Forensic and clinical significance of serum amylase, lipase and gamma glutamyl transferase as predictors of outcome in head injured patients.

Head trauma is one of the leading causes of death and disability worldwide. Combined head lesions consist of more than one form of lesions. Biochemical markers of brain injury are used in determining the extent of brain injury and predicting its outcomes. The aim of this study was to investigate the forensic and clinical significance of serum amylase, lipase and gamma glutamyl transferase (GGT) as predictors of the outcome in head injured patients. PATIENTS AND METHODS: Sixty head injured patients were enrolled and subjected to personal history taking, general and local physical examination. Glasgow coma scale (GCS), head computed tomography scan and pelvi-abdominal ultrasound were performed. Two blood samples (each 3 mL) were drawn at the time of admission and after 24 h for measuring serum amylase, lipase and GGT levels using special kits. RESULTS: Most cases of head trauma occurred accidentally during daytime, in the street as a result of falls and road traffic accidents (RTA). Significant increase of serum amylase, lipase and GGT levels on re-evaluation after 24 h from admission were demonstrated in combined head lesions. There was a high significant negative correlation between GCS and these enzymes both on admission and 24 h after admission. Serum levels of measured enzymes were significantly higher in non-survivors as compared to survivors. CONCLUSION: Serum amylase, lipase and GGT are good predictors of the outcome in head injured patients. This could be useful for forensic experts to deduce that the poor outcome of the victims was primarily related to the effects of head trauma and its sequences.

Electric injury-induced Purkinje cell apoptosis in rat cerebellum: Histological and immunohistochemical study.

INTRODUCTION: Electrical injury is a prominent problem in low income countries with increased morbidity and mortality rate. Nervous system is one of the most susceptible systems to electrical current because of its low resistance. There were different studies demonstrated electrocution effect on the nervous system, however little was made on the cerebellum. AIM: This study was conducted to produce an experimental suggestion concerning injury of the nervous system through evaluating Purkinje cell apoptosis and number in rat cerebellum by fatal and non-fatal electric current using histological and immunohistochemical study. Also to support the diagnosis of electrocution as a probable cause of death and delayed neurological damage as well as disability. MATERIALS & METHODS: Fifty male Wistar rats were divided into five groups (10 rats each); control group: normal rats that were sacrificed without exposure to electric current, groups 1-3 (non-fatal electrocution groups): rats were exposed to alternating electric current (220v, 50Hz) for one minute then were sacrificed immediately, after 2h, and after 4h respectively, and group 4 (fatal electrocution group): rats were sacrificed after being electrified up to death (153±27s). Sections from cerebellum were processed for histological and caspase-3 immunohistochemical study. RESULTS: Purkinje cells showed marked histopathological changes in the form of shrunken dark stained cells with significant reduction of their number in H &E stained sections when compared to control, widespread argyrophilia, and degenerated organelles along with shrunken irregular nuclei. For caspase-3 staining, there was significantly increased number of caspase-3 positive cells in groups 1-3 (non-fatal electrocution groups) and markedly increased in group 4 (fatal electrocution group) in comparison to control group. These changes were gradually increased with the increased duration after exposure to the electric current. CONCLUSION: Apoptosis and loss of Purkinje cells were involved in the pathogenesis of immediate and long term effect of electrical injury on Purkinje cells, which will be an aid to the forensic pathologist to determine the cause of death and residual damage as well as disability after electric shock.

Estimation of Early Postmortem Interval Through Biochemical and Pathological Changes in Rat Heart and Kidney.

Accurate estimation of time passed since death is a complicated task in forensic medicine especially in homicide or unwitnessed death investigations. Changes in oxidant/antioxidant parameters were investigated if it can be relied upon in estimating the early postmortem interval (EPI) in rat heart and kidney, and whether these changes were correlated with histopathological findings in these tissues. Heart and kidney tissues of 84 male albino rats were divided into 2 parts. One part used for estimation of levels of malondialdehyde (MDA), nitric oxide (NO), and total thiol as well as the activity of glutathione reductase (GR), glutathione S transferase, and catalase. The second part was examined histopathologically. It was found that MDA and NO were significantly increased earlier in the heart than kidney tissues. Meanwhile, total thiol, catalase, glutathione S transferase, and GR were commenced to be significantly decreased in the heart before kidney tissues. Linear regression analysis of independent variables of heart was found to be of a high predictive value of 97.2% (EPI = 8.607 - 0.240 GR + 0.002 MDA + 0.014 NO). Structural deterioration of heart started 3 to 4 hours compared with renal sections that began 5 to 6 hours after death. The relationship between oxidant and antioxidant parameters is crucial in determining the EPI. The kidney was found to be more resistible to oxidative damage. Further research on humans is needed.