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.

Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.

Methods

This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.

Results

The study recruited 4273 patients from 144 centres in 25 …

Our research question is; could follicular fluid (FF) leptin solely or contemporaneously with other clinical, biochemical and sonographic adiposity measures predict the probability of having a live birth during ICSI cycles? .This is a prospective cohort study that enrolled infertile women without polycystic ovary syndrome scheduled for ICSI. At baseline, women had assessment of obesity using different metrics: clinical, serum biochemical, and sonographic. Clinical measures encompassed waist circumference and body mass index. Biochemical evaluation comprised assessment of homeostasis-model for insulin resistance, visceral adiposity index and lipid accumulation product. Preperitoneal and subcutaneous abdominal fat were measured using ultrasound and body fat index was calculated. On day of oocyte retrieval, pooled FF was sampled to assess FF leptin. Our primary outcome was live birth after one fresh embryo transfer cycle.