efficacy of intradermal injection of botulinum toxin in patients with post-herpetic Neuralgia

Several treatments have been suggested in shingles viral infection caused by Varicella zoster virus that may lead to complications such as PHN [Post-herpetic neuralgia]. Intradermal injection of botulinum toxin was shown with few side effects. This study evaluates the efficacy of intradermal injection of botulinum toxin in patients suffering from PHN. Fifteen patients suffering from PHN for more thanl month were enrolled. Data collected were patients' age, sex, and lesion site, the dermatome involved and the duration and severity of pain by visual analog scale [VAS]. Botulinum [15 units /every 10 cm[2] of body involved] was injected intradermally. The patients were followed 2, 14 and 30 days after injection. Of participants, 6 were males and 9 females. The mean age was 60 years and the mean duration of neuralgia was 6.5 months. The mean VAS on day 2 was 6.4, on day 14 was 7.2 and after 30 days was 7.6. The overall pain after injection decreased but was not significant. It seems that intradermal injection of botulinum toxin decreases pain in PHN patients and this de-crease is less prominent by passing time

indirect immunological effect of concurrent human schistosomiasis and fascioliasis on helicobacter pylori pathogenesis

The impact of Schistosoma mansoni and Fasciola parasitic infections on H. pylori induced pathogenesis was studied in 20 patients exclusively having H. pylori infection alone. The patients were compared to 20 patients having schistosomiasis mansoni co-infected with H. pylori and to another 20 patients having fascioliasis co-infected with H. pylori. 15 patients exclusively having schistosomiasis mansoni alone and 15 patients exclusively having fascioliasis alone were also included in the study. All patients were subjected to thorough medical examination, parasitological, endoscopic and histopathological studies. The results showed that severe gastritis was significantly more common in the patients exclusively infected with H. pylori alone. Chronic atrophic gastritis and intestinal metaplasia or precancerous lesions were present in patients with exclusively H. pylori infection. We may conclude that the concomitant of parasitic diseases with H. pylori infection probably reduce the gastroduodenal pathogenesis through indirect immune response

Modified endocystectomy versus pericystectomy in echinococcus granulosus liver cysts: a randomized controlled study and the role of specific anti-hydatid iGG4 in detection of early recurrence

The evidence based data of hydatid liver disease indicate that the level of evidence was too low to help decide between radical or conservative surgeries [level IV evidence, grade C recommendation]. So, there is a need for accurately designed randomized trials with precise goals to compare pericystes-tomy versus a specific modified endocystectomy technique for the treatment of hepatic hydatid cysts 8 cm or less in diameter in Egyptian patients, regarding the operative time, intra-opera-tive blood loss, complications and long term recurrence and to test the role of anti-hydatid IgG4 in diagnosis and detection of early recurrence. 60Patients with 131 liver cysts of E. granu-losus fulfilling the study criteria were randomly divided to two groups. G1: 32 patients with 69custs treated by modified endo-cystectomy and GII: 28 patients with 62cysts treated by closed total pericystectomy. GIa included 40cysts >5cm in diameter [mean 6.86, SD +/- 0.809] and GIb29cysts5cm in diame-ter [mean 7.01 SD +/- 0.79] and GIIb25cysts >/-cm in diameter [mean 4.04 SD +/- 0.93]. Preoperative evaluation inclyded histo-ry taking, clinical examination, blood tests, specific anti-hydat-id IgG4, abdominal sonography and CT scan. The operative time for dealing with each cyst was in minutes. Operative blood loss and need for blood trancfusion were estimated for each patient. Specific anti-hydatid IgG4 by ELISA was used to diagnose and to detect early rasurrence. Patients were followed up clinically and by ultrasonography every 3 months and for anti-hydatid IgG4 every 6 months for 24-90 months. The mean maximum operative time was in GIIa followed by GIa, GIb, then GIIb. The operative time was significantly lower in GIIb than Ib and in GIa than IIa. Seven patients [GII] had blood transfusion. The intraoperative bleeding in GI was <500ml/patient, and 18patients [GII] each bled >500ml. No intra-peritoneal seedling during the follow up. Five of 55patients [9%] were serologically suspected of relapse or incomplete cure. One [GII] showed early recurrence at 3 months. High IgG4 antibodies were detected in patients which decreased gradually after surgery and normal after 18 months post-operation.

Screening of microhematuria in school children

Microhematuria [MH] is present in 0.5 - 2% of children. A renal or urologic disorder may present with symptom obviously pointing to the urinary tract as hematuria or the kidneys may be involved in several different systemic diseases including the vasculitis syndromes, collagen vascular diseases and the thrombotic microangiopathic diseases due to variable etiologies. Each of these diseases has important renal manifestations that may symptomatise as hematuria. We aimed to detect and depict any eventual correlation that might make microhematuria a useful tool on the predictive level on renal participation in medical disorders. More especially so in tropical settings, where specific diseases are expected to have an insulting impact upon the kidney if not the whole organisms and to determine the prevalence of microhematuria in healthy school aged children the study was conducted on 100 children with MH detected by dip- sticks and confirmed microscopically, the age range from 6 to 12 years either symptomatic or not. It was conducted among healthy children attending the outpatient clinic of the National Hepatology and Tropical Medicine Research Institute [NHTMRI] and in 2 primary schools, through screening of 5342 children by dipsticks for microhematuria. Cases were compared with 20 healthy children of the same age and sex matched as a control. All cases were subjected to full history taking, clinical examination and laboratory studies including complete urinalysis, urine culture and sensitivity, urinary Ca/creatinine ratio, blood urea nitrogen, serum creatinine, serum complement C3, CBC, retics, ASOT, CRP, ESR and coagulation profile [PT, PTT, BT and CT]. Pelvi-abdominal ultrasonography was done for all cases. In selected cases, 1VU, voiding cystourethragraphy, DMSA scan and renal biopsy were done The prevalence of MH was 1.9%. Glomerular group represented 14% and included, acute post streptococcal glomerulonephritis, APSGN [9%], IgA nephropathy [3%] and membranoproliferative glomerulonephritis [2%], non-glomerular group represented 42% of the studied cases and included UTI [24%], hypercalciuria [14%], renal stone [2%], UPJ obstruction [1%] and VUR [1%] and group of unidentified cause of MH [44%] who had no MH after 6 months of follow up Dipsticks can be used as a useful screening test for MH; however this should be confirmed by microscopic examination of the urine. The most common glomerular cause of MH in the event study was APSGN whereas the most common nonglomerular cause was UTI and hypercalciuria. Follow up is recommended for cases of MH with unidentified origin. MH is positively suggested as reliable simple, however preliminary tool in clinical diagnosis of renal and urological disorders

Evaluating the effectiveness of high-dose misoprostol in the prevention of postpartum haemorrhage

To investigate the effectiveness of high dose rectal msoprostolpreventing postpartum haemorrhage. Study design: 270 women were randomly allocated to receive 600 micro g misoprostol per rectum after norrnal vaginal delivery or to receive no medication in their third stage of labour. Any excessive bleeding in either group was actively managed with conventional oxytocic agents. Blood loss was measured directly. Setting: Damietta and Ali-Hussein University Hospitals. The inclusion criteria were similar. Blood loss of >/= 1000 ml occurred in 2.3% [3/1 30] of the misoprostol group and 6.4% [9/140] of the "no drug' group. Additional oxytocic therapy was required by 1.5% [2/130] and 4.2% [6/140] respectively. Side effects attributable to prostaglandins, particularly-shivering and pyrexia, occurred more frequently in the misoprostol group. The use of 600 micro g misoprostol per rectum in the management of the third stage of labour was well tolerated and associated with statistically significant less postpartum haemorrhage

Elective surgical repair of groin hernias with mesh versus herniorraphy in ascitic liver patients

To initially evaluate the possibility of electively repairing groin hernias in ascitic liver patients, to test the feasibility of the use of mesh in these patients and to evaluate mesh repair versus herniorraphy, 30 patients' [3 females and 27 males] with liver ascites and uncomplicated groin hernias were treated operatively for their hernias. They were divided into two groups: group I [Gp I]: 14 patients [9 indirect, 3 direct and 2 femoral] treated by herniorraphy and group II [Gp II]: 16 patients [10 indirect, 3 direct, 3 femoral] treated by polypropylene mesh placement with or without plug. All operations were performed under local anesthesia with preoperative prophylactic antibiotic cover. 23 patients were followed up: 11 in Gp I [4 to 24 months mean = 14.82 SD, 6.08] and 12 in group II [7 to 28 months mean = 14.42 SD, 5 98] Seventeen ascitic fluid samples were taken intra-operatively for bacteriological study. There was no operative mortality. Post operative complications included : temporary increase in ascites which occurred in 25 patients [12 in group [I], 13 group[II]]. In 21 cases. It responded to medical treatment and in three it required paracentesis. There was no deep wound infection. There were three cases of superficial wound infection [2 in group I and one in group II]. Scrotal hematoma and/or seroma occurred in four cases. A major attack of variceal bleeding occurred in a patient in the mesh group and was treated successfully. There was no spontaneous bacterial peritonitis. There were three recurrences: two in Gp I and one in Gp II. two of the recurrences were attributed to technical mistakes. Five [29.41%] of the bacteriological samples showed mono-microbial organisms i.e. bacterascites. Three were gram-ve two of them were E coli and one Pantoea spp. and two were Gram +ve Staph aureus [one was methicillin resistant] Findings indicate that elective groin hernia repair in liver patients with ascites is feasible even without prior peritoneovenous shunting with no mortality and an acceptable overall rate of complication. The use of mesh seems justified in -those patients with comparable of not superior, results to herniorraphy. Mesh placement was not associated with any increase in the rate of complications or wound infection .Although no spontaneous bacterial peritonitis occurred in this .study, caution should be taken and long antibiotic cover is probably important to avoid this fatal complication because bacterascites was found in 29 41% of the patients