Altered Intestinal Permeability and Drug Repositioning in a Post-operative Ileus Guinea Pig Model

Background/Aims@#The aim of this study is to identify the alteration in intestinal permeability with regard to the development of post-operative ileus (POI).Moreover, we investigated drug repositioning in the treatment of POI. @*Methods@#An experimental POI model was developed using guinea pigs. To measure intestinal permeability, harvested intestinal membranes of the ileum and proximal colon was used in an Ussing chamber. To identify the mechanisms associated with altered permeability, we measured leukocyte count and expression of calprotectin, claudin-1, claudin-2, and mast cell tryptase. We compared control, POI, and drug groups (mosapride [0.3 mg/kg and 1 mg/kg, orally], glutamine [500 mg/kg, orally], or ketotifen [1 mg/kg, orally] with regard to these parameters. @*Results@#Increased permeability after surgery significantly decreased after administration of mosapride, glutamine, or ketotifen. Leukocyte counts increased in the POI group and decreased significantly after administration of mosapride (0.3 mg/kg) in the ileum, and mosapride (0.3 mg/kg and 1 mg/kg), glutamine, or ketotifen in the proximal colon. Increased expression of calprotectin after surgery decreased after administration of mosapride (0.3 mg/kg), glutamine, or ketotifen in the ileum and proximal colon, and mosapride (1 mg/kg) in the ileum. The expression of claudin-1 decreased significantly and that of claudin-2 increased after operation. After administration of glutamine, the expression of both proteins was restored. Finally, mast cell tryptase levels increased in the POI group and decreased significantly after administration of ketotifen. @*Conclusions@#The alteration in intestinal permeability is one of the factors involved in the pathogenesis of POI. We repositioned 3 drugs (mosapride, glutamine, and ketotifen) as novel therapeutic agents for POI.

Altered Intestinal Permeability and Drug Repositioning in a Post-operative Ileus Guinea Pig Model

Background/Aims@#The aim of this study is to identify the alteration in intestinal permeability with regard to the development of post-operative ileus (POI).Moreover, we investigated drug repositioning in the treatment of POI. @*Methods@#An experimental POI model was developed using guinea pigs. To measure intestinal permeability, harvested intestinal membranes of the ileum and proximal colon was used in an Ussing chamber. To identify the mechanisms associated with altered permeability, we measured leukocyte count and expression of calprotectin, claudin-1, claudin-2, and mast cell tryptase. We compared control, POI, and drug groups (mosapride [0.3 mg/kg and 1 mg/kg, orally], glutamine [500 mg/kg, orally], or ketotifen [1 mg/kg, orally] with regard to these parameters. @*Results@#Increased permeability after surgery significantly decreased after administration of mosapride, glutamine, or ketotifen. Leukocyte counts increased in the POI group and decreased significantly after administration of mosapride (0.3 mg/kg) in the ileum, and mosapride (0.3 mg/kg and 1 mg/kg), glutamine, or ketotifen in the proximal colon. Increased expression of calprotectin after surgery decreased after administration of mosapride (0.3 mg/kg), glutamine, or ketotifen in the ileum and proximal colon, and mosapride (1 mg/kg) in the ileum. The expression of claudin-1 decreased significantly and that of claudin-2 increased after operation. After administration of glutamine, the expression of both proteins was restored. Finally, mast cell tryptase levels increased in the POI group and decreased significantly after administration of ketotifen. @*Conclusions@#The alteration in intestinal permeability is one of the factors involved in the pathogenesis of POI. We repositioned 3 drugs (mosapride, glutamine, and ketotifen) as novel therapeutic agents for POI.

Synergistic effects of combined therapy of curcumin and Fructus Ligustri Lucidi for treatment of osteoporosis: cellular and molecular evidence of enhanced bone formation / 中西医结合学报

OBJECTIVE@#The present study explored the effects of the combined herbal therapy consisting of curcumin (CUR) and Fructus Ligustri Lucidi (FLL) on aspects of bone regeneration.@*METHODS@#Prior to analyzing the ability of this novel combined herbal therapy to promote aspects of bone regeneration, its cytotoxicity was determined using MC3T3-E1 cells (pre-osteoblast model). Cell proliferation was evaluated using phase-contrast microscopy and cell differentiation was estimated using alkaline phosphatase activity. The effect of the combined herbal therapy (CUR + FLL) was also assessed in terms of mineralization in the extracellular matrix (ECM) of cultured cells. Further, to explore the molecular mechanisms of bone formation, time-dependent expression of bone-regulating protein biomarkers was also evaluated.@*RESULTS@#Combined herbal therapy (CUR + FLL) significantly upregulated the viability, proliferation and differentiation of MC3T3-E1 cells compared to the monotherapy of CUR or FLL. The magnitude of ECM mineralization (calcium deposition) was also higher in MC3T3-E1 cells treated with combined therapy. The time-dependent expression of bone-forming protein biomarkers revealed that the tendency of expression of these bone-regulating proteins was remarkably higher in cells treated with combined therapy.@*CONCLUSION@#The co-administration of CUR and FLL had superior promotion of elements of bone regeneration in cultured cells, thus could be a promising alternative herbal therapy for the management of bone erosive disorders such as osteoporosis.

The Effect of Trimebutine on the Overlap Syndrome Model of Guinea Pigs

BACKGROUND/AIMS: Functional dyspepsia (FD) and irritable bowel syndrome (IBS) are common gastrointestinal (GI) disorders and these patients frequently overlap. Trimebutine has been known to be effective in controlling FD co-existing diarrhea-dominant IBS, however its effect on overlap syndrome (OS) patients has not been reported. Therefore, we investigated the effect of trimebutine on the model of OS in guinea pigs. METHODS: Male guinea pigs were used to evaluate the effects of trimebutine in corticotropin-releasing factor (CRF) induced OS model. Different doses (3, 10, and 30 mg/kg) of trimebutine were administered orally and incubated for 1 hour. The next treatment of 10 μg/kg of CRF was intraperitoneally injected and stabilized for 30 minutes. Subsequently, intragastric 3 mL charcoal mix was administered, incubated for 10 minutes and the upper GI transit analyzed. Colonic transits were assessed after the same order and concentrations of trimebutine and CRF treatment by fecal pellet output assay. RESULTS: Different concentrations (1, 3, and 10 μg/kg) of rat/human CRF peptides was tested to establish the OS model in guinea pigs. CRF 10 μg/kg was the most effective dose in the experimental OS model of guinea pigs. Trimebutine (3, 10, and 30 mg/kg) treatment significantly reversed the upper and lower GI transit of CRF induced OS model. Trimebutine significantly increased upper GI transit while it reduced fecal pellet output in the CRF induced OS model. CONCLUSIONS: Trimebutine has been demonstrated to be effective on both upper and lower GI motor function in peripheral CRF induced OS model. Therefore, trimebutine might be an effective drug for the treatment of OS between FD and IBS patients.

Exploring dynamic biomedical algorithm of Eurycoma longifolia Jack and its bioactive phytochemicals: A review of pharmacokinetic and pharmacodynamic implications and future prospects

Eurycoma longifolia Jack (E. longifolia) is a well-recognized traditional herbal medicine that offers a wide dynamic range of biomedical applications including anti-osteoporotic, anticancer, anti-proliferative, anti-malarial, antimicrobial, antioxidant, aphrodisiac, anti-inflammatory, anxiolytic, anti-diabetic, anti-rheumatism and anti-ulcer properties. This review aims to overview the pharmacokinetic and a pharmacodynamic algorithm of E. longifolia and its bioactive components. Analysis of pharmacokinetic profile revealed that E. longifolia exhibit higher bioavailability, high volume of distribution, slow elimination rate, and does not show inhibitory effects on cytochrome P450 isoenzymes. E. longifolia has been used, alone or in combination with other pharmacological agents, in the form of crude extracts, standard extracts, or decoctions of different plant parts (i.e., herbs, shrubs, stem, leaves, and roots) for the treatment of various ailments in animals and humans. Among various bioactive constituents, eurycomanone has been found to be the most remarkable, super-stable, versatile, and most potent phytochemical (isolated or extracted from root extracts) against various types of animals and human diseases. Based on its well-established pharmacokinetic and pharmacodynamic profiles, we suggested that E. longifolia can be a well-accepted complementary and alternative medicine for the treatment of different types of human ailments.

Antimicrobial and antiurease potential of diorganotin [IV] schiff bases

Six new diorganotin [IV] Schiff bases, [[CH3]2SnL] [I], [[C2H5]2SnL] [II], [[n-C4H9]2SnL] [III], [[C6H5]2SnL] [IV], [[CH2C6H5]2SnL] [V] and [[n-C8H17]2SnL] [VI] where L = N-[5-bromo-2 oxidobenzylidene]phenylacetohydrazide, were synthesized and characterized by elemental analysis, FT-IR, multinuclear NMR [1H, 13C] and UV-visible spectroscopy. Spectroscopic studies indicate coordination of ligand to the diorganotin [IV] moieties via ONO donor sites generating a pentacoordinated tin center. The synthesized compounds were tested in vitro for antibacterial activity against Klebsiella pneumonia, Salmonella typhimurium, Escherichia coli, Aeromonas, Staphylococcus aureus, Vibrio cholerae, Pseudomonas aeruginosa, Shigella flexneri, and in vitro antifungal activity against Aspergillus nigar, Fusarium solani, Aspergillus fumigatus and Alternaria species. All the compounds were also screened for antiurease activity

Inflammation, Impaired Motility, and Permeability in a Guinea Pig Model of Postoperative Ileus

BACKGROUND/AIMS: Postoperative ileus (POI) is characterized by impaired propulsive function of the gastrointestinal tract after surgery. Although inflammation is considered to be an important pathogenesis of POI, significant data are lacking. We aim to correlate the recovery time of postoperative dysmotility with that of inflammation and mucosal permeability. METHODS: An experimental POI model of guinea pig was used. Contractile activity of the circular muscle of the stomach, jejunum, ileum, and proximal colon was measured through a tissue bath study. Inflammatory cells were counted, and the expression of calprotectin and tryptase were analyzed. The expression of protease-activated receptor 2 (PAR-2), claudin-1, and claudin-2 were analyzed with immunofluorescence. RESULTS: The small bowel and colon showed decreased contractile amplitude in the POI groups compared to control. In contrast to the colon, the contractile amplitude of the small bowel significantly recovered in the POI group at 6 hours after the operation compared to the control group. Inflammation was highly significant in the POI groups compared to the control and sham groups, especially in the colon. Immunofluorescence showed increased PAR-2 expression in the POI groups compared to sham. The decreased claudin-1 expression and increased claudin-2 expression may suggest increased mucosal permeability of the small bowel and colon in the POI groups. CONCLUSIONS: Increased inflammation and mucosal permeability may play an important role in the differential recovery stages in POI. These data may provide further insights into the pathophysiology and potential new therapeutic prospects of POI.

Eurycoma Longifolia as a potential adoptogen of male sexual health: a systematic review on clinical studies / 中国天然药物

Eurycoma longifolia (EL) has been well recognized as a booster of male sexual health. Over the past few decades, numerous in vivo animal studies and human clinical trials have been conducted across the globe to explore the promising role of EL in managing various male sexual disorders, which include erectile dysfunction, male infertility, low libido, and downregulated testosterone levels. The aim of the present review is to analyze and summarize the literature on human clinical trials which revealed the clinical significance and therapeutic feasibility of EL in improving male sexual health. This systematic review is focused on the following databases: Medline, Wiley Online Library, BioMed Central, Hindawi, Web of Knowledge, PubMed Central and Google Scholar, using search terms such as "Eurycoma longifolia", "EL", "Tongkat Ali", "male sexual health", "sexual infertility", "erectile dysfunction", "male libido", and "testosterone levels". Notably, only human clinical studies published between 2000 and 2014 were selected and thoroughly reviewed for relevant citations. Out of 150 articles, 11 met the inclusion criteria. The majority of articles included were randomized placebo-controlled trials, multiple cohort studies, or pilot trials. All these studies demonstrated considerable effects of EL on male sexual health disorders. Among them, 7 studies revealed remarkable association between the use of EL and the efficacy in the treatment of male sexual disorders, and remaining 4 studies failed to demonstrate sufficient effects on male sexual health. In summary, there is convincing evidence for the prominence of EL in improving the male sexual health. The review also substantiates the use of current methodology in the development of novel and more rationale natural herbal medicines for the management of male sexual disorders.

Efficient hepatoprotective activity of cranberry extract against CCl

Objective To investigate the hepatoprotective efficacy of cranberry extract (CBE) against carbon tetrachloride (CCl

Efficient hepatoprotective activity of cranberry extract against CCl-induced hepatotoxicity in Wistar albino rat model: Down-regulation of liver enzymes and strong antioxidant activity

OBJECTIVE@#To investigate the hepatoprotective efficacy of cranberry extract (CBE) against carbon tetrachloride (CCl)-induced hepatic injury using in-vivo animal model.@*METHODS@#The hepatoprotective efficacy of CBE (200 and 400 mg/kg) was investigated against CCl (4 mL/kg)-induced hepatotoxicity, elevated liver enzymes [ALT (alanine aminotransferase), AST (aspartate aminotransferase), and alkaline phosphatase (ALP)], and total protein (TP) contents in the serum. Moreover, CBE-aided antioxidant defense against hepatotoxic insult of CCl was measured by evaluating a number of anti-oxidative biomarkers including reduced glutathione (GSH), superoxide dismutase (SOD), catalase (CAT), and malondialdehyde (MDA) in the serum by using spectrophotometric analyses.@*RESULTS@#Results showed that the exposure of experimental animals to CCl did induce significant hepatotoxicity compared to the non-induced (untreated) group. The oral administration of CBE demonstrated a significant dose-dependent alleviation in the liver enzymes (AST, ALT, and ALP), increased antioxidant defense (GSH, SOD, and CAT), and reduced MDA levels in the serum of treated animals compared to the animals without treatment. The resulting data showed that the administration of CBE decreased the serum levels of ALT, AST, and ALP compared to the CCl-induced group.@*CONCLUSIONS@#The resulting data evidenced that CBE exhibits promising hepatoprotective potential against the chemical induced hepatotoxicity, maintains homeostasis in liver enzymes, and can provide significant antioxidant defense against free radicals-induced oxidative stress.

Phytopharmacological potential of different species of Morus alba and their bioactive phytochemicals: A review

Medicinal plants of Moraceae family have been well-recognized traditionally due to their versatile applications in various fields including agriculture, cosmetic and food as well as in pharmaceutical industries. Their biomedical and medicinal importance is reflected from their broad range of pharmacological activities for treatment of various inflammatory conditions, cancer, infectious diseases, and gastrointestinal disorders. The present review was aimed to summarize and critically discuss the biomedical implications of Morus species, their bioactive compounds, and phytochemicals. Bioactivity guided fractionation of these medicinal plants revealed that different types of bioactive phytochemicals and secondary metabolites such as steroids, saponins, alkaloids, glycosides and phenolic compounds including terpenoids, flavonoids, anthocyanins and tannins were present. The critical analysis of the literature revealed that the aqueous, methanolic, and ethanolic extracts of Morus species and their bioactive compounds exhibit remarkable anti-oxidative, anti-diabetic, anti-stress, nephroprotective, antimicrobial, anti-mutagenic, anticancer, anxiolytic, hepatoprotective, anthelmintic, antimicrobial, immune-modulatory and cholesterol lowering effects. Based on the literature review and bioactivity guided investigation of Morus species and their phytomedicinal effects, we anticipate that these herbal products hold excellent potential for future research.

The Effect of Peripheral CRF Peptide and Water Avoidance Stress on Colonic and Gastric Transit in Guinea Pigs

Functional dyspepsia (FD) and irritable bowel syndrome (IBS) are common gastrointestinal (GI) diseases; however, there is frequent overlap between FD and IBS patients. Emerging evidence links the activation of corticotropin releasing factor (CRF) receptors with stress-related alterations of gastric and colonic motor function. Therefore, we investigated the effect of peripheral CRF peptide and water avoidance stress (WAS) on upper and lower GI transit in guinea pigs. Dosages 1, 3, and 10 µg/kg of CRF were injected intraperitoneally (IP) in fasted guinea pigs 30 minutes prior to the intragastric administration of charcoal mix to measure upper GI transit. Colonic transits in non-fasted guinea pigs were assessed by fecal pellet output assay after above IP CRF doses. Blockade of CRF receptors by Astressin, and its effect on GI transit was also analyzed. Guinea pigs were subjected to WAS to measure gastrocolonic transit in different sets of experiments. Dose 10 µg/kg of CRF significantly inhibited upper GI transit. In contrast, there was dose dependent acceleration of the colonic transit. Remarkably, pretreatment of astressin significantly reverses the effect of CRF peptide on GI transit. WAS significantly increase colonic transit, but failed to accelerate upper GI transit. Peripheral CRF peptide significantly suppressed upper GI transit and accelerated colon transit, while central CRF involved WAS stimulated only colonic transit. Therefore, peripheral CRF could be utilized to establish the animal model of overlap syndrome.

Association between functional dyspepsia and severity of depression

Objective: To determine the association between functional dyspepsia and the severity of depression

Study Design: Cross-sectional study

Place and Duration of Study: Department of Medicine, King Edward Medical University/Mayo Hospital, Lahore, from September 2012 till January 2013

Methodology: After taking informed written consent, patients with symptoms of dyspepsia fulfilling the Rome III criteria were included in the study. All patients were evaluated for depression, using Hamilton depression rating scale [HDRS]. Upper gastrointestinal endoscopy was done. Fischers' exact test and independent t-test were used for determining significance of association

Results: One hundred and one patients with mean age of 35.81 [ +/- 14.81] years and male to female ratio of 1.41:1 [54/47] were included. Predominant symptoms were early satiety [72.3%], epigastric pain [65.3%], bloating [49.5%], postprandial fullness [40.6%], and regurgitation [40.6%]. Alarm symptoms were positive in 44 [43.6%] patients. Dyspepsia were classified as epigastric pain syndrome [EPS, 69.3%], and postprandial distress syndrome [PDS, 30.7%]. Significantly more females had PDS [p=0.04], with positive endoscopic findings in EPS [p=0.03]. Positive endoscopic findings noted were esophagitis in 21.8%, and gastritis in 48.5% patients. All patients except one had depression, mild in 22.8%, moderate in 33.7%, severe in 31.7%, and very severe in 10.9% patients. Severe depression was seen in 32 [45.7%] patients with EPS and PDS; whereas very severe depression was in 11 [15.7%] patients of EPS, while 11 [35.4%] patients of PDS had severe depression but the difference was not significant

Conclusion: Functional dyspepsia is associated with depression, while positive endoscopic findings are more likely in patients with EPS. Very severe depression was only seen with epigastric pain syndrome

The Effect of DA-9701 in Opioid-induced Bowel Dysfunction of Guinea Pig

BACKGROUND/AIMS: Opioid induced bowel dysfunction (OIBD) is associated with decreased gastrointestinal (GI) propulsive activity due to intake of opioid analgesics. DA-9701, a novel prokinetic agent formulated with Pharbitis Semen and Corydalis Tuber has promising effects on GI motor function. Therefore, we aim to evaluate the prokinetic effects of DA-9701 in an OIBD model of guinea pig. METHODS: The ileal and distal colon muscle contraction in presence of different doses of DA-9701, morphine, and combination (morphine + DA-9701) was measured by tissue bath study. The prokinetic effect of DA-9701 was assessed by charcoal transit and fecal pellet output assay in an OIBD model of guinea pig. RESULTS: DA-9701 significantly increased the amplitude and area under the curve of ileal muscle contraction, while there was insignificant effect on the distal colon compared to the control. The maximal amplitude of ileal muscle contraction was acquired at a concentration of 10 μg/mL of DA-9701. In contrast, morphine significantly decreased the amplitude of ileal and distal colon muscle contraction compared to the control. Morphine delayed both upper (P < 0.01) and lower (P < 0.05) GI transit, and delayed GI transit was restored by the administration of DA-9701. Morphine induced reduction of contractility was significantly ameliorated by addition of DA-9701 in both ileal and distal colon muscles. CONCLUSIONS: DA-9701 significantly increased the amplitude of contraction of the ileal muscle, however the distal colon muscle contraction was insignificant. Additionally, it restored delayed upper and lower GI transit in an OIBD model of guinea pig, and it might prove to be a useful candidate drug in a clinical trial for OIBD.

Outcome of decompressive craniectomy [DC] for severe traumatic brain injury [STBI] in adults

To evaluate the outcomes of decompressive craniectomy [DC] in adults with severe traumatic brain injury [STBI]. Observational cross-sectional. Neurosurgical unit CMH Rawalpindi from July, 2011 to June 2014. Total of 39 patients who underwent DC for STBI were included in the study. Patients of both sexes and of age range 20 - 48 [32.03 +/- 8.01] years were included in the study. The DC was performed within 24 and after 24 hours. Parameters recorded were mortality, neurological outcome / complications like brain herniation, wound dehiscence, cerebrospinal fluid [CSF] leak, contusion expansion, sinking flap syndrome, subdural hygromas and hydrocephalus. Data was analyzed by using SPSS version 17 and descriptive statistics, frequency, rate and percentage was computed for presentation of qualitative outcomes. Favourable neurological outcome was seen in 21 patients [53.85%] where as 6 patients [15.38%] had moderate to severe disability and 3 patients [7.69%] were vegetative respectively. Patients operated within 24 hours and with Glasgow coma scale [GCS] range 6-8 had better outcome. . Overall 9 patients [23.08%] did not survive the injury and procedure. As high mortality is associated with STBI, DC is an effective option to lower down the refractory intracranial hypertension with an acceptable surgical outcome

Can spinal anaesthesia be a routine for single level lumbar discectomy?

To compare the efficacy of spinal anaesthesia with general anaesthesia for lumbar discectomy in terms of theatre time and post-operative effects. Randomized controlled trial. Neurosurgery department Combined Military Hospital Rawalpindi, from November 2013 to April 2014. A total 60 consecutive patients with herniated lumbar discs were enrolled in this study to undergo randomly into assigned spinal anaesthesia group SA [n=30, group A] or General anaesthesia GA [n=30, group B].Variables included age, gender, level of lumbar disc prolapse, type of anaesthesia, operative time, and combined total theatre time, post-operative pain using visual analogue scale [VAS] and hospital stay in days. Mean theatre time in group A was 62.70 and for group B it was 90.73 [p<0.001]. The mean hospital stay after surgery in group A was 2.0 days and in group B was 2.27 days [p< 0.002]. Peak post- operative pain scores according to visual analogue scale and resultant analgesic requirements in group A was 5.10 while for group B it was 6.87 p< 0.001. Spinal anaesthesia is safe and can be routine anaesthesia for most of the patients undergoing lumbar discectomy

Application of the upper lip catch test for airway evaluation in edentulous patients: an observational study

Application of upper lip catch test [ULCT] for airway evaluation in edentulous patients. This research is an evaluation of a clinical diagnostic test in edentulous patients prior to operation. Five hundred eighty eight edentulous patients in a referral university hospital, between March 2008 and June 2011 scheduled for elective surgery under general anesthesia were enrolled. Those unable to open the mouth and those with pharyngo-laryngeal pathology were excluded. ULCT was assessed and compared with Cormack-Lehane grading as a gold standard for airway evaluation. A high negative predictive value of 99.4% was a notable finding for the ULCT. The results also showed a high specificity [89.4%], high sensitivity [75.0%] and a high accuracy [89.3%] in a comparatively higher range for the ULCT. The ULCT proved to be a useful predictor for airway assessment in edentulous patients in this setting. Further studies are needed to reconfirm its validity in other ethnic groups

Risk factors of chronic subdural hematoma recurrence after burr hole surgery

Background: Chronic subdural hematoma [CSDH], a common type of intracranial hemorrhage and one of the most common clinical entities encountered in daily neurosurgical practice tends to occur in elderly patients

Objective: To determine the frequency and risk factors of chronic subdural hematoma recurrence after burr holes surgery

Patients and Methods: This descriptive cross sectional study was conducted in neurosurgery department Nishtar Hospital Multan from 1[st] January 2013 to 31[st] December 2013. All the patients diagnosed as CSDH, confirmed on computed tomography [CT] and treated by hematoma evacuation and drainage through cranial bur hole during the study duration were included in the study. Routine computed tomography [CT] was performed in all the patients, the day after the surgery, one week after the surgery, two months after the surgery and all the patients were followed up to three months after the surgery. Preoperative and postoperative CT findings were compared to calculate the recurrence rate. Data was entered and analyzed by using SPSS version 17. P-value = 0.05 was considered significant

Results: There were 72.64% male and 27.36% female patients. 78.31% patients were = 70 years age and 21.69% below 70 years. CT demonstrated CSDH as hypo dense to cerebral parenchyma in 49.05%, isodense in 29.24% and hyperdense in 21.71%. Recurrence of chronic subdural hematoma after the bur holes craniotomy was observed in 10.8% [12] patients. Major risk factors identified for recurrence were age = 70 years and re-expansion of the brain after the surgery

Conclusion: It is concluded that recurrence of chronic subdural hematoma after burr holes evacuation is directly related with age and re-expansion of the brain after surgery

Asphyxial deaths: a four year retrospective study in Peshawar

The study provides epidemiological analysis of autopsy record on asphyxial deaths and different methods used to carry it out. It was a retrospective [descriptive] study done at the Department of Forensic Medicine and Toxicology, Khyber Medical College Peshawar. Analysis of autopsy record was done and cases of asphyxial deaths and the cause of asphyxia was noted. The data covers a period from January 2009 to June 2012. A total of 3,265 [males n=2839, Females n= 426] cases were presented for autopsy to Forensic Medicine and Toxicology Department of Khyber medical college Peshawar and 130 deaths were due to asphyxia compared with 2370 deaths due to firearm. Homicide was the most common manner of death. 89 cases were males and 41 were females. Approximate ages of the autopsies conducted were 0-19 years n= [18.2%], 20-40 years n= [64.5%], 41-60 years n= [13%] and 61 or above n=4 [3.0%]. Strangulation was found to be the most common method used. Asphyxial deaths are not as common as firearm deaths in Peshawar. Homicide is the most common method of death. The findings may be helpful for the security agencies in investigation of asphyxial deaths