Background: Rheumatoid arthritis (RA), a chronic inflammatory disease, affects around one percent of people.

Aim and objectives: To compare vitamin D concentration in serum in normal individuals & RA cases, evaluate the connection among vitamin D concentration & disease activity and follow up on the effect of vitamin D supplementation on disease activity.

Patients and methods: This case control research has been performed on 130 cases, separated into two groups: Group I involved 65 RA patients and Group II involved 65 healthy subjects at an internal medicine outpatient clinic who were admitted to the department in the rheumatology unit from August 2022–August 2023.

Results: Cases with RA showed a significantly less concentration of vitamin D compared with the control group (17.98 ± 3.45 vs. 38.09 ± 12.09 ng/ml; p< 0.001). Most (53.8%) of the RA group had an insufficient level of vitamin D, while 10 (15.4%) patients had a sufficient level and the other 20 (30.8%) patients had a deficient level. Cases with remission had a significantly greater level of vitamin D in comparison with cases with low or moderate DAS-28 (25.08 ± 4.44 vs. 14.81 ± 2.45 ng/ml; p< 0.001) & cases with high DAS-28 (25.08 ± 4.44 vs. 7.80 ± 1.09 ng/ml; p< 0.001). 

Conclusion: Deficiency of vitamin D is widespread among RA cases, with disease severity inversely proportional to 25-OHD levels. In cases of vitamin D deficiencies, vitamin D supplementation appeared to enhance disease activity.

Background: Rheumatoid arthritis (RA), a chronic inflammatory disease, affects around one percent of people.

Aim and objectives: To compare vitamin D concentration in serum in normal individuals & RA cases, evaluate the connection among vitamin D concentration & disease activity and follow up on the effect of vitamin D supplementation on disease activity.

Patients and methods: This case control research has been performed on 130 cases, separated into two groups: Group I involved 65 RA patients and Group II involved 65 healthy subjects at an internal medicine outpatient clinic who were admitted to the department in the rheumatology unit from August 2022–August 2023.

Results: Cases with RA showed a significantly less concentration of vitamin D compared with the control group (17.98 ± 3.45 vs. 38.09 ± 12.09 ng/ml; p< 0.001). Most (53.8%) of the RA group had an insufficient level of vitamin D, while 10 (15.4%) patients had a sufficient level and the other 20 (30.8%) patients had a deficient level. Cases with remission had a significantly greater level of vitamin D in comparison with cases with low or moderate DAS-28 (25.08 ± 4.44 vs. 14.81 ± 2.45 ng/ml; p< 0.001) & cases with high DAS-28 (25.08 ± 4.44 vs. 7.80 ± 1.09 ng/ml; p< 0.001). 

Conclusion: Deficiency of vitamin D is widespread among RA cases, with disease severity inversely proportional to 25-OHD levels. In cases of vitamin D deficiencies, vitamin D supplementation appeared to enhance disease activity.

Lupus nephritis (LN) is a common major organ manifestation and main cause of morbidity and mortality of the disease. We aimed to determine the level of serum and urinary monocyte chemoattractant protein1(sMCP-1 and uMCP-1) in systemic lupus erythematosus (SLE) patients with and without LN and analyze their association with different clinical and serologic parameters of disease activity. We enrolled 60 female patients with SLE (32 with LN and 28 without LN) and 20 controls.MCP-1 and anti-dsDNA were measured by ELISA. There was statistically significant increase in serum and urinary MCP-1 in all SLE patients (mean=711.59, 676.68 pg/ml respectively) as compared to the control group (mean= 635.70, 632.40 pg/ml respectively), P=0.034, 0.020 respectively. Among patients with LN there was statistically significant increase in sMCP-1 (mean=723.58) compared to the control group (P=0.038, and in uMCP-1 (mean=699.08) compared to patients without LN (mean=651.07) and control group (mean=632.40), P=0.007, 0.002 respectively. Urinary, but not serum MCP-1, positively correlated with 24 hour proteinuria, anti-dsDNA, renal SLEDAI ,biopsy activity index (r=0.362, P=0.004; r=0.303, P=0.019; r= 0.267, P=0.039; r=0.353, P=0.047 respectively) and negatively correlated with serum albumin (r=-0.329, P=0.010).There was statistically significant increase in uMCP-1 and anti-dsDNA in patients with poor response compared to patients with good response to immunosuppressant therapy (P= 0.025; P=0.034 respectively). In conclusion, uMCP-1 is associated with LN and disease activity and may be used as a useful tool for diagnosis and follow up

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 p193.2 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.

Background The importance of uric acid has been increasingly appreciated because of its association with the development of diabetes mellitus and related diseases, and with the increasing incidence of diabetes, studying the impact of hyperuricemia in patients with diabetes type 2 is necessary. So we aimed to measure serum uric acid (SUA) levels in patients with diabetes type 2 and to assess the relation between the estimated glomerular fltration rate (eGFR) and the SUA in patients with type 2 diabetes (T2DM). Subjects and methods This study is a cross-sectional conducted on 142 adult patients who attended the Outpatients Diabetes Clinic and Endocrinology Center in the Department of Internal Medicine, Assiut University Hospitals, in the period from the 1st of November 2021 up to October 2022. We measured serum uric acid level, serum creatinine, cholesterol, low- and high-density lipoproteins, triglycerides, and eGFR. Results Overall, 142 patients were enrolled in the study; all patients had type 2 diabetes. The mean age of the participants was 61.08±9.73 years. Based on SUA level, 46 (32.4%) patients had normal SUA and 96 (67.6%) patients had high SUA. Sixty-nine (48.6%) patients had normal eGFR and 73 (51.4%) patients had reduced eGFR. We found that serum uric acid had a positive signifcant correlation with the number of metabolic syndrome criteria, cholesterol, low-density lipoproteins, and triglycerides. Meanwhile, it had a negative signifcant correlation with eGFR and highdensity lipoproteins. Conclusion Serum uric acid was strongly associated with metabolic syndrome components and reduced eGFR in patients with T2DM. Keywords Serum uric acid level, Type 2 diabetes, Metabolic syndrome

Aim

To investigate the pregnancy rate in women with normal uterine cavity and those with previously corrected uterinecavitary lesions, assessed by hysteroscopy in ICSI cycles.

Study Design

A prospective cohort study.

Materials and Methods

The study included women undergoing ICSI cycles. Patients were allocated into two groups,patients with normal uterine cavity (group 1, n=122) and patients with previously corrected uterine cavitary lesions (group < br />2, n=122). Office hysteroscopy was performed post-menstrual. The main outcome measure was clinical pregnancy rate.Secondary outcomes were the implantation rate and the take home baby rate.

Results

In both groups the mean±SD of the total amount of gonadotrophins used, duration of stimulation, peak estradiollevel, endometrial thickness and number of mature follicles, the implantation rate there was not statistically significantdifferent in both groups (2.22 ± 0.84 vs. 2.46 ± 0.95, p=0.419). Also, the pregnancy rate showed no statistically significantdifference between both groups (33.6% vs. 23.8%, p=0.089).

Conclusion

Correction of uterine cavitary lesions makes the implantation rate and pregnancy rate to be comparable towomen with normal uterine cavity.

Purpose: To compare the efficacy of peri-levator injection
of both betamethasone and triamcinolone in the management
of thyroid eye disease-related upper eyelid retraction without
proptosis.
Methods: This prospective, double-blind, randomized
clinical trial was conducted at Assiut University Hospital,
Upper Egypt in the period between December 2021 and October
2023. The study included 47 patients (56 eyes) and was divided
into 2 groups. In group A, 1 ml betamethasone was injected
into the peri-levator area, while in group B, 1 ml triamcinolone
was injected. The injection was repeated every month for up
to 5 injections if there was an improvement in margin reflex
distance 1 (MRD1). The injection was stopped if MRD1
reached the normal value or if 2 successive injections caused
no improvement in MRD1. The postinjection outcome was
divided into: 1) effective if MRD1 reached the normal ≤4.5 mm;
2) partially effective if MRD1 was improved but did not reach
the normal; and 3) ineffective if there was no improvement in
MRD1. The follow up ranged from 6 to 20 months.
Results: In group A, the injection was effective in 26 eyes
(92.9%) and partially effective in 2 eyes (7.1%). In group B,
the injection was effective in 17 eyes (60.7%), partially effective
in 6 eyes (21.4%), and ineffective in 5 eyes (17.9%). The mean
number of injections was significantly lower in group A than in
group B: 1.61 ± 0.50 versus 2.36 ± 1.16.
Conclusions: This study results suggest that betamethasone
is more effective with a smaller number of injections than
triamcinolone in the management of thyroid eye disease-related
upper eyelid retraction.