Objective: To evaluate the efficacy and safety of metformin use in rheumatoid arthritis (RA) patients receiving conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs).Methods: A prospective, randomized, controlled, single blinded, study was carried on 66 RA patients with moderate and high disease activity state, receiving csDMARDs. Patients were simply randomized to receive either metformin 850 mg twice daily (Metformin group, n = 33), or placebo twice daily (Control group, n = 33) in addition to their stable anti-rheumatic regimen and followed up for 6 months. Serum C-reactive protein (CRP), disease activity of 28 joints based on CRP (DAS-28-CRP), and quality of life (QOL) were evaluated at baseline and then every 3 months. Moreover, serum adiponectin was assessed at baseline and after 6 months.Results: Sixty patients completed the study. Drop out was due to intolerance to metformin side effects (n = 3) and non-compliance (n = 3). Metformin significantly decreased CRP levels and DAS-28-CRP after 6 months compared to the control group (p-value <0.001). A significant improvement in QOL of metformin group was observed as early as after 3 months (p-value = 0.006) with a continued improvement observed at 6 months (p-value <0.001) compared to the control group. Despite the significantly higher serum adiponectin in the metformin group at baseline, it was significantly reduced after 6 months in the metformin group with median percent change of −63.49% compared to the significant increase in the control group with median percent change of 92.40%.Conclusion: Metformin significantly improved inflammation, disease severity, and QOL in RA patients with high safety profile.Clinical Trial Registration: Clinical-Trials.gov, identifier [NCT08363405].

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Background: hypertensive diseases represent a major disease burden in Egypt. The prevalence of hypertension in Egypt in 2008 among adults of age ≥ 25 was 17.6%. In 60% of patients, hypertension is usually associated with cardiovascular risk factors. This leads to increased cardiovascular morbidity and mortality. Management of hypertension in Egypt is not easy because of treatment costs and inefficient primary health care system. There is a need for developing national hypertension guidelines to improve the rates of awareness, treatment and control of hypertension with the final goal of preventing and decreasing mortality and morbidity. Aim of work: to assess the essential hypertension status among the Egyptian adult population of age≥ 25 and to study the modifiable social and environmental risk factors, health consequences, and assess the cardiovascular and non-cardiovascular complications to help disease prevention and limitation of complications. Patients and methods: this study was conducted on 312 patients of age ≥ 25 with essential hypertension. All patient were subjected to full medical history and physical examination that including measurement of blood pressure (BP) and fundus examination. Anthropometric measurements including height, weight, waist circumferences, and hip circumferences were also measured. Waist to hip ratio and body mass index (BMI) were calculated. Laboratory investigations were performed including complete blood count (CBC), fasting blood glucose, measurement of creatinine, uric acid and lipid profile. Microalbuminuria was also assessed. Other investigations including electrocardiogram and echocardiograph were done. Results: Male patients were 134(42.9%), while females were 178(57.1%). Their ages ranged from 30 to 85 years with a mean ±SD of 55.16±9.4years.Dyslipidemia was found in 152 (49%) patients. Left ventricular diastolic dysfunction (LVDD) was represented in160 (51%) patients. Uncontrolled BP was represented in (73%), (66%) and (55%) of non-educated, mild to moderate educated and high educated patients respectively. Retinopathy was found in 121 (38.8%) patients, 76 (60%) patients were hypertensive diabetic and 45 (24%) patients were hypertensive non-diabetic. Albumin in urine was present in 20%of patients. Conclusion: strategies that enhance public awareness of hypertension and increase access to affordable medications are urgently needed. Prevention of hypertension needs both a population strategy and an intensive strategy focused on individuals at high risk. The complications of hypertension can be prevented by adequate blood pressure control with screening programs to identify the population at risk

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Background: Rheumatoid arthritis is a systemic inflammatory disease that can involve other tissues and organs as well as synovial joints. It is characterized by destructive polyarthritis and extra-articular organ involvement, including skin, eye, heart, lung, renal, central and peripheral nervous system and gastrointestinal tract. The extra-articular manifestations of RA can occur at any age. Objectives of this study are to evaluate extra articular manifestations in Egyptian rheumatoid arthritis patients, its relation to the disease activity score (DAS28) and Anti-Cyclic Citrullinated Peptide (ACPA). Methods: This study was conducted on 50 patients they were diagnosed as RA by fulfilling the American College of Rheumatology (ACR) criteria of RA. Their age (mean±SD) is 45.78±13.26 years. Forty four (88%) of them were females, 6 (12%) were males. They were subjected to full medical history and examination, laboratory investigations were done, calculation of DAS28 score, measurement of plasma Anti-Cyclic Citrullinated Peptide (ACPA). RA patients were classified according to DAS 28 into three groups. Results: RA group 1 (mild disease activity) includes 12 (24%) patients with mean±SD of DAS 28 was 2.5±0.55, group II (moderate disease activity) includes 28 (56%) patients with mean±SD of DAS 28 was 3.9±0.55 and group III (severe disease activity) includes 10 (20%) patients with mean±SD of DAS 28 was 5.35±0.238. There was highly significant increase in mean±SD of ACPA titer in group III (sever activity), 90.31±40.78 IU/ml than that of group II 56.48±27.62 IU/ml, (p=0.000) and group1; 36.74±18.95 IU /ml also mean ACPA in group II increased significantly than that of group I, (P=0.000). Fifty (100%) RA patients had extra articular manifestations (ExRA); 37 (74%) had respiratory system disorders, 35 (70%) had hematological manifestations. CVS manifestations were found in 23 (46%). Eye manifestations present in 23 (46%) RA patients. Twelve (24%) RA patients had skin manifestations. GIT manifestations occur in 11 (22%) patients, 5 (10%) RA patients had renal manifestations. Four (8%) RA patients had neurological manifestations. The most common ExRA respiratory disorders was found in 8/12 (66.6%) patients in group I while it affect 22/28 (78.5%) patients in group II and 7/10 (70%) patients in group III (P = 0.000) with highly significant changes. Conclusion: This study showed that the ExRA are a common feature in Egyptian RA patients and they are related to the disease activity. [Egypt J Rheumatology & Clinical Immunology, 2014; 2(1): 71-79]

Both diabetes and obesity are associated with chronic low-grade inflammation. IL-18 is a cytokine that stimulates various cell types and has pleiotropic functions. It is elevated in obesity, metabolic syndrome and type 2 diabetes (T2D).The hypothesis that serum level of IL-18 and high sensitive C-reactive protein can be used as markers for presence of chronic low-grade inflammation in type 2 diabetes more than in obesity per se was tested. The study recruited 80 subjects. They comprised 20 diabetic obese cases (DM-OB group), 20 diabetic non-obese cases (DM-NOB group), : 20 non-diabetic obese cases (NDM-OB group) and 20 non-diabetic non-obese subjects (NDM-NOB group). All participants were submitted to careful history taking, through clinical investigations and laboratory assessment. It was found that hs-CRP was significantly high in DMOB group (3.4±0.5 mg/dl) followed by NDM-OB group (2.9±0.4 mg/dl) then DM-NOB group (2.3±0.3 mg/dl) and least in NDM-NOB (0.8±0.3 mg/dl). It was also found that serum IL-18 was significantly highest in DMOB group (397.8±33.9 pg/mL) followed by NDM-OB (368.8±26.7 pg/mL) group followed by DM-NOB group (335.9±18.4 pg/mL) and least in NDM-NOB group (281.1±22.9 pg/mL). Serum IL-18 levels are directly correlated with BMI, waist circumference, hip circumference and waist/hip ratio in all the studied groups and with HbA1c in the diabetic groups. It could be concluded that Serum IL-18 and hs-CRP are related to diabetes and obesity. They are associated with dyslipidemia, poor glycemic control, insulin resistance and impaired liver and renal functions