Caregiver-fabricated illness in a child is a form of child maltreatment caused by a caregiver inducing a child's illness, leading to unnecessary and potentially harmful medical procedures and treatments. This condition can result in significant morbidity and mortality. We present the case of three siblings in Tunisia who were poisoned with chloralose by their own mother. The symptoms that the children presented with led to misdiagnoses, which resulted in the death of two of the children. Characteristics of the clinical presentation are articulated, followed by a discussion of the legal measures that apply to the offender and the role of physicians, nurses, and medicolegal experts involved in such a complex medical situation.
Background: The growing proportion of elderly implies that natural and unnatural deaths of the elderly will be increasingly confronted. The objective of our study was to determine the unnatural manner and causes of death in the elderly, defined as individuals at least 65 years of age at the time of death. We conducted a monocentric restrospective study based on police investigation reports and medicolegal autopsy reports collected from the Department of Legal Medicine of Charles Nicolle Hospital in Tunis, Tunisia between January 1st, 2016 and December 31st, 2017. Results: During this period, 3837 autopsies were performed. Five hundred ninety-two (15.4%) were 65 years or older at the time of death. Of these, 264 deaths were categorized as accidental, suicidal, homicidal, or unknown. The mean age of victims was 75.3 years (± 6.7), unnatural deaths were higher in urban areas (64%) and victims were living alone in 24.7% of cases. Accidents accounted for the majority of unnatural deaths (90.5%) and were more common in males. Traffic accidents accounted for 66.9% of accidental deaths; they were more frequent in pedestrians and more frequent on Monday. They were followed by accidental falls which accounted for 17.2% of accidents and occurred in the home especially or in the workplace. Charcoal brazier was incriminated in 11 cases of accidental thermal burns and in all cases of accidental carbon monoxide poisoning. Suicide and homicide were uncommon manners of death; they were observed in 16 and eight cases respectively. Hanging was the most used suicidal mean. Suicides were more common in males; they took place especially in the victim's home, and history of psychiatric disorders was frequently elicited. Conclusions: Autopsies provide important statistical data that can be used for preventive strategies. For instance, actions must be carried out on the maintenance of public roads and raising awareness among public road users. Preventive measures should also include home improvement to help the elderly avoid accidental falls, installing smoke detectors, and the non-use of defective or rudimentary heating.
Synthetic cathinones are one of the major pharmacological families of new psychoactive substances and 4-methylethcathinone (4-MEC) has emerged in recent years as a recreational psychostimulant. We report a case of a 35-year-old man found dead and naked at home by his friend. Although no anatomic cause of death was observed at autopsy, toxicological analysis identified 4-MEC and hydroxyzine at therapeutic level (160 ng/mL). 4-Methylethcathinone was quantified in autopsy samples by a validated method consisting in liquid-liquid extraction and gas chromatography coupled to tandem mass spectrometry: peripheral blood, 14.6 μg/mL; cardiac blood, 43.4 μg/mL; urine, 619 μg/mL; vitreous humor, right 2.9 μg/mL and left 4.4 μg/mL; bile, 43.5 μg/mL; and gastric content, 28.2 μg/mL. The cause of death was 4-MEC intoxication and the manner of death could be either accidental or suicidal. The literature concerning 4-MEC was reviewed, focusing on distribution in classical postmortem matrices and 4-MEC metabolism and postmortem redistribution and stability.
A man was found lying dead next to a ladder, with only a laceration surrounded by an abrasion visible upon external examination. No skull fractures were palpable. A CT scan and MRI showed a Jefferson fracture of the atlas, associated to a posterior displacement of the skull, a fracture of the dens of the axis, and fractures of the bodies of C5 and C6. Jefferson fractures typically result from a blow to the apex of the skull. In such cases, forensic pathologists should suspect the existence of a Jefferson fracture, particularly when no severe injuries are visible externally.
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