Effect of resin infiltration and bleaching on surface roughness and microhardness of human enamel with induced white spot lesions / Efeito do infiltrante resinoso e do clareamento na rugosidade e microdureza de superfície do esmalte humano com lesões de mancha branca induzidas

Objective: To comparatively evaluate the effect of resin infiltration, bleaching and bleaching followed by resin infiltration on the surface roughness and microhardness of human enamel with induced white spot lesions (WSLs) and their resistance to acidic challenge. Material and Methods: Sixty human specimens were randomly divided into three groups (n=20) according to the treatment modality applied; group I Icon® resin infiltration, group II bleaching and group III bleaching followed by Icon® resin infiltration. For each treatment modality, 10 specimens were tested for surface roughness and another 10 for microhardness. WSLs were artificially induced in all specimens and after treatment, all specimens were subjected to acidic challenge. Surface roughness was measured by the tapping mode of the atomic force microscope (AFM) and microhardness was measured by digital Vickers hardness tester at baseline, after induction of WSLs, after treatment and after acidic challenge. Results: Groups I and III showed significant reduction in surface roughness after treatment, while group II showed significant increase. Groups I and III showed significant increase in the microhardness after treatment, while group II showed insignificant increase. The three tested groups showed significant increase in surface roughness values and significant reduction in microhardness after acidic challenge. Conclusion: Resin infiltration and bleaching followed by resin infiltration reduced the surface roughness and enhanced the microhardness of the WSLs. The three treatment modalities failed to resist acidic challenge resulting in increasing surface roughness and reducing microhardness. (AU)

Objetivo: Avaliar comparativamente o efeito do infiltrante resinoso, clareamento e clareamento seguido de infiltração resinosa sobre a rugosidade e microdureza superficial do esmalte humano com lesões de manchas brancas induzidas (WSLs) e sua resistência ao desafio erosivo. Material e Métodos: Sessenta espécimes humanos foram divididos aleatoriamente em três grupos (n = 20) de acordo com a modalidade de tratamento aplicada; grupo I infiltrante resinoso Icon®, grupo II clareamento e grupo III clareamento seguido de infiltração resinosa Icon®. Para cada modalidade de tratamento, 10 corpos-de-prova foram testados para rugosidade superficial e outros 10 para microdureza. WSLs foram artificialmente induzidos em todas as amostras e, após o tratamento, todas as amostras foram submetidas ao desafio erosivo. A rugosidade de superfície foi medida por microscopia de força atômica em modo de contato intermitente (AFM) e a microdureza Vickers foi medida inicialmente, após a indução de WSLs, após o tratamento e após o desafio ácido. Resultados: Os grupos I e III apresentaram redução significativa da rugosidade superficial após o tratamento, enquanto o grupo II apresentou aumento significativo. Os grupos I e III apresentaram aumento significativo na microdureza após o tratamento, enquanto o grupo II apresentou aumento insignificante. Os três grupos testados mostraram aumento significativo nos valores de rugosidade superficial e redução significativa na microdureza após o desafio erosivo. Conclusão: O infiltrante resinoso e o clareamento seguido de infiltração resinosa reduziram a rugosidade de superfície e aumentaram a microdureza dos WSLs. As três modalidades de tratamento falharam em resistir ao desafio erosivo, resultando em aumento da rugosidade de superfície e redução da microdureza.(AU)

Ángulo de bifurcación corregido versus ángulo de bifurcación distal para la predicción de la rama lateral. Compromiso después de la bifurcación provisional Intervención Coronaria / Corrected Bifurcation Angle versus Distal Bifurcation Angle for Prediction of Side Branch Compromise after Provisional Bifurcation Coronary Intervention

Provisional bifurcation percutaneous coronary intervention (PCI) is recommended over two stent strategy but with the risk of side branch (SB) compromise. Prediction SB compromise is crucial for optimizing of the procedure outcome. Neglecting the proximal bifurcation angle (BA), the distal BA was presented as a reliable predictor of SB compromise supposing that the main vessel is always a straight vessel. However, its impact on the fate of side branch is debated. This study aims to compare between of the corrected BA, the sum of proximal and distal BAs, and the distal BA in terms of prediction of SB compromise. This prospective cohort study was conducted in Zagazig university hospitals in the duration between March 2019 and March 2020, and involved 185 patients who underwent provisional bifurcation PCI. Patients were divided according to the corrected BA into two groups; straight bifurcation model group which involved 73 patients with corrected BA = 180º, and wide bifurcation model group which involved 112 patients with corrected BA > 180 º. Compared to the wide bifurcation model, the incidence of SB compromise was substantially higher in the straight bifurcation model (52.1% vs. 15.2%; P < 0.001). The corrected BA had a better area under the curve compared to the distal BA with statistically significant difference (0.711 vs. 0.580; P = 0.023). Multivariate analysis demonstrated that the corrected BA was among the independent predictors of SB compromise. The study concluded that the corrected BA could be a novel strong predictor of SB compromise after provisional bifurcation PCI for future verification.

Physicians' Understanding of Nutritional Factors Determining Brain Development and Cognition in the Middle East and Africa / 대한소아소화기영양학회지

PURPOSE: Proper nutrition is essential for brain development during infancy, contributing to the continued development of cognitive, motor, and socio-emotional skills throughout life. Considering the insufficient published data in the Middle East and North Africa, experts drafted a questionnaire to assess the opinions and knowledge of physicians on the impact of nutrition on brain development and cognition in early life. METHODS: The questionnaire consisted of two parts: The first focused on the responders' demographic and professional characteristics and the second questioned the role of nutrition in brain development and cognition. Descriptive statistics were used to summarize respondents' characteristics and their responses to questions. RESULTS: A total of 1,500 questionnaires were distributed; 994 physicians responded. The majority of the surveyed physicians (64.4%) felt that nutrition impacts brain development in early childhood (0–4 years), with almost 90% of physicians agreeing/strongly agreeing that preventing iron, zinc, and iodine deficiency would improve global intelligence quotient. The majority of physicians (83%) agreed that head circumference was the most important measure of brain development. The majority of physicians (68.9%) responded that the period from the last trimester until 18 months postdelivery was crucial for brain growth and neurodevelopment, with 76.8% believing that infants breast-fed by vegan mothers have an increased risk of impaired brain development. CONCLUSION: The results of this study show that practicing physicians significantly agree that nutrition plays an important role in brain and cognitive development and function in early childhood, particularly during the last trimester until 18 months postdelivery.

Study of lipid profile in different grades of non- alcoholic fatty liver disease

Background: The prevalence of NAFLD [non- alcoholic fatty liver disease] is increasing as it exceed [31.79%] in Middle East and the metabolic syndrome prevalence in patients with NAFLD ranges from 18% to 67%, according to the body weight. Imaging or histology is very important tools in diagnosis of NAFLD. Early detection of NAFLD is very important especially if there is a non-invasive method. The clinicians in the primary, secondary and tertiary care are in need for specific and sensitive diagnostic tool that can be used easily

Aim: To study and analyze serum lipid changes in non-alcoholic fatty liver disease of different grades

Patients and methods: 100 patients diagnosed by ultrasonography as NAFLD, whose age was more than 18 years, were included in the study. History taking, full clinical examination and anthropometric measurement of weight, height and body mass index [BMI] were done for all patients. Serum lipid profiles including total cholesterol, HDL, LDL, triglycerides, ALT, AST. CBC, fasting and 2hpp blood glucose and TSH were measured

Results: The largest group of patients [38%] was in the fifth decade of life. followed by 30% in the sixth decade of life. As the grade of NAFLD increased, there was associated significant increase in levels of serum total cholesterol [P-value 0.005], TG [P-value 0.002] LDL [P-value 0.001] and VLDL [P-value 0.003] and associated significant decrease in HDL [P-value 0.001]

Conclusions: abdominal ultrasonography and increased lipid profile values can be used to detect NAFLD early

Chemical content, antibacterial and antioxidant properties of essential oil extract from Tunisian Origanum majorana L. cultivated under saline condition

Essential oils of marjoram were extracted from plants, growing under non-saline and saline condition [75mM NaCl]. Their antioxidant and antibaterial activity againt six bacteria [Enterococcus faecalis, Escherichia coli, Salmonella enteritidis, Listeria ivanovii, Listeria inocula, and Listeria monocytogenes] were assessed. Result showed that, [i] independently of salt treatment, marjoram essential oils inhibited the growth of most of the bacteria but in degrees. The least susceptible one was Enterococcus faecalis. [ii] Gram negative bacteria seemed more sensitive to treated essential oils than Gram positive ones. [iii] Compared to synthetic antibiotics, marjoram essential oils were more effective against E. coli, L. innocua and S. enteridis. This activity was due to their high antioxidant activity. Thus, essential oils of marjoram may be an alternative source of natural antibacterial and antioxidant agents

Ultra Structure of the Mid-Gut of the Third Instar Larvae of Sarcophaga Aegyptiaca (Diptera: Sarcophagidae).

The mid-gut of third instar larvae of Sarcophag aegyptiaca was divided into anterior, middle and posterior mid-gut regions. A well-developed peritrophic membrane appeared in the apical part of the anterior and middle portions of mid-gut while it is absent from the posterior portion. The microvilli differs in 3 portions, appeared as apical membrane in the anterior portion, sparse in middle portion to long slender compact microvilli in posterior portion. Numerous organelles were observed throughout the cytoplasm of the 3 portions; lipid spheres, rough endoplasmic reticulum, seceretory vesicles and mitochondria. A large apically nucleus appeared in the 3 portion of mid-gut. A basal labyrinth was observed in both anterior and posterior regions of mid-gut while it was absent in middle portion of mid-gut. Thin basement membrane was observed in the 3 portions of mid-gut of third instar larvae of Sarcophag aegyptiaca.

Safety of Minimally Invasive Oesophagectomy without Pyloroplasty.

Open oesophagectomy may be associated with significant morbidity and mortality. With the increa-sing experiences in laparoscopic and thoracoscopic techniques, minimal invasive approaches to oesophagectomy are being explored to determine the feasibility, results, and potential advantages. Pyloroplasty is performed during oesophagectomy to avoid delayed gastric emptying and hence reduces the risk of aspiration pneumonia. By contrast, it has been argued that pyloroplasty is unnecessary as gastric outlet obstruction is a rare occurrence following oesophagectomy and that the procedure itself is associated with a number of complications. Aim: The aim of this study is to assess the safety of minimally invasive oesophagectomy without pyloroplasty. Methods: Retrospective cohort study was carried out of 90 consecutive surgically fit oesophagogastric cancer patients irrespective to the age and gender having undergone minimally invasive oesophagectomy without pyloroplasty. The outcomes were measured in terms of developing postoperative gastric outlet obstruction or evidence of pyloric stenosis in endoscopy, operative time, intraoperative complications, in hospital and 30 days mortality rate. Results: 8/90 of minimally invasive oesophagectomy without pyloroplasty developed postoperative gastric outlet obstruction with endoscopic evidence of pyloric stenosis (8.9%). 7/8 with postoperative delayed gastric empyting had been managed conservatively with repeated endoscopic dilatation (87.5%) while one out of eight patient necessitated laparoscopic pyloroplasty (12.5%). Only one among 90 necessitated laparoscopic pyloroplasty .The mean operative time was 366 minutes. 11/90 had postoperative leak (12.2%) which was managed conservatively. The postoperative in hospital mortality was 4/90 (4.4%) and the 30 days mortality is 2/90 (2.2%). Conclusion: Routine pyrloroplasty is not advocated as the incidence of post operative complication delayed gastric empting, leak, aspiration pneumonia are comparable with pyroloplasty more over pyloroplasty is associated with increased operative time ,so not doing is a safe and a wise decision.

Polypropylene Mesh for Recurrent Incisional Hernia: Different Operative Techniques.

Aims: To locate the plane of mesh insertion whether it is onlay, inlay, sublay, or underlay. Design: Prospective study Place and Duration: Done at Bani suef hospital between May 2011 till May 2012 with follow till May 2014. Methodology: Twenty two patients, six were males sixteen were females with recurrent incisional hernias were included in the study with a mean age ± SD of 44 years ± 11.87, there were 14 patients presented after the first recurrence (Groups 1, 2), 7 patients after the second recurrence (Groups 3, 4) and only one for the third recurrence. There were no significant difference between patients presented by 1st and 2nd recurrence concerning the age, sex and level of hernia. To all patients a polypropylene mesh was applied, 12 onlay, 2 inlay, 5 sublay and 3 underlay. Results: There were two serosal lesions and only one perforation. There were 4(18%) patients with seroma, 1 (4.5%) with haematoma, 4 (18%) with infection, 3 (13.6%) with DVT, 1 (4.5%) with non fatal PE, and 1 (4.5%) respiratory failure. The highest incidence of complications were in the onlay repair, the lowest in the underlay repair. The patients were followed for two year, there were 6 recurrence (27.2%), most of them were in the onlay repair with the highest incidence in the inlay repair. The incidence of recurrence in the onlay to inlay was statistically non significant (P<0.5), the onlay to the sublay was significant (P<0.05) and the onlay to the underlay was highly significant (P<0.02). Conclusion: It is to be concluded that when a patient with recurrent incisional hernia is in need for repair, it is better to avoid inlay technique, not to do the underlay and the onlay techniques, and recommended to do the sublay approach.

Upper digestive stenosis due to a hydatid cyst of the liver

The complications of the hydatid cyst of the liver are dominated by infection and rupture. The compression of adjacent organs [mainly the inferior vena cava, the portal vein and the bile ducts] can be seen, when the cyst is located in the dome, in the hilum or within the hepatic parenchyma. Upper digestive stenosis by compression of the duodenum by the hydatid cyst is an exceptional complication. A 63 year-old patient had, for two months, upper digestive stenosis associated with a sensation of weight in the right hypochondrium. Digestive endoscopy showed an extrinsic compression of the second portion of the duodenum. Biopsies were negative. Abdominal CT showed up a hydatid cyst in the segment VI of the liver, adhering to the duodenum, with an exo-vesiculation compressing it. The patient was operated on: There was a hydatid cyst of the right lateral sector compressing the duodenum. A partial intralamellar pericystectomy was performed. Hydatid cyst of the liver, a parasitic disease described as benign, may give mechanical complications related to compression of adjacent organs [especially the bile ducts and veins]. Compression of the digestive tract is exceptional. This is due to the proximity of the cyst to the duodenum and the thickness of the cyst wall

Environmental, urinary iodine status and prevalence of goitre among schoolchildren in a high altitude area of Saudi Arabia

This study aimed to assess the iodine deficiency, prevalence of goitre among schoolchildren and measuring environmental iodine in Taif city, Saudi Arabia. A cross-sectional multistage cluster-sampling methodology was done on 1887 schoolchildren. Their urinary iodine concentration [UIC] and goitre prevalence was assessed. Blood level of triiodothyronin, thyroxine and thyroid-stimulating-hormone was carried out for students with normal, mild; moderate and sever iodine deficiency. The iodine content of salt, water and soil was also assessed. Goitre prevalence was 7.4% and about 71% of the participants had UIC less than 100 microg/L. An inverse relationship between median UIC and the percent prevalence of goitre was found. The mean serum T3, T4 and TSH were 1.05 ng/dL, 6.81 microg/dL, and 5.69mIU/L, respectively. A significant positive correlation was found between the mean value of urinary iodine and the mean value of both T3 and T4. While a significant negative correlation between the mean value of urinary iodine and the mean value of TSH was also noted. The results revealed the presence of a potential public health problem of iodine deficiency among school going children in high altitude areas of Saudi Arabia. There is a need to monitor and evaluate the salt iodization process, and distribute adequately iodized salt in the affected areas

Experimental rat model of diabetic nephropathy: RAGE detection and effect of spironolactone monotherapy

The glycation process results in formation of advanced glycation end products [AGEs], which accumulate in different organs at an accelerated rate in diabetes, resulting in alteration of both structure and function. This effect is via the receptor for AGES [RAGE], which is a signaling receptor leading to profibrotic reactions. The renin angiotensin aldosterone system [RAAS] is activated in diabetic nephropathy [DN] and leads to more renal damage. This is inhibited by angiotensin converting enzyme inhibitors [ACEIs] and angiotensin receptor blockers [ARBs] and mineralocorticoid receptor blockers [MRBs]. To show the monotherapeutic effect of spironolactone in diabetic nephropathy and to detect RAGE. Diabetes was induced in rats by streptozotocin. Three weeks after,spironolactone [SPL] was given for 4 weeks. Then, control, diabetic and treated rats were sacrificed. The results of blood chemistry at the end of 4 weeks showed statistical increase in serum sodium, potassium and urea with no effect on serum creatinine or blood glucose. Kidney pathological injuries were attenuated by SPL also, RAGE deposition compared to the diabetics. The study showed RAGE deposition in the experimental DN and confirmed the beneficial effects of MRB in DN

How to Improve Eating Behaviour during Early Childhood / 대한소아소화기영양학회지

Eating behaviour disorder during early childhood is a common pediatric problem. Many terminologies have been used interchangeably to describe this condition, hindering implementation of therapy and confusing a common problem. The definition suggests an eating behaviour which has consequences for family harmony and growth. The recent Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition does not cover the entire spectrum seen by pediatricians. Publications are substantive but level of evidence is most of the time low. This purpose of this review is to clarify terminology of eating behaviour problems during early childhood; including benign picky eating, limited diets, sensory food aversion, selective eating, food avoidance emotional disorder, pervasive refusal syndrome, tactile defensiveness, functional dysphagia, neophobia and toddler anorexia. This tool is proposed only to ease the clinical management for child care providers. Diagnostic criteria are set and management tools are suggested. The role of dietary counselling and, where necessary, behavioural therapy is clarified. It is hoped that the condition will make its way into mainstream pediatrics to allow these children, and their families, to receive the help they deserve.

[Meningitis after spinal anesthesia [cases reports and litterature review]]

Meningitis is a rare complication after spinal anesthesia. We report 4 cases of meningitis occurred after spinal anesthesia. These meningitis were diagnosed during tow months and with 3 different operators. The first symptoms appeared 4 to 6 hours after surgery and were represented especially by headaches and fever. Cyto-chimic analysis of cerebrospinal fluid [CSF] indicates bacterial meningitis but soluble antigens and culture were negative. Evolution was favorable in all cases under or without antibiotics. The exactly cause of these meningitis remained unknown and an insufficient asepsis was the principle risk factor found in all cases. Prevention of this risk consists on hygienic rules and perfect skin disinfection

[Evaluation of a protocol of spinal anesthesia for Cesarean in Tunisian maternity: hemodynamic repercussions and risk factors of hypotension]

To evaluate hemodynamic repercussion of a protocol of spinal anesthesia [SA] for cesarean and release the predictive factors of maternal arterial hypotension post spinal anesthesia. We included parturients proposed for Cesarean under SA. They were not included the women of statute ASA > II, preeclamptics, eclamptics and/or having counter-indications of SA. We excluded the cases where there were technical difficulties at the time of the realization of SA, a failure or a complication of this SA. We injected 10 Mg of bupivacaïne 0.5% isobar, 10 micro g of fentanyl and 100 micro g of morphine. The data were collected before the realization of SA [anthropometric parameters; antecedents; basic systolic and diastolic blood pressures [BSBP and DSBP] and basic heart rate [BHR]] and after SA [systolic and diastolic blood pressure [SBP and DBP], heart rate [HR]; occurred or not of a sympathetic block [falls of the SBP of more than 20% of its basic value or a SBP<90 mm Hg]; the time of installation of the sympathetic block and the duration of hypotension. The full number of parturients included was 1016 among whom 16 were excluded. Only 1000 parturients finished the study and were divided into 2 groups [group 1: 500 emergency cesarean and group 2: 500 elective cesarean]. The incidence of the sympathetic block was of 44.2% as a whole and this block was significantly more frequent in group 2 [p=0.0001]. There was a significant relation between the incidence of a sympathetic block and the advanced age of the parturient [p=0.0001], the important weight [p=0.047], high ASA statute [p=0.0001], the presence of hypertension [p=0.0001], diabetes [p=0.001] or cesarean [p=0.00015] in the antecedents and the low BSBP [p=0.015]. In spite of the beneficial effect of the reduction in the amounts of local anesthetic in the SA, the sympathetic block remains frequent after SA for Cesarean. Thus, it is essential to detect the high risk women of occurred of sympathetic block after SA, and to propose strategies of prevention, monitoring and management for this population

[Risk factors of children overweight and obesity]

The increase of the prevalence of children obesity in some countries as Tunisia, necessitate to welling known risk factors for obesity, to prevent and early management. To determine the prevalence of overweight and of obesity in a group of 4-6 year-old school children in Monastir and to investigate the association with possible risk factors. A descriptive transversal study including 121 children aged 4-6 years old [637 males, 698 females], was conducted in 10 Kindergartens in Monastir, in 2011. Personal data such as age, sex, birth weight, breastfeeding history and parental data including parental weights and heights, parental education level and occupation were collected by questionnaires completed by parents. Height and weight were measured with a weighing-scale and body mass index [BMI; kg/m2] was calculated. The prevalence of overweight and obesity was defined based according to the curves of the french reference of Rolland Cachera. Prevalence of overweight and obesity was 9.1% and 11.6% respectively. Parental factors associated with overweight were: parental obesity: 44% vs 17% [p=0.005] [OR = 3.65: 1.27-10.57], artificial feeding: 68% vs 33% [p=0.0016] [OR= 4.25: 1.51-12.27], and the early diversification of food before the age of 6 months: 88% vs 65% [p=0.029] [OR= 3.84: 0.98 - 17.66]. Exclusive breast feeding duration >/= 6 months is probably protector factor against obesity: 0% vs 21% [p=0. 01] [OR=0: 0.00 < OR < 0.78]. We found no significant difference between overweight and non-overweight schoolchildren in frequency of high degree educated mother and father, birth weight, breakfast intake, eating habits and exercise. However overweight children intake high-caloric food, low in fiber, with troubles of nutritional comportment, and a sedentary lifestyle. Risk factors for obesity, well known in most industrialized countries, necessitate to be more understood in Tunisia, to place a preventive strategy included supervision of children weight, nutritional education and promote physical activity and reducing the time spent watching television

[N-acetylcysteine in septic shock]

To focus on the various studies evaluating the effects of Nacetylcysteine in septic shock. Main references obtained from the medical database Medline using the keywords: N-acetylcysteine; septic shock, free radicals. Septic shock remains the leading cause of mortality in intensive care units. The progressive knowledge of the pathophysiology of septic shock, underline the production of free radicals and their cellular and microcirculatory effects. The Nacetylcysteine used mainly in paracetamol poisoning, has properties to control free radicals. The explosion of free radicals in septic shock has led to multiple studies assessing the role of N-acetylcysteine as an anti radical, and for its anti inflammatory action. NAC seems to play an important role in septic shock to control free radicals and the inflammatory response. But these results remain contradictory. Some larger and more standardized studies should allow to evaluate the actual effects of NAC in septic shock

Effects of aging and anti-aging hormones on the kidney, the thyroid functions and the histology of the testis of male albino rats

The present study was carried out to evaluate the effect of aging and anti-aging hormones on the kidney, the thyroid and the testis of aged male albino rats from the physiological and histological points of view. Thirty five male rats were used in the present study. They were allocated into five groups. The first group [5 months old] served as control group and the other remaining groups are [18 months old]. The second group 1 ml/kg b.w. corn oil intramuscular injection through a period of two weeks. The third group received 2mg/kg b.w. of melatonin hormone orally daily for two weeks. The fourth group received 0.57 mg/kg b.w. of testosterone hormone via intramuscular injection through two weeks. The fifth group received the same dose of both hormones [Melatonin and Testosterone] for two weeks. Some biochemical parameters of the kidney, the thyroid and histological structure of the testis were examined. The untreated aged group showed insignificant change in urea level with highly significant decrease in creatinine, T[3] and T[4] hormones levels. The melatonin treated group showed significant decrease in urea level with highly significant decrease in creatinine, T[3] and T[4] hormones. The testosterone treated group showed highly significant increase in urea, T[3] and T[4] hormones and highly significant decrease in creatinine level. Whereas, fifth group showed significant decrease in urea accompanied with a highly significant decrease in creatinine and highly significant increase in T[3] with a significant increase in T[4]. The histological changes induced by aging and anti-aging hormones included intertubular haemorrhage, odematous areas present between the seminiferous tubules. The interstitial tissue was degenerated. The degenerated seminiferous tubules revealed maturation arrest in late-stage spermatides. In conclusion, aging and anti-aging hormones administration into adult male rats exerts a clear effect on the kidney and the thyroid functions and on the testicular structure. On the other hand, amelioration in T3 and T4 serum level was found in anti-aging treated rats compared with untreated aged rats

Ultrasonography in clinical assessment of inflammatory and destructive changes in patients with psoriatic arthritis

To investigate the presence of asymptomatic entheseal abnormalities in psoriatic patients in an attempt for preclinical detection of psoriatic arthritis before joint affection becomes established. study included 50 patients who were divided into 2 groups; group I included 20 psoriatic patients with established psoriatic arthritis [as a control group] and group II included 30 psoriatic patients who didn't have any rheumatologic manifestations. Clinical assessment, routine laboratory studies, rheumatoid factor assessment, routine X-ray, musculoskeletal ultrasound [US], and power Doppler sonography were performed to all patients. US detected changes in 53.3% of psoriatic patients. The most common was inactive synovitis [53.3%], followed by tenosynovitis of flexor and extensor tendons of the hand [33.3%], then achillis tendinitis in 20%, and active synovitis along with achillis bursitis to be 6.7% for each. It was found that the PASI score and CRP were statistically higher in psoriatic patients with US findings than those with no US findings [p<0.05]. Higher tilers of CRP were associated with more synovitis, effusion, achillis tendinitis and bursitis in psoriatic patients; yet CRP tilers did not have in effect on US findings in patients with arthritis. It was found that active joint disease was significantly associated with joint spurs. US could detect subclinical musculoskeletal changes in asymptomatic psoriatic patients, and these changes are related to active skin disease and high levels of inflammatory markers. That is why proper control of skin disease and regular US follow up may lead to early, subclinical diagnosis of psoriatic arthritis and hence, early intervention to prevent joint destruction