Comparative study of preservation versus elective division of ilioinguinal nerve on chronic groin pain after lichtenstein tension free inguinal hernia repair

Background: Post-hernioplasty chronic groin pain is one of the most important complications encountered after inguinal hernia repair. Routine ilioinguinal nerve excision has been proposed to avoid chronic post-hernioplasty neuralgia. The study aimed to evaluate the effect of routine ilioinguinal nerve excision compared to nerve preservation on chronic groin pain and other sensory symptoms in lichtenstein inguinal hernia repair.Methods: The study was conducted in the department of general surgery, at S.P. Medical College and PBM Hospital, Bikaner for duration of 15 months from august 2018 to November 2019. A total of 60 patients of uncomplicated inguinal hernia, who met the inclusion criteria, planned for lichtenstein hernioplasty were randomly divided into 2 groups with 30 cases with ilioinguinal nerve preservation (group A) and 30 cases with elective division of the nerve (group B). Follow up was done upto1 year and patients were inquired regarding pain, hypoesthesia and numbness and data was compared and analysed.Results: The incidence of post-operative neuralgia was 23.33% vs 6.67% (p=0.05) at 1 year in group A and group B respectively. The difference in pain was significant in both groups. The incidence of post-operative hypoesthesia was 10% vs 16.67% (p>0.05) at 1 year follow up in group A and group B respectively. The incidence of numbness was 11.11% vs 16.67% (p>0.05) at 1 year in group A and group B respectively. No statistically significant difference was found in both groups.Conclusions: The prophylactic exicision of ilioinguinal nerve during lichtenstein mesh repair decreases the incidence of chronic groin pain after surgery.

Hepatitis C virus infection and risk factors in health-care workers at Ain Shams University Hospitals, Cairo, Egypt

The objectives of this study were to document the background prevalence and incidence of HCV infection among HCWs in Ain Shams University Hospitals in Cairo and analyse the risk factors for HCV infection. A cross-sectional survey was conducted in 2008 among 1770 HCWs. Anti-HCV prevalence was age-standardized using the Cairo population. A prospective cohort was followed for a period of 18 months to estimate HCV incidence. The crude anti-HCV prevalence was 8.0% and the age-standardized seroprevalence was 8.1%. Risk factors independently associated with HCV seropositivity were: age, manual worker, history of blood transfusions and history of parenteral anti-schistosomiasis treatment. The estimated incidence of HCV infection was 7.3 per 1000 person-years. HCWs in this setting had a similar high HCV seroprevalence as the general population of greater Cairo

Natural killer cell populations in Egyptians infected with hepatitis C virus

Natural killer [NK] cells are key players in the immune response to viruses. This study examined the effect of hepatitis C virus [HCV] on the frequency of NK cells and their subsets in individuals with different clinical outcomes; 20 positive for anti-HCV and HCV-RNA [chronic hepatitis C], 20 positive for anti-HCV but negative for HCV-RNA [spontaneously resolved] and 20 healthy controls free of HCV. There was a significant reduction in the frequency of total NK cells in the chronic group compared to the control [P= 0.001] or resolved [P= 0.01] groups. The percentage of CD56 [bright] cells was significantly higher than the control group [P= 0.04]. While the percentages of CD56 [dim] cells and their CD16 expression were lower in the chronic group, this was not statistically significant. The frequency of CD3+CD56- T cells was significantly lower in both the chronic and resolved groups compared to the control group [P= 0.04]. Our results confirm a potential role of NK cells and the different subsets in the pathogenesis of chronic HCV infection

Alphafetoprotein in screening for congenital hypothyroidism

This study was conducted on 500 full-term neonates and 25 older patients with congenital hypothyroidism [CH], newly or previously diagnosed. Alphafetoprotein [AFP] was elevated in two neonates. In one, persistent elevation of AFP and thyroid stimulating hormone [TSH] with low thyroxine [T4] were found [congenital hypothyroidism]. In the other, AFP, TSH and T4 levels normalized [transient hypothyroidism]. The mean AFP level in new CH patients was significantly higher than in previously diagnosed patients, and was higher in CH patients than in controls. Significant relationships were found between AFP and T4, AFP and TSH, and AFP and age. AFP is a sensitive indicator of thyroid status and can be used as a screening test for hypothyroidism from the first day of life and in follow-up of CH patients

Clinical significance of urinary neopterin in chronic liver disease

Increased neopterin concentration in serum, urine and other biological fluids have been reported in conditions causing stimulation of cellular immunity with increased macrophage activity. Assessment of neopterin production in these conditions conveys useful information on disease activity and prognosis. In our study, urinary neopterin was measured in 40 patients with liver cirrhosis of different etiologies other than hepatitis B infection and 30 controls. The results showed high significant statistical difference between group I [HCV with viremia], group II [HCV without virenlia], group III [HCV+viremia+Bilharziasis] [P<0.001] and significant statistical difference for group IV [Bilhraziasis without HCV] [P<0.05] compared with the control group. The highest mean value of urinary neopterin was in group 1 [299.98 +/- 94.785] which was significantly higher than group II [216.18 +/- 37.55] and group IV [201.29 +/- 52.46] [P<0.05] no statistical difference with group III [226.56 +/- 80.18] [P> 0.05]. In conclusion, urinary neopterin has proved to be a simple and reliable method which helps in the diagnosis of activity in chronic HCV infection in patients with chronic liver disease

Serum nitric oxide level in different stages of liver cirrhosis

Patients with liver cirrhosis are suffering from hemodynamic disturbances and its subsequent complications. In this study nitric oxide [NO] [serum nitrite and nitrate] is measured in three groups of patients [25 patients each] with liver cirrhosis versus a control group. Group [I] included patients with compensated liver cirrhosis, group [II] patients had decompensated liver cirrhosis and group [III] patients suffered from hepato-renal syndrome. It was found that NO was high in group [I] compared with the control, Higher in group [II] compared with the control and group [I] and highest in group [III]. With the increase of serum NO there was increase in serum interlekin-1 [one of time trigger factors for NO release]. However, no statistical positive correlation was found, with time increase of NO there was decrease in the GFR in group [III] but this negative correlation was not statistically significant. There might be a possible role of NO and IL-1 in the pathogenesis of hemodynamic disturbances found in patients with liver cell failure and those developing hepatorenal syndrome

Anticardiolipin antibodies, hemolytic anemia and thrombocytopenia in systemic lupus erythematosus

29 patients with SLE [27 females and 2 males], mean age [26.5 years]. 11 of these patients had autoimmune hemolytic anemia [AIHA] and 18 SLE patients without AIHA [control patients]. Anticardiolipin [ACL] antibodies IgG and IgM levels were measured by ELISA. Elevated IgM ACL antibodies were seen in 7 [63.6%] of 11 patients with AIHA and 2 [11.1%] of 18 control SLE patients [P <0.01]. There was no significant difference in IgG ACL antibodies levels between the two groups. Thrombocytopenia was present in 7 [63.6%] of 11 patients with AIHA and 4 [22.2%] of 18 control SLE patients [P <0.05]. Elevated IgG ACL antibodies were found in 3 [75%] of 4 control SLE patients with thrombocytopenia, [P <0.05] while IgM ACL antibodies were not detected in these patients. It was concluded that in patients with SLE and autoimmune hemolytic anemia, there is a high prevalence of both thrombocytopenia and IgM ACL antibodies which may act as anti- erythrocyte autoantibodies. Also, there is an association between IgG ACL antibodies and presence of thrombocytopenia in SLE. These antibodies may play a direct role in mediating platelet destruction

primary antiphospholipid syndrome, clinical and serological study

The aim of this study was to analyze the clinical and serological features in a series of patients with primary antiphospholipid syndrome [PAPS]. 12 patients were reported. The antiphospholipid antibodies were determined with the following techniques: IgG and IgM anticardiolipin antibodies by ELISA, lupus anticoagulant by Exner test. The results showed that the mean age of the patients was 32.5 years with a female/male ratio of 2: 1. The most frequently observed clinical manifestations were deep venous thrombosis [DVTs], 6 patients [50%]. Arterial occlusions were less frequent, 4 patients [33%], recurrent fetal losses in 4 patients [33%]. Thrombocytopenia was detected in 5 patients [42%], antinuclear antibodies in 3 patients [25%]. Antiphospholipid antibody study demonstrated the presence of anticardiolipin antibodies in 10 patients [83%], lupus anticoagulant in 4 patients [33%]. It was concluded that the primary antiphospholipid syndrome may exist as a distinct clinical entity and all younger patients presenting with thrombotic events, fetal losses and/or thrombocytopenia without evidence of a well defined disease, should be tested for antiphospholipid antibodies in order to rule out this syndrome

value of electron microscopy in the study of sperm morphology in asthenospermia patients

Electron microscopic examination of 25 semen samples of asthenospermic patients was done. A wide variety of fine structural defects were observed in the majority of sperm tails in addition to head anomalies. Electron microscopy [EMy] demonstrated a great percentage of spermatozoal abnormalities [80 percent] when compared to those detected by the ordinary light microscope [50 percent]. Most of the sperm tails are abnormal and showed multiple defects including: confused arrangement of axoneme, extra coarse fiber, displaced or missing central pair and/or supernumerary doublets of axoneme. The result accentuates EMy as a greatly necessary tools in evaluating the fertilizing capacity of spermatozoa in male infertility

study of the coagulopathy of nephrotic syndrome and its relation to quantitative estimation of protein C

Ten children were having nephrotic syndrome during relapse, ten were during remission and the other twenty were normal children, age and sex matched as control. After good history taking and thorough clinical examination, complete urine examination was done, serum albumin, serum cholesterol, ESR, partial thrombo plastin time [PTT], and protein C antigen level in plasma. None of the children had any evidence of thrombo-embolic manifestations on clinical grounds. There was a significant rise of PC% in nephrotic children during relapse than in the remission group and the control. No significant difference was present between the nephrotic group in remission and the control group. A negative correlation was shown between serum albumin and protein C level, while there was a positive correlation between serum cholesterol and protein C level.As regards PTT there was a significant decrease in group A as compared to both group B and C although group A cases were showing no thromboembolic manifestation, yet still they have got the tendency to thrombosis