Early detection of factor VIII inhibitors in hemophilia a patients with different treatment modalities

Hemophilia care in underdeveloped and developing countries is extremely inadequate and in some instances, completely absent. Persons with hemophilia battle the complications of both the disease and its treatment. One of the most serious of these problems is the development of the inhibitors. The development of the inhibitors influences their quality of life. This work was designed to: 1- elucidate the inhibitors status 2-to study the relation of factor VIII inhibitors and modes of therapy and duration of treatment 3- to clarify the cause of bleeding, is it related to insufficient treatment or development of inhibitors 4- to study the effect of the severity of hemophilia in the frequency of factor VIII inhibitors and their correlation with factor VIII level. The study included 63 hemophilic patients under different treatment modalities and were classified to four groups according to the types of treatment; they were group [I] included [7] patients with no previous anti hemophilic treatment and were considered as a control group, group [II] included [12] patients who were on treatment with fresh frozen plasma, group [III] consists of [16] patients who were under treatment with cryoprecipitate and group [IV] was [28] patients who were under treatment with concentrated factor VIII.To all groups of patients complete blood count, prothrombin time and prothrombin concentration, activated partial thromboplastin time, factor IX, von willebrand factor, factor VIII levels and factor VIII inhibitor levels were performed. Development of inhibitors was obvious in severe hemophilic patients especially in those who were receiving on demand factor VIII concentrate therapy

Serum vascular endothelial growth factor in rheumatoid arthritis: a relationship to disease activity and pathogenesis

This study aims to determine the serum level of vascular endothelial growth factor [VEGF] in rheumatoid arthritis [RA] patients and to search for a relationship between serum VEGF level and clinical, laboratory, and radiological variables of the disease in an attempt to provide more insight regarding its role in disease activity and pathogenesis. 75 RA patients, diagnosed according to the American College of Rheumatology [ACR] criteria and 20 control subjects were included in this study. RA patients were divided into active group [38 patients] and non-active group [37 patients] as assessed clinically by using modified disease activity score [DAS-28] and laboratory by using erythrocyte sedimentation rate [ESR] and C-reactive protein [CRP]. All patients included in this study were subjected to full history taking, thorough clinical examination and laboratory investigations including ESR, CRP, complete blood picture, rheumatoid factor, and serum VEGF assay using ELISA technique. Assessment of radiological severity by Larsen's score was done by using plain X-ray for both hands and wrists joints. We found that serum VEGF level was higher in RA patients group than control subjects and in the active group than non-active one. In RA patients, the serum level of VEGF was positively correlated to DAS-28, ESR and CRP. Also, the levels of serum VEGF were higher in patients with early grades of Larsen's score than those with late grades. Also, RA patients with early disease duration [<2 years] had higher serum VEGF levels than those of late disease duration [>3 years]. We suggest that VEGF may be involved in the pathogenesis of RA, and serum VEGF is a non-invasive useful method for monitoring the disease activity of RA, although this is not a specific marker for RA. Anti-VEGF strategies should largely be confined to modulating angiogenesis in RA