A Scoping Review on Salt Reduction Intervention

@#Excessive salt intake has been linked to the development of hypertension and non-communicable diseases. This study aims to explore the different types of salt reduction intervention implemented among adults aged ≥18 years and to identify the suitable settings, duration and tools used for effective salt reduction interventions. This review adapted the established structured scoping review framework by Arksey and O’Malley. Related articles from the year 2008 to 2018 were retrieved based on the study objectives using keywords in electronic databases and through a bibliographic search of books, reports, conference proceedings, posters and summaries. Out of 130 potentially relevant full-text articles assessed, 14 articles were included in the review. Suitable salt reduction initiatives for the community who regularly consume home-cooked food are through cooking and usage of a tool such as a salt-restriction spoon, together with awareness on the benefits of salt reduction in their daily diet. Healthy catering initiative should be implemented in the workplace or institution-based settings. Policy development targeting the source of salts such as mandatory usage of salt-substitutes or Front-of-Pack labelling of salt content in all food products suitable for population-level intervention.

Perspectives of Malaysian parents on eating out: A qualitative analysis

@#Introduction: The culture of eating out among Malaysians has substantially increased in recent years due to the urbanisation of the society. Frequent eating out has been linked with reduced quality of diet, reduced intake of micronutrients, and increased weight gain. This study aims to explore specific factors on the perceptions and behaviours related to eating out from the perspective of parents. Methods: A qualitative study was carried out among 27 informants from various ethnicities and locations in Peninsular Malaysia. All sessions were audio-recorded, fully transcribed and analysed using thematic content analysis. Results: The main overarching theme that surfaced from this study was the role of parents in shaping the practice of eating out. Time constraints due to parents’ work commitments, the availability of various food outlets, increase in family bonding time and food preferences were recurring themes revealed by informants as facilitating factors to eating out. Other emerging themes, such as hygiene of food premises and cost of food, posed as barriers to eating out. Conclusion: These findings offered a better understanding on the eating out practices of a family from the parents’ perspective. Information as such could be incorporated in strategies to enhance the promotion of healthy eating and nutrition interventions that aim to inculcate healthy food choices while eating out.

Knowledge, Attitude And Practice Of Breast Cancer Screening Among Health Science Students In Shahrekord City, Iran

@#The aim of this study is to assess the knowledge, attitude and practices of breast cancer among health science students in Shahrekord city, Iran. A cross- sectional study was conducted in 2017-2018 academic year among 334 health science students in Shahrekord University of Medical Sciences. Data was collected using self-administered structured questionnaire. The total score for knowledge was 18. Any respondent who had more than 9 was considered as having good knowledge and below 9 as having poor knowledge. The total score for attitude was 7. Any score more than 4 was considered as good attitude and score less than 4 was considered as bad attitude. The mean age of the respondents was 21.21± 1.19 years. Most of the respondents aged 18 to 21 years. The knowledge level was significantly different by age group (P=0.002), department (P=0.000) and those who attended training course (P=0.000). Those who perform BSE (Breast Self-Examination) had higher knowledge score about breast cancer than those who do not perform BSE (P=0.000). The participants’ attitude was not significantly different by age group, department, family history of cancer and attending of training courses (p > 0.05). The breast self-examination practice was significantly different by age group (P=0.002), department (P=0.000) and those who attended training course (P=0.000). About half of the respondents had good knowledge on breast cancer. However, more than half of the participants had negative attitude towards breast cancer. For example, less than half of the respondents performed BSE and none of the respondents has performed CBE (Clinical Breast Examination) or mammogram before.

Food Choices and Diet Quality in the School Food Environment: A Qualitative Insight from the Perspective of Adolescents

@#Introduction: Overweight and obesity among adolescents are not caused by a single factor, and evidence indicates that the food environment is one of the driving forces behind the current escalating obesity epidemic. Therefore, it is imperative to explore any perceived factors related to food choices and quality of food in the school food environment among adolescents. Methods: A qualitative study based on the Socio-Ecological Model (SEM) was conducted on a purposive, multi-ethnic sample of 51 adolescents from different localities. The semi-structured and in-depth interviews were fully transcribed and analyzed qualitatively using Atlas.Ti. The transcribed texts were coded into similar and related themes such as food choices, quality of food, social-peers’ influence, cost of food and self-awareness. Results: The findings revealed that there is a clustering of barriers to practising a healthy dietary intake within the school food environment. Accessibility to low cost snacks and fried foods, influence by parents and peers, as well as the autonomous character of informants in making their own purchases are the contributing factors to healthy eating practice among adolescents. Conclusions: The study highlights that the barriers to practicing healthy eating considerably outweighs the enabling factors. Therefore, the findings will help facilitate the construction of policy-driven environmental changes as well as strategies in designing effective and multilevel interventions that raise awareness in helping adolescents navigate healthy food in their school’s compound

Functional outcome in patients with Supra Tentorial Hypertensive Intracerebal Hemorrhage after surgical intervention

Objectives: To determine the functional outcome in patients with supratentorial intracerebral hemorrhage after surgical intervention

Study Design: Retrospective descriptive study

Place and Duration of Study: This study was carried out at the department of Neurosurgery, Combined Military Hospital Rawalpindi [CMH], from Jan 2015 to Dec 2015

Material and Methods: Retrospectively the records of eighty two patients with a diagnosis of supratentorial hypertensive intracerebral bleed on computed tomography scan [CT] brain, who were surgically managed in our department over one year period, were collected and evaluated. All the patients had undergone clinical examination, baseline investigations including complete blood counts, urea, creatinine, electrolytes, prothrombin time [PT], partial thromboplastin time [PTTK], electrocardiography [ECG] and chest x-ray. In case of deranged coagulation profile platelets or fresh frozen plasma were transfused preoperatively. Outcome of patients was assessed by Glasgow outcome scale [GOS] at 3 months after surgery. A GOS score of 4 and 5 was considered favorable outcome and score of 1, 2 and 3 was considered unfavorable outcome, and these were noted in proforma. Descriptive statistics for age, gender, hospital stay and clinical outcome were calculated by using SPSS version 20

Results: Eighty two patients of supra tenteorial bleed were operated over the study period. The mean age of patients was 44.82 +/- 9.25 years and the average hospital stay was 13.21 +/- 4.41 days. Fifty six patients [68.3 percent] were male while 26 [31.7 percent] were female. Favorable outcome at three months was observed only in 24 patients [29.26 percent] while unfavorable outcome in 58 [70.73 percent] cases

Conclusion: Unfavorable results at three months after surgery were observed in 70.73 percent of patients in our sample suggesting poor functional outcome in early evacuation of supratentorial bleed

Assessment of the knowledge of gastroesophageal reflux disease among the Saudi population of Altaif City

Background: gastroesophageal reflux disease [GERD] ranks as one of the most common gastrointestinal disorders. Up to this date, no studies examined the level of health knowledge of Saudi population about GERD

Aim of the study: this study aimed to assess knowledge about GERD signs, symptoms and risk factors in Saudi residents of Altaif City

Methods: this minimal knowledge questionnaire that was distributed among the general public in Altaif City, Saudi Arabia. The questionnaire consisted of two sections: section 1 included personal data and section 2 explored the awareness and knowledge about the most common symptoms and risk factors of GERD. Only questionnaires without missing data were subjected to statistical analysis

Results: respondents who answered all the questions correctly represented 7.4%, while those who answered all wrongly were 1.5%. The mean proportion of minimal medical knowledge [MMK] score was 64.66%. Respondents with higher education [p < 0.001], medical background [p = 0.004] and health knowledge derived from books [p = 0.001] achieved the highest total scores. Sex, residence, marital status, and past/family history of GERD seemed not to affect the mean MMK scores [p = 0.277, 0.234, 0.970, 0.873 and 0.085 respectively]

Conclusion: some symptoms [Globus sensation, dysphagia and odynophagia] and risk factors [Scleroderma and asthma] for GERD remained unknown to nearly half the participants. We recommend providing health information concerning GERD on the Internet or to prepare booklets to be distributed through the health care facilities

Antihyperglycemic effect of Conocarpus erectus leaf extract in alloxaninduced diabetic mice

Synthetic drugs have widely been helpful in management of diabetes mellitus type 2. However, side effects associated with synthetic drugs serve as an impetus to explore plants as alternate mode of treatment. The hydroethanolic leaf extracts of Conocarpus erectus were evaluated for phenolic contents, flavonoid distribution, antioxidant activity and antidiabetic potential. The maximum extract yield, total phenolic and flavonoid contents were exposed by 60% ethanolic extract. The Antioxidant and anti alpha-glucosidase tendency of 60% ethanolic extract was the most promising and complemented by in-vivo antihyperglycemic impact on mice. The findings were substantial regarding suppression of blood glucose levels in alloxan induced diabetic mice establishing the Conocarpus erectus as proficient pool of nutraceuticals for diabetes mellitus type 2 management

Transcallosal, transforaminal approach for excision of colloid cysts of third ventricle

Objective: To study the efficacy of transcallosal, transforaminal approach in excision of colloid cysts of third ventricle in terms of complete excision and post-operative complications. Study Design: Prospective observational study. Place and Duration of Study: Study was carried out in neurosurgery department of CMH Rawalpindi, from July 2009 to Jun 2014

Material and Methods: All suspected cases were subjected to CT scan and MRI of brain for diagnosis and size and site of colloid cyst. All patients having colloid cyst of anterior third ventricle irrespective of age, sex and size of the cyst were included in the study. Patients with recurrence or previous surgery were excluded from the study. Patients with psychiatric illness and abnormalities of memory were also excluded. A uniform approach in terms of position of patients, craniotomy site and flap elevation was adopted for all patients. Post operatively the complications were recorded at 2nd day and 6th week. Derangement of short and long term memory, beads stringing and touch localization were recorded on a specific proforma

Results: A total of 19 patients with colloid cyst of 3[rd] ventricle were included, thirteen were male and 6 were female patients. The most common presentation was headache and vomiting. Most frequent cyst size was 1-2 cm and was present in 57.9%, while 4 patients presented with a large cystic swelling measuring 2-3 cm. A preoperative shunt had to be inserted in two cases due to sudden deterioration of the neurological status. Most of the cases [68.4%] presented with hydrocephalus, and it was absent only in 6 cases. Complete excision was obtained in 17 cases while in 2 cases the cyst could not be removed completely. Most frequent complication on 2[nd] postoperative day was the impaired short term memory which was present in 13 patients. Beads stringing was impaired in 9 patients on 2[nd] post-operative day. On sixth post-operative week, only 2 cases had short term memory loss as improvement occurred in all complications

Conclusion: Transcallosal, transforaminal approach is an effective and safe approach for the excision of colloid cysts of anterior third ventricle. Very few complications of less severity and temporary nature are associated withthis approach

Sorafenib tosylate, Ribavirn and Sofosbuvir combination therapy for HCV virus infected patients with decompensated liver cancer

Hepatitis C is the most common health problem worldwide and is major cause of death due to proliferation of hepatocellular carcinoma. The medicines available for HCV treatment overcome up-to 95% complications of HCV. However, liver cancer needs some additional care. Normally Sorafenib tosylate 200 mg is recommended for liver cancer. There is no such trial in which this drug could effectively be used in combination of direct acting antivirals for HCV. The study was conducted for HCV patients [n=30] with liver cancer having decompensated stage. Combination of Sorafenib tosylate, Ribavirn and Sofosbuvir were used for the pharmacokinetics of these medicines. Child pugh score less then 7 [CP A] in adults during treatment phase [received 12 weeks of Sorafenib tosylate 200 mg, Ribavirn and Sofosbuvir 400 mg once daily] have no side effect while child pugh score 7-9 [CP B] have evidence of hypertension. The main efficiency end point sustained virology response with overcoming liver cancer as well in 12 weeks after end treatment [SVR-LLC 12]. Mean pharmacokinetic exposure to Sorafenib tosylate 200 mg, Ribavirn and Sofosbuvir at week 8[th] was 2.1, 1.5,1.2 times greater in CP B than in CP A. Adverse effects [AEs] were observed in 12 out of 30 patients but not severe as lethal for life. Treatment with Sorafenib tosylate, Ribavirn and Sofosbuvir for twelve weeks was harmless and well accepted, 100 % patients achieve [SVR LLC 12] with 10-fold cure rate more than previous ones. The combination therapy of Sorafenib tosylate, Ribavirn and Sofosbuvir was found helpful for the management of decompensated liver cancer

Effect of breastfeeding on anthropometric parameters in postnatal growth of pre-pubertal male children

Background: Breastfed and bottle-fed children's growth is not on the same pattern. This study was conducted to find out the effect of breast and bottle feeding on pre-pubertal children

Methods: This comparative study was conducted in the Department of Physiology, University of Health Sciences, Lahore. The study was conducted during the period from Oct 2013 to Apr 2015. A total number of 90 male pre-pubertal children were included in this study. Only male children were included to avoid bias of sex. Participants were selected from the school children of the locality around the University of Health Sciences [UHS] Lahore. They belonged to middle socioeconomic group. Their age range was 8-10 years, on the basis of history taken from parents of children. Participants were divided into two groups. Group-I, It included 45 male children having exclusive breastfeeding during the first year after birth. Group-II, It included 45 male children having exclusive bottle feeding during the first year after birth

Results: The median [Q1-Q3] weights were 27 Kg [25-29] and 25 Kg [22-29] in breastfed and bottle-fed groups respectively. The difference was considered significant with p=0.017. The median [Q1-Q3] heights were 133 Cm [130-137] and 130 Cm [122-136] in breastfed group and bottle-fed group respectively. The breastfed group children had significantly greater height [p=0.030] as compared with the bottle-fed group children

Conclusion: Breastfeeding has a positive effect on Height and weight of pre-pubertal children

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?

Frequency of acute myocardial infarction in patients with diabetes mellitus

Objectives: To determine the frequency of Acute Myocardial Infarction in patients with Diabetes Mellitus, and short term survival in these patients

Methodology: This study included 100 patients, was carried out in department of Cardiology, Liaquat University Hospital Hyderabad. Diagnosed cases of type 2 Diabetes Mellitus [DM] requiring Hospitalization with ST elevation, myocardial Infarction and meeting the criteria were enrolled in the study. The final diagnosis of Acute Myocardial Infarction was made within 48 hours of admission. The blood glucose level and glycosylated haemoglobin [HbA1c] were checked to evaluate the glycemic status. The short term survival was evaluated by recording in hospital mortality and mortality during follow-up period of 30 days; by contacting at their residential address or contact number

Results: In the present study total 100 consecutive diabetic cases with acute Myocardial infarction were selected. The males patients outnumbered females. On the ECG and echocardiogram findings 39% patients had anterior wall MI. All male [n=65] patients had short term mortality of 27.68%, stratification showed that 6.15% was between 1 -10 days, 9.23% between 11-20 days and 12.30% mortality was found between 21-30 days. The corresponding figures in female [n=35] patients was 25.33%, stratification showed 8.57% mortality between 1-10 days, 5.71% seen between 11-20 days and in the 11.4% mortality was noted between 21-30 days

Conclusion: The short term mortality after acute myocardial infarction in diabetic patients is significantly high, both male and female suffer almost equally

Myocardial infarction in young patients

Background: Coronary artery disease [CAD] has a predilection for older age. However, both in developed and developing countries, an epidemiological shifts for CAD is observed and now it is more frequently seen in young adult population, but there is paucity of data regarding emerging clinical picture. Therefore, the present study was designed to determine the percentage of patients at 45 years of age and below afflicted with myocardial infarction. The study was also aimed to determine the sex distribution, associated risk factors and clinical features in young patients

Methods: This descriptive study conducted through convenient sampling technique at Coronary Care Unit of Liaquat University Hospital, Hyderabad and on all patients admitted with acute myocardial infarction during the period of one year to determine the frequency of acute myocardial infarction among younger patients aged

Results: The overall prevalence of acute myocardial infarction among young adults was 46.80%. The mean age of study subjects was 37.63 +/-6.26 years; male outnumbered [80.7%, n= 71] female [19.3%, n=17]. Most of the patients belongs to age group between 41 - 45 years [40.9%, n= 36] and the most common underlying condition that may linked to myocardial infarction was cigarette smoking [65.9%, n= 58]. Out of total 88 patients the mortality rate was [12.5%, n= 11] and ventricular arrhythmias were the most common [6.8%, n=6] complication

Conclusion: The acute myocardial infarction is not uncommon in younger aged male smokers

Expediting support for the pregnant mothers to obtain antenatal care at public health facilities in rural areas of Balochistan province, Pakistan

Objectives: To identify, and compare relative importance of, factors associated with antenatal care [ANC] utilization in rural Balochistan, toward framing a policy to increase such utilization. Methods: This cross sectional study was conducted among 513 pregnant women in Jhal Magsi District, Balochistan, in 2011. A standardized interviewer-administered questionnaire was used. Predisposing, enabling, and reinforcing factors were evaluated with generalized linear models [Poisson distribution and log link]. Results: Prevalence of any ANC was only 14.4%. Predisposing, enabling, and reinforcing factors were all important determinants of ANC utilization. Reinforcing factors were clearly most important, husband's support for ANC was more important than support from other community members. Among predisposing factors, higher income, education, occupation, and better knowledge regarding benefits of ANC were positively and statistically significantly associated with ANC However increased number of children showed negative association. Complications free pregnancy showed positive significant association with ANC at public health facility among enabling factors. Conclusion: It is very important to increase antenatal care utilization in the study area and similar areas. Policy to achieve this should focus on enhancing support from the husband

Ultra structural study of the rat cheek epithelium treated with Neem extract

The purpose of this study was to investigate the effects of neem extract [Azadirachta indica A. Juss] on the ultrastructure of the rat oral epithelium, because neem extract has been added in the tooth paste as an anti-plaqueforming substance in Asian countries. The non-toxic dose of 2000 mg/kg body weight of Neem extract [NBE] was applied daily to the surface of buccal epithelium for four weeks and controls did not receive Neem extract. After four weeks cheek epithelial tissues were excised and processed for light microscopy, scanning and transmission electron microscopy. Light microscopy did not show significant differences between NBE-treated and control epithelium. Difference between control and treated rats weight was non-significant. Moreover, time period was also non-significant. Irregular cell surfaces were noticed when compared to control specimens when examined by scanning electron microscopy. Under transmission electron microscopy, wider intercellular spaces were observed in the treated epithelial spinous cellular layers when compared to control. Further, more keratohyalin granules were present in experimental granular cells. It was concluded that present study showed differences between Neem-treated and control in epithelial tissues but these structural differences may not be related to adverse side effects of the Neem extract

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

Incidence of right ventricular infarction in patients with acute inferior wall infarction

Objectives: to find out the frequency of right ventricular infarction [RVI] in patients with acute inferior wall myocardial infarction and also to see its clinical correlation and prognostic value

Methods: 198 consecutive patients with acute inferior wall myocardial infarction [MI] were enrolled. Elevated ST segments in V4R or V3R to V6R were used to diagnose RVI. We assessed the incidence of ST-segment elevation in these leads and their correlation on clinical ground

Result: in 96 patients [48.5%], RVI was present. Clinical correlation showed that raised JVP was present in 58.5% and raised JVP with hypotension in 34.5% of patients. Normal JVP was present in 41.5% of patients in which 22% of patients were with hypotension and 20% of patients were without clinical findings. Hypotension observed in 53% of patients. Complications were higher in patients with elevated ST segments in V4R [51%] in contrast to those without RVI [21%]. In-hospital mortality was more than double in RVI Group

Conclusion: RVI in acute inferior MI is common. Elevated ST segments in V4R or V3R to V6R can be used to diagnose RVI. Clinical correlation can help but may not be diagnostic and it has higher mortality compared to inferior MI alone

Factors associated with utilization of antenatal care services in Balochistan province of Pakistan: an analysis of the Multiple Indicator Cluster Survey [MICS] 2010

Objective: The study was conducted to identify factors affecting the utilization of Antenatal Care [ANC] in Balochistan Province, Pakistan

Methods: Data on ANC utilization, together with social and economic determinants, were derived from a Multiple Indicator Cluster Survey [MICS] conducted in Balochistan in 2010. The analysis was conducted including 2339 women who gave birth in last two years preceding the survey. The researchers established a model to identify influential factors contributing to the utilization of ANC by logistic regression; model selection was by Akaike Information Criterion [AIC] and Bayesian Information Criterion [BIC]

Results: Household wealth, education, health condition, age at first marriage, number of children and spouse violence justification were found to be significantly associated with ANC coverage. Literate mothers are 2.45 times more likely to have ANC, and women whose newborns showed symptoms of illness at birth that needed hospitalization are 0.47 times less likely to access ANC. Women with an increase in the number of surviving children are 1.07 times less likely to have ANC, and those who think their spouse violence is socially justified are 1.36 times less likely to have ANC. The results draw attention towards evidence based planning of factors associated with utilization of ANC in the Balochistan province

Conclusion: The study reveals that women from high wealth index and having education had more chances to get ANC. Factors like younger age of the women at first marriage, increased number of children, symptoms of any illness to neonates at birth that need hospitalization and women who justify spouse violence had less chances to get ANC. Among components of ANC urine sampling and having tetanus toxoid [TT] in the last pregnancy increased the frequency of visits. ANC from a doctor decreased the number of visits. There is dire need to reduce disparities for wealth index, education and urban/rural living

Comparison of morbidity of three flank approaches for open renal surgery

The aim of this study was to compare the morbidity of three flank incisions, subcostal, transcostal and supracostal for open renal surgery in terms of incision times, postoperative pain, postoperative hospital stay and long term complications. Prospective comparative and analytic study. This study was conducted at Department of Urology, Nishtar Hospital Multan and Department of Urology, Ghulam Mohamed Maher Medical College/Teaching Hospital Sukkur from January 2007 to December 2011. In this study twelve hundred sixty [n-1260] patients who underwent open surgical procedures over a period of five years are analyzed. Patients were studied in three groups. Group A, subcostal,[n-407] 32.3%. Group B transcostal [n-526] 41.7% and Group C, supracostal, included [n-327] 25.9%. Mean incision time in Groups A, B and C was 17.3 min, 21.08 min and 23.81 min respectively. Mean amount of injectable analgesic required in first three post operative days in Groups-A, B and C was 41.36 mg, 46.87 mg and 49.40 mg of Nalbin respectively. Mean Post operative hospital stay in Group A Band C was 4.63, 5 days and 4.64 days respectively. Pleural injury was none in Group A, thirty five [n- 35] cases [6.61%] in Group B and thirty nine [n-39] cases [11.9%] in Group C. Incisional hernia was noted in Group A 12 cases 3%, Group B 6 cases 1.1 % and none in group C. With subcostal approach, incision time, dose of analgesia and pleural injury is minimum but high incidence of incisional hernia is there. In transcostal and supracostal approach the incision time, dose of analgesia and incisional hernia is minimum but incidence of pleural injury is relatively high