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The infection caused by the hepatitis C virus (HCV) is a significant global health concern. The prevailing genotype of HCV in Egypt is 4a, commonly referred to as GT‐4a. A significant proportion exceeding 50% of patients infected with HCV experience extrahepatic manifestations (EHMs), encompassing a diverse range of clinical presentations. These manifestations, including essential mixed cryoglobulinemia (MC), can serve as initial and solitary indicators of the disease. The complete understanding of the pathogenesis of EHM remains unclear, with autoimmune phenomena being recognized as the primary causative factor. In this study, we examined the predictive significance of T‐cell subpopulations in relation to the occurrence and prognosis of cryoglobulinemia in HCV patients. A total of 450 CHC genotype four treatment naïve patients were enrolled in this analytic cross‐sectional study after thorough clinical, laboratory, and radiological examinations. All patients underwent laboratory investigations, including testing for cryoglobulin antibodies and measurements of CD4 and CD8 levels; two groups were described according to their test results: Group 1 consists of patients who have tested positive for cryoglobulin antibodies and Group 2 consists of patients who have tested negative for cryoglobulin antibodies. The exclusion criteria encompassed individuals with HIV infection or chronic HBV infection. Additionally, pelvi‐abdominal ultrasonography was performed. Our study included 450 treatment naïve CHC patients (59% male, mean age 50.8 years). The patients were categorized according to their cryoglobulin antibodys test results into two groups: group A, CHC patients with cryoglobulin antibodies (Abs) negative (364 patients), and group B, CHC patients with cryoglobulin Ab positive (86 patients). Group B demonstrated a higher average age, elevated international normalized ratio, more prolonged duration of HCV infection, lower albumin, higher alanine aminotransferase, higher aspartate aminotransferase, higher bilirubin, lower CD8, lower CD4, and lower CD4:CD8 ratio. In contrast, 27 out of 86 (31.40%) patients in group B had symptoms; 85.8% had purpura and arthralgia, 74.3% had paresthesias, 86.7% had weakness, and 12.2% had non‐Hodgkin's lymphoma. The levels of CD4 and CD8 were found to be decreased in chronic HCV patients with MC. T‐cell subpopulation serves as a reliable indicator for assessing the prevalence and prognosis of MC in individuals with genotype 4 chronic hepatitis C. However, additional research is needed to further understand the development and spread of various emerging infectious diseases. Nevertheless, it is noteworthy that a critical threshold may exist beyond which EHM reaches a point of no return. [ABSTRACT FROM AUTHOR]

Background: Flexor tendon injuries represent a significant per-centage of admissions in emergency departments in Egypt. A bloodless surgical field is important to perform a hand surgery. Traditionally, a tourniquet is used for hemostasis, and the standered anesthetic techniques utilized in hand surgery were general anesthesia, intravenous regional anesthesia, or brachial plexus block. Recently the evolving Wide-Awake Local Anesthesia No Tourniquet (WALANT) technique where patient is operated on under local anesthesia and hemostasis is achieved via adrenaline could be a better choice. Aim of this work is to compare the intraoperative pain scores, induction time, operating time, blood loss, postoperative pain scores, and patient satisfaction with WALANT versus supraclavicular brachial plexus block (SC-BPB ) with tourniquet, in patients under-going flexor tendon repair. Patients and Methods: In the current study 52 patients who underwent flexor tendon intervention were divided randomly into two groups, each group consisting of 26 patients. Group A: Patients in this group received WALANT. Group B: Patients in this group received SC-BPB with a tourniquet applied to the arm. Results: Intraoperative Wong-Baker Faces scale revealed no statistically significant difference in intraoperative pain scores in both groups, except during injection (p = 0.04). Tourniquet-related pain was reported in 23% of patients of SC-BPB group (p = 0.001). Induction time was significantly shorter in WALANT (p < 0.01) but time needed to obtain sufficient hemostasis is sig-nificantly more in WALANT than SC-BPB (p < 0.01) while surgical time was similar in both groups (p = 0.538). Blood loss in spite of being minimal it was statistically significant higher in WALANT (p < 0.01). Conclusion: WALANT anesthesia was found to be better alter-native to SC-BPB in flexor tendon repair surgeries in adults being more simple technique and no need for special skills or ultrasound device, less time consumed in induction and less injection pain also no tourniquet-related pain, intraoperative active motion of the hand is preserved facilitating surgical technique, better effect on postoperative analgesia and more patient and surgeon satisfaction. [ABSTRACT FROM AUTHOR]

Hepatitis C virus (HCV) infection can affect the neurological system, and neuropathy is one of these manifestations. Hepatitis C virus infection is associated with diabetes mellitus (DM) type II, and diabetic patients are at higher risk of acquiring HCV infection. Sweat function has been proposed to assess early autonomic neuropathy. This study aimed to evaluate small fiber neuropathy in asymptomatic HCV-related cirrhotic patients with or without DM through sweat function assessment by Sudoscan test. Three groups were involved: 47 healthy controls, 48 HCV-related cirrhotic patients without DM (group 1), and 49 HCV-related cirrhotic patients with DM type II (group 2). All participants were subjected to liver panel tests, renal function tests, cell blood counts, HbA1c, and abdominal ultrasound. Sweat function was assessed in all patients and controls by measuring hand and feet electrochemical skin conductance (ESC, microSiemens [µS]) using Sudoscan. Peripheral neuropathy was detected in none of the controls, 39% of group 1 patients, and 62% of group 2 patients (P < 0.0001). The mean feet ESC (FESC) was 88.3 ± 6.8 µS in controls, 67.2 ± 19.2 µS in group 1, and 57.9 ± 19.4 µS in group 2 (P < 0.0001). A significant correlation was observed between FESC and bilirubin, albumin, creatinine, international normalized ratio, transaminases, and splenic size. Electrochemical skin conductance measurement is a valuable, noninvasive method for early detection of small fiber neuropathy in asymptomatic HCV-related cirrhosis, with or without DM.