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دراسة تاثير الهرمونات جريلين، الانسولين عامل النمو , الليبتين والانسولين على نمو الاطفال المصابين بالسمنه == The Impact of Ghrelin,Insulin like growth factor - 1(IGF - 1),Leptin and Insulin on the growth of Obese Children

Author name: زيـنة عزالدين نور الــدين

Supervisor name: هدف ظافر الياسين | محجوب نفل النداوي

General topic: Medicine

Specific topic: Clinical Biochemistry

Degree: Master

University: University of Baghdad - Faculty Of Medicine

Language: English

University location: Baghdad

First pages:

Abstract: الجريليين يعرف بانه الرابط الداخلي للمستقبلات المسؤولة عن افراز هرمون النمو ويعمل بمثابة اشارة منمي جسدي ومشهي من المعدة .يعتبر الجرليين فريد من نوعه بعد التعديل حيث ان مجموعة الهيدروكسيل من جهة الحمضي الاميني الثالث عادة هو سيرين ولكن في بعض الانواع ثريونين مؤسترة من حمض الاوكتانيك وهذا ضروري للانشطة البايولوجية للجريليين .يزداد افراز هرمون جريليين في ظل ظروف الطاقة السلبية مثل الجوع , دنف , فقدان شهية العصبي في حين يقل في ظل ظروف الطاقة الايجابية مثل التغذية ,ارتفاع السكر في الدم والسمنة . اضافة الى تاثير هرمون جريليين القوي على افراز هرمون النمو فانه يحفز الاستهلاك الغذائي وارسال اشارات الى نوى تحت المهاد (الهايبوثالامس) التنظيمية من اجل التوازن في التحكم بالطاقة . وهكذا من المثير للاهتمام ان نلاحظ ان المعدة لا تقتصر على لعب دور هام في عملية الهضم فحسب بل ايضا في تحفيز الغدة النخامية في افراز هرمون النمو وكذلك تنظيم التغذية المركزية . ان اكتشاف هرمون جريلييين من ممكن ان يخلق جسرا يربط النمو الجسدي مع الايض الغذائي . الهدف من هذة الدراسة : هو اختبار ما اذا كان ممكن للجريليين ان يلعب دورا في ظهور الاعراض المبكرة للبدانة او ان تترافق مع معطيات القياسات البشرية وافراز الانسولين ,هرمون اللبتيين او انسولين عامل النمو في الاطفال البدناء او الذين يعانون من زيادة في الوزن ومقارنتهم مع اطفال اصحاء الوزن .التصميم والاساليب : تم استخدام طريقة ELISA لفحص الجريليين , اللبتيين , الانسولين , انسولين عامل النمو . بواسطة اخذ عينة دم من اربعين طفلا يعانون من السمنة المفرطة , و11 طفلا يعانون من زيادة الوزن , و29 طفلا اصحاء طبيعي الوزن اعمارهم تتراوح بين ( 5 - 11 سنة ) .النتائج : كان متوسط تركيز الجريليين اقل بكثير في الاطفال البدناء الذين يعانون من زيادة في الوزن مقارنة بمجموعة التحكم ( P < 0.000 ) . كان متوسط تركيز هرمون انسولين النمو اعلى بكثير في الاطفال البدناء مقارنة بمجموعة التحكم ( P < 0.000 ) . وكان متوسط تركيب الانسولين اعلى بكثير لدى الاطفال البدناء مقارنة بمجموعة التحكم ( P < 0.007 ) . كان متوسط تركيز اللبتيين اعلى بكثير لدى الاطفال البدناء مقارنة بمجموعة التحكم ( P < 0.000 ) . وجدت علاقة عكسية بين جريليين و( مؤشر كتلة الجسم , لبتيين , الانسولين ) عند الاطفال ما قبل البلوغ في حين كان الارتباط ايجابي بين الجريليين وانسولين عامل النمو في الاطفال مفرطين السمنة .الاستنتاجات : ان التغيرات الحاصلة في هرمون الجريليين في الاطفال لا تشير الى انه المحفز المباشر لهرمون النمو ولكن الاثار الثانوية على محور انسولين عامل النمو يمكن ان تسهم في تسريع النمو خلال البلوغ . | Ghrelin, identified as an endogenous protein for the growth hormone secretagogue receptor, functions as a somatotrophic and orexigenic signal from the stomach. Ghrelin has a unique post - translational modification : the hydroxyl group of the third amino acid, usually a serine but in some species a threonine, is esterified by octanoic acid and is essential for ghrelin’s biological activities. The secretion of ghrelin increases under conditions of negative energy balance, such as starvation, cachexia, and anorexia nervosa, whereas its secretion decreases under conditions of positive energy - balance such as feeding, hyperglycemia, and obesity. In addition to having a powerful effect on the secretion of growth hormone, ghrelin stimulates food intake and transduces signals to hypothalamic regulatory nuclei that control energy homeostasis. Thus, it is interesting to note that the stomach may play an important role not only in digestion but also pituitary growth hormone release and central feeding regulation.The discovered hormone, ghrelin, may well be the bridge connecting somatic growth with general metabolism.The aim of this study was to test whether Ghrelin could play a part in predisposing to early onset of obesity or be associated with anthropometric data and secretion of leptin , insulin or IGF1 in over weight and obese children , and to compare with control children with normal weight .Design and methods : ELISA method was used to assay Ghrelin , Leptin , IGF1 and Insulin . Blood was taken with drawn sample from 40 obese children, 11 overweight children and 29 normal weight healthy children their age (5 - 11) years .Results : The mean of Ghrelin concentration was significantly lower in obese and overweight children than in controls ( P < 0.000 ) . The mean of IGF1 concentration was significantly higher in obese and overweight children than in controls ( P < 0.000 ) . The mean of insulin concentration was significantly higher in obese and overweight children than in controls ( P < 0.007 ) . The mean of Leptin concentration was significantly higher in obese and overweight children than in controls ( P < 0.000 ) . Negative correlation between Ghrelin and BMI , Leptin , Insulin in pre pubertal children while positive correlation between Ghrelin and IGF1 in obese children . Conclusion : The changes in Ghrelin over childhood do not suggest that it is a direct growth - promoting hormone, but its secondary effects on the IGF axis could contribute to growth acceleration over puberty.

Author name: افيل نديم كاظم

Supervisor name: خضير جاسم صبيح الرواق

General topic: Medicine

Specific topic: Diagnostic Radiology

Degree: Higher Diploma

University: University of Baghdad - Faculty Of Medicine

Language: English

University location: Baghdad

First pages:

دراسة معدل انتشار التدرن الكامن في سجن اصلاح الكبار في محافظة بابل == Prevalence of Latent Tuberculosis in Hilla Male Prison

Author name: مرتضى نجاح جواد

Supervisor name: قاسم محمد سلطان

General topic: Medicine

Specific topic: Diseases - Thoracic

Degree: Higher Diploma

University: University of Baghdad - Faculty Of Medicine

Language: English

University location: Baghdad

First pages:

Abstract: Background : Tuberculosis (TB) is one of the oldest diseases known toaffect humans, it caused by infection with Mycobacterium Tuberculosis(M.TB). M.TB is most commonly transmitted from a patient withinfectious pulmonary TB to other person by droplet nuclei .prisoners areexposed to a variety of infections, including TB. the standard test fordetecting Latent TB infection (LTBI) is tuberculin skin test (TST).Objectives : determination the prevalence of latent tuberculosis amongAL - Hilla male prisoners .and Assessing its correlations with various riskfactors.Methods : A stratified random sampling technique was used to select asample of 120 male prisoners aged >20years old from the AL - Hillaprison. The selected inmates were interviewed using a structured pretestedquestionnaire,5 units of PPD(0.1mL) had been injectedintradermally to the volar surface of forearm to be seen within 48 - 72hours. The test was considered positive if ( >=10mm induration)developed.Results : The study shows the rate of tuberculin reactivity amongprisoners is 23.3% (28/120). A significant relationship between age ofprisoner, mean area of accommodation per prisoner in the prison and TSTpositivity. The overall mean age of prisoners was (34.43± 12.70) yearsold and (47.5%) of the prisoners was aged between 20 - 30 years. Majority(77.5%) of the prisoners were living in urban area. (57.5%) of theprisoners were married. The alliterated prisoners were(53.3%). selfemployedprisoners were(61.7%). (53.3%) of prisoners had monthlyincome between 500 000 - 1 Million IQD. (39.2%) of prisoners spent oneyear of their prison period .The prevalence of smokers were(76.7%) andVIIonly (14.2%) of prisoners had contact with TB patients, meanwhile,(6.7%) of prisoners had contact with TB patients in prisons. Theprisoners had BCG vaccine signs were (74.2%).the prisoners who did notshare their house holding were (57.5%). The overall mean prisoners BMIwas (22.21± 3.19) kg/m2. The mean space of each cell in prison was(120.67± 85.38) m2, meanwhile the mean prisoners per each cell was(43.07± 17.72).So space of each prisoner approximately is : 2.8 m2 .Conclusion : significant relationship between age, area of accommodationfor each prisoner inside cell and positivity of TST.

تقييم كهروتشخيصي لمرضى اعتلال جذور الاعصاب العنقية == ELECTRODIAGNOSTIC ASSESSMENT IN PATIENTS WITH CERVICAL RADICULOPATHY

Author name: زينه سليم فخري

Supervisor name: نجيب محمد | احسان محمد

General topic: Medicine

Specific topic: Physiology

Degree: Doctorate

University: University of Baghdad - Faculty Of Medicine

Language: English

University location: Baghdad

First pages:

Abstract: Cervical radiculopathy can be defined as pain in a radicular pattern in one or both upper extremities related to compression and/or irritation of one or more cervical nerve roots. In the electrodiagnostic laboratory, various types of electrodiagnostic studies may be considered when evaluating a patient for cervical radiculopathy. Potential tests including (needle electromyography, motor and sensory nerve conduction studies, late responses, and somatosensory evoked potentials) serves to confirm the presence of radiculopathy, establish the involved nerve root level, determine if axon loss or conduction block is present, grade the severity of the process, estimate the age of the radiculopathy and exclude other peripheral nerve diseases that mimic radiculopathy.The aim of this study was to approve the usefulness of the electrodiagnostic studies (NCS, EMG and SSEP) in the diagnosis of cervical radiculopathy, asses the role and accuracy of the SSEP test (specifically spinal N13 component) in the diagnosis of cervical radiculopathy, identify the extent and distribution of cervical paraspinal muscles denervation in cervical radiculopathy and match the electrodiagnostic results with imaging data in the localization of the root lesion involved.This is case control study had been conducted during the period from April 2016 to October 2017. Ninety five (95) patients with cervical radiculopathy with a mean age of (48.4±11) years and twenty six (26) healthy control subjects with a mean age of (45.2±10.1) years involved in the study. Each subject submitted for medical history, clinical examination and electrophysiological study using Nicolete Viking Quest , EMG, NCS, EP measuring system.XIIFor SNCS, Onset latency, SNAP amplitude and conduction velocity, while for MNCS, distal motor latency, CMAP amplitude and conduction velocity, in addition to the minimal F wave latency (that assess the late response) of median and ulnar nerves are performed.Whereas for right and left sides median nerve SSEP test, the following peak and interpeak latencies (1) N9; (2) N13; (3) N20; (4) N9 - N20; (5) N9 - N13 ; (6) N13 - N20 are measured.Concerning the needle EMG, the following parameters; insertional activity, spontaneous activity and motor units action potential characteristics (duration and phases) of the right and left trapezius, rhomboids major, deltoid, biceps, triceps, extensor indicis and first dorsal interosseous muscles are considered and recorded. In addition to the assessment of the spontaneous activity of the cervical paraspinal muscles.The results of this study revealed that there are significant differences; higher values for the patients when compared with that of control groups regarding Rt and Lt sides N13 peak latency, N9 - N13 and N13 - N20 inter - peak latency. Moreover, the sensitivity of SSEP components in comparison with the MRI (as a gold standard) is the higher for that of spinal N13.From the EMG and MRI findings, C6 and C7 cervical roots are the most roots affected in respect to C5, C8 or C4 roots.Consequently, there are mismatching in the percentages of cervical radiculopathies when diagnosed by the MRI of the cervical spine, needle EMG of the upper limbs muscles and that of the cervical paraspinal muscles, in such a way that Rt C7 radiculopathy 71.6% by cervical spine MRI mismatched with that of upper limbs EMG (66.3%) and 5.3% by the cervical paraspinal muscles.However, the percentages of each level of cervical radiculopathy proved to be higher by the combination of the EMG abnormaities of the cervical paraspinalXIIImuscles with that of the upper limbs muscles than by using the EMG of the paraspinal muscles or upper limbs muscles in an isolation (for Rt C6 radiculopathy 4.2% by paraspinal muscles EMG, 66.3% by upper limb and 68.4% by combination.Furthermore, the sensitivity of the EMG in cervical radiculopathy (using the MRI as a gold standard) increases by the combination of the abnormalities of the cervical paraspinal muscles with that of the upper limbs muscles, for example the sensitivity of Lt C6 radiculopathies 89.9% by upper limbs EMG, 93.2% by the combination of the EMG of PSM with that of the upper limbs muscles.In conclusion, traditional electrodiagnostic tests (NCS, EMG and SSEP) proved to be useful and complementary to the clinical examination in the evaluation of patients with cervical radiculopathy. The benefit of SSEP test for the evaluation of radiculopathies is based on the fact that signs and symptoms in radiculopathies can usually be related to injury of the afferent fibers and the SSEP test can monitor injury to these fibers.In addition to, spinal N13 is a sensitive technique suitable for detecting early and mild symptomatic cervical nerve root lesion.Moreover, cervical paraspinal muscles EMG is complementary to the upper limbs muscles EMG since that significant percentages of cervical radiculopathy will be missed if the examination of PSM is not part of the electrodiagnostic evaluation of patients with suspected radiculopathy. Furthermore, the sensitivity of the needle EMG is increased by the combination of the EMG of the paraspinal muscles with that of the upper limbs muscles, without paraspinal muscles needle EMG the screen of cervical radiculopathy misses much of its sensitivity. Finally, EMG and MRI are valuable and complementary diagnostic tools in the localization and extent of the cervical roots lesion.

Author name: زياد طارق ملغوث

Supervisor name: قاسم محمد سلطان

General topic: Medicine

Specific topic: Diseases - Thoracic

Degree: Higher Diploma

University: University of Baghdad - Faculty Of Medicine

Language: English

University location: Baghdad

First pages:

الاستكشاف السريع للاسترواح الصدري بواسطة جهاز السونار في المريض المتعدد الاصابات == Rapid detection of pneumothorax by Ultrasonography in patient with multiple traumas

Author name: فاضل خليفة موسى

Supervisor name: قصي عبد فهد

General topic: Medicine

Specific topic: Diagnostic Radiology

Degree: Master

University: University of Baghdad - Faculty Of Medicine

Language: English

University location: Baghdad

First pages:

Abstract: الغرض من الدراسة هو لمعرفة قابلية طبيب الاشعة لاستكشاف الاسترواح الصدري في مرضى الاصابات المتعددة والطارئة في شعبة الطوارئ في جهاز السونار ومقارنة النتائج مع نتائج المفراس. تم البحث خلال فترة عشرة اشهر وتم اجراء فحص السونار الى 37 مصاب على شكل 30 (81%) منهم رجال و7(19%) نساء وباعمار تتراواح مابين 30 - 50 سنة. واظهرت النتائج انه يمكن فحص المرضى ذوات الاصابات المتعددة بجهاز سونار الطوارئ ومعرفة وجود الاسترواح الصدري حيث اظهرت النتائج ان دقة الكشف تتناسب مع كمية الهواء الموجود داخل غشاء الجنب. حيث كلمزاادت الكمية زادت قابلية الكشف وبتناسب طردي. الغرض من هذا البحث هو امكانية الاستغناء عن المفراس لبحلزوني واشعة الصدر في الكشف عن الاسترواح الصدري وخاص في الكميات المتوسطة والكبيرة من الهواء. | Early detection of pneumothorax in multiple trauma patients is critically important. It can be argued that the efficacy of ultrasonography (US) for detection of pneumothorax is enhanced if it is performed and interpreted directly by the clinician in charge of the patients.The aim of this study was to assess the ability of clinician to perform bedside US to detect and assess the size of the pneumothorax in patients with multiple trauma.MethodsOver a 10 month period, patients with multiple traumas treated in the emergency department were enrolled in this prospective study. Bedside US was performed in emergency department.Portable supine chest radiography (CXR) and computed tomography (CT) were obtained within an interval of three hours. Using CT and chest drain as the gold standard, the diagnostic efficacy of US and CXR for the detection of pneumothorax, defined as rapidity and accuracy (sensitivity, specificity, positive predictive value, negative predictive value), were compared. The size of the pneumothorax (small, medium and large) determined by US was also compared to that determined by CT.Results : The study included 37 patients 30 (81%) of them were males and 7 (19%) were females.The average age was 42 ± 11.6 years. All patients presented trauma, including explosives and missiles injuries (37.8%) RTA (24.3%), falls (16.2%), and others (21.6%).Out of the 37 trauma patients, 32 did had pneumothorax according to the gold standard (CT scanning) and five patients did not, according to the ultrasonography findings of those patients, 30 patients did had pneumothorax (true positive) and 2 patients missed by ultrasonography, while 5 patients did not have pneumothorax on CT, ultrasound correctly identify 4 of them as negative (true negative), so the sensitivity and specificity and accuracy of ultrasonography were 93.7%, 80% and 92% respectively.The size of pneumothorax which had been determined by ultrasonography (17) patient had identified as large pneumothorax, (9) patients as moderate and (4) patients as mild, while CT findings were (17,9 and 6) respectively, when a kappa agreement test had been performed, it had been significantly found that US agreement with the CT was directly associated with the size of pneumothorax, US has more agreement, more sensitivity and more specificity in large and moderate pneumothorax rather than mild pneumothorax in trauma patients, P< 0.05.Conclusion My US examination provides a reliable tool and has the advantages of being simple and rapid as compared with CT and CXR and having high sensitivity as compared to CXR for the detection of pneumothorax in patients with multiple trauma.

Author name: سيف عبد الكريم رؤوف

Supervisor name: نزار عبد اللطيف جاسم

General topic: Medicine

Specific topic: Diseases - Joints

Degree: Higher Diploma

University: University of Baghdad - Faculty Of Medicine

Language: English

University location: Baghdad

First pages:

Abstract: الخلفية : تشمع الصلب هو مرض التهابي جهازي مزمن يؤثر بشكل اساسي على الهيكل العظمي المحوري، على الرغم من ذلك فان المفاصل الطرفية وانسجة الارتكاز والانسجة خارج المفصل قد تتاثر ايضا بالمرض مثل العيون والقلب والرئتين. يرتبط ارتفاع المؤشرات الالتهابية ( بروتين سي التفاعلي او معدل ترسيب كريات الدم الحمراء) في المرضى المصابين بتشمع الصلب في بداية اعطاء الادوية المضادة لعامل تنخر الورم مع استجابة سريرية افضل. الهدف من الدراسة : تقييم دور ارتفاع المؤشرات الالتهابية ( بروتين سي التفاعلي او معدل ترسيب كريات الدم الحمراء) في تنبؤ الاستجابة للادوية المضادة لعامل تنخر الورم في المرضى المصابين بتشمع الصلب.المرضى والطرائق : ادخل في الدراسة الاترابية 71 مريضا من المصابين بتشمع الصلب كعدد كلي، كلهم كانوا مطابقين لمعايير نيويورك المعدلة لتشخيص تشمع الصلب ومعايير تصنيف الجمعية الدولية لتقييم التهاب المفاصل الصلبي لغرض تشخيص التهاب المفاصل الصلبي. تم استثناء 19 مريضا من الدراسة نتيجة انقطاعهم عن استخدام الادوية المضادة لعامل تنخر الورم واستمر 52 مريضا بالدراسة وتمت متابعتهم لمدة ثلاثة اشهر . تم جمع البيانات الديموغرافية ، مدة المرض ، نوع العلاج ، مؤشر نشاط مرض التشمع الصلب والمؤشر الوظيفي لمرض تشمع الصلب من المرضى. وتم ايضا فحصهم مختبريا لبروتين سي التفاعلي، معدل ترسيب كريات الدم الحمراء ، كريات الدم البيضاء ، الهيموغلوبين وعدد الصفائح الدموية.النتائج : كان متوسط عمر المرضى 35.2 ± 9.6 سنوات ، شكل الذكور 84.6% منهم وكان متوسط مدة المرض 5 (3 - 10) سنوات. اظهر التحليل احادي المتغير بان المتنبئات للاستجابة للادوية المضادة لعامل تنخر الورم شملت الارتفاع الاساسي لبروتين سي التفاعلي ، معدل ترسيب كريات الدم الحمراء ، مؤشر نشاط مرض التشمع الصلب والمؤشر الوظيفي لمرض تشمع الصلب. اظهر التحليل متعدد المتغير بان المتنبئ المستقل الوحيد للاستجابة للادوية المضادة لعامل تنخر الورم هو الارتفاع الاساسي لبروتين سي التفاعلي. كانت نقطة القطع المثلى لبروتين سي للاستجابة للادوية المضادة لعامل تنخر الورم اكثر من 7.5 ملغم/ لتر بحساسية 94.29% ونوعية 88.24%, بينما لمعدل ترسيب كريات الدم الحمراء كانت اكثر من 32 ملم/ ساعة بحساسية 74.29% ونوعية 94.12%. كان هنالك نزول واضح في مؤشر نشاط مرض التشمع الصلب والمؤشر الوظيفي لمرض تشمع الصلب بعد ثلاثة اشهر من العلاج (لكلا العلاجين ايتانرسيبت وانفلكسماب). لم تتنبا المتغيرات الاخرى التي تم دراستها والتي تشمل البيانات الديموغرافية، مدة المرض، الهيموغلوبين، كريات الدم البيضاء، الصفائح الدموية، نوع العلاج، وجود التهاب المفاصل الطرفية، التهاب انسجة الارتكاز او التهاب القزحية بالاستجابة.الاستنتاجات : يتنبا الارتفاع الاساسي للمؤشرات الالتهابية ( بروتين سي التفاعلي او معدل ترسيب كريات الدم الحمراء) باستجابة افضل للادوية المضادة لعامل تنخر الورم في المرضى المصابين بتشمع الصلب. بروتين سي التفاعلي لديه تنبؤ افضل للاستجابة للادوية المضادة لعامل تنخر الورم من معدل ترسيب كريات الدم الحمراء | Background : Ankylosing spondylitis is a chronic systemic inflammatory disorder mainly affecting the axial skeleton, although peripheral joints, entheses and extra - articular tissues may also be involved such as eyes, heart and lungs. Raised inflammatory markers (C - reactive protein or erythrocyte sedimentation rate) in patients with AS at the start of anti - tumor necrosis factor therapy associated with more clinical response.Aim of the study : To assess the role of raised inflammatory markers (C - reactive protein and erythrocyte sedimentation rate) in predicting response to anti - tumor necrosis factor drugs in patients with ankylosing spondylitis.Patients and methods : A prospective cohort study enrolled a total of 71 patients with AS, all of them were fulfilling the modified New York criteria for Ankylosing Spondylitis and Assessment of Spondyloarthritis International Society classification criteria for diagnosing spondyloarthropathy. Nineteen patients were excluded from the study due to discontinuation of anti - TNF therapy and 52 patients continued in the study and were followed for three months. Demographic data, disease duration, type of treatment, Bath Ankylosing Spondylitis Disease Activity Index and Bath Ankylosing Spondylitis Functional Index were collected from the patients. They were also investigated for C - reactive protein, erythrocyte sedimentation rate, white blood cell, hemoglobin and platelet count. Results : The mean age of the patients was 35.2±9.6 years, males constitute 84.6% of them and the median disease duration was 5 (3 - 10) years. Univarite analysis showed that the predictors of response to anti - TNF were raised baseline C - reactive protein, erythrocyte sedimentation rate, Bath Ankylosing Spondylitis Disease Activity Index and Bath Ankylosing Spondylitis Functional Index. Multivariate analysis showed that the only independent predictor for response to anti - tumor drugs was raised baseline C - reactive protein. The optimal cut point for C - reactive protein to predict response was >7.5 mg/l with a sensitivity 94.29% and specificity 88.24% , while for erythrocyte sedimentation rate was > 32 mm/hour with a sensitivity 74.29% and specificity 94.12%. For both drugs (etanercept and infliximab) there was significant reduction in Bath Ankylosing Spondylitis Disease Activity Index and Bath Ankylosing Spondylitis Functional Index after 3 months of therapy. Other variables which were studied including demographic data, disease duration, hemoglobin, white blood cell, platelet, type of treatment, presence of peripheral arthritis, enthesitis or uveitis did not predict response.Conclusions : Raised inflammatory markers (C - reactive protein and erythrocyte sedimentation rate) at baseline predict better response to anti - tumor necrosis factor drugs in Ankylosing Spondylitis patients. C - reactive protein had better prediction of response to anti - tumor necrosis factor dugs than erythrocyte sedimentation rate.