Sexual violence against women in southern Tunisia: Epidemiology and risk factors.

INTRODUCTION: Sexual violence (SV) against women represents a public health problem. Despite, the promulgation of the new Act of 2017-58, SV remains frequent in Tunisia. In this paper, we propose to determine the socio-demographic characteristics of women victims of SV and to identify risk factors related to serious SV. MATERIAL AND METHODS: This is a retrospective, descriptive and analytical study including all women victims of SV, examined at the Forensic Department of Sfax Hospital, between 1st March 2018 and February 29th, 2020. We defined serious SV as any sexual violence associated with genital or anal lesions. RESULTS: We collected 269 cases of women victims of SV. This sexual violence was associated with extra-genital physical violence in 18.86 % of the cases. The average age of the victims was 21.23 years (+/-10.67 years). The consultation delay was relatively long. Only 11.52 % of victims consulted within 24 h. It was mainly an extra-family abuse. Vaginal examination revealed recent defloration in 9.29 % of the cases. The proctological examination was normal in most cases (61.63 %).Seven victims were pregnant. In the analytical study, we studied the risk factors of serious SV against women. A total of 150 cases were considered serious (55.8 %). Serious SV was statistically related to the age (over 18),the profession (housewives),the origin (urban),and the relationship with the aggressor (friend, neighbor, or family member).The risk of serious SV was greater when the victim didn't have any traumatic extra-genital injury. CONCLUSION: Sexual violence is a serious problem worldwide and in Tunisia. The Tunisian legislation repressing SV has been strengthened by the promulgation of the 2017-58 Act. However, much effort remains to be deployed to fight against this form of violence.

Physical violence against women in southern Tunisia: Epidemiology and risk factors.

INTRODUCTION: Violence against women is a widespread offense worldwide. It causes serious physical, psychological, and medico-legal repercussions. We aim to specify the socio-demographic characteristics of female victims of physical violence well as the medical consequences and risk factors related to serious physical violence against women in Tunisia. MATERIALS: This is a retrospective study including all women victims of physical violence, examined on judicial requisition at the Forensic Department of Habib Bourguiba University Hospital in Sfax, over two years (March 1st, 2018 to February 29th, 2020). Physical violence is considered serious whena forensic specialist predicts long term effects at the lesional stage (determining partial permanent disability: PPD). RESULTS: In our study, 2909 women were victims of physical violence. The average age of the victims was 34 ± 13 years (extremes:2 and94 years). The majority of victims were married (83.3%), jobless (52.5%), and of an urban origin (72.7%). Physical violence predominated in summer and autumn with a peak in frequency in July and at weekends. The consultation delay ranged between 1 and 30 days in two-thirds of the cases. The perpetrator was an intimate partner in 38.2% of cases, a stranger in 11.1% of cases, and a family member in 5.9% of cases. The weapon used was a blunt object in 82.8% of cases. Injuries were preferentially located in the upper limbs (52.6%) followed by the head and face (42.7%), consisting essentially of bruising and abrasions. The median duration of the total temporary disability (TTD) was 5 days (extremes: 0-60 days). The duration of TTD was statistically correlated to the type and the site of the most serious injuries. Moreover, there was a statistically significant correlation between the duration of TTD and the PPD prediction (p < 0.001). A 9-day TTD represented the threshold to expect PPD. A total of 198 cases (6.8%) were considered serious. Serious physical violence was statistically correlated to the origin of the victim (urban), the relationship with the aggressor (stranger, or thief), the type of weapon used (sharp or thermal force), the type of injury (contused wound, sharp wound, penetrating wound, fracture-dislocation, or head trauma) and thesite of the injury (head and face). CONCLUSION: Violence against women is a very widespread practice in our society. Despite legislative advances, Tunisian women remain victims of discrimination in several areas. A change in mentalities and an awareness of the need to respect women's rights are necessary and require collaboration between the various social, legal and medical stakeholders.

[Pulmonary thromboembolism: incidence, physiopathology, diagnosis and treatment]. / L'embolie pulmonaire fibrino-cruorique fréquence, physiopathologie, tableau Clinique et traitement.

AIM: The objective of this work was to review current data about the pathophysiology, clinical features, and treatment of pulmonary thromboembolism. Venous thromboembolism (VTE) remains a major challenge in hospitalised especially the care of critically ill patients. Pulmonary embolism (PE) is the major complication of VTE. By occluding the pulmonary arterial bed it may lead to acute life-threatening but potentially reversible right ventricular failure. The outcome of patients with PE is quite variable depending primarily on the cardio-respiratory status and the embolus size. PE is a difficult diagnosis that may be missed because of non-specific clinical presentation. Clinical signs include hypoxia, tachypnea, and tachycardia. Severe cases of untreated PE can lead to circulatory instability, and sudden death. However, in ICU, most of patients require sedation and mechanical ventilation. The clinical manifestations usually observed in this condition (PE) cannot be exhibited by these patients and clinical presentation is usually atypical. For these reasons, the diagnosis of PE is usually suspected when un-explicated hypoxemia and/or shock and arterial hypotension were observed. Positive diagnosis is based on these clinical findings in combination with laboratory tests and imaging studies. D-dimer testing is of clinical use when there is a suspicion of DVT or pulmonary embolism PE. In Emergency department, a negative D-dimer test will virtually rule out thromboembolism with a negative predictive value at 95 to 98%. In massive and submassive PE, dysfunction of the right side of the heart can be seen on echocardiography. While the gold standard for diagnosis is the finding of a clot on pulmonary angiography, CT pulmonary angiography is the most commonly used imaging modality today. When the diagnosis is confirmed, anticoagulant therapy is the mainstay of treatment. Acutely, supportive treatments a pivotal role in the management of patients with PE. Severe cases may require thrombolysis with drugs such as tissue plasminogen activator (tPA) or may require surgical intervention via pulmonary thrombectomy. Prevention is highly warranted.