Background Musculoskeletal symptoms are common and could be the first presenting symptom in up to 50% of systemic lupus erythematosus patients, and they affect more than 95% of patients during the clinical course. The present study aimed to assess joint involvement in the wrists, hands, and knees of SLE patients using musculoskeletal ultrasonography and to correlate these findings with disease activity. The study enrolled 40 Patients with SLE who were attending the Immunology outpatient clinic and internal medicine department of Beni-Suef University Hospital and 20 age and sex nearly matched healthy controls who have no rheumatological complaints. Participants had a comprehensive physical examination, series of laboratory tests, functional assessment by Health Assessment Questionnaire score, disease activity assessment of by European Consensus Lupus Activity score, and radiological examination by high-resolution Ultrasound machine called (LOGIC P 9) using a gray-scale US mode (13–18 MHz) with Power Doppler to detect joint synovitis, synovial hypertrophy, bone erosions and or tenosynovitis. Results There was a statistically significant prevalence of US abnormality of knee joints in both asymptomatic and symptomatic cases versus controls contrary to the wrist and hand US abnormality. The presence of SLE increases the risk of US abnormalities in knee joints 28 times more than controls also increasing the age of the patient one year increase the probability of getting abnormal findings in the knee joint by 1.156 times. While the only independent variable that can affect US abnormal findings in the wrist joint is the increase in Systolic Blood Pressure 1 mmHg with 1.06 times. Conclusion Musculoskeletal Ultrasound with applied Power Doppler is a good tool for the detection of early affection of joints either in symptomatic or asymptomatic SLE patients.

This paper is devoted to the numerical solution of the bi-harmonic problem: Δ2 w = p . The operator is split into two harmonic ones. The finite difference scheme of the harmonic operator is used to get discretized operators, coupling those leads to a global system A w → = p → , this system is to be solved with any well-posed boundary conditions. In this way, boundary conditions need not be specified with the decoupled equations, but rather with the global system. Numerical test problems are provided. The extension of this technique to poly harmonic equations is straightforward.

Background: gabapentin was originally discovered over 40 years ago by the Japanese, who initially were looking for an antispasmodic or muscle relaxant, but, later it was used as an antiepileptic and multimodal perioperative drug. Objective of this randomized study is to assess the some cardiovascular effects of gabapentin as well as its effect on the neuromuscular blockade induced by Cisatracurium. The interactions between both of them was also done in cats and rats & in patients undergoing elective spinal surgeries. Materials & Methods: The pharmacological study was carried out at the pharmacological lab of Al-Azhar University. The effect of different doses of cisatracurium (0.25-4 µg/ml) and Gabapentin (6-96 µg/ml) & interactions between gabapentin (24µg/mL) and cisatracurium (0.25-4 µg/mL) were also done to test the effect on the amplitude of contraction of isolated Rat phrenic nerve-diaphragm preparation. Effect of intravenous (IV) injection of cisatracurium (1-16 mg/kg) and Gabapentin (15-240 mg/kg) and interactions between gabapentin (60mg/kg) and cisatracurium (1-16 mg/kg) on mean arterial blood pressure (MAP) and electrocardiogram (ECG) were also studied on anesthetized cats. Each experiment was done on six preparations. The clinical Study was carried out at Al-Zahraa University Hospital on 90 patients (ASA I or II) of both sexes undergoing spinal operations were randomized into three equal groups (30 patients) for each; one hour preoperatively they received oral capsules, group I; gabapentin (1200mg), group II gabapentin (800mg) and group III; placebo capsules. After induction of anesthesia with (IV) fentanyl, thiopental and cisatracurium & tracheal intubation, anesthesia was maintained by isoflurane (0.5-2%), Patients were assessed for heart rate (HR), MAP, neuromuscular blockade. Isoflurane concentration, fentanyl needed and cisatracurium consumption were recorded. Results: Experimentally: In-vitro study: Cisatracurium besylate (0.25-4µg/ml) produced dose-dependent significant reductions on the amplitude of muscle contractions. Gabapentin (6-96µg/ml) produced dosedependent significant reductions on the amplitude of muscle contractions at 24-96 µg/mL while the first two doses 6-12 µg/mL have no effect. On interactions Gabapentin (24 µg/ml) produced synergistic effect on neuromuscular blocker effect of cisatracurium (0.25-4 µg/mL). In-vivo study cisatracurium, IV, (1-16 mg/kg) produced no effect on both mean arterial blood pressure (MAP) and heart rate (HR) of anesthetized cats. Gabapentin (15-240 mg/kg) caused dose-dependent significant reductions on the MAP and the HR of the anesthetized cats except the first two doses (15-30 mg/kg). On interactions Gabapentin (60 mg/kg) potantiated the effect of cisatracurium (1-16mg/kg) and caused significant reduction on mean arterial blood pressure and heart rate. Clinically: Gabapentin 1200mg produced highly significant reduction in MAP&HR at pre-induction and immediately after intubation which extended for 120min. It also prolonged the duration of neuromuscular b...

Hepatitis C Virus (HCV) is a major health care concern worldwide. Egypt shows the highest worldwide HCV prevalence. Fibrosis progression is common in HCV and it is the most important prognostic factor in chronic HCV patients. The aim of this study was to investigate changes in some parameters of liver fibrosis progression after successful HCV eradication by direct acting antiviral (DAA) therapy in Egyptian patients. The study included 100 chronic HCV patients. liver stiffness measurement (LSM) was obtained by Transient elastography (TE) or Fibroscan before starting DAA treatment, after the end of 12 weeks of treatment and after achieving sustained virologic response12 (SVR12). Based on baseline LSM, patients were stratified into F2, F3 and F4 groups (METAVIR), F0-F1 patients were excluded. LSM and laboratory data after the end of treatment and after achieving SVR12 was compared with that baseline values in each fibrosis group. Following DAA treatment, all patients achieved SVR12. Mean baseline LSM dropped from 13.5 to 10.1 (kPa) post SVR12; the maximum change occurred in F2 patients 84.3% versus 84.2%, 43.3% in F3, and F4 patients respectively (p<0.001). At baseline, 30 patients were in the F4 group; only 11 patients (43.3%) regressed to noncirrhotic range (<12.5 kPa), while 19 patients (56.7%) were still cirrhotic despite achieving SVR12 (p<0.001). Patients showed significant improvement in platelets count and decreased ALT enzyme levels after achieving SVR12 (p<0.001). So, successful eradication of HCV results in significant LSM improvement; the best improvement occurs in F2 and F3 patients.