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Background: Hepatocellular carcinoma (HCC) is the third leading cause of cancer mortality. There is a need for a marker associated with HCC progression. A disintegrin and metalloprotease (ADAMs) family proteins have a lot of functions in cell adhesion, migration, proteolysis and signaling. Aim: The aim of the study was to investigate the relation between ADAM 10 gene single nucleotide polymorphisms (SNPs) and HCC progression. Methods: This study involved 201 cases divided: Group I (67 HCC patients), Group II (67 cirrhotic patients), Group III (67 control). Each group was subjected to laboratory investigations: (CBC, blood sugar, kidney and liver function, viral markers, alpha fetoprotein), imaging: (abdominal ultrasonography, and triphasic C.T) and ADAM 10 gene polymorphism (rs 653765, rs 383902) detection by real – time PCR. Results: There was a statistically significant difference in the frequency and genotyping of ADAM10 SNPs in HCC patients in comparison to cirrhotic and control groups [the frequency of rs 653765 genotypes (p=0.015) and model (p=0.013)]; likewise, the frequency of rs 383902 genotypes (p<0.001) and model (p=0.001)). Also, there was a statistically significant association between different SNP rs 383902 genotype with CLIP stages (p=0.02), and with VISUM stages (p=0.035). Conclusion: ADAM-10 are overexpressed in HCC patients and involved in HCC progress. These findings highlight that ADAM inhibitor may be used as therapeutic goals in treatment of HCC.

Background: Hernia repair one of the most common operations performed by general surgeons. Mesh repair is the gold standard for these repairs, the rates of postoperative chronic pain associated with these meshes are still unclear. The aim of the study is to compare the post-operative persisting pain after 3 months in open hernia repair with light weight and heavyweight mesh.Methods: A randomized control study was conducted in a tertiary care hospital with sample size of 80. lightweight and heavyweight mesh were used after randomization with equal participants in each group. Postoperative pain was analysed 1 week, 2 week and 3 months after surgery using visual analogue scale.Results: The study was conducted on a total of 80 participants. The mean age was 53(±16) and 46(±19) in those who received heavyweight mesh and lightweight mesh respectively. Majority of them 73(91.2%) were males and only 7 (8.8%) of them were females. Out of 80 participants, number of participants operated with lightweight mesh and heavyweight mesh was equal (1:1). At three months follow up, only mild and moderate pain was reported with both the groups. Among patients treated with heavy weight meshes 14 patients (35%) reported moderate pain with 26 patients (65%) reported mild pain. Among patients treated with lightweight mesh reported only 4 patients (10%) reported moderate pain with 36 patients (90%) reported only mild pain. There was significant difference in the mean of VAS score between the groups and there was significant difference between the type of mesh used and pain after 3 months (P<0.01).Conclusions: Partially absorbable lightweight mesh can be used for open inguinal hernia repair with significantly less chronic postoperative pain with improved quality of life and functional outcome.

Background: Appendicitis remains a common indication for urgent surgical intervention in pediatric age group. Acute appendicitis has the highest incidence during the second decade of life. When the diagnosis is performed, perforation could be already present in 30%-75% of children, with young children being at higher risk. The challenge for the practitioner is to perform a timely diagnosis of acute appendicitis in first years of life before complications occur.Methods: A facility based cross sectional study was conducted with sample size of 108. The patients diagnosed and operated for acute appendicitis using Alvarado score were correlated with intra operative findings.Results: Total 108 patients with median age of 11 (IQR 9–13) years, were included in the study in which 66% were male. Overall 18% (95% CI 11%-25%) had perforated appendix and 5% (95% CI 2%-11%) had appendicitis with abscess. Male gender, patients presenting with fever, guarding, rigidity and patients presenting 48 hours after developing symptoms, had higher chance of perforation. Mean count of WBC (17000 v/s 11000) and neutrophils (75% v/s 68%) were found to be higher in patients with perforated appendicitis.Conclusions: One-fifth of the pediatric appendicitis patients presenting in tertiary care patients had perforated appendicitis.