Gastrointestinal Parasites in Asian and African Elephants: A Systematic Review

@#Gastrointestinal parasites (GIPs) in elephants have been reported in several studies over the last decades. Nonetheless, comprehensive data on clinicopathology of elephant GIPs, parasite burden threshold value, and the effectiveness of conventional anthelmintic drugs are still lacking. Herein, we have systematically reviewed the available knowledge on elephant GIPs identified among different parts of the world based on their prevalence, epidemiology, pathology, diagnosis, treatment, and control. Two electronic databases were searched for publications that met the inclusion criteria. About19 English journal articles published between year of 2011- 2021 were included. The main GIPs reported in elephants were Cyathostomidae (at least 14 species), Ancylostomidae, Haemonchus contortus, Trichostrongylus colubriformis, Oesophagostomum columbianum, Oesophagostomum aceleatum, Ascarids, Trichurids, Strongyloides, Anophlocephalidae, flukes, and Coccidia across different parts of the world, including Malaysia, Indonesia, Thailand, Myanmar, Sri Lanka, India, Kenya, Nigeria, and South Africa. Most elephants show no clinical signs until the equilibrium between parasite and host is disturbed. The common diagnostic methods for GIPs are traditional direct smear, faecal floatation, sedimentation, and McMaster egg counting technique, all involving morphological identification. However, some articles described the use of molecular detection to characterise common GIPs of elephants. Although benzimidazoles and macrocyclic lactones group of anthelmintic are the most conventional GIPs treatment and control for captive and semi-captive elephants, there is limited data on the threshold value of faecal egg count as the baseline for treatment decision. Over the last decades, various studies regarding elephant GIPs have been conducted. However, more focused and systematic studies are required to enhance our knowledge in multiple aspects of elephant parasitology to find effective solutions and improve elephant health.

Gastrointestinal parasitic infections of buffaloes (Bubalus bubalis) in Sarawak Borneo: Prevalence, risk factors, and farming practices

@#The objectives of this study were to investigate the prevalence and associated risk factors for gastrointestinal (GI) parasites in buffaloes from various areas of Sarawak, and to assess current management practices of GI parasites among farmers. Faecal samples were collected from 15 farms and 129 animals, as well as data on farm and animal-based characteristics. A total of 129 faecal samples were examined for GI parasites using a modified McMaster and sedimentation. Association between potential risk factors and the prevalence of GI parasites was investigated using Chi-square statistic. The prevalence of Paramphistomum sp., strongyles, and coccidia were 75.2% (95% CI±7.5), 52.7% (95% CI±8.6) and 48.1% (95% CI±8.6), respectively. Farms which had a grazing area less than 50 acres in size had significantly higher prevalence of strongyles (70.5%, χ² = 8.34, P = 0.004) and paramphistomes (88.6%, χ² = 6.46, P = 0.01) relative to farms with a larger grazing area (43.5% and 68.2%, respectively). Prevalence of strongyles was lower in farms that did not implement a cut- and-carry system (45.6%, χ² = 4.17, P = 0.04) in comparison to those that did (64%). The prevalence of paramphistomes was higher on farms with more than 40 animals (80.6%, χ² = 3.18, P = 0.05) relative to farms with fewer animals. The majority of farmers surveyed (67.9%) showed awareness of GI parasite infection and reported that they recognized the associated symptoms. Most farmers practised deworming, and ivermectin was the most commonly used anthelminthic (60.4%); only 1.9% of farmers used albendazole. Overall this study revealed a high prevalence of GI parasites in buffalo in Sarawak. Although farmers report they are aware of parasitic diseases, further education is still required. This could include how they can successfully implement on-farm changes to reduce the prevalence of GI parasites in their herds.

Prevalence of Toxoplasma gondii Antibodies in Stray Dogs from Various Locations in West and East Malaysia

Toxoplasmosis is caused by an obligate intracellular protozoan parasite; Toxoplasma gondii, which is one of the most important zoonotic parasite worldwide. In dogs, the sexual reproductive cycle of T. gondii is lacking, and the animals are not widely consumed as food, but they are vital in the mechanical transmission of the parasite. However, there is no present data on the exposure of stray dogs to T. gondii in Malaysia. The objective of this serological survey was to determine the prevalence of T. gondii antibodies (IgG) and associated factors in stray dogs in East and West Malaysia. Antibodies to T. gondii were determined in serum samples from 222 stray dogs from 6 different states in East and West Malaysia (Peninsular Malaysia) using an Indirect ELISA. The seroprevalence for T. gondii was 23.4% (Confidence interval: CI 17.8-29.2%). Stray dogs from Selangor and Kuala Lumpur had the highest seroprevalence (32.4%; CI 13.2-45.5%) and lowest in those from Penang and Kedah (12.5%; CI 1.3-23.5%). Gender and breed were not associated with T. gondii seropositivity. However, adult dogs were more likely to be seropositive for T. gondii (OR=2.89; CI 1.1-7.7) compared with younger dogs. These results revealed that T. gondii is prevalent in stray dogs in the studied areas in Malaysia, and indicative of the level of environmental contamination of this parasite especially in urban areas.

First molecular detection of Tritrichomonas foetus in domestic cats in Klang Valley, Malaysia

@#Tritrichomonas foetus is known to cause chronic diarrhea in the feline species in many different regions of the world. However, there is a paucity of information on T. foetus among cats in Malaysia. This study was conducted to determine the prevalence of Tritrichomonas foetus in the pet and stray cat population in Klang Valley, Malaysia. A total of 201 pet and stray cats’ fecal samples were collected in Klang Valley. 24 samples were cultured in the InPouch® TF Feline to observe for motile trophozoites. A nested PCR protocol was used to screen for T. foetus in the collected samples. The prevalence of T. foetus in the cat population in Klang Valley was 33%. There was no association between Tritrichomonas infection and age, sex, breed or management of the cats. However, statistical analysis revealed that stray cats were more likely to be infected with T. foetus compared to pet cats. This study confirmed for the first time the presence of T. foetus among the cat population in Klang Valley, Malaysia.

Prevalence of Toxoplasma gondii in pet and stray cats in Klang Valley, Malaysia

@#Toxoplasma gondii, a zoonotic protozoan that has a worldwide distribution, is known to infect many warm-blooded vertebrates. The feline species including domestic cats are the definitive hosts for Toxoplama gondii and shed the infective oocyst. There is lack of information on the prevalence of Toxoplasma gondii in cats in Malaysia. The objective of this study was to determine both the seroprevalence of T. gondii and the prevalence of T. gondii DNA in cats’ feces in Klang Valley, Malaysia. 198 blood and 201 fecal samples were collected from pet and stray cats from the local council, Dewan Bandaraya Kuala Lumpur (DBKL) and University Veterinary Hospital, Universiti Putra Malaysia respectively. The overall seroprevalence of Toxoplasma gondii in cats in the Klang Valley was found to be 5.5%. There was a high prevalence (10.5%) of T. gondii DNA detected in the cat fecal samples in both pet and stray cats suggestive of T. gondii oocyst shedding. Stray cats showed a higher seroprevalence and molecular prevalence of T. gondii than the pet cats. However, comparative analysis using Chi-square test showed no significant difference between both groups (P>0.05). Higher prevalence (10.5%) of cats shedding T. gondii DNA as compared to the seroprevalence (5.5%) was found in the cat population in the Klang Valley. The high prevalence of cats shedding T. gondii DNA is alarming as this may directly reflect the number of oocysts excreted into the environment posing a significant public health hazard.

Analysis of adverse drug reactions encountered in a tertiary care hospital: a cross sectional study

Background: Adverse drug reactions are due to hazards of drug therapy and can occur with any class of drugs. The aim of this study was to evaluate and record adverse drug reactions reported from various departments of a tertiary care hospital.Methods: A Cross Sectional study conducted in a tertiary care hospital for a period of 4 months from March to June 2017 after Institutional Ethics Committee approval. ADRs reports collected and analyzed for causality, severity and preventability by international standardized scales.Results: A total of 38 ADR’s were reported during the study period with male predominance (58%). Most of the ADR’s (42%) were common in patients in the age group 19-39 years. More number of ADR’s were from Medicine (29%). Most commonly affected organ systems were skin (45%). The drugs mostly accounted were antibiotics (55%) especially Cephalosporins (33%). According to Naranjo’s causality assessment scale 74% of reactions were probable, 26% were possible, Modified Hartwig and Seigel severity assessment scale revealed 45% ADRs to be moderate, 42% were mild and 13% were severe, Modified Schumock and Thorton Preventability assessment scale which revealed 61% ADRs were not preventable, 32% were probably preventable,7% were definitively preventable.Conclusions: Adverse Drug Reactions are common and some of them resulted in increased healthcare cost due to need of some interventions and increased length of hospital stay. The health system should promote the spontaneous reporting of ADR’s. The proper documentation and periodic reporting to Pharmacovigilance Centres is required to ensure drug safety.

Integration of mental health into primary healthcare: perceptions of stakeholders in Pakistan

Background: In Pakistan, there is high prevalence of mental health disorders, but mental health services to address these are not well developed. To provide effective mental health services, the World Health Organization emphasizes the integration of mental health into primary health care [PHC]. Objectives: This study aimed to assess the views of key stakeholders about integration of mental health into PHC in Karachi, Pakistan. Methods: A qualitative, exploratory study was conducted between June and September 2013 among 15 decision-making [from the Department of Health] and implementation-level stakeholders [mental health and public health professionals and primary care staff] from both the public and private sectors. Face-to-face, in-depth interviews were conducted using a semi-structured interview guide. Data were collected until theoretical saturation was achieved and conventional content analysis was carried out. Results: Although there was general support among all the stakeholders for integration of mental health services within PHC, there were also a number of reservations. First was the perceived lack of support within the system in terms of resource allocation and acceptance from the community. Second was the lack of human resources in the field of mental health. In addition, resistance at the PHC level is likely as staff are already burdened with other preventive care services. Conclusions: The study suggests that strong political commitment, adequate human and financial resources, and strong advocacy are needed for the integration of mental health into PHC in Pakistan

Nasal itching and bleeding due to excessive exposure to air conditioners

Introduction: Nasal mucosa is very sensitive when it is exposed to extreme dry and cold weather conditions. Persistent or recurrent nasal itching due to such exposure is usually followed by the epistaxis. Objective of the study was to analyze effects of excessive exposure to dry and cold air of air conditioners on nose in terms of nasal itching and epistaxis

Methods: This prospective cohort study carried out on 144 healthy Pakistani individuals working in United Nations Hospital in Nyala, Sudan from February 2014 to May 2014. Individuals spending less than 8 hours daily inside air conditioners were compared to those spending more than 15 hours daily. Chi square tests were applied to compare the proportions of incidence of nasal itching and epistaxis between these two groups as well as between two age groups

Results: Mean age of all 144 subjects was 35.01 years [+/- 6.4]. Chi square test results confirmed that there was statistically significant difference of both the symptoms [nasal itching p-value 0.021 and nasal bleeding p-value 0.044] between two groups. Those spending more time in air conditioners were significantly more affected by dry and cold air. As for as the age group is concerned significantly higher number of subjects of ages more than 40 years had nasal bleeding compared to the younger age group [equal or less than 40 years]

Conclusion: Effects of exposure of dry air of air conditioners on nasal mucosa in terms of nasal itching and nasal bleeding were found to be significantly higher when subjects were exposed 15 hours or more per day. Furthermore nasal bleeding was more commonly seen in elderly subjects [more than 40 years] due to such exposure

Rotavirus infection in children under 2 years of age at tertiary care hospital

Objective: To determine frequency of rotavirus infection in children under 2 years of age presenting with acute watery diarrhea at tertiary care hospital. Study Design: Cross sectional study. Place and Duration of Study: Department of Pediatrics, MH Rawalpindi, from Jan to Jun 2016

Material and Methods: Total 246 children, hospitalized with complaints of non-bloody acute watery diarrhea at the time of admission were included. Stool samples were collected and transported to Armed forces institute of Pathology [AFIP] for stool antigen detection for Rotavirus. Descriptive statistics were calculated. Stratification was done and post stratification Chi-square test was applied. A p-value <0.05 was considered as significant

Results: There were 48.8% [120] male and 51.2% [126] female children. Mean no. of stools per day were 6.62 +/- 1.92 in children whose stools for Rotavirus antigen were positive in 174 [70.7%] patients, no. of stools per day was significantly associated with positive results

Conclusion: Rotavirus was found to be positive in majority of children causing substantial morbidity. There was significant association of rotavirus infection with increased no of watery stools per day

Efficacy of Azadirachta indica organic extracts against clinical methicillin resistant Staphylococcus aureus isolates

In current study we investigated the efficacy of organic extracts of Azadirachta indica leaves against Methicillin Resistant Staphylococcus aureus [MRSA] clinical isolates. For this purpose fresh leaves were used to prepare ethanol, methanol and chloroform extract. Secondly, a cross sectional study was conducted to isolate MRSA in clinical samples from patients having surgical/ non-surgical wounds from Allied Hospital and District Head Quarter Hospital, Faisalabad. The S. aureus isolates were initially identified by biochemical characterization, followed by identification of MRSA using cefoxitin disc diffusion test that was finally confirmed by genomic amplification of mecA gene, responsible for resistance. All MRSA isolates were tested to find vancomycin resistant S. aureus [VRSA] using E-strips [M.I.C. EvaluatorTM, Oxide, UK]. The data showed an overall 37% prevalence of S. aureus including 56.75% clinical MRSA isolates while none of the isolated S. aureus showed resistance to vancomycin. The antimicrobial activity was measured as mean zone of inhibition for each extract against all MRSA isolates and it was found as 15.38+/-2.26, 16.09+/-3.09 and 17.42+/-2.48 for methanol, ethanol and chloroform extracts respectively. Chloroform extract showed significantly high antimicrobial activity against MRSA isolates. Altogether, the current study exposed the high prevalence of MRSA isolates from tertiary care hospitals. However, all MRSA isolates were found susceptible to organic extracts of A. indica leaves

Development of quality standard and phytochemical analysis of Carica papaya Linn leaves

Carica papaya Linn is the member of Caricaceae family of Kingdom Plantae. The study was executed for the development of qualitative standards of male and female leaves of the plant. The study included evaluation of macroscopial, physico-chemical and preliminary phytochemical parameters to authorize the purity and authenticity of leaf of Carica papaya Linn based on guidelines provided by WHO. Qualitative phytochemical screening of extracts revealed the existence of alkaloids, flavonoids, tannins, phenolic compounds, glycosides including cardiac glycosides, proteins and carbohydrate in different extracts of Carica papaya Linn which are majorly rich in female leaves as compared to male. Mean ash values, acid insoluble ash, water soluble ash, foaming index, swelling index and moisture contents were also evaluated which are more or less similar. FTIR profile of the samples were also generated that confirmed distinct peak values with respective functional groups exhibited by Carica papaya male and female plant. The current research reflected that female and male plant showed variations in phyto-constituents. This data will be utilized for additional Pharmacological and Instrumental evaluation of the plant which can not only be beneficial in discriminating and refining the type as well as nature of various phytochemicals present in Carica papaya male and female leaves but also establish the quality standards for future researches

Comparision of pre-operative on Dansetron versus combination of Dexamethasone and Ondansetron for postoperative Nausea

Objective: To compare the efficacy of ondansetron with a combination of ondansetron and dexamethasone after elective laparoscopic cholecystectomy in terms of postoperative nausea and vomiting

Study Design: Randomized controlled trial

Place and Duration of Study: Department of Surgery, Combined Military Hospital Rawalpindi Pakistan, from Apr 2014 to Mar 2015

Materials and Methods: Two hundred and twenty two patients fulfilling the inclusion criteria were selected for study and divided into two groups of 111 each. Group A was given ondansetron while group B was given combination of ondansetron and dexamethasone at induction of general anesthesia. Patients of both groups were observed at 24 hours postoperatively for nausea and vomiting

Results: Sixty six patients in group A had nausea as compared to 50 patients in group B [p-value 0.03], 46 patients in group A had vomiting as compared to 19 patients in group B [p-value <0.001], showing statistically significant difference between the two groups

Conclusion: Postoperative nausea and vomiting is significantly lower in ondansetron and dexamethasone combination group as compared to ondansetron alone group after elective laparoscopic cholecystectomy

King Vision video laryngoscope for severe post burn contracture neck: an encouraging experience / Videolaringoscópio King Vision para contratura grave do pescoço após queimadura: uma experiência encorajadora

Abstract Background and objectives Managing the airway of post burn contracture of the neck has always been challenging to anesthesiologists as it limits the alignment of oro-pharyngo-laryngeal axes because of functional and anatomical deformities that occur as a result of long standing contractures. Here the role of the King Vision video laryngoscope which is the latest in the series of video laryngoscope has been evaluated for such patients. Case report A 35 year old male patient with post burn contracture of neck was scheduled for release of the contracture. As the patient had had fixed flexion deformity of the neck we did not attempt the conventional laryngoscopy. Instead we opted for King Vision video laryngoscope. Conclusion We therefore conclude that King Vision videolaryngoscope can be used for difficult airway situations like post burn contracture of neck.

Resumo Justificativa e objetivos O manejo de vias aéreas em contratura de pescoço após queimadura sempre foi um desafio para os anestesiologistas, pois a contratura limita o alinhamento do eixo orofaringolaríngeo devido às deformidades funcionais e anatômicas que ocorrem como resultado de contraturas de longa duração. Relato de caso Paciente do sexo masculino, 35 anos de idade, com contratura do pescoço após queimadura foi programado para liberação da contratura. Como estava com deformidade fixa em flexão no pescoço, não tentamos a laringoscopia convencional e optamos por usar o videolaringoscópio King Vision. Conclusão O videolaringoscópio King Vision pode ser usado em situações de via aérea difícil como a contratura de pescoço após queimadura.

Frequency of pressure ulcers in patients with spinal cord injury

Objectives: To determine the frequency of pressure ulcers in patients with spinal cord injury. To compare frequency of pressure ulcers in complete and incomplete spinal cord injury using ASIA impairment scale

Study Design: Cross sectional study

Place and Duration of Study: Departments of Armed Forces Institute of Rehabilitation Medicine Rawalpindi, from Jun 2013 to Jan 2014

Material and Methods: After permission from the hospital ethical committee and informed consent, spinal cord injury [SCI] patients were included from the outdoor and the indoor departments of Armed Forces Institute of Rehabilitation Medicine Rawalpindi from June 2013 to January 2014. Patients were divided in two groups of complete SCI and incomplete SCI on the basis of American Spinal Injury Association [ASIA] impairment scale. SPSS version 17 was used for data analysis

Results: Total 62 SCI patients were included. Mean age of patients was 36 +/- 0.93 SD. Males were more in number 79% [49]. On ASIA scoring 51.6% [32] were in ASIA 'A' followed by 19.4% [12], 17.7% [11] and 11.3% [7] patients in ASIA 'B', 'C and 'D' respectively. SCI was complete in 51.6% [32] and incomplete in 48.4% [30]. PU were present in 32.3% [20] patients. PU were in stage 4 in 30% [6] patients. PU were more frequent in ASIA [A] injuries followed by [B], [C] and "D" involving 43.8%, 25%,18.2% and 14.3% of patients respectively. Pressure ulcers [PU] were common in complete injuries involving 43.8% [14] than in incomplete injuries 20% [6] [p=0.041]

Conclusions: Pressure ulsers were more common complication detected after spinal cord injury with more frequency in complete spinal cord injury

Diagnosis of hepatitis C in pregnant mothers and its transfer pattern in neonates

Hepatitis is the most common liver diseases in the Pakistan caused by blood-borne infection of HCV. Viral transmission is frequent through blood contact. Vertical transmission is transfer of disease from mother to infant. The women who are infected with hepatitis C virus RNA are at high risk of infecting their babies. Actual transmission occurs during labor and at time of delivery when blood of both mother and neonate is in contact with each other. Vertical transmission rate is lowered when mother is HCV RN Anegative. The project was designed to determine the percentage of transmission and prevalence of Hepatitis C virus from mother to neonates. Assessment of the quantitative analysis of RNA levels in mother blood and viraemic status from the early postpartum period onwards of children born to HCV-infected mothers. For the diagnosis of hepatitis C in mothers, blood samples of fifty HCV pregnant women between 23-41 years old were taken. The blood samples were centrifuged at 8,000 rpm and serum was separated and stored at 4°C. The values of the Alanine Aminotransferase was determined at 2nd and 3rd trimester of pregnancy. After extraction HCV-RN Awere transcribed and amplified by PCR. The samples were further authenticated through the Agarose Gel Electrophoresis system and bands were obtained. Nested reverse transcription PCR [RT-PCR] was conducted for the quantitative analysis of HCV-RNA. The results showed that in 66% cases, the mothers had high level of ALT at 2[nd] trimester of pregnancy. Their ALT level was decreased in the 3[rd] trimester of pregnancy. PCR results showed that 40% pregnant women had quantity of HCV-RNA in the range of 1000-10,000 lU/mL and in 18% women were above 100000 The results of spectrophotometer showed that 80% infants had the antibodies against HCV-RNA while only 20% of the neonates did not have antibody right after birth. The 29% babies got HCV-RNA in their serum and became positive for HCV-RNA?

Role of pulsed electromagnetic therapy in the management of backache: a study conducted at armed forces institute of rehabilitation medicine, Rawalpindi

To determine the role of pulsed electromagnetic therapy in providing pain relief for backache. This was a quasi experimental study. This study was conducted at Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, Pakistan from Jan 2012 to June 2012. This study included 65 consecutive patients with backache. The pain was assessed on 11 points [0-10] Numeric Rating Scale [NRS] and patients with score >1 were included in the study. Detailed history was obtained and examination was performed. All patients were subjected to pulsed electromagnetic therapy. The pain was assessed at first week, 2nd week, third week and six week after start of the pulsed electromagnetic therapy. Data was compiled and analysed using SPSS version 17. A p-value < 0.05 was considered as significant. There was marked reduction in pain of patients with backache after treatment with pulsed electromagnetic therapy. Reduction in pain as calculated by the NRS [numeric rating scale] value after 1[st] week was 25.35% [p=0.002], after 2[nd] week was 43.66% [p=0.001], after 3[rd] week was 50.7% [p=0.001] and after 6 weeks was 71.83%[p=0.001]. Pulsed electromagnetic therapy is very effective in relieving pain in patients with backache

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

MRI brain findings in patients with high serum prolactin levels

The purpose of the study was to find MRI findings in patients with Prolactin levels above1000mIU/L. Methodology: This Retrospective study was conducted in Radiology Department, Rehman Medical Institute,Peshawar, from December 2009 to October 2012. A total of 86 patients, aged 16-48 years with high Prolactinlevels, were screened with MRI for pituitary gland abnormalities. Only new undiagnosed patientswere considered for the study. Children and patients with known causes for hyperprolactinaemia wereexcluded.The most common abnormality on MRI was microadenoma [n=34, 39.5%] followed by macroadenoma[n=14, 16.3%]. 12[7%] cases of complete/partial empty sella syndrome were seen. Macroadenomawas more common in males [n=6 out of 14, 42.3%] while microadenoma was more common in females[n=32 out of 72, 44.4%]. Majority of Patients had an abnormal MRI finding, showing that MRI screening should berecommended for Prolactin levels above 1000mIU/L. Microadenoma was the most common abnormality,having higher incidence in female patients

Analysis of autopsy record of unnatural deaths in Peshawar district

This study was undertaken to describe the unnatural deaths and their causes in Peshawar and its suburbs. This descriptive study was conducted at the Department of Forensic Medicine and Toxicology, Khyber Medical College, Peshawar. Autopsy data from January 2009 to April 2012 was analyzed and only those cases were selected for the study where the cause of death was unnatural i.e., homicide, suicide, accidental or undetermined. Of a total of 3,265 autopsies due to unnatural causes during 40 months period, 2,839 [87%] were males and 426 [13%] were females. There were 2,856 cases of homicide - 2,475 [87%] were males and 381[13%] were females, 317 were accidental deaths - 281 [89%] males and 36 females [11%], 66 were suicide cases - 61 [92%] males and 5 females [8%] and 26 were undetermined deaths - 22 males [85%] and 4 [15%] females. Most victims were aged 20-40 years. Most common cause of death was firearm - 2370 cases, blunt trauma 279 cases and bomb blast/explosives 167 cases. The rate of unnatural deaths in Peshawar is very high. Autopsies done during the study period were a lot more than previous years. Homicide is the most common manner of death with firearms being the most common weapon used. Strict laws should be implemented to limit illegal weapons. Surveillance must be increased in all parts of the city to reduce the loss of precious human lives