Homicidal sharp force cases: An 11-year autopsy-based study.

Sharp force injuries represent a major constituent of physical assaults and homicidal fatalities, especially in countries with strict firearm legislations. In forensic investigations, the examination of homicidal sharp force cases remains a challenge for both determining the cause and manner of a death. The aim of this study is to analyze the patterns of homicidal sharp force cases in Northern Tunisia. We perform a descriptive study with a retrospective data collection over an 11-year period (January 2007-December 2017). During the study period, 405 cases of homicidal sharp force casualties were observed. The mean age was 33.9 years, with a range of 2 months-89 years. We note a male predominance (male to female ratio of 4.7), most of who were single (91.2%). The casualties lived mainly in urban areas (68.4%) and were unemployed or daily workers in 61% of cases. Assaults occurred mainly during summer (52.4%) at weekends (38%) in a public place (62.4%) with essentially one perpetrator (68.6%) who was an acquaintance of the deceased in 32.6% of cases. The injuries were primarily located in the thorax (75%) and were associated with defensive wounds in the upper limbs. The most frequent cause of death observed was hemorrhage (82.9%). The analysis of patterns in homicidal sharp force cases allows us to construct specific preventive measures that target young males. Lesion analysis aids forensic specialists in following a thorough autopsy to determine the causes of death.

Unusual bullet embolism in the brachial artery: Case report and literature review.

Chest cardio-vascular trauma by a gunshot bullet is less common than head trauma in forensic medicine practice, but still an extremely mortal injury. In front of no exit wound, ballistic trajectory could appear unexplained. We present the case of a 43-year-old man who sustained a gunshot wound in his chest. The entrance was facing the sternum and there was no exit wound. An autopsy completed by forensic radiology (CT-scan of the whole body) showed a wound of anterior pericardial, massive bleeding of pericardia, a wound of the anterior ascending thoracic aorta, and then the bullet embolism to the left brachial artery. Without forensic imaging, the bullet was difficult to find. Bullet embolization should be suspected when there is a gunshot injury to the chest without an exit injury and with no projectile in the area, particularly if the projectile is small. Forensic radiology can help to find bullet projectile: by using whole-body radiography or computed tomography.

Age estimation based on the acetabulum using global illumination rendering with computed tomography.

INTRODUCTION: The acetabulum has been reported as a reliable age estimation marker. However, analyzing its morphological changes can be challenging using computed tomography (CT) imaging. Newly introduced global illumination rendering (GIR) applied to CT can improve the visualization of the fine details and thus the method's performance. This study aimed to analyze age estimation using morphological features of the acetabulum using GIR applied to CT. METHODS: We collected 200 postmortem CT scans. A segmentation of the acetabular joint was initially done. Then, three-dimensional (3D) reconstruction of the images was performed using GIR. These images were saved and then analyzed by two operators based on the three morphological criteria described in the Rougé-Maillart method. Reproducibility was assessed by intraclass correlation (ICC). Age estimation was assessed by multiple linear regression. RESULTS: The sample was composed of 155 males and 45 females, with a mean age of 50 ± 18.3 years old. We observed high agreement in both the inter-observer and intra-observer reproducibility for the three variables (ICC of 75.6 to 90.8% and 89.3 to 95.8%, respectively) and the total score (ICC of 93.5% and 95%, respectively). The three variables, as well as the total score, were significantly correlated with age groups. The total score showed a prediction rate higher than 85% for ages under 40 and over 70 years old. We identified three models with two validated models with an adjusted R2 of 85.6% and 84.8%, respectively; a standard error of 0.688 and 0.706, respectively; and a good correlation of all variables and no inter-correlation. The first validated model included the three morphological criteria scores, and the second model was based on the total score. CONCLUSION: GIR applied to CT provides photorealistic images that can be useful for forensic imaging intended for age estimation based on morphological methods.

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

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.

Workplace traumatic accidental death in Northen Tunisia.

BACKGROUND: Workplace accidents represented a Global public health problem with about two millions persons dying from accidents at work or occupational diseases. In Tunisia, data on fatal traumatic workplace accidents remain scarce. Work-related accidents accounted for 0.4% of the employed population in 2014, with a prevalence of fatal accidents between 4 and 25 per 100,000 workers depending on the region and the field. AIM: To describe the victim's profile of workplace traumatic accidents in Northern Tunisia. METHODS: It was a retrospective cross-sectional study, including all cases of accidental workplace traumatic accidents autopsied at the Department of Forensic Medicine, Charles Nicolle Hospital in Tunis over a period of 12 years (2003- 2014). RESULTS: We collected 741 cases, including 724 men. The median age was 38.5 years. Construction sector represented 70% and the industrial sector represented 12.6% of cases. Victims were workers in 91.4%. Falls from height was the most frequent accident type (43.5%), followed by objects falling (26.5%) and electrocutions (18.5%). Death occurred at the place of accidents in 58% cases. CONCLUSION: Our study highlighted the need to reinforce and to adapt the prevention measures toward workers in the construction sector, in order to reduce the mortality from traumatic workplace accidents.

Workplace Homicides in Northern Tunisia: A 15-Year Study (2003-2017).

BACKGROUND: Death in workplaces remains a public health issue. However, data regarding workplace homicides are scarce in most of regions, especially in the Arab world. The aim of our study was to analyze the epidemiological features of workplace homicides in northern Tunisia. MATERIALS AND METHODS: This is a descriptive study with retrospective data collection over a 15-year period (January 2003 to December 2017). RESULTS: We recorded 50 workplace homicide cases. Sex ratio was 49:1 (male/female). The mean age was 41.6 ± 15.13 years. Occupations the most at risk were security guards (odds ratio, 8.25; 95% confidence interval, 4.28-15.91; P < 0.0001) and taxi drivers (odds ratio, 5.61; 95% confidence interval, 2.39-13.18; P < 0.00001). The motive of the aggression was either interpersonal conflict or robbery (47.9% and 43.8%, respectively). Victims working as security guards or taxi drivers were most frequently assaulted by an unknown perpetrator, the motive being robbery. Death was most frequently secondary to blunt trauma (n = 20) or stab wounds (n = 15). CONCLUSIONS: Workplace homicides represent a substantial phenomenon in Tunisia. The application of prevention measures is required based on improving environmental measures targeting, in priority, security guards and taxi drivers.

Submandibular lipoblastoma: Case report of a rare tumor in childhood.

Lipoblastoma is a rare, benign tumor usually occurring in childhood. It is essentially localized in the extremities and trunk, with few cases reported in the neck. We report the case of a 2-year-old girl with a rapidly enlarging, painless neck mass. Magnetic resonance imaging (MRI) revealed a 3-cm mass in the right submandibular region. Review of literature, diagnostic methods, and genetics of lipomatous tumors are discussed. Complete surgical excision via a lateral cervical approach demonstrated a white soft tissue with an adherent ganglion. Histology and immunohistochemistry confirmed the diagnosis of lipoblastoma. Cervical lipoblastoma is rare, and typically asymptomatic, rarely causing nerve compression or airway obstruction. MRI can help identifying the lipomatous nature of the mass, but the findings can be inconsistent due to variable maturity of fat cells and the mesenchymal content of the tumor. Diagnosis is always based on pathological examination. Further chromosomal analysis is useful in differentiating lipoblastoma from liposarcoma. Complete surgical excision is the recommended treatment.