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7. Post mortem kinetics of secobarbital.

Author

Quatrehomme, G., Bourret, F., Zhioua, M., Lapalus, P., and Ollier, A.

Subjects
Barbiturates -- Analysis, Forensic toxicology -- Methods, Postmortem changes -- Research
Published
1990

9. Modeling, Dynamics, Bifurcation Behavior and Stability Analysis of a DC-DC Boost Converter in Photovoltaic Systems

Author

Enginyeria Electrònica, Elèctrica i Automàtica, Universitat Rovira i Virgili, Zhioua, M.; El Aroudi, A.; Belghith, S.; Bosque-Moncusi, J. M.; Giral, R.; Al Hosani, K.; Al-Numay, M., Enginyeria Electrònica, Elèctrica i Automàtica, Universitat Rovira i Virgili, and Zhioua, M.; El Aroudi, A.; Belghith, S.; Bosque-Moncusi, J. M.; Giral, R.; Al Hosani, K.; Al-Numay, M.

Abstract

A study of a DC¿DC boost converter fed by a photovoltaic (PV) generator and supplying a constant voltage load is presented. The input port of the converter is controlled using fixed frequency pulse width modulation (PWM) based on the loss-free resistor (LFR) concept whose parameter is selected with the aim to force the PV generator to work at its maximum power point. Under this control strategy, it is shown that the system can exhibit complex nonlinear behaviors for certain ranges of parameter values. First, using the nonlinear models of the converter and the PV source, the dynamics of the system are explored in terms of some of its parameters such as the proportional gain of the controller and the output DC bus voltage. To present a comprehensive approach to the overall system behavior under parameter changes, a series of bifurcation diagrams are computed from the circuit-level switched model and from a simplified model both implemented in PSIM© software showing a remarkable agreement. These diagrams show that the first instability that takes place in the system period-1 orbit when a primary parameter is varied is a smooth period-doubling bifurcation and that the nonlinearity of the PV generator is irrelevant for predicting this phenomenon. Different bifurcation scenarios can take place for the resulting period-2 subharmonic regime depending on a secondary bifurcation parameter. The boundary between the desired period-1 orbit and subharmonic oscillation resulting from period-doubling in the parameter space is obtained by calculating the eigenvalues of the monodromy matrix of the simplified model. The results from this model have been validated with time-domain numerical simulation using the circuit-level switched model and also experimentally from a laboratory prototyp

Published
2016

21. Death in detention in the Northern part of Tunisia: a 15-year study (2005-2019).

Author

Zaara MA, Ben Khelil M, Bellali M, Gharbaoui M, Kort I, Banasr A, Zhioua M, and Hamdoun M

Abstract

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., (© Emerald Publishing Limited.)

Published
2023
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22. A comparative study of the injury pattern between suicidal and accidental falls from height in Northern Tunisia.

Author

Kort I, Hmandi O, Grayaa M, Bellali M, Kouada R, Gharbaoui M, Zhioua M, and Allouche M

Subjects
Humans, Male, Adult, Middle Aged, Retrospective Studies, Tunisia epidemiology, Cross-Sectional Studies, Accidental Falls, Suicidal Ideation
Abstract

Background: Falls from height are a common cause of marbidity and mortality. The aim of this study is to examine the characteristics of the victims, the circumstances of the fall and distribution of the injuries of accidental and suicidal falls from height., Materials and Methods: It was a retrospective cross-sectional study, based on autopsies performed over 16 years (January 2005 to December 2020). The recorded variables included demographic data of the victim, height of fall, death scene findings, length of hospital stay, autopsy findings, and toxicological results., Results: Of the 753 victims of fall from height, 607 were fallers and 146 were jumpers. We found that male victims were predominant in the accidental group (86.8% vs. 69.2%). The mean age at death was 43.6 ± 17.9 years. Suicidal falls occurred in a private house in the majority of cases (70.5%), while accidental falls occurred most frequently at workplace (43.8%). Suicidal falls were higher than accidental falls (10.4 ± 7.3 m vs. 7.1 ± 5.7 m). Injuries in the thorax, abdomen, pelvis, upper and lower extremities were more frequentl in the suicidal falls group. Pelvic fractures were 2.1 times more likely to occur in the suicidal falls. Head injuries were more frequent in the accidental falls group. The survival delay was shorter in the suicidal falls group., Conclusions: our study highlights the differences in the profile of the victims and in the pattern of injuries caused by falls from height, depending on the victim's intention to fall., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2023 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)

Published
2023
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23. An autopsy case of primary abdominal pregnancy.

Author

Ben Abderrahim S, Meddeb MA, Belhaj A, Allouche M, Zhioua M, and Ben Khelil M

Subjects
Female, Humans, Pregnancy, Autopsy, Pregnancy Trimester, Second, Adult, Abdominal Pain etiology, Pregnancy, Abdominal diagnosis, Pregnancy, Abdominal surgery
Published
2023
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24. 2022 TUNISIAN NATIONAL CONGRESS OF MEDICINE ABSTRACTS.

Author

Yacoub A, Ayadi A, Ayed W, Ayari S, Chebbi S, Magroun I, Ben Afia L, Mersni M, Mechergui N, Brahim D, Ben Said H, Bahri G, Youssef I, Ladhari N, Mziou N, Grassa A, M'rad M, Khessairi N, Krir A, Chihaoui M, Mahjoub S, Bahlous A, Jridi M, Cherif Y, Derbal S, Chebbi D, Hentati O, Ben Dahmen F, Abdallah M, Hamdi I, Sahli F, Ouerdani Y, Mnekbi Y, Abaza H, Ajmi M, Guedria A, Randaline A, Ben Abid H, Gaddour N, Maatouk A, Zemni I, Gara A, Kacem M, Maatouk I, Ben Fredj M, Abroug H, Ben Nasrallah C, Dhouib W, Bouanene I, Sriha A, Mahmoudi M, Gharbi G, Khsiba A, Azouz M, Ben Mohamed A, Yakoubi M, Medhioub M, Hamzaoui L, Azouz M, Ben Attig Y, Hamdi S, Essid R, Ben Jemia E, Rezgui B, Boudaya MS, Hassine H, Dabbabi H, Fradi Y, Cherif D, Lassoued I, Yacoub H, Kchir H, Maamouri N, Khairi W, Ben Ammar H, Abaza H, Chelbi E, Merhaben S, Neffati W, Ajmi M, Tarchalla S, Boughzala S, Gazzeh M, Gara S, Labidi A, Touati H, Nefzi AM, Ben Mustpha N, Fekih M, Serghini M, Boubaker J, Zouiten L, Driss A, Meddeb N, Driss I, Walha S, Ben Said H, Bel Hadj Mabrouk E, Zaimi Y, Mensi A, Trad N, Ayadi S, Said Y, Mouelhi L, Dabbèche R, Belfkih H, Bani M, Moussa A, Souissi S, Trabelsi Werchfeni B, Chelly S, Ezzi O, Ammar A, Besbes M, Njah M, Mahjoub M, Ghali H, Neffati A, Bhiri S, Bannour R, Ayadi S, Khouya FE, Kamel A, Hariz E, Aidani S, Kefacha S, Ben Cheikh A, Said H, Dogui S, Atig A, Gara A, Ezzar S, Ben Fradj M, Bouanène I, M'kadmi H, Farhati M, Dakhli N, Nalouti K, Chanoufi MB, Abouda SH, Louati C, Zaaimi Y, Dabbeche R, Hermi A, Saadi A, Mokaddem S, Boussaffa H, Bellali M, Zaghbib S, Ayed H, Bouzouita A, Derouiche A, Allouche M, Chakroun M, Ben Slama R, Gannoun N, Kacem I, Tlili G, Kahloul M, Belhadj Chabbah N, Douma F, Bouhoula M, Chouchene A, Aloui A, Maoua M, Brahem A, Kalboussi H, El Maalel O, Chatti S, Jaidane M, Naija W, Mrizek N, Sellami I, Feki A, Hrairi A, Kotti N, Baklouti S, Jmal Hammami K, Masmoudi ML, Hajjaji M, Naaroura A, Ben Amar J, Ouertani H, Ben Moussa O, Zaibi H, Aouina H, Ben Jemaa S, Gassara Z, Ezzeddine M, Kallel MH, Fourati H, Akrout R, Kallel H, Ayari M, Chehaider A, Souli F, Abdelaali I, Ziedi H, Boughzala C, Haouari W, Chelli M, Soltani M, Trabelsi H, Sahli H, Hamdaoui R, Masmoudi Y, Halouani A, Triki A, Ben Amor A, Makni C, Eloillaf M, Riahi S, Tlili R, Jmal L, Belhaj Ammar L, Nsibi S, Jmal A, Boukhzar R, Somai M, Daoud F, Rachdi I, Ben Dhaou B, Aydi Z, Boussema F, Frikha H, Hammami R, Ben Cheikh S, Chourabi S, Bokri E, Elloumi D, Hasni N, Hamza S, Berriche O, Dalhoum M, Jamoussi H, Kallel L, Mtira A, Sghaier Z, Ghezal MA, Fitouri S, Rhimi S, Omri N, Rouiss S, Soua A, Ben Slimene D, Mjendel I, Ferchichi I, Zmerli R, Belhadj Mabrouk E, Debbeche R, Makhloufi M, Chouchane A, Sridi C, Chelly F, Gaddour A, Kacem I, Chatti S, Mrizak N, Elloumi H, Debbabi H, Ben Azouz S, Marouani R, Cheikh I, Ben Said M, Kallel M, Amdouni A, Rejaibi N, Aouadi L, Zaouche K, Khouya FE, Aidani S, Khefacha S, Jelleli N, Sakly A, Zakhama W, Binous MY, Ben Said H, Bouallegue E, Jemmali S, Abcha S, Wahab H, Hmida A, Mabrouk I, Mabrouk M, Elleuch M, Mrad M, Ben Safta N, Medhioub A, Ghanem M, Boughoula K, Ben Slimane B, Ben Abdallah H, Bouali R, Bizid S, Abdelli MN, Ben Nejma Y, Bellakhal S, Antit S, Bourguiba R, Zakhama L, Douggui MH, Bahloul E, Dhouib F, Turki H, Sabbah M, Baghdadi S, Trad D, Bellil N, Bibani N, Elloumi H, Gargouri D, Ben Said M, Hamdaoui R, Chokri R, Kacem M, Ben Rejeb M, Miladi A, Kooli J, Touati S, Trabelsi S, Klila M, Rejeb H, Kammoun H, Akrout I, Greb D, Ben Abdelghaffar H, Hassene H, Fekih L, Smadhi H, Megdiche MA, Ksouri J, Kasdalli H, Hayder A, Gattoussi M, Chérif L, Ben Saida F, Gueldich M, Ben Jemaa H, Dammak A, Frikha I, Saidani A, Ben Amar J, Aissi W, Chatti AB, Naceur I, Ben Achour T, Said F, Khanfir M, Lamloum M, Ben Ghorbel I, Houman M, Cherif T, Ben Mansour A, Daghfous H, Slim A, Ben Saad S, Tritar F, Naffeti W, Abdellatif J, Ben Fredj M, Selmi M, Kbir GH, Maatouk M, Jedidi L, Taamallah F, Ben Moussa M, Halouani L, Rejeb S, Khalffalah N, Ben Ammar J, Hedhli S, Azouz MM, Chatti S, Athimni Z, Bouhoula M, Elmaalel O, Mrizak N, Maalej M, Kammoun R, Gargouri F, Sallemi S, Haddar A, Masmoudi K, Oussaifi A, Sahli A, Bhouri M, Hmaissi R, Friha M, Cherif H, Baya C, Triki M, Yangui F, Charfi MR, Ben Hamida HY, Karoui S, Aouini F, Hajlaoui A, Jlassi H, Sabbah M, Fendri MN, Kammoun N, Fehri S, Nouagui H, Harzalli A, Snène H, Belakhal S, Ben Hassine L, Labbene I, Jouini M, Kalboussi S, Ayedi Y, Harizi C, Skhiri A, Fakhfakh R, Jelleli B, Belkahla A, Fejjeri M, Zeddini M, Mahjoub S, Nouira M, Frih N, Debiche S, Blibech H, Belhaj S, Mehiri N, Ben Salah N, Louzir B, Kooli J, Bahri R, Chaka A, Abdenneji S, Majdoub Fehri S, Hammadi J, Dorgham D, Hriz N, Kwas H, Issaoui N, Jaafoura S, Bellali H, Shimi M, Belhaj Mabrouk E, Sellami R, Ketata I, Medi W, Mahjoub M, Ben Yacoub S, Ben Chaabene A, Touil E, Ben Ayed H, Ben Miled S, El Zine E, Khouni H, Ben Kadhi S, Maatoug J, Boulma R, Rezgui R, Boudokhane M, Jomni T, Chamekh S, Aissa S, Touhiri E, Jlaiel N, Oueslati B, Maaroufi N, Aouadi S, Belkhir S, Daghfous H, Merhaben S, Dhaouadi N, Ounaes Y, Chaker K, Yaich S, Marrak M, Bibi M, Mrad Dali K, Sellami A, Nouira Y, Sellami S, Anane I, Trabelsi H, Ennaifer R, Benzarti Z, Bouchabou B, Hemdani N, Nakhli A, Cherif Y, Abdelkef M, Derbel K, Barkous B, Yahiaoui A, Sayhi A, Guezguez F, Rouatbi S, Racil H, Ksouri C, Znegui T, Maazaoui S, Touil A, Habibech S, Chaouech N, Ben Hmid O, Ismail S, Chouaieb H, Chatti M, Guediri N, Belhadj Mohamed M, Bennasrallah C, Bouzid Y, Zaouali F, Toumia M, El Khemiri N, El Khemiri A, Sfar H, Farhati S, Ben Chehida F, Yamoun R, Braham N, Hamdi Y, Ben Mansour A, Mtir M, Ayari M, Toumia M, Rouis S, Sakly H, Nakhli R, Ben Garouia H, Chebil D, Hannachi H, Merzougui L, Samet S, Hrairi A, Mnif I, Hentati O, Bouzgarrou L, Souissi D, Boujdaria R, Kadoussi R, Rejeb H, Ben Limem I, Ben Salah I, Greb D, Ben Abdelghaffar H, Smadhi H, Laatiri H, Manoubi SA, Gharbaoui M, Hmandi O, Zhioua M, Taboubi F, Hamza Y, Hannach W, Jaziri H, Gharbi R, Hammami A, Dahmani W, Ben Ameur W, Ksiaa M, Ben Slama A, Brahem A, Elleuch N, Jmaa A, Kort I, Jlass S, Benabderrahim S, Turki E, Belhaj A, Kebsi D, Ben Khelil M, Rmadi N, Gamaoun H, Alaya Youzbechi F, Brahim T, Boujnah S, Abid N, Gader N, Kalboussi S, Ben Sassi S, Loukil M, Ghrairi H, Ben Said N, Mrad O, Ferjaoui M, Hedhli L, Ben Kaab B, Berriche A, Charfi R, Mourali O, Smichi I, Bel Haj Kacem L, Ksentini M, Aloui R, Ferchichi L, Nasraoui H, Maoua M, Chérif F, Belil Y, Ayed MA, Alloulou Y, Belhadj S, Daghfous J, Mehiri N, Louzir B, Abbes A, Ghrab A, Chermiti A, Akacha A, Mejri O, Debbiche A, Yahiaoui C, Binous M, Tissaoui A, Mekni K, El Fekih C, Said MA, Chtioui S, Mestiri S, Smaoui H, Ben Hamida S, Haddar A, Mrizek N, Gares N, Zaibi A, Bouazizi N, Gallas S, Lachhab A, Belhadj M, Hadj Salem N, Garrouch A, Mezgar Z, Khrouf M, Abbassi H, Souissi D, Hamra I, Ben Mustapha N, Abessi I, Boubaker F, Bouchareb S, ElOmma Mrabet H, Touil I, Boussoffara L, Knani J, Boudawara N, Alaya W, Sfar MH, Fekih S, Snène H, Boudawara N, Gargouri I, Benzarti W, Knaz A, Abdelghani A, Aissa S, Hayouni A, Mejri I, Kacem M, Mhamdi S, Daboussi S, Aichaouia C, Moatemri Z, Chaachou A, Fsili R, Ben Ghezala H, Ben Jazia A, and Brahmi N

Published
2023

25. Pattern of homicidal burns in Northern Tunisia: An autopsy-based study over 15 years (2005-2019).

Author

Belghith M, Ben Khelil M, Harzallah H, Kebsi D, Zhioua M, and Hamdoun M

Subjects
Adolescent, Adult, Age Distribution, Aged, Aged, 80 and over, Child, Child, Preschool, Cross-Sectional Studies, Female, Humans, Male, Marital Status statistics & numerical data, Middle Aged, Motivation, Retrospective Studies, Sex Distribution, Tunisia epidemiology, Unemployment statistics & numerical data, Urban Population statistics & numerical data, Young Adult, Burns mortality, Crime Victims statistics & numerical data, Homicide statistics & numerical data
Abstract

Data about homicidal burns remain scarce. Intentional burns are a challenging situation in the case of an individual found dead in a fire zone with no witness of the fatal act. This study aimed to analyze the victim profiles of homicidal burns in Northern Tunisia. It was a descriptive cross-sectional study with a retrospective data collection over 15 years (January 2005-December 2019). In total, 60 cases of homicidal burns were collected. The mean age was 40.22 ± 18.1 years (range 4-82 years). We noted a male predominance (sex ratio M/F = 1.3). Most of the victims were married (48.3%), unemployed (40%), and living in an urban area (63.3%). Homicidal burns occurred most frequently in private homes for female victims (80.8%) and in public places for male victims (31.4%) (p < 0.001). The reported motive varied according to the victim's sex; males were mostly assaulted by an acquaintance in an interpersonal conflict (47.1%), and females were mostly assaulted by an intimate partner while in a dispute (42.3%; p = 0.001). The median total body surface area (TBSA) that was burned was 60.4%, and burn injuries were observed mainly in the anterior part of the body. In 19 cases, the burns were associated with another type of trauma, from which the most common association was burning and stab wounds (12 cases). The identified pattern of homicidal burn casualties was similar to the reported data in Western countries and to homicides in general in Tunisia, suggesting that prevention measures should address those of intentional interpersonal violence., (© 2021 American Academy of Forensic Sciences.)

Published
2021
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26. Trends of infanticides in northern Tunisia: A 40 years study (1977-2016).

Author

Ben Khelil M, Boukthir I, Hmandi O, Zhioua M, and Hamdoun M

Subjects
Autopsy, Developing Countries, Female, Humans, Infant, Newborn, Infanticide statistics & numerical data, Male, Mothers, Prevalence, Retrospective Studies, Tunisia, Infanticide trends
Abstract

Background: The Tunisian Penal Code defines infanticide as the murder committed by the mother on her child at birth or immediately after. There is a dearth of studies and official statistics on infanticide in the Arab region and North Africa., Objective: to analyze the infanticide trends in northern Tunisia between 1977 and 2016., Participants and Setting: we included all cases of infanticides autopsied at the Legal Medicine Department of Charles Nicolle Hospital in Tunis, over a period of 40 years (1977-2016)., Methods: A descriptive retrospective study., Results: We collected a total of 513 cases of infanticide over the study period. The general prevalence of infanticide was 0.42 per 100,000 live births per year. Infanticide often occurred during the week, in winter (31.5%) and in spring (30.9%). The newborn was often found on public roads (40.9%) and in urban areas (81.4%). The newborn was often full-term (73.6%), mature, without any congenital malformation, found completely naked (75.2%) and with an empty stomach (93.7%). The umbilical cord was often cut (71.5%), not ligated (82%) with an irregular edge (64%). There was often no putrefaction (54.4%). The hydrostatic test (81.8%) and histological examination (81.1%) showed that infants had breathed. Neglect was the most common cause of death (49.9%)., Conclusion: Northern Tunisia has a low prevalence of infanticide compared to most of the previous European and American studies. A better understanding of infanticide would allow us to adapt measures of prevention., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Published
2019
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27. Pattern of suicide by self-poisoning in Northern Tunisia: An eleven-year study (2005-2015).

Author

Gharbaoui M, Ben Khelil M, Harzallah H, Benzarti A, Zhioua M, and Hamdoun M

Subjects
Adolescent, Adult, Age Distribution, Aged, Aged, 80 and over, Butanes poisoning, Caustics poisoning, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Pesticides poisoning, Prevalence, Retrospective Studies, Sex Distribution, Tunisia epidemiology, Unemployment statistics & numerical data, Young Adult, Poisoning mortality, Suicide statistics & numerical data
Abstract

Objective: The aim of our study was to discuss the epidemiological features of self-poisoning suicide in Northern Tunisia., Methods: We conducted a retrospective, descriptive and cross-sectional study, including all the cases of fatal self-poisoning suicide occurring between January 2005 and December 2015., Results: In the study period, 204 cases of self-poisoning suicide occurred in northern Tunisia, with a prevalence of 0.44 cases/100 000 inhabitants/year. Among these cases, 59% were females (the sex ratio was 0.69). The mean age was 34 ± 15.3 years-old. The most common age group of the victims (28.4%) was between 20 and 29 years old. Victims were unemployed in 45% of cases and single at the time of suicide in 52%. None of the victims left a suicide note. Self-poisonings were due to the ingestion of drugs (52.5%), pesticides (42.6%), caustic products (5.5%) and Butane gas (1 case)., Conclusions: Fatal casualties of self-poisoning in Tunisia are frequently young, single, unemployed women. This pattern would allow planning of targeted preventive measures., (Copyright © 2018 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)

Published
2019
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28. [Legal redress in relation to physical injury due to post-traumatic anterior pituitary insufficiency].

Author

Mahjoub M, Jedidi M, Mezgar Z, Masmoudi T, Zhioua M, Euch KE, and Njah M

Subjects
Disability Evaluation, Female, Hormone Replacement Therapy, Humans, Hypopituitarism diagnosis, Hypothyroidism etiology, Middle Aged, Time Factors, Tunisia, Accidents, Traffic legislation & jurisprudence, Craniocerebral Trauma complications, Hypopituitarism etiology
Abstract

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.

Published
2017
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29. Impact of the Tunisian Revolution on homicide and suicide rates in Tunisia.

Author

Ben Khelil M, Gharbaoui M, Farhani F, Zaafrane M, Harzallah H, Allouche M, Zhioua M, and Hamdoun M

Subjects
Adolescent, Adult, Age Distribution, Aged, Aged, 80 and over, Cross-Sectional Studies, Female, Humans, Male, Mental Disorders epidemiology, Middle Aged, Residence Characteristics statistics & numerical data, Retrospective Studies, Sex Distribution, Socioeconomic Factors, Tunisia epidemiology, Young Adult, Homicide statistics & numerical data, Suicide statistics & numerical data, Warfare
Abstract

Objectives: To analyze the impact of the Tunisian Revolution on suicide and homicide patterns in Tunisia., Methods: It is a retrospective, cross-sectional study, including all the cases of homicides and suicides that occurred during an 8-year period (2007-2014) in Northern Tunisia. We compared data before and after the revolution., Results: After the revolution, the number of suicides rose 1.7 times, with a prevalence rising from 1.8 to 3.12 suicides per 100,000 persons per year. Homicides rose 1.3 times after the revolution. For both manner of death, victims were mostly males, aged between 20 and 39 years, living in urban areas. Hanging and self-immolation rose, respectively, 1.8 and 3 times after 2011. We observed suicide cases most frequently occurred in public places and in front of public administration after 2011. Homicide victims' profile and circumstances showed a single variation which is an increase in number of cases happening in rural areas., Conclusions: Our results proved a short-term impact of the transition period on homicides and suicides. Urgent preventive measures are needed especially to decrease the suicide rates.

Published
2016
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30. First molecular evidence of [i]Borrelia burgdorferi[/i] sensu lato in goats, sheep, cattle and camels in Tunisia.

Author

Ben Said M, Belkahia H, Alberti A, Abdi K, Zhioua M, Daaloul-Jedidi M, and Messadi L

Subjects
Animals, Borrelia burgdorferi Group, Cattle, Cattle Diseases microbiology, Cattle Diseases parasitology, Cross-Sectional Studies, Female, Goat Diseases microbiology, Goat Diseases parasitology, Goats, Ixodidae classification, Lyme Disease epidemiology, Lyme Disease microbiology, Male, Real-Time Polymerase Chain Reaction veterinary, Sheep, Sheep Diseases microbiology, Sheep Diseases parasitology, Tick Infestations epidemiology, Tick Infestations parasitology, Tunisia epidemiology, Camelus, Cattle Diseases epidemiology, Goat Diseases epidemiology, Ixodidae physiology, Lyme Disease veterinary, Sheep Diseases epidemiology, Tick Infestations veterinary
Abstract

Borrelia burgdorferi sensu lato (s.l.) are tick-transmitted spirochaetes of veterinary and human importance. Molecular epidemiology data on ruminants are still lacking in most countries of the world. Therefore, the aim of this study was to estimate the rate of B. burgdorferi s.l. infection in ruminants from Tunisia. A total of 1,021 ruminants (303 goats, 260 sheep, 232 cattle and 226 camels) from different bioclimatic areas in Tunisia were investigated for the presence of B. burgdorferi s.l. DNA in blood by real time PCR. Prevalence rates were 30.4% (92/303) in goats, 6.2% (16/260) in sheep, 1.3% (3/232) in cattle, and 1.8% (4/226) in camels. Only tick species belonging to Rhipicephalus and Hyalomma genera were found on the investigated animals. In small ruminants, the prevalence of B. burgdorferi s.l. varied significantly according to localities and farms. Goats located in humid areas were statistically more infected than those located in sub-humid areas. Prevalence rates varied significantly according to age and breed in sheep, and age and tick infestation in goats. This study provides the first insight into the presence of B. burgdorferi s.l. DNA in ruminants in Tunisia, and demonstrates that host species such as goats and sheep may play an important role in natural Lyme disease cycles in this country.

Published
2016
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31. Sudden death due to pulmonary embolism in north Tunisia: 37 cases study.

Author

Shimi M, Allouche M, Ben Ahmed H, Zoghlemi B, Gloulou F, Ben Khelil M, Banasr A, Zhioua M, Benzarti A, Hamdoun M, and Baccar H

Subjects
Adult, Aged, Aged, 80 and over, Autopsy, Cohort Studies, Death, Sudden etiology, Death, Sudden pathology, Female, Humans, Male, Middle Aged, Pulmonary Embolism complications, Pulmonary Embolism pathology, Tunisia epidemiology, Young Adult, Death, Sudden epidemiology, Pulmonary Embolism mortality
Abstract

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.

Published
2014

32. Sudden death due to hydatid disease: a six-year study in the northern part of Tunisia.

Author

Khelil MB, Allouche M, Banasr A, Gloulou F, Benzarti A, Zhioua M, Haouet S, and Hamdoun M

Subjects
Adolescent, Adult, Age Distribution, Anaphylaxis mortality, Arterial Occlusive Diseases etiology, Brain Edema pathology, Child, Ecchymosis pathology, Erythema pathology, Female, Forensic Pathology, Heart Failure etiology, Hemorrhage etiology, Hemorrhage pathology, Humans, Male, Mesenteric Arteries pathology, Middle Aged, Pulmonary Edema pathology, Respiratory Insufficiency mortality, Retrospective Studies, Rupture, Sepsis mortality, Sex Distribution, Tunisia epidemiology, Death, Sudden epidemiology, Echinococcosis mortality
Abstract

Human ecchinococcosis also known as hydatid disease is a zoonotic infection caused by the tapeworm Ecchinococcus with 2-3 Million cases worldwide. We hereby report a 6 years period study of Sudden death due to hydatidosis aiming to analyze the epidemiological criteria, death circumstances, and autopsy observations attributed to hydatid disease. During the past 6 years, 26 death cases were due to hydatid disease. Our analysis shows that the sex ratio (M/F) was 1.6, the mean age was 31-year old, and 65% of the subjects lived in rural places. In 17 cases, death occurred in the victim's place, five victims died after a heavy exercise, and in two cases, death occurred immediately after trauma. At autopsy, 91% of the cysts were found in the liver. In three cases, death followed a septic state, and in two cases, it followed an acute respiratory failure. Death was attributed to anaphylaxis in 17 cases., (© 2013 American Academy of Forensic Sciences.)

Published
2013
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33. [Sudden death during sport activity in Tunisia: autopsy study in 32 cases].

Author

Allouche M, Boudriga N, Ahmed HB, Banasr A, Shimi M, Gloulou F, Zhioua M, Bouhajja B, Baccar H, and Hamdoun M

Subjects
Adolescent, Adult, Aged, Aortic Aneurysm, Thoracic complications, Aortic Aneurysm, Thoracic pathology, Arrhythmogenic Right Ventricular Dysplasia complications, Arrhythmogenic Right Ventricular Dysplasia pathology, Cardiomyopathy, Dilated complications, Cardiomyopathy, Dilated pathology, Cardiomyopathy, Hypertrophic complications, Cardiomyopathy, Hypertrophic pathology, Coronary Artery Disease complications, Coronary Artery Disease pathology, Coronary Vessel Anomalies complications, Coronary Vessel Anomalies pathology, Female, Humans, Male, Middle Aged, Retrospective Studies, Status Asthmaticus complications, Status Asthmaticus pathology, Tunisia, Autopsy statistics & numerical data, Death, Sudden, Cardiac etiology, Death, Sudden, Cardiac pathology, Sports
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 79 years with an average age of about 33.16 years. Young subjects whose age is less than 35 years 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 35 years, 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 © 2012 Elsevier Masson SAS. All rights reserved.)

Published
2013
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34. [Four cases of deadly intoxication by Lepiota brunneoincarnata].

Author

Ben Khelil M, Zhioua M, Bakir O, Allouche M, Gloulou F, Banasr A, Haouet S, Hedhili A, and Hamdoun M

Subjects
Adolescent, Autopsy, Child, Child, Preschool, Family, Female, Hemorrhage etiology, Humans, Mushroom Poisoning mortality, Necrosis, Mushroom Poisoning pathology
Abstract

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.

Published
2010
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35. Unusual suicides with band saws: two case reports and a literature review.

Author

Gloulou F, Allouche M, Khelil MB, Bekir O, Banasr A, Zhioua M, and Hamdoun M

Subjects
Adult, Forensic Pathology, Humans, Male, Middle Aged, Schizophrenic Psychology, Construction Materials, Head Injuries, Penetrating pathology, Neck Injuries pathology, Suicide, Wounds, Penetrating pathology
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.

Published
2009
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36. A review of acute poisoning from Atractylis gummifera L.

Author

Hamouda C, Hédhili A, Ben Salah N, Zhioua M, and Amamou M

Subjects
Acute Disease, Humans, Poisoning diagnosis, Poisoning pathology, Poisoning therapy, Atractylis poisoning
Abstract

Atractylis gummifera is a poisonous plant widely found in North Africa. The thistle grows commonly in dry areas, and the juice of the rhizome is poisonous. It provokes frequent poisoning, especially of children. Toxic glucosides have been isolated and their identified as atractyloside and carboxyatractyloside. Tissues of high metabolic activity are the main target organs. Atractylis gummifera glucosides cause a severe hepatitis with fatal liver failure common. The plant's poisonous compounds interact with detoxication and/or transformation systems in the liver even at doses not likely to induce cytolysis by blocking ADP-ATP conversion through inhibition of P450 cytochrome. Clinical manifestations are related to an induced hypoglycemia and neurovegetative disorders or subsequent renal failure. Liver transplantation or immunotherapy may improve the often fatal prognosis.

Published
2004

37. Plant poisonings from herbal medication admitted to a Tunisian toxicologic intensive care unit, 1983-1998.

Author

Hamouda C, Amamou M, Thabet H, Yacoub M, Hedhili A, Bescharnia F, Ben Salah N, Zhioua M, Abdelmoumen S, and El Mekki Ben Brahim N

Subjects
Adolescent, Adult, Aged, Blood Cell Count, Blood Gas Analysis, Blood Glucose analysis, Child, Child, Preschool, Chromatography, Gas, Chromatography, Thin Layer, Creatinine blood, Electrolytes blood, Female, Humans, Liver Failure etiology, Male, Middle Aged, Plant Poisoning epidemiology, Plant Poisoning therapy, Radiography, Thoracic, Retrospective Studies, Tunisia epidemiology, Urinalysis, Phytotherapy, Plant Poisoning etiology, Plants, Toxic toxicity
Abstract

To collect data on Tunisian herbal toxicity we analysed 56 medical records of patients admitted to the toxicological intensive care unit from 1983 to 1998 following the ingestion of plants. The sex ratio of patients was 1:2, the mean age of patients was 26y (2 to 75y) and II species of plants were involved with Atractylis gummifera (32%), Datura stramonium (25%), Ricinus communis (9%), Nerium oleander (7%) and Peganum harmala (7%) most commonly infested. Poisonings involved neurological (91%), gastrointestinal (73%) and cardiovascular systems (18%). Treatment was mainly symptomatic. The only lethal cases of liver failure involved 16 Atractylis gummifera poisonings.

Published
2000

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