Unexpected infant death secondary to a pulmonary infiltration due to acute myelocytic leukaemia

Acute myeloid leukaemia (AML) often presents with non-specific symptoms such as fatigue, anaemia or infection. Pulmonary involvement is uncommon in AML during the course of the disease and is usually caused by infection, haemorrhage, leukaemic pulmonary infiltrates and leukostasis. Lung localization of AML is very uncommon and potentially life threatening if not diagnosed and treated rapidly. The authors describe the sudden death of an asymptomatic five-month-infant because of a misdiagnosed lung localization of AML. Autopsy examination followed by histopathological studies showed an extensive leukostasis and extramedullary leukaemic infiltrating the lungs. Special stains and immunohistochemical studies revealed findings consistent with acute myelogenous leukaemia. This case suggests that underlying acute leukaemia should be considered as a cause of flu-like symptoms in infants. Medical personnel are urged to be alert to fever, sore throat, weakness and dyspnea that may be characteristic of serious systemic diseases.

[Clinical and sociodemographic characteristics of sudden cardiac death victims in northen Tunisia]

The sudden cardiac death remains a major public health problem. This dramatic event has not been well investigated in Tunisia. The aim of this work is to study the epidemiological and socio demographic characteristics of Tunisian victims. We prospectively collected clinical, socio demographic and pathology data of victims of sudden cardiac death occurring in the northern Tunisia from October 2010 to September 2012. The study population included 392 men and 108 women with a mean age of 52,2 + / - 15,8 years. Three quarters of the victims were sedentary, 57,9% were smoker and a family history of sudden death was identified in 9,8% of cases. Half of victims had a primary school education, only 8,4% has a university education, 65,6% of subjects lived in urban areas and 64% of victims were married. The vast majority of deaths had occurred either in a public place [41,4%] or at home [36,6%]. The most frequent circumstance of death was at rest [67%]. Only 5,1% of victims were transported by emergency medical services and 12,1% by civil protection. Ischemic heart disease was the leading cause of death with 267 cases; however a negative autopsy was denoted in 13,9% of victims. Victims of sudden cardiac death in northern Tunisia were relatively young with a male predominance. Physical inactivity and smoking were the most common risk factors for cardiovascular disease. The majority of victims were married, had an urban origin and a low level of education. Ischemic heart disease was the first etiology of sudden death

[Weekly variation of sudden cardiac death in northen Tunisia]

The sudden cardiac death remains a major public health problem. Several studies have reported weekly variation of this dramatic event. The aim of this work is to determine the day-of-week variability in sudden cardiac death in northen Tunisia. Methods: We prospectively collected clinical, socio demographic and autopsic data of victims of sudden cardiac death occurring in the northern Tunisia between October 1 st ,2010 and September 30,2012. The study population included 392 men and 108 women with a mean age of 52.27 + / - 15.8 years. Three quarters of the victims was sedentary, 57.9% were smoker and a family history of sudden death was identified in 9.8% of cases. The vast majority of deaths had occurred either in a public place [41.4%] or at home [36.6%]. Ischemic heart disease was the leading cause of death with 267 cases [53.4%]; however a negative autopsy was found in 13.9% of victims. The highest sudden death occurrence was on Sundays [17.8%] and the lowest on Mondays [11.4% p: 0.01].The same weekly variation was noted among both men and women, and also in victims > 60 years, a minimum of events occurred on Mondays [11.6%] and a maximum on Sundays [21.9%]. In addition, we found the same peak of mortality on Sunday [18.8%] in young adults and the nadir on Monday [10.3%]. The present study demonstrates marked variation in the occurrence of sudden cardiac death in the northern Tunisia with peak on Sundays and nadir on Mondays. No age or gender- related differences were found in weekly variation of sudden death

Sudden death due to pulmonary embolism in north Tunisia: 37 cases study

To determine frequency of pulmonary embolism as the cause of sudden death and to study clinical, epidemiological characteristics and risk factors. 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. 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. 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

[Relationship between ambient temperature, humidity and sudden cardiac death in Northern Tunisia]

Several studies have suggested a relationship between weather parameters and the occurrence of sudden cardiac death. The aim of this work was to study the impact of changes in temperature and humidity level on the occurrence of sudden cardiac death in the north of Tunisia. It's an autopsic study that included all victims of sudden cardiac death occurring in northern Tunisia between October 2010 and September 2012. The minimum, maximum and average of daily temperatures and humidity during the study period were recorded and compared with the monthly variation in the occurrence of sudden death. The study population included 392 men and 108 women with a mean age of 52.2 +/- 15.8 years. The highest rate of sudden death [37%] was observed at ambient temperatures below 15 degrees and only 4.2% of deaths occurred at temperatures above 30 degrees ambient temperatures [p <0.001]. Among the population aged over 60 years, the highest mortality rate [47.3%] were recorded at temperatures below 15 degrees, while 35.5% of young patients under 40 years died during periods with temperatures between 20 and 30 degrees and 56.8% of deaths occurred in the humidity levels between 60 and 78% . In the north of Tunisia where the climate is temperate, a temperature drop below 15 degrees was significantly associated with a sudden cardiac death. This excess winter cardiac mortality was more pronounced in the elderly

[Occupational Carpal tunnel syndrome [Concerning 27 cases]]

Carpal tunnel syndrome is the most frequent of tunnel syndromes in the field of the professional sphere. It is related to repetitive movements of flexion-extension of the wrist and fingers or to a support on the heel of the hands. To determine the posts in a risk and to specify the modalities of guaranteed reimbursement of professional carpal tunnel syndrome. A retrospective and descriptive study of 27 medical files of employees indemnified for professional carpal tunnel syndrome registered in the medical control services of the social security office in charge of medical insurance of Tunis and Sousse during a period of 10 years [1995 - 2004]. There were 24 women and 3 men with the average age of 40 years all occupying posts in a risk. Their average time of service is 15 years. Two-thirds of them work in the clothing and textile industry. The attack is bilateral in 13 cases. Nightly acroparaesthesia rules the clinical rate [44.44% of cases]. Motor disorders are noted in the quarter of cases. The electromyogram had confirmed diagnosis in all of cases. The previous state study put in evidence the antecedent of carpal tunnel syndrome in 5 cases and diabetes in one case. Twenty-one patients had profit of permanent partial incapacity with a rate varying from 3 to 25%. Five had got a transfer of working place and one stayed in the same post with a half-time work. The professional origin of carpal tunnel syndrome must be called up in front of an activity in a risk. The reparation is done according to picture 82 of occupational diseases

[Community-acquired pneumonia due to panton-valentine producing staphylococcus aureus: first description in Tunisia]

Community-acquired pneumonia clue to Panton-Valentine producing S. aureus is a serious infection recently described. Many cases have been reported worldwide. We report here the first case in Tunisia. Our patient is a previously healthy fourteen-year-old girl hospitalized for bilateral hypoxemic pneumonia. The clinical course had violently deteriorated two hours later, marked by massive hemoptysis that lead to rapid degradation of her hemodynamic state and death. Toxicologic research and blood cultures were negatives. A post- mortem pleural specimen culture yielded a meticillin-resistant Staphylococcus aureus strain that carried the Panton-Valentine leucocidin genes. Community-acquired pneumonia due to Panton-Valentine producing Staphylococcus aureus is a serious affection unrecognized in our country. Thus, this pathogen must imperatively be included in the spectrum of those responsibles for pulmonary infections in children and young adults