 10.25% and signs of degeneration of myocytes were noted in 10 cases. In concordance with what has been reported in the literature, there is still no consensus regarding the criteria to be adopted to pose with certainty the diagnosis of ARVD and the presence of adipose tissue remains the criterion more suggestive., (Copyright © 2015. Published by Elsevier SAS.)

The aim of this study was to assess the fourth rib phase İşcan method on a Tunisian sample. One hundred and eight (108) specimens of sternal ends of fourth ribs of Tunisian male population were collected during forensic autopsies performed in the Department of Forensic Medicine and Pathology of the University Hospital Fattouma Bourguiba of Monastir. Two operators, independently, assigned each rib to İşcan's phase. The data obtained by the two operators were analyzed using SPSS 17.0 and MedCalc. The repeatability and accuracy of İşcan method was tested by kappa coefficient (κ), for each operator. Spearman correlation coefficient (R), between estimated İşcan phase and İşcan phase relative to chronological age, was good with values of 0.758 (CI: 0.664-0.828) and 0.717 (CI: 0.611-0.798) for operator 1 and operator 2, respectively. The perfect agreement, between İşcan phase related to chronological age and İşcan phase estimated by both operators, was found for phases fewer than 5. Intra-observer agreement was highest for both operators with kappa value of 0.73 for operator 1 and 0.71 for operator 2. The estimation of the observers fell within one phase from the ideal and there was minimal disparity. A good accuracy between operator 1 and operator 2 was found (κ=0.747, p=0.057). In order to improve the results, we have pooled ages in five new phases. The correlation, between new age groups and İşcan phase estimated by both operators, was moderate. We conclude that İşcan method can be applicable in Tunisian population with a good correlation for age ranges under 39years., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Dog-bite-related injuries and fatalities are increasing in incidence and represent an important public health concern, as dogs are more and more becoming an integral part of human social life. We report the case of a 27-year-old woman who was found dead in her home. Her body was discovered lying face down in a large pool of partially desiccated blood with signs of having been dragged. Site examination revealed the presence of severe injuries on the face, neck and head, which were then traced back to the dog she owned. Death was attributed to exsanguinations due to a neck blood vessel's laceration with fracture of the fifth cervical vertebra. This was uncommon because the dog bites injured the vertebral artery only without any lacerations of the carotid artery. Confirming that the injuries are dog-bite related was based on a multidisciplinary approach including histological findings, odontological examination of bite marks and DNA analysis., (Copyright © 2013 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)