Ali Chadly

Multidisciplinary approach to fatal dog attacks: a forensic case study.

Dog-bite-related injuries and fatalities are increasing in incidence and represent an important public health concern, as dogs are more and more becoming an integral part of human social life. We report the case of a 27-year-old woman who was found dead in her home. Her body was discovered lying face down in a large pool of partially desiccated blood with signs of having been dragged. Site examination revealed the presence of severe injuries on the face, neck and head, which were then traced back to the dog she owned. Death was attributed to exsanguinations due to a neck blood vessels laceration with fracture of the fifth cervical vertebra. This was uncommon because the dog bites injured the vertebral artery only without any lacerations of the carotid artery. Confirming that the injuries are dog-bite related was based on a multidisciplinary approach including histological findings, odontological examination of bite marks and DNA analysis.

Unusual foreign body aspiration as a cause of asphyxia in adults: an autopsy case report.

Most asphyxia deaths caused by foreign body aspiration occur in children and the elderly. It can also occur in specific high-risk groups of adults, such as those with underlying esophageal diseases, prisoners, those with mental retardation, and those with psychiatric illnesses. We report the case of a 49-year-old man, without previous medical history, who died rapidly after aspirating a sole fish while he was unraveling the fishing net using his teeth. At autopsy, the foreign body was found in the trachea, wedged in the carina and obstructing the right bronchus origin. The finding from the usual toxicological screening was negative.

Dental age assessment among Tunisian children using the Demirjian method

Context: Since Demirjian system of estimating dental maturity was first described, many researchers from different countries have tested its accuracy among diverse populations. Some of these studies have pointed out a need to determine population-specific standards. Aim: The aim of this study is to evaluate the suitability of the Demirjians method for dental age assessment in Tunisian children. Materials and Methods: This is a prospective study previously approved by the Research Ethics Local Committee of the University Hospital Fattouma Bourguiba of Monastir (Tunisia). Panoramic radiographs of 280 healthy Tunisian children of age 2.8–16.5 years were examined with Demirjian method and scored by three trained observers. Statistical Analysis Used: Dental age was compared to chronological age by using the analysis of variance (ANOVA) test. Cohens Kappa test was performed to calculate the intra- and inter-examiner agreements. Results: Underestimation was seen in children aged between 9 and 16 years and the range of accuracy varied from −0.02 to 3 years. The advancement in dental age as determined by Demirjian system when compared to chronological age ranged from 0.3 to 1.32 year for young males and from 0.26 to 1.37 year for young females (age ranged from 3 to 8 years). Conclusions: The standards provided by Demirjian for French-Canadian children may not be suitable for Tunisian children. Each population of children may need their own specific standard for an accurate estimation of chronological age.

Age estimation from the sternal end of the fourth rib: A study of the validity of İşcan’s Method in Tunisian male population

The aim of this study was to assess the fourth rib phase İşcan method on a Tunisian sample. One hundred and eight (108) specimens of sternal ends of fourth ribs of Tunisian male population were collected during forensic autopsies performed in the Department of Forensic Medicine and Pathology of the University Hospital Fattouma Bourguiba of Monastir. Two operators, independently, assigned each rib to İşcans phase. The data obtained by the two operators were analyzed using SPSS 17.0 and MedCalc. The repeatability and accuracy of İşcan method was tested by kappa coefficient (κ), for each operator. Spearman correlation coefficient (R), between estimated İşcan phase and İşcan phase relative to chronological age, was good with values of 0.758 (CI: 0.664-0.828) and 0.717 (CI: 0.611-0.798) for operator 1 and operator 2, respectively. The perfect agreement, between İşcan phase related to chronological age and İşcan phase estimated by both operators, was found for phases fewer than 5. Intra-observer agreement was highest for both operators with kappa value of 0.73 for operator 1 and 0.71 for operator 2. The estimation of the observers fell within one phase from the ideal and there was minimal disparity. A good accuracy between operator 1 and operator 2 was found (κ=0.747, p=0.057). In order to improve the results, we have pooled ages in five new phases. The correlation, between new age groups and İşcan phase estimated by both operators, was moderate. We conclude that İşcan method can be applicable in Tunisian population with a good correlation for age ranges under 39years.

Age assessment in canine and premolar by cervical axial sections of cone-beam computed tomography

Age estimation in adults is a challenge in both anthropological and forensic situations compared to sub-adults age estimation. The present study explored, for the first time, the cervical zone of single rooted teeth. The deposition of secondary dentin is responsible for a decrease in the volume of the dental pulp cavity with aging, and therefore is often used as an age indicator. The current study aimed at estimating the chronological age among adults by measuring the pulp/dentin area ratio (physiological ratio) by axial sections at cervical region of maxillary canine and mandibular second premolar. The sample consisted of 120 cone beam CT images of 120 Tunisians whose age ranged from 22 to 67, from the database of a private clinic of radiology. The first axial section of chosen teeth without enamel was selected. Linear regression models were derived for canine, premolar and for all variables to predict the age. They indicated that dentin deposition on canine and premolar have almost the same correlation with age (r=-0.838 and -0.837 respectively). The residual standard errors (RSE), when these regression equations applied for the entire sample, were ranged between 8.27, 8.29 and 7.06 for canine, premolar and for all variables respectively. Tested for younger ages (from 22 to 44years) the RSE decreased considerably and thus ranged between 4.32, 4.72 and 4.05. The outcomes of this study show that the physiological ratio is a useful variable for assessing age with a satisfying accuracy.

Sudden Death and Primary Leptomeningeal Melanocytosis: A Case Report With an Autopsy Diagnosis.

Abstract Meningeal melanocytoma is a rare benign pigmented tumor. It develops from melanocytes normally present in the meninges of the posterior fossa and medulla. It is an extra-axial tumor that manifests because of compression of adjacent structures. Although classified as a benign tumor, it can cause sudden death by several mechanisms. We report a rare case of meningeal melanocytoma and discuss the mechanism of death.  A 21-year-old man with a previous history of recurrent lipothymia was admitted to the emergency department because of generalized seizures. Death occurred despite resuscitation. A medico-legal autopsy was performed. External examination of the body showed nonspecific asphyxia signs without any violence evidence. Necropsy noticed a brain edema with a dark color of the meninges especially in the frontal part. Histological examination concluded to diffuse meningeal melanocytoma with cerebral edema.

Applicability of Willems methods and Demirjian’s four teeth method for dental age estimation: Cross sectional study on Tunisian sub-adults

This study aims to evaluate and compare the applicability of three dental methods for age estimation, including Demirjians four teeth, Willems I, and Willems II methods in a sample of Tunisian children. Panoramic radiographs of 500 children (241 females, 259 males) aged between 5 and 15 years were examined. The mean absolute error (MAE) was performed to assess the accuracy of age estimation. Independent samples t-test was employed to compare the differences, the chronological age minus dental age (CA-DA), between sexes for the three methods. All of the three methods underestimated the chronological age on the average, and almost for all age groups. The discrepancy between the chronological age and the estimated age was most frequently observed for ages above 8 years for all methods. In our study, the Demirjians four teeth method underestimated the chronological age by 0.45 years for males and 0.32 years for females, with no significant difference (p=0.124). Whereas the Willems I method is indicted for underestimating the chronological age by 0.40 years for males, and by 0.69 years for females. Willems II method underestimated age by 0.91, and 0.64 years for males and females, respectively. It is established that the Demirjians four teeth method was more accurate in estimating the dental age than the Willems I and II methods, with a mean absolute error of 0.76 years for males and 0.79 years for females (MAE=1.10, and 0.98 years for the Willems I/1.02, and 0.92 years for the Willems II). According to the results, it is highly recommended that the Demirjians four teeth method should be applied when estimating the dental age in Tunisian males and females. In forensic cases, when the sex is unknown or doubted, the Willems II method could be appropriate.

Breast Textiloma: An unending medico-legal issue about a case report

Highlights • Forgetting sponges in the breast after surgery is uncommon and may mimic a recurrent tumor after years.• Medico-legal implications are heavy which jeopardize the reputation of the surgeon.• The patient was not informed about the real diagnosis because of fear of litigation.

Liver Subcapsular Hematoma: A Rare Cause of Sudden Unexpected Death

The spontaneous subcapsular hematoma of the liver is very rare. There are only a few reported cases in the literature.Most reported cases of liver hematoma often occur during pregnancy as part of the hemolysis, elevated liver enzymes, and low platelet count syndrome. The other causes may be due to amylosis, rupture of hepatocellular carcinoma, adenoma, focal nodular hyperplasia, hemorrhagic cyst, or hemopathy. Idiopathic spontaneous subscapular hematoma is a rare and often fatal condition.We report a case of a 43-year-old woman having Steinert disease who died because of a fatal spontaneous liver hemorrhage occurring without any traumatism. We did not find any apparent cause that could explain this hemorrhage even after a histological study of the liver.

An unusual case of smothering by a medical nebulizer

The following report describes an unusual case of smothering by a medical nebulizer of a psychiatric in-patient and discusses the manner of death. A 43-year-old man, with previous medical history of paranoia was hospitalized at a psychiatric department because of a suicide attempt. He was found dead by the medical staff in the seclusion room. The patient is known suffering from asthma attacks treated by Ventoline(®) spray. Autopsy findings showed a ventolines nebulizer impacting within the pharynx and in the upper part of oesophagus. These findings were compatible with a death by smothering. Smothering is an uncommon cause of suicide and is particularly observed in psychiatric patient. Suicidal death is established by the study of the circumstances and autopsy finding. This paper highlights the importance of a closer psychiatric in-patient residing in seclusion room.