Objectives: This prospective cohort study evaluate the reliability of ultrasonography in nutritional assessment for patients with liver cirrhosis undergoing major abdominal surgery by follow up the quantitative and morphological changes of rectus femoris (RF) and anterior tibialis (AT) muscles. Methods: Seventy-two adults cirrhotic patients, subjective global assessment grade (SGA A&B) scheduled for major abdominal surgery were assessed preoperative and postoperative days (POD) 1, 3, 5 and 7 in ICU using anthropometric measurements, laboratory investigations, ultrasonography for cross-sectional area (CSA), anteroposterior (AP) and laterolateral (LL) diameters of (RF) and (AT) muscles and record hospital stay time. Results: We reported significant decrease in all measures of RF and AT muscle masses (CSA, AP and LL) diam. started early after ICU admission up to 7 days. All statistically significant decreased compared to POD0 and 1 (p = 0.000). There was 0.56%, 2.05%, 3.28% and 3.67% loss of CSA of RF at POD1, POD3, POD5 and POD7 correspondingly. As well as there was 0.23%, 1.03%, 1.84%, 2.49% loss of CSA of AT in POD1, POD3, POD5 and POD7 correspondingly. Echogenicity score of both muscles were significant increase in POD3, 5 and 7 compared to POD0 (p = 0.000). Conclusion: We used the ultrasound easily for skeletal muscle assessments as well as it helped us to detect the qualitative changes of these muscles and subsequently it can be used as a nutritional assessment tool in LC patients. Muscle US is an emerging tool can used in nutritional guided protocol on malnourished hepatic patient in the future.

Background: Pain is an unpleasant sensation experienced when tissues are damaged. Therapeutic management of pain requires consideration of many factors due multiplicity of etiopathogenesis. Objectives: The present study was designed to assess and compare the analgesic effects of gabapentin, diclofenac and tizanidine as well as their combinations in acute and chronic pain. Methods: 128 rats were randomly allocated into two main equal categories; one for acute inflammatory and other for chronic neuropathic pain study. The acute category was divided into 8 equal groups; control, carrageenan, diclofenac, gabapentin, tizanidine, gabapentin-diclofenac, gabapentintizanidine and tizanidine-diclofenac groups. Acute inflammatory pain was induced by carrageenan injection in the animals paw. In the chronic category neuropathic pain was induced by right sciatic nerve ligation except for control and sham groups. This category was divided into; control, sham, gabapentin, tizanidine, gabapentin-diclofenac, gabapentin-tizanidine and tizanidinediclofenac groups. The mean reaction time was assessed in all groups. Results: In acute pain the three drugs and their combinations had significant analgesic effects. Tizanidine potentiated the analgesic effects of diclofenac and gabapentin. In chronic neuropathic pain diclofenac and gabapentin had significant analgesic action while, tizanidine had no analgesic effect. Conclusion: Tizanidine didn't show analgesic effect on chronic pain but potentiated the analgesic effect of gabapentin and diclofenac in acute pain model.