Diagnosis and phenotypic assessment of Pakistani Haemophilia B carriers

Objectives: 1: To assess the diagnostic utility of three polymorphisms [DdeI, XmnI and TaqI] and direct sequencing in haemophilia B [HB] carrier detection in Pakistani families. 2: To compare phenotypes of HB carriers with those of healthy females

Methods: The study was conducted from March 2014 till February 2016 at Khyber Medical University Peshawar and National Institute of Blood Diseases, Karachi. Individuals from HB families of Khyber Pakhtunkhwa [KP] and Federally Administered Tribal Areas [FATA] with known F9 mutation in the proband were enrolled into the study. FIX activity [FIX:C] levels were determined in all the participants. Bleeding scores [BS] and complete blood counts were performed in the female participants. Linkage analysis followed by targeted Sanger sequencing was carried out in all the study participants. Heterozygosity rate was determined for each polymorphism. Healthy females and the carrier groups were compared for bleeding phenotypes

Results: A total of 30 males and 48 females from 13 HB families were studied. The polymorphisms had a low heterozygosity rate. Direct sequencing determined the carrier status in all cases. The mean FIX:C was reduced whereas BS was raised in the carriers when compared with healthy females. A significant raise in white blood cells [WBCs] count was observed in the carriers

Conclusion: The three polymorphisms have a low heterozygosity rate in HB families from KP and FATA. Sanger sequencing is conclusive in determining carrier status in all the cases. FIX:C is low and BS is raised in the HB carriers in comparison to that of normal females. The mean WBCs count is significantly higher in the HB carriers than the normal females

Impact of medical autopsy on final diagnosis

Objective: To determine the difference between diagnosis and misdiagnosis after medical autopsy

Study Design: Prospective study

Place and Duration of Study: Histopathology Dept Army Medical College Rawalpindi and Military Hospital [MH] Rawalpindi from Jan 2009 to May 2012

Material and Methods: A retrospective cross sectional descriptive study of medical autopsies was conducted on patients at Histopathology Department Army Medical College and MH Rawalpindi who expired at or was brought in dead at MH Rawalpindi during a 41 months period between January 2009 to May 2012. Permission from the ethical committee was obtained for the study. Autopsy for medical purpose was performed on the deceased after receiving written consent from the next of kin. Medical autopsies were performed to determine and find the medical cause of death and to evaluate any disease or injury that may be present. Total of 72 medical autopsies were conducted during the above period. All these consecutive autopsies were included in the study. Ratio of total autopsies done was 0.17% of total hospital deaths at MH Rawalpindi in the duration of study. All subjects were male, military persons, aged between 19 and 50 years. Mean age was 35.5 years. Data was analyzed in excel. Descriptive statistics was applied on qualita ive variables. Frequency and parentages was used

Results: Ante mortem diagnosis confirmed as correct on total of 25/72 Autopsies. Clinically missed / wrong diagnosis was found on 47/72 autopsies

Conclusion: Medical autopsy even today in the environment of a tertiary care hospital has irrefutable contribution in establishing final diagnosis and determining errors and omissions. Consequently it has pivotal role in continued improvement in medical care and in study of evolving disease patterns in real time

Assessing the frequency of dental pain and its associated factors in 11-14 years old children

Objective: the purpose of this study was to assess the frequency, characteristics and other factors affecting dental pain in 11-14 years old school children in Islamabad, Pakistan

Methods: a cross sectional survey was carried out in May 2015 to assess the frequency of dental pain in 11-14 years old school children attending government and private schools in Islamabad, Pakistan. Total samples consisted of 526 school children from 9 randomly selected government and 9 from private schools. Two hundred and seventy three children from government schools and 253 children from private schools participated in the study. Response rate was 83.65%. A standardised questionnaire comprised of 15 questions related to demographics and pain experience was completed by the children

Results: the frequency of dental pain in 11-14 years old school children was 29.1% in Islamabad, Pakistan. The frequency of dental pain in males was 30.2% and in females it was 27.6%. In this study, dental pain in the last six months was not significantly associated with gender in children [p=0.618]. Similarly dental pain was not statistically significantly associated with the type of school in which the child was studying [p=0.302]. However dental pain was significantly related to occupation of father [p=0.027]. The children, whose fathers had jobs as labourers, had a higher frequency of dental pain than fathers with white-collar jobs. Almost 36.7% of the children reporting dental pain described the intensity of pain as discomforting and 28.1% of children had mild pain. The pain did not radiate to the surrounding area in 36.7% of the children. The pain radiated to surrounding area to mild and moderate extent in 41.4% and 13.3% of children respectively. It was found that eating from the side of mouth with dental pain had no effect on the severity of pain in 15.6% of children. Almost 13.3% of children claimed that eating made the pain moderately more severe

Conclusion: overall the frequency of dental pain in children was 29%. Dental pain was not associated with gender of the school child. Efforts should be directed to determine the cause of dental pain in school children. Prevention of dental pain can be done by promoting oral health in children to reduce the impact of dental pain on quality of life

Socioeconomic status and smokeless tobacco consumption in fishermen community of a coastal area of Karachi

Objective: The aim of this study was to assess the frequency of Gutka consumption and its relationship with socioeconomic status among fisherman community of Costal area of Karachi. Methods: Socioeconomic status and information about Gutka habit was collected from 408 fisherman of Ibrahim Hyderi, a coastal area of Karachi from 15th July 2014 to 21st July 2014.The Kuppuswamy scale was used to measure socioeconomic status [SES]. A subject was considered to be belonging to higher socioeconomic status if the family head's education and the number of earning members were higher and the number of children and dependents was less since childhood in his or her household. Single investigator carried out structured face-to-face interview. Convenient sampling technique was used. Results: Out of 408 subjects, 326 regularly consumed Gutka, the common reasons for the habit were the co-workers' influence and to keep awake at work. The prevalence of the Gutka chewing habit was much lesser [25%] among the people belonging to higher social class when compared to the minimal or no improvement group [75%]. A majority of those free from the habit [73.7%] were belonging to the group, which showed improved educational attainment. Among those with good social status, the percentage of workers with high frequency of Gutka chewing and those with a longer duration of the Gutka chewing habit was low when compared to the lower social class group. Conclusion: This study based on data collected by questioner and analyzed on SPSS version 17.It is recommended that intervention in the form of primary and secondary smokeless tobacco use, prevention with association and careful planning including restricted resources available to be implemented efficiently

Placental morphology at different maternal hemoglobin levels: a histopathological study

To evaluate the histopathological parameters of the placenta like weight, infarct and syncytial knots, at different maternal hemoglobin levels, in both qualitative and quantitative manner. Descriptive study. Army Medical College, National University of Sciences and Technology in collaboration with Department of Obstehics and Gynecology, Military Hospital, Rawalpindi, Pakistan, from December 2011 to November 2012. A total of 75 placentas were included, that were collected from full term mothers at the time of childbirth. Placental weight was taken without umbilical cord and gross placental infarcts were noted. Samples of placental tissue were taken and stained by haematoxylin and eosin [H and E]. Microscopic study was done to evaluate placental infarcts and syncytial knots. Mean placental weight at normal and low maternal hemoglobin was 581.67 +/- 83.97 g and 482.58 +/- 104.74 g respectively. Gross placental infarcts were found in all cases having low maternal hemoglobin concentration [60% cases]. Syncytial knots were found in all placentas but they were considerably more at decreasing levels of maternal hemoglobin [19.79 +/- 5.22]. The present study showed decrease in placental weight, increase in placental infarcts and syncytial knot hyperplasia at low maternal hemoglobin concentration, displaying adaptive alterations

histopathologic analysis of chronic inflammatory infiltrate in patients of H. pylori associated chronic gastritis

To determine the relationship between H. pylori density with severity of chronic inflammatory infiltrate. A cross-sectional study. The study was carried out in the Department of Pathology [Histopathology], Army Medical College, National University of Sciences and Technology [NUST] Islamabad, from Nov 2011 to Nov 2012. Gastric antral biopsies of H. pylori associated chronic gastritis were included in the study. Demographic characteristics and relevant clinical information were collected. First hundred biopsies of H. pylori associated chronic gastritis were assessed for density of H. pylori and chronic inflammatory infiltrate. Histopathological features like lymphoid aggregates, ulcer slough, superficial epithelial damage, dysplasia and nuclear reactive changes were simply assessed in case of their presence or absence. A sigruficant moderate positive correlation was found between grades of H. pylori and chronic inflammatory infiltrate [rs= 0.636]. Insigruficant correlation was found with lymphoid aggregates, superficial epithelial damage, dysplasia and nuclear reactive changes. In conclusion this study corroborated the determination of histopathological parameters and depicted that, the greater the density of H. pylori mfection, the greater the degrees of chronic inflammatory infiltrate

Pattern of acid base abnormalities in critically ill patients

To find out the pattern of acid base abnormalities in critically ill patients in a tertiary care health Sacility. A descriptive study. The study was carried out in the department of pathology, Combined Military Hospital Kharian from January 2013 to June 2013. Two hundred and fifty patients suffering from various diseases and presenting with exacerbation of their clinical conditions were studied. These patients were hospitalized and managed in acute care units of the hospital. Arterial blood gases were analysed to detect acid base status and their correlation with their clinical condition. Concomitant analysis of electrolytes was carried out. Tests related to concurrent illnesses e.g. renal and liver function tests, cardiac enzymes and plasma glucose were assayed by routine end point and kinetic methods. Standard reference materials were used to ensure internal quantify control of analyses. Two hundred and fifteen patients out of 250 studied suffered from acid base disorders. Gender distribution showed a higher percentage of male patients and the mean age was 70.5 +/- 17.4 years. Double acid base disorders were the commonest disorders [34%] followed by metabolic acidosis [30%]. Anion gap was calculated to further stratify metabolic acidosis and cases of diabetic ketoacidosis were the commonest in this category [47%]. Other simpie acid base disorders were relatively less frequent. Delta bicarbonate was calculated to unmask the superimposition of respiratory alkalosis or acidosis with metabolic acidosis and metabolic alkalosis. Though triple acid base disorders were noted in a small percentage of cases [05%], but n7ere found to be the most complicated and challenging. Mixed acid base disorders were associated with high mortality. A large number of critically ill patients manifested acid base abnormalities over the full spectrum of these disorders. Mixed acid base disorders were commonest and were bad prognostic indicators, most often associated with high mortality. This warrants a high index of suspicion, a thorough clinical assessment of patient and a structured approach to analyze the relevant laboratory data in the given clinical setting. Only with prompt detection of an acid base disorder, clinician can formulate an appropriate management strategy for the patient

Frequency of thrombocytopenia in plasmodium vivax malaria

To determine the frequency of thrombocytopenia in Plasmodium vivax [P.vivax] malaria cases at two hospitals. Cross-sectional descriptive study. The study was conducted at the departments of Pathology, Combined Military Hospitals Malir and Sibi, Pakistan from Jul 2011 to Mar 2012. A total of 2709 samples were collected from febrile patients for detection of malaria parasite [944 from CMH Malir and 1765 from CMH Sibi]. Cases having infection with P. falciparum alone or having mixed infection with P. vivax and P. falciparum were excluded from the study. Both thick and thin film microscopy and immunochromatographic method [OptiMAL-IT] were used for detection of malarial parasite. Platelet counts were done using automated haematology analyser [Sysmex KX 21] with re-evaluation of low counts with manual methods. Total of 170 patients were found positive for P. vivax malaria [44 from CMH Malir and 126 from CMH Sibi]. Platelet counts ranged from 21 - 457 x loyi with a mean of 134 x loyi. Ninety five [2.1%] from CMH Malir and 4.2% from CMH Sibi out of 170 patients had thrombocytopenia, and the difference in thrombocytopenia at the two hospitals was insignificant [0.017]. Thrombocytopenia in patients with P. vivax infection is equally prevalent in the two hospitals, representing a widely different geographical area and should prompt a more thorough search for malarial parasite

Stroke; a hospital based study on stratification of risk factors of stroke, its clinical features and response to treatment in Mirpur Azad Kashmir

The objective of the present study was to determine the risk factors of stroke, its clinical features and response to treatment in Mirpur Azad Kashmir. Prospective observational study. This study was conducted at Medical Wards of DHQ Teaching Hospital Mirpur Azad Kashmir from March 2012 to January 2013. Two hundreds patients with established diagnosis of stroke were selected. A questionnaire was prepared in accordance with the objectives of the study. Questionnaire contained detail history, general physical examination, and neurological examination. Association of risk factors with stroke was also studied. Different clinical features were also noted and response to the given treatment was checked by morbidity and mortality ratio. The data thus obtained was subjected to statistical analysis. One hundred and thirty two[66%] had hypertension, fifty five[27.5%] were smoker, fifty three[26.5%] had diabetes, twenty five[12.5%] had ischemic heart disease. In clinical features one hundred and two [51%] had headache, ninety nine [49.5%] had hemiplegia, ninety four patients [47%] had loss of consciousness. On CT scan finding one hundred and forty four patients [72%] had infarction while fifty six [28%] had hemorrhagic stroke. After recommended treatment patients discharged were one hundred and eighty two [91%] while eighteen[9%] died within a month. Hypertension, smoking, diabetes are major modifiable risk factors, headache, hemiplegia, loss of consciousness are major clinical features, chances of ischemic stroke are much more as compared to hemorrhagic. Response to treatment is good

Bidirectional ventricular tachycardia of unknown etiology

A 45 years old male presented to the emergency department with palpitations, headache and apprehension. Hiselectrocardiogram revealed bidirectional ventricular tachycardia. He remained vitally stable and responded to intravenous beta-blocker. Initially digitalis toxicity was suspected but history was negative for digitalis intake. The cause remained unidentified in patient despite detailed investigations. During a short follow-up [of 6 months] he remained asymptomatic and no cause was further identified during this period. Some other unseen causes of bidirectional ventricular tachycardia need to be explored

Clinical presentation, risk factors and outcome of stroke at a district level teaching hospital

Stroke is a fatal clinical syndrome with mortality rate ranging up to 25%. Hypertension, smoking and diabetes mellitus are common preventable risk factors which are associated with serious outcome. Objective of this study was to determine the clinical presentation, risk factors and outcome of stroke. A cross-sectional study was conducted in the Medical Wards of DHQ Teaching Hospital, Mirpur Azad Kashmir from March 2010 to January 2011. A questionnaire was prepared in accordance with the objectives of the study. Frequency of risk factors in patients with stroke were studied. Different clinical features were also noted and response to the given treatment was checked in the form of mortality and recovery. Frequencies and percentages were calculated using SPSS-12. Two hundred patients with stroke were selected. Of the total, 136 [68%] had hypertension, 55 [27.5%] were smokers, 53 [26.5%] had diabetes and 25 [12.5%] patients had ischemic heart disease. One hundred and two [51%] patients presented with headache, 99 [49.5%] developed hemiplegia and 94 [47%] had loss of consciousness. CT brain showed infarction in 144 [72%] patients while 56 [28%] had haemorrhage. Observed mortality in this study was 18 [9%] while 182 [91%] patients were discharged after treatment. Hypertension, smoking and diabetes mellitus are major modifiable risk factors for stroke. Headache, hemiplegia and loss of consciousness are major clinical features. Ischemic stroke is much common compared to hemorrhagic stroke. With proper care stroke is manageable satisfactorily

Nephrotic syndrome: a rare cause of acute coronary syndrome in a child

Patients with nephrotic syndrome are at risk of developing thrombosis in both veins and arteries. Various manifestations in different organs have been reported. Thrombi in heart seen, associated with multiorgan thrombosis have been reported on autopsy earlier, but only once in a living patient with nephrotic syndrome. Here, we report a 13 years old boy with steroid-resistant nephrotic syndrome, who developed an asymptomatic but potentially hazardous large intracardiac thrombus. The child developed nephrotic syndrome at the age of 9 years and had multiple recurrences. At the age of 13 years, he developed myocardial infarction [MI] due to embolism from a large intracardiac thrombus. Later on, he was treated with heparin and warfarin anticoagulation

Salmonella typhi infection: a rare cause of endocarditis

A 21 years old male with a history of mitral valve repair for mitral regurgitation is discussed. He was presented with a history of fever and loose motions for one month and shortness of breath for 03 days. Chest radiograph and ECG was within normal limits. Total leukocyte count was elevated and antibodies to salmonella typhi were positive. Blood culture revealed Salmonella typhi growth. Echocardiography revealed small echogenic masses on mitral valve. He responded to treatment with ceftriaxone given for 4 weeks. This is a rare case where Somonella typhi was isolated from blood of a patient with echocardiographic evidence of documented mitral valve disease and endcarditis

Personal and social factors regarding medical non-compliance in cardiac failure patients

To determine the frequency and association of various personal and social factors with medical non-compliance in cardiac failure patients. Cross-sectional, observational study. National Institute of Cardiovascular Diseases [NICVD], Karachi from January to August 2010. Patients admitted in the medical wards of NICVD, who were being treated for cardiac failure, were included. Information regarding basic demographics, education level, self engagement in therapy and status of compliance was obtained by questionnaire. Statistical analysis was carried out by using Fisher's exact test and chi-square. Level of significance was < 0.05. Data was analyzed using SPSS V-15. Out of 267 patients, 73 [27.3%] were compliant while 194 [72.7%] were non-compliant. Educated, self caring patient, and those who knew names of their medications were more compliant than the rest. Medical non-compliance is very common in heart failure patients. Illiteracy and no self engagement in therapy are associated with non-compliance

Reasons of medical noncompliance in heart failure patients

To determine various reasons of medical noncompliance in heart failure patients. Observational survey. National Institute of Cardiovascular Diseases, Karachi from January 2010 to August 2010. Study was conducted in all medical wards of NICVD. We included patients who were already diagnosed heart failure and were on treatment. Patients were asked for reason of noncompliance. Data was analyzed using spss V-13. Out of 267 patients 73 [27.3%] were compliant while 194 [72.7%] were noncompliant. Various reasons of non compliance were, inadequate prescription 20.2%, financial reasons 15.5%, 15.5% of the patients doesn't feel need of taking medication, miscommunication 15%, side affects 13.5%, nonavailability of medication 11.4%, 7.3% other reasons and 1.1% medication were stopped due to other illness. Medical noncompliance has many reasons. Financial, social, and medical are the main reasons

Diagnostic accuracy of pipelle biopsy in endometrial pathologies

To evaluate the diagnostic accuracy of Pipelle biopsy as compared to endometrium of hysterectomy specimen [gold standard] in various gynaecological abnormalities pertaining to endometrium. This validation study was carried out in the Department of Histopathology, Army Medical College in collaboration with Department of Gynaecology, Military Hospital Rawalpindi from Feb 2008 to Jan 2009. Consenting 100 patients undergoing hysterectomy for various indications at Military Hospital Rawalpindi during the study period fitting the inclusion criteria were incorporated. The preoperative Pipelle and subsequent hysterectomy samples were both delivered to the laboratory in 10% formal saline. Pipelle samples were embedded as such. From the hysterectomy specimen, three representative sections were taken from endomyometrium. Both the samples were processed in automated tissue processor. Paraffin blocks of Pipelle and gold standard were made in paraffin embedding machine. Through rotary microtome, 3-5 micrometer thickness sections were made. Sections were stained by haematoxylin and eosin in autostainer and then mounted. The slides were then examined by resident histopathologist and final diagnosis was given by consultant histopathologist. Endometrial hyperplasia without atypia was a frequent pathology detected on Pipelle accounting for 16% of all cases. Diagnostic accuracy of Pipelle sampling in chronic endometritis, endometrial hyperplasia

Assessment of atherosclerotic plaque vulnerability of coronary arteries in cases of sudden cardiac death

To study the plaque vulnerability in coronary arteries taken from autopsy specimens, of individuals dying of ischemic heart disease in our setup and to compare it with atheroma of those who died of non-cardiac causes. Case control study. Study was carried out in the department of Pathology [Histopathology], Army Medical College, Rawalpindi and National University of Sciences and Technology [NUST], from June 2008 to June 2009. Sixty coronary arteries having atherosclerosis, from autopsies of patients who died of sudden cardiac death were divided into case and control groups. Case group included thirty coronary arteries having atherosclerosis from autopsies of patients of whose death was attributable to Ischemic Heart Disease [IHD]. Control group included thirty coronary arteries where atherosclerotic changes were found by chance [death not attributable to ischemic heart disease]. Plaques were assessed for fibrous cap thickness, foam cells; mean percentage of inflammatory cells on Haemotoxylin and Eosin [H and E] stained slides whereas immunohistochemical [IHC] markers for T-Cells were done by IHC stain method. In present study, foam cells are significantly more in study group than in control group [P=0.007]. Fibrous cap thickness fulfilling the criteria of vulnerable plaque was more in study group as compared to control group [P<0.001]. The present study demonstrated that there was insignificant difference [P=0.152], in the mean percentage of inflammatory cells in case group and control group. An overall significant association was found between vulnerable plaque and death due to ischemic heart disease [P<0.001]. Patients dying of ischemic heart disease have more vulnerable plaque in their coronary arteries as compared to those dying from non ischemic cause. Although this is an autopsy study but the significance of in this study can be very important to guide cardiologists to identify patients at high risk of acute coronary syndrome and use new diagnostic modalities like intravascular ultrasonography and therapeutic strategies like genomic and proteomic techniques. This will help the early detection and treatment of such cases and may ultimately reduce the incidence of sudden cardiac death

Role of single layer interrupted extramucosal anastomosis in small intestine in patients of abdominal trauma

To have recent local evidence behind to support the utilization of single layer interrupted extramucosal suturing technique in patients presenting with abdominal trauma. This case series study was carried out in the Department of General Surgery, DHQ [BBS] Hospital, Abottabad from July 2008 to July 2009. All the patients either male or female patients admitted through emergency with small intestinal trauma were included in the study. Patients were put in a single group. The details of each procedure were explained to each patient. Out of 125 patients most of the patients were seen in age between 21-30 years i.e. 50 [48%] patients. Age range was 16 to 55 years. Out of 125 patients, 86 [69%] patients were male and 39 [31%] were females. Among them 90 [72%] patients were from rural areas and the remaining 35 [28%] patients were residing in urban areas. Among 125 patients, the majority 50 [40%] patients got injuries, in road transport accidents. It was concluded from the study that single layered extramucosal interrupted anastomosis is associated with less risk of dehiscence than the full thickness and continuous extramucosal anastomosis

Liver biopsy in chronic hepatitis C: An assessment of inter and intra-observer's variability

To evaluate the inter and intraobserver variability in the histological grading and staging according to modified Knodell scoring system. A cross-sectional comparative study. Histopathology department Army Medical College, Rawalpindi, Pakistan from June 2006 to December 2006, at the Slides and original reports of already reported chronic hepatitis C cases were retrieved from the case files. A total of 52 liver biopsies of patients were reevaluated by two pathologists. The inter and intraobserver reproducibility for grade of necroinflammation and stage of fibrosis were calculated by using kappa statistics. For grades of necroinflammation a substantial level of interobserver [kappa=0.802] and intra-observer [kappa= 0.749] reproducibility was found. Disagreement in the interobserver results was detected in 11.5% cases, with difference of only one grade in all the cases. Disagreement in the intraobserver diagnosis was noted in 15.4% cases, again with the difference of only one grade of necroinflammation. Similarly for the stage of fibrosis, a substantial level of interobserver [kappa= 0.66] and intra-observer [kappa=0.77] reproducibility was present. Main disagreement for interobserver results was of stage 2 and 3 fibrosis. For intraobserver stage of fibrosis, disagreement was found in 9 cases [17.3%]. There was disagreement in 6 of the 9 cases with fibrosis stage 3, where original histological stage was reported 4. There were 3 [5.8%] cases where presence of steatosis was missed [all in non-tabulated form of reports]. Substantial level of inter and intra-observer agreement can be achieved, both for the necroinflammatory grade and stage of fibrosis, if the scoring system of chronic hepatitis is strictly followed

Comparison between mass closure and layered closure in major abdominal laparotomies

To compare the. number of complications after continuous layered closure with continuous mass closure in major abdominal laparotomies and to describe the frequency and types of complications after each procedure. From December 2002 to July 2003. The study was conducted in Surgical Unit-I in Nishtar Hospital, Multan. A total 50 patients, 25 in each group. In group-A, 17 [70%] were male and 8 [30%] were female while in group-B there were 16 [64%] male and 9 [36%] female. Age of the patient varied from 13 years to 30 years. In group-A 11 [44%] patients were from elective laparotomies and 14 [56%] from emergencies, while in group-B 8 [32%] patients were from elective operation and 17 [68%] from emergency. In group-A, 6 [24%] had midline incisions while 19 [76%] had paramedian incisions. In group-A clean wound were 12 [48%] and clean contaminated were 13 [52%]. In group-B clean wound were 9 [36%] and clean contaminated were 16 [64%] patients. Group-A had 2 [8%] patients with chest infection and cough in 5 [20%], while in group-B had 1 [4%] patient with chest infection, 2 [8%] with hemorrhage. In group-A small bowel 8 [32%], stomach and duodenum 2 [6%], billiary tract 6 [24%], major abdominal vessels 2 [8%], liver and spleen 1 [4%], colon 3 [12%] and miscellaneous 3 [12%]. In group-B the corresponding figures are small. In group-A wound dehiscence occurred in 2 [8%] patients out of 25 whereas in group-B the dehiscence occurred in none of 25 patients. Using non-absorbable monofilament polyprophylene [prolene] is better than the conventional layered closure with regard to gain of early and late wound strength