Background:A large number of women undergo caesarean section throughout the world. These women pass through a period of post operative pain and a morbidity period. These women translate into a substantial portion of population and hence there is a load on the financial resources of healthcare system. Use of the appropriate technique to approximate the wound after caesarean section would not only avoid financial load but also help in early recovery of the patient.Aim:The aim of this study is to compare the effects of alternative techniques for closure of subcutaneous fat and skin on maternal health and use of healthcare resources in caesarean section.Materials and Methods:Patients undergoing Caesarean section were divided in two groups of one thousand patients each. Patients with hematological disorders or a malignancy, diabetes, septicemia or chorioamnionitis were excluded from the study. In all the patients, after stitching the uterus, the rectus sheath was stitched with thread vicryl No.1 (synthetic absorbable braided sutures with polyglycolic acid, polycaprolactone and calcium stearate coating), using a round body needle. Then the patients were divided into two groups. In group I, vicryl No.1 thread used in stitching of the rectus sheath was continued into the skin with application of subcuticular stitches, after securing the edges with a knot. In group II, after stitching the rectus sheath with vicryl No. 1, the thread was cut and interrupted sutures were applied in subcutaneous fat with thread vicryl No. 2. Skin was stitched with subcuticular stitches using proline 2, a non-absorbable propylene suture. The two groups of patients were observed for the duration of surgery, post-operative pain in stitches, patient satisfaction about removal of stitches, evidence of wound infection or seroma, and cosmetic results.Results:It was noted that the duration of surgery in group I was on average 7.5 minutes less as compared to the duration in group II. Patients in group I were more satisfied with the results of the surgery and were relieved to know that their stitches did not need to be removed.Conclusion:Although no difference was found in the rates of wound infection and formation of scar tissue between the group I and group II, the duration of surgery was less and the patients were more satisfied in group I.

Aims:To analyze the outcome of trial of scar in patients with previous caesarean section and to assess the fetal and maternal complications after trial of scar.Patients and Methods:The study was conducted at Military Hospital, Rawalpindi, Pakistan, with 375 pregnant patients who had a previous delivery by caesarean and who had regular antenatal checkup. Data were recorded on special pro-forms designed for the purpose.Results:The results from the 375 patients who had one previous lower segment caesarean section due to non-recurrent causes were analyzed and compared with national and international studies. Indications of previous caesarean section (non-recurrent causes) included malpresentations, fetal distress/cord prolapse, failure to progress, severe pregnancy-induced hypertension/eclampsia and twins with abnormal lie of the first twin. 0 218 patients reported spontaneous labor. Among these patients, 176 delivered vaginally and 42 patients had repeat caesarean sections. There were a total of 157 patients who experienced induction of labor. 97 patients were induced by cervical ripening with mechanical method, followed by artificial rupture of membranes and augmentation (if required) with syntocinon infusion. 60 patients were induced with prostaglandin E2 vaginal tablet.Conclusion:This study concludes that females with a prior caesarean are at increased risk for subsequent caesareans, regardless of mode of delivery. Eliminating vaginal-birth-after-caesarean will not eliminate the risk. Therefore, vaginal birth after caesarean should be encouraged in selected cases from obstetric units to reduce the risks of repeated caesarean sections. Failed vaginal-birth-after-caesarean can result in increased morbidity than that with elective caesarean section.

Introduction: This project was aimed to determine the seropositivity status for Hepatitis B surface antigen (HBsAg), antiHepatitis C (HCV) antibodies and antibodies to Human Immune Deficiency Virus (HIV) I and II in healthy blood donorsdonating blood at Shaikh Zayed Hospital Lahore.Material and Methods: The relevant data was collected during a period of 28 months from 1st January 2006 till 31st March2008. It was a cross sectional study which entailed screening of 60719 healthy donors. The donors were aged between 16years to 45 years. There were 93.43% males and 6.57% females.Results: The seroprevalence of Anti HCV antibodies was 3.870%; for HBsAg it was 1.407%; for HIV antibodies it was0.00658%. Our study demonstrated a higher seropositivity for HIV in healthy donor population than all of the previousreports except one with which it matched precisely. HBsAg showed a definite downwards inclination when compared withsimilar previous studies carried out in the last 7 years. Seroprevalence of anti HCV antibody was found to be similar whencompared with previous studies and demonstrated a higher trend in large cities with a multiethnic population.Key Words: MeSH: Blood donors, seroprevalence, HbsAg, antiHCV, HIV.

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Abstract:We report 2 cases of primary hyperoxalurea who presented with refractory anaemia, nephrolithiasis, renal failure warranting repeated renal transplantation in one of the cases. Renal biopsy of the patients revealed crystals of calcium oxalate in the tubules. The same crystals were also visualized in bone marrow biopsy which confirmed the diagnosis of systemic oxalosis. We conclude that Primary hyperoxalurea may rarely cause anemia secondary to calcium oxalate crystal deposition in the bone marrow. DOI