Circulating Preptin as a Marker for Osteoblast Inhibition in Rheumatoid Arthritic Patients Treated with Corticosteroids

Preptin is a newly isolated 34 amino acid peptide hormone co-secreted with insulin and amylin from pancreatic β-cells as a regulatory element in bone metabolism with an unclear yet mechanism Rheumatoid arthritis (RA) is an autoimmune disease that causes chronic inflammation of the joints Two classes of medications are used in the management of RA: fast-acting non-steroidal anti-inflammatory drugs and corticosteoids, and slow-acting drugs. Corticosteroids are well known to have several adverse effects on bone metabolism. Aim The aim of the present study is to assess the association of corticostroids when used in the treatment of rheumatoid arthritic patients, with circulating preptin, in an attempt to shed a light on the mechanism of induced osteoporosis in such patients. Subjects and methods Ninety subjects were enrolled in this study. Divided into three groups: G1= Thirty RA lean patients taking DMARDs + corticosteroids G2= Thirty RA lean patients taking DMARDs without corticosteroids G3= Thirty healthy weight and aged matched controls Circulating serum preptin was measured in all groups using ELISA technique. Results Results showed that circulating serum preptin was elevated in patients with RA. However it was lower in G1 than in G2 In conclusion Results showed that preptin was affected in such patients when compared to arthritic patients not treated with corticosteroids. This suggests that this newly discovered hormone could be considered as a new marker for bone mineral density and osteoporosis

Serum IL17 and IL6 levels in a Sample of Iraqi Patients with Rheumatoid Arthritis: A Case Control Study

Objectives: To determine serum IL17 and IL6 levels in a sample of Iraqi patients with rheumatoid arthritis (RA) and to evaluate the correlation between them if present. Methods: A case control single center study was conducted for 11 months. A total of 50 patients with RA diagnosed according to the 1987 American College of Rheumatology (ACR) and 30 individuals matched in age and sex as control group were included. Serum IL17 and IL6 levels were measured in both groups by enzyme-linked immunosorbent assay (ELISA). The cut off value was assessed by receiver operating characteristics (ROC) test and correlation by spearman's Rho linear correlation coefficient. Results: Frequency of females was more than males in patients and controls (88% and 76.7% respectively).Ages of patients range between 20-70 years with a median 43.76 years while in controls, ages range between 20-60 years with a median 37.67 years.Serum IL17 concentration was significantly higher in patients compared to controls (median 154.4 pg/ml versus 111.1 pg/ml respectively, p=0.02). Also serum IL6 concentration was higher and highly significant in patients compared to controls (median 150 versus 49 pg/ml respectively, p=0.001). There was a direct strong highly statistical significant correlation between serum IL17 and serum IL6 concentration      (r=0.771, p<0.001).The optimum cut off value for IL17 was ? 71.8 pg/ml and IL6 concentration?8.1pg/ml. Conclusions: serum IL17 and IL6 concentrations were significantly higher in Iraqi sample of RA patients compared to controls with direct strong highly significant correlation between these cytokines. This may help in diagnosis of RA and suggest potentially an effective treatment. Key words: Rheumatoid arthritis, IL17, IL6, rheumatoid arthritis and cytokines.

Investigating the Effectiveness of ESL Games and Activities in Developing Listening Skills among ESL Learners

This study aimed to examine the efficacy of using ESL games and activities to enhance ESL learners\u27 listening skills. The study was conducted with participants of 75 from various universities in Kurdistan Region, selected using a stratified random sampling method. The pretest-posttest control group design was employed in this study, in which the experimental group received ESL games and activities, while the control group received traditional listening instruction. Data analysis was performed using descriptive statistics, independent t-tests, and ANCOVA. The findings of the study revealed that the experimental group outperformed the control group on the post-test, indicating that ESL games and activities had a significant impact on the development of listening skills among ESL learners. This study’s outcomes have several implications for teaching and learning practices. Instructors and curriculum designers could integrate ESL games and activities into their teaching methodologies to make language learning more engaging and interactive. Furthermore, learners could benefit from a more enjoyable and dynamic learning experience. The study’s limitations were that it was conducted in a specific cultural and educational context, which may limit its generalizability. Additionally, the study did not consider individual differences among participants, such as prior language proficiency or motivation levels, which may have influenced the results. In conclusion, this study indicates that ESL games and activities can enhance listening skills among ESL learners. Future research could explore the effectiveness of these methods in different educational settings and with different populations of ESL learners

Cost-effectiveness Analysis of Reference Infliximab (Remicade) Compared to its Biosimilar (Remsima) in Iraqi Patients with Rheumatoid Arthritis (Conference Paper )#

The study objective was to conduct Pharmacoeconomics study (cost-effective analysis) between infliximab reference (Remicade) and its biosimilar (Remsima) in patients with rheumatoid arthritis (RA) in Iraqi hospitals. This is a retrospective multicenter pharmacoeconomic analysis conducted at two large teaching governmental hospitals in Baghdad, Iraq which provided infliximab to patients with RA. Data were collected from patient’s medical records and face-to-face interviews with the patients from December 2021 to April 2022. The study included 57 patients with rheumatoid arthritis (RA).  The patients were categorized into two groups according to the type of infliximab they received over 30 weeks: 27 patients received reference infliximab (Remicade) and 30 patients received biosimilar infliximab (Remsima). The two groups had comparable demographic and baseline disease parameters, with a mean age of 49.6 years and a BMI of 30.0. The vast majority of participants were women (82.5%) with low level of formal education (65%). Overall, both infliximab biopharmaceuticals had good effectiveness to reduce the RA disease activity (CDAI) and improve patient quality of life. They both had comparable adverse reactions including UTI, fatigue, and headache. There was no significant difference (P-value >0.05) in disease activity between the two groups according to RA clinical disease activity index (CDAI) score across all three-time measures: before biological therapy, 14 weeks post-therapy and 30 weeks post-therapy. In 2019, Remicade was slightly more effective and provide better quality of life, but costlier ($41,896 per QALY) compared to Remsima. It was not clear whether the reference biologic (Remicade) or its biosimilar (Remsima) was more cost effective. In 2021, Remicade was more cost effective compared to Remsima because Remicade was less expensive and relatively more effective according to CDAI and EQ-5D-5L scores. Registering and purchasing both reference infliximab and its biosimilar was good idea to keep the competition in the price and maintain infliximab for RA patients.

Association of radiological osteoarthritis of the knee joint with locomotor disability

Background:  Knee osteoarthritis (KOA) is a common joint disorder leading to considerable pain and locomotor disability in lower limb function. Locomotor disability, which is difficulty in activities of daily living related to lower limb function, can be the consequence of KOA, so early diagnosis and management may improve quality of life.&#x0D; Objective: To assess the contribution of radiological osteoarthritis of the knees to disability in the activities of daily living related to lower limb function.&#x0D;  Methods: One hundred twenty Iraqi KOA patients (104 females and 16 males) who were attending to Rheumatology Unit, Full history was taken and complete clinical examination was done for all patients. Wight-bearing X-rays of both knees (anteroposterior and lateral view) were taken for patients and were graded according to Kellgren and Lawrence scale.&#x0D; Results: The frequency of locomotor disability, was 62.50% for men and 72.11% for women (p=0.431). The frequency of radiological osteoarthritis of the knee was 50% for men and 40.37% for women (p=0.651). There was significant statistical differences between; locomotor disability, and increased age, morning stiffness, muscle wasting &amp; BMI (p=0.000, p=0.003, p=0.002 and p=0.028 respectively). There was no statistical significant association between; KOA radiological grading, and gender, morning stiffness, BMI &amp; lower limb locomotor functions disability (p=0.651, p=0.357 and p=0.972 respectively).&#x0D; Conclusion:  Radiological osteoarthritis of the knee is only weak independent predictors of locomotor disability. Patient's age, pain of the knees, muscle wasting, morning stiffness and obesity seem to be the most important independent determinants of locomotor disability.</jats:p