BackgroundViral myocarditis is a major cause of sudden unexpected death in children and young adults. Until recently, coxsackievirus B3 (CVB3) has been the most commonly implicated virus in myocarditis. At present, no standard diagnosis is generally accepted due to the insensitivity of traditional diagnostic tests. This has prompted health professionals to seek new diagnostic approaches, which resulted in the emergence of new molecular pathological tests and a more detailed immunohistochemical and histopathological analysis. When supplemented with immunohistochemistry and molecular pathology, conventional histopathology may provide important clues regarding myocarditis underlying etiology.MethodsThis study is based on post-mortem samples from sudden unexpected death victims and controls who were investigated prospectively. Immunohistochemical investigations for the detection of the enteroviral capsid protein VP1 and the characterization and quantification of myocardial inflammatory reactions as well as molecular pathological methods for enteroviral genome detection were performed.ResultsOverall, 48 sudden unexpected death victims were enrolled. As for controls, 37 cases of unnatural traffic accident victims were studied. Enterovirus was detected in 6 sudden unexpected death cases (12.5 %). The control samples were completely enterovirus negative. Furthermore, the enteroviral capsid protein VP1 in the myocardium was detected in enterovirus-positive cases revealed by means of reverse transcriptase-polymerase chain reaction (RT-PCR). Unlike control samples, immunohistochemical investigations showed a significant presence of T and B lymphocytes in sudden unexpected death victims.ConclusionsOur findings demonstrate clearly a higher prevalence of viral myocarditis in cases of sudden unexpected death compared to control subjects, suggesting that coxsackie B enterovirus may contribute to myocarditis pathogenesis significantly.

Background: Mortality rates and causes of death of the detainees are hence different from those of the general population and there also vary according to regions and countries. Aims: To study the peculiarities of death among individuals detained in the region of Sousse in Tunisia and to suggest preventive measures. Material and methods: This is a descriptive retrospective study of all deaths in detention collated in the Forensic Medicine department of Farhat Hached teaching hospital in Sousse, Tunisia during a 10-year period 2006 to 2015. Results: 26 deaths were collected. All the victims were males. The mean age was 39.5 years. The deaths occurred inside the prison in 42.3% and 57.7% in a hospital. The deaths were of natural causes in 69.2%. The most common natural causes were cancer (6 cases, 33.3%) and infections (5 cases,27.8%). Violent death accounted for 31.8% of deaths with 08 victims. Suicide and homicide were the violent death causes most incriminated each with 11.5% (3 cases). The suicide means was hanging in all cases. The death was accidental in 2 cases (7.7%). Conclusion: This study shows that a large proportion of deaths among prisoners are preventable. Prevention is, on the one side, by improving the prison health coverage and on the other side by training the prison staff on the identification of suicidal crises and on controlling the technical devices facilitating the transition to the suicidal act, in particular the hanging cases.

The natural history of the echinococcosis can be studded with multiple complications; the most formidable is sudden death. We studied the epidemiological, pathological, and thanatological features of 34 sudden deaths due to hydatid cyst. The mean age was 33.2 years. A male predominance was observed with a sex ratio of 1.8. Most of our victims were from rural areas (79.4%). Sudden death was preceded by prodromal symptoms in 61.7% of cases. The most common was dyspnea (23.5%), followed by hemoptysis (11.8%). In 85.3% of cases, the cyst location was liver. It was cracked in 25 cases and broken in 6 cases. The rupture was spontaneous in 25 cases (73%). It was preceded by trauma in 7 cases. Death was related to an anaphylactic shock in 82.3% of cases, infection in 14.7%, and respiratory distress in 3% of cases. Sudden death is a serious and not exceptional complication of hydatid cyst. Several mechanisms may explain the sudden death.

Violence against women represents a serious concern worldwide. In Tunisia, despite an advanced legislative framework, we still receive women victims of violence. This survey aimed to characterize the demographic and clinical profile of women victims of violence in Kairouan, central Tunisia. This survey was designed as a cross-sectional study. It concerned women victims of violence over 18 years old, consulting the emergency department of the University Hospital of Kairouan during 3 months in 2017. We defined violence against women according to the Tunisian protection of gender discrimination law. This survey included 100 Tunisian victims of violence; their median age was 35 (ranging from 18 to 59 years old). This study showed that 58% of victims, CI95% [48.3%, 67.6%], were illiterate or had only a primary level education and that 90%, CI95% [84.1%, 95.8%], had a low or middle socioeconomic level. The Intimate Partner Violence was about 70% among all cases, CI 95% [61.0%, 78.9%]. Most aggressive partners were young (aged between 39 and 51 years old). The most affected part of the body was the face (76%, CI 95% [67.6%, 84.3%]). Alcohol consumption was the primary risk factor of violence in 29.6% of cases, CI95% [20.0%, 37.9%]. Other risk factors were the occupational instability, conflicts with the family in-laws and infidelity. Violence against women remains widespread. Even strict legislations in Tunisia didn't protect women sufficiently from different types of violence. It mostly happens within intimate relationships. Therefore, surveillance and early intervention controlling risk factors are extremely important.

High chairs are commonly used to feed children after 6 months. Related injuries are oftentime minor and rarely leading to death. We describe a case of a 2-year-old female child who used to jump alone on her high chair and also had the habit to fasten the straps by herself. Her mother found her hanging by the waist straps. A thorough investigation showed that she climbed her high chair and fastened the waist straps but not the crotch one. The girl slid down into the seat, trapping her neck in the waist straps and thus resulting in hanging. In here, we concluded that the victim's death was caused by asphyxia, itself, caused by accidental hanging. The present case is of a special interest because of the rare similar cases reported. This case suggests that a correct restraint use and a close supervision would have prevented such a fatal issue.