Managing mass disasters linked to the sinking of illegal migrant boats: experiences of the Sfax forensic medicine service.

Background: The sinking of illegal migrant boats has been unpredictable. It has resulted in mass disasters that cause deaths and attracts huge media attention, thus making it a medico-social emergency. Aims: This paper reports activities of the forensic medicine service in Sfax, Tunisia and describes the forensic management of mass disasters related to the sinking of illegal migrant boats as well as the main challenges. Methods: This is a retrospective, descriptive study that includes all cases of drowning deaths examined at the forensic department of Habib Bourguiba Hospital, Sfax, following the sinking of illegal migrant boats over a four-year period (October 2017 to September 2021). Results: During the study period, we received 539 corpses following the sinking of illegal migrant boats. The median number of deaths was 93 per year. There was a significant decrease in the number of victims in 2019 (13 victims), followed by a significant increase in 2020 (115) and 2021 (271). We noted two frequency peak periods in June and July, 31.4% and 20.8%, respectively. The victims were mostly male (67.5%) with a sex ratio of 2.08. Minors aged under 18 years were 5.8% and pregnant women were 2.4%. The majority (63.1%) of the victims were of sub-Saharan origin and there has been an increase in the number of victims from this region over the past two years. Samples were systematically collected for genetic investigation and 146 (27.1%) victims were identified. Conclusion: There have been significant advances in the identification of the victims of migrant boat sinking around the Tunisian coast, however, there are several challenges in providing information rapidly to the families of the victims to clarify the uncertainty about the fate of their missing loved ones.

[Medico-legal issues of the practice of ritual circumcision by nurses in Tunisia]. / Enjeux médico-légaux de la pratique de la circoncision rituelle par les infirmiers en Tunisie.

Circumcision is the most performed surgical procedure in the world. This removal of the foreskin answers most often to an obligatory ritual practice in the Jewish and Muslim religions. In Tunisia, this act, formerly practiced by customary circumcisers, is mainly performed by nurses. In case of complications, the responsibility of the latter remains unclear, in the absence of regulations specific to this ancestral practice, with the exception of two ministerial circulars.

[Medical experimentation on prisoners (part 5): ethical considerations].

Medical experimentation on prisoners is one of the most difficult ethical issues because it brings many principles into conflict with the reality of the practice. These ethical principles, which are universal and timeless, are accepted as elementary rights for every human being. However, in a detention setting, these principles are easily lost. Moreover, the scope of this problem goes far beyond the walls of the penitentiary to touch on conflicting issues of scientific publication, social discrimination, and even political decisions sometimes. The present history note, the fifth in a series on medical experimentation on prisoners, intended to discuss the main ethical considerations regarding prisoners, and to highlight the difficulty of their implementation.

Criminal medical liability in the context of Covid-19 pandemic.

The COVID-19 infection causes to medical community many difficulties worldwide. In addition to its therapeutic problems, it can generate situations with high medico-legal risk to doctor who can see his criminal medical liability engaged. In fact, in Tunisia, this new infection imposes many specific legal obligations. Some of these obligations have recently been introduced, therefore still little or not known by doctors, despite the need for them to comply with. In this paper, we propose to analyse the circumstances of medical practice in Covid-19 pandemic period , which risk to engage the doctor's criminal medical liability, and to set out the sanctions incurred, in order to protect health professionals against the specific legal risk of this emerging disease.

The Causality Nexus Between the Tako-tsubo Syndrome and an Assault: A Forensic Case Report.

"Tako-tsubo" cardiomyopathy, also known as "broken heart syndrome," is one of the rarest types of stress-induced cardiomyopathy. It frequently mimics acute coronary syndrome, characterized by transient left ventricular dysfunction, electrocardiographic changes, and release of myocardial enzymes. After treatment, the patients are cured in most cases without sequelae. Tako-tsubo syndrome is rarely considered as a reason for consultation in the forensic department.Herein, we report a case of a 68-year-old woman who was assaulted by her police officer neighbor. The latter punched her in the arms and kneed her in the gut without causing any intrathoracic or abdominal injury. The victim was urgently hospitalized in the cardiology department for chest pain and dyspnea accompanied by ST-segment elevation and high troponin level.Tako-tsubo cardiomyopathy diagnosis was based on clinical findings, echocardiography, coronary angiography, and magnetic resonance imaging findings. A forensic medicine consult was initially solicited for the drafting of an initial medical certificate and for evaluating the total transitory disability rate. A second consultation was then sought to evaluate the permanent partial disability.We report this work to discuss the conduct of the forensic pathologist and to prove the causality relationship between the assault and the physical injuries.

Congenital heart disease in 37,294 births in Tunisia: birth prevalence and mortality rate.

AIM: To investigate the previously unknown birth incidence, treatment, and mortality of children with congenital heart disease in Tunisia. METHODS: We undertook a retrospective review of medical records of all patients who were born in 2010 and 2011, and were diagnosed in Sfax (Tunisia) with congenital heart defect. RESULTS: Among 37,294 births, 255 children were detected to have congenital heart disease, yielding a birth incidence of 6.8 per 1000. The most frequently occurring conditions were ventricular septal defects (31%), ostium secundum atrial septal defects (12.9%), and pulmonary valve abnormalities (12%). Coarctation of the aorta, tetralogy of Fallot, univentricular physiology, pulmonary atresia with ventricular septal defect, and transposition of the great arteries were found in 4.3%, 6.2%, 3.4%, 2.7%, and 2.7%, respectively. During the follow-up of 1 year, 23% of the children died. About three-quarters of those deaths happened before surgery. CONCLUSION: The present study is in line with the general estimates in the world. It has revealed a high case of mortality among the patients awaiting corrective surgery. These children need more facilities.

[Fetal cytomegalovirus infection diagnosed on autopsy: a case report]. / Infection fœtale à cytomégalovirus de diagnostic autopsique: à propos d'un cas.

The cytomegalovirus (CMV) is the most common maternal-fetal transmission infectious disease. The diagnosis of this infection is rarely made on antenatal sonographic signs. Pathological examination could, in this case, make etiologic diagnosis. We report the case of a terminated pregnancy, at the term of 19 weeks of gestation, occurring in a 31-year-old woman. The sonography found a terminated pregnancy with anamnios. Histological examination of samples of fetal internal organs showed intranuclear inclusions, compatible with CMV infection. The main objective of our work is to emphasize the value of histological examination in the diagnosis of fetal death etiology. Moreover, we will discuss the benefit of antenatal screening of CMV maternal infection.