Platelet count, mean platelet volume and aggregation as markers of disease activity in rheumatoid arthritis

Rheumatoid arthritis [RA] is a chronic inflammatory disorder that affects small joints of hands and feet. Different forms of hematological disorders are associated with RA as anemia, neutropenia, thrombocytosis, thrombocytopenia, eosinophilia, and hematological malignancies. To correlate the value of mean platelet volume [MPV], platelet count and platelet hyperactivity with Disease Activity Score [DAS 28 score] and their reflection on cardiovascular system in RA. 50 newly diagnosed RA patients were attending the Clinical Rheumatology Unit during the year 2012 with twenty five control helthy subjects randomly selected. For all, CBC, including platelet count, MPV, platelet aggregation using ADP, echocardiography in addition to ECG, ESR, and CRP were done. MPV, Platelet count, CRP and ESR were, significantly higher in RA patients than controls, while Platelet aggregation, hemoglobin level, mean diastolic function and ejection fraction[EF] were significantly lower in RA patients than control group. Significant positive correlations were detected between DAS 28 score and both MPV and platelet count, while significant negative correlations were found with both hemoglobin and EF. Significant increase of the platelet aggregation in sero-negative compared to sero-positive rheumatoid arthritis patients was detected. Platelet count and MPV are inexpensive tests, may be useful for a rapid assessment of disease activity in patients with RA

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

[Listeria monocytogenes meningitis in immunocompetent children. [a case report]]

Introduction: Listeria monocytogenes is, increasingly, recognised as a cause of life-threatening disease mainly in immunocompromised persons, but it is an uncommon cause of bacterial meningitis beyond the newborn period in healthy subjects

Report: We present the case of a 10-year-old previously healthy child who was admitted at a general pediatric unit for high fever, impaired consciousness and intra cranial hypertension syndrome. Cerebrospinal fluid examination revealed 980 cells/mm3 in mixed formula [neutrophils = 50 per cent, lymphocytes = 50 per cent], decreased glycorrachia [1.5 mmol/l], increased albuminorrachia [2g/l] and normal chlorurachia. Gram's stain was negative. initial parenteral antibiotics combining cefotaxime and vancomycin didn't lead to clinical improvement. In fact, after 48 hours, the temperature was usually high and the patient remained obnubilated and, also, developed bilateral convergent strabismus. The second cerebrospinal fluid sample showed lymphocytic meningitis [125 cells/mm3, neutrophils = 5 per cent, lymphocytes = 95 per cent], decreased glycorrachia [0.5 mmol/l], increased albuminorrachia [1.2 g/l], normal chlorurachia and negative soluble antigens. Gram's stain showed Gram positive bacilli. Subsequent culture yielded Listeria monocytogenes. The patient was so treated with parenteral ampicillin for fifteen days and showed uneventful recovery. No immunocompromised conditions were identified in this patient

Discussion: In its most severe form, listeriosis is an invasive disease that affects not only immunocompromised but also immunocompetent persons in whom the neuromeningeal form is the most frequent

Conclusion: L. monocytogenes should be considered among the aetiologies of bacterial meningitis in children who do not respond initially to conventional antimicrobial treatment or who deteriorate rapidly even if they are immunocompetent and non-neonates

Significance of vascular endothelial growth factor in chronic liver disease and hepatoceliular carcinoma

Vascular endothelial growth factor [VEGF] is the most potent directly acting angiogenic growth factor that plays an important role in inducing tumor-associated angiogenesis. The aim of this study was to evaluate the clinical significance of the circulating VEGF in hepatocelluar carcinoma [HCC] and chronic liver disease [CLD]. The study included 13 with chronic viral hepatitis [CVH], 14 with liver cirrhosis [LC] and 13 with HCC, in addition to 15 age and gender- matched healthy subjects as controls. For each studied subject, detection of hepatitis viral markers, and assessment of liver function tests, alpha-fetoprotein [AFP] and VEGF were performed. Results of the study showed a highly significant [p < 0.001] increase of VEGF in sera of HCC patients as compared to other groups. VEGF serum level was significantly [p < 0.01] associated with portal vein thrombosis, however, it was not significantly associated with tumor size. There was no significant difference between the serum level of VEGF among either LC or CVH group compared to the controls. Moreover, no significant difference was detected between different Child-Pugh classes among LC patients. Furthermore, no correlation was found between serum level of VEGF and AFP, serum albumin, aminotransferases or prothrombin time among the studied groups. In conclusion, serum VEGF can be used as a tumor marker for diagnosis of HCC and as a prognostic marker for tumor invasion