Background: Ninety patients American Society of Anesthesiologists (ASA) I–II, aged (18–60 years), were enrolled in this randomized controlled trial. All enrolled patients had undergone elective primary unilateral open inguinal hernia repair under spinal anesthesia; at the end of the surgery, transversus abdominis plane (TAP) block was done by bupivacaine combined with 4 mg dexamethasone in (group I), 8 mg dexamethasone in (group II), or saline in (group III.). We aimed to compare the analgesic efficacy of two different doses of dexamethasone (4 mg and 8 mg) added to bupivacaine in a unilateral single-injection (TAP) block. The first outcome measure was the time of the first analgesic request, and the secondary outcome measure was the VAS scale in the first postoperative 24 h.
Results: There was no need for any analgesia in group I and group II in the first postoperative 24 h. The time of the first analgesic request in group III was 720 ± 90 min. VAS scores were significantly lower in group I and group II than in group III, with no significant difference between group I and group II.
Conclusions: There is no difference in the first postoperative 24 h analgesic effect of the two doses of dexamethasone when added to a long-acting local anesthetic mixture in TAP blocks in patients undergoing inguinal hernia repair.
Trial registration: ClinicalTrials.gov, NCT03863977 Keywords: TAP block, Inguinal hernia, Dexamethasone

Rheumatoid arthritis (RA) is a chronic autoimmune disease with multiple morbidity burdens. Early
diagnosis of RA is the main key in management and prevention of disease complications. Much
research nowadays is looking for a serological marker with high accuracy in diagnosis of early RA
cases. Our aim in this study was to evaluate the role of anti-mutated citrullinated vimentin (anti-
MCV) antibodies in the early diagnosis of RA. In addition to compare its diagnostic sensitivity and
specificity with anti-cyclic citrullinated peptide antibodies (anti-CCP) and RF antibodies in early versus
established RA patients. This prospective cross-sectional study included 80 participants: 40 RA
patients (20 early RA patients and 20 established RA patients), 20 patients with other rheumatic
diseases (as a disease control group), and 20 apparently healthy participants as normal controls. All
participants underwent history taking, clinical examination (general, articular assessment and
calculation of disease activity score (DAS28-ESR)) for RA patients, radiological and laboratory
investigations (RF, anti-CCP2 and anti-MCV antibodies measurements by ELISA technique). The
results showed that the mean values of anti-CCP2 and anti-MCV were significantly increased in RA
cases compared to the control groups (p=0.00 and p=0.01, respectively). Anti-MCV had sensitivity
and specificity of 63% and 83%, respectively for diagnosing of early RA at area under curve of 0.80
compared to sensitivity and specificity 37% and 100%, respectively for anti-CCP2. Also, both (anti-
CCP2 and anti-MCV) had positive significant correlations with ESR (p<0.001 and p=0.02, respectively),
CRP (p=0.01 and p=0.02, respectively) and DAS 28 (p<0.001 for both). In conclusion, our data
indicated that anti-MCV antibodies may represent a valuable marker for diagnosis of early RA cases.
Keywords: RA, RF, Anti CCP, Anti MCV, DAS-28.

Systemic lupus erythematosus (SLE) is an autoimmune inflammatory disease, with multi systematic
affection. Lupus nephritis (LN) is the most frequent cause of renal damage in SLE patients with
variable presentations that may progress to end stage renal failure. Coagulation disorders are
frequently reported in SLE and LN with higher mortality rates. Renal biopsy is an invasive process,
and the existing indicators for LN diagnosis and activity are unreliable. New urinary biomarkers with
significant validity, safety, and accuracy are the current focus of most studies. Our study sought to
assess the value of urinary tissue factor (uTF), tissue factor pathway inhibitor (TFPI), and plasmin as
biomarkers for the early identification and detection of LN and its activity. This was a cross-sectional
study, included 100 subjects (80 SLE patients, and 20 healthy controls), they were recruited from the
Internal Medicine department, Rheumatology and Nephrology units and outpatient's clinics at Assiut
University hospital between the period of 2020 and 2022. All patients underwent full history taking,
clinical evaluation, and activity scoring calculation and laboratory investigations. The results showed
that the best diagnostic accuracy of LN was observed with TFPI (90% accuracy, sensitivity 80% and
specificity 95% with p<0.001 at cutoff point of >193.2 ng/ml), followed by uTF (75.4% overall
accuracy at cut off point of >12.6 ng/ml, sensitivity 90% and specificity 68% with p< 0.001) and
plasmin (70.3% accuracy at cut off point of >30.5 ng/ml, sensitivity 55% and specificity 78% with p<
0.001). Urinary TFPI was the best predictor of LN occurrence with odd ratio of 4.34, (p< 0.001). In
conclusion urinary TFPI could be used as a diagnostic marker for LN with high accuracy and an early
predictor of LN.