Proprioception is fundamental for accurate movements, balance, and postural control, ensuring stability and orientation in both static and dynamic tasks. Iron deficiency anemia (IDA) may impair proprioceptive acuity, thereby affecting motor control. As physical training is known to improve proprioception in both healthy and clinical populations, combining exercise with iron supplementation may offer additional benefits. This study aimed to explore the effects of 8-week Tabata training based on plyometric exercises combined with iron supplementation on proprioceptive acuity in young women with IDA. This randomized controlled trial included young women with IDA (18–25 years) who were randomly allocated to a Tabata training group (TG; n = 18) or an untrained control group (UTG; n = 20). Both groups received iron supplementation (494.5 mg ferrous sulfate), while the TG additionally completed an eight-week Tabata-based plyometric training program. Hemoglobin (Hb) and serum ferritin levels were assessed, as well as, fatigue, attentional capacity, and proprioceptive acuity were evaluated using the Multidimensional Fatigue Inventory (MFI), an online simple reaction time test, and the weight discrimination test, respectively, at baseline and 72 h after the final intervention session. The results of this study demonstrated significantly higher improvements post intervention in most proprioceptive acuity increments [0.4 kg (P = 0.003), 0.28 kg (P = 0.023). 0.11 kg (P < 0.001)], Hb levels (P = 0.03), as well as in general and physical fatigue (P < 0.001) and reduced motivation (P = 0.003) scores in TG compared to UTG. The findings of this study revealed greater improvements in proprioceptive acuity in the TG compared to the UTG, highlighting the additional benefits of our combined training program compared to iron supplementation therapy alone, particularly on Hb concentrations, general and physical fatigue and motivation scores. This study was registered retrospectively on pan African clinical trials registry (ID: PACTR202507672075403; Date of Registration: 02/07/2025).

This study aimed to determine explanatory mechanisms of postural control disorders in adult women with IDA. Forty adult women with IDA participated in this cross-sectional study. Attentional capacity, muscle performance, fatigue, proprioceptive acuity, and postural control were assessed. Our results revealed that, in general, the center of pressure velocity (CoPv) values were significantly correlated with hemoglobin (Hb) (P < 0.01) and serum ferritin (P < 0.05) concentrations, alterations in attentional capacity (P < 0.05), proprioceptive acuity (P < 0.05), muscle performance (P < 0.05), and fatigue scores (P < 0.05). Furthermore, regression analysis showed that Hb and serum ferritin levels, proprioceptive acuity, muscle performance, and general, physique and mental fatigue were associated with postural disorders in IDA women. This study demonstrated a relationship between postural control in women with IDA and Hb and serum ferritin levels, attentional capacity, proprioceptive acuity, muscle performance, and fatigue scores. Particularly, regression analysis indicated that Hb and serum ferritin concentrations, muscle performance, proprioception, and general, physical, and mental fatigue were associated with postural control in women with IDA.

BackgroundImmune dysfunction and chronic low-grade inflammation contribute substantially to morbidity and cardiovascular risk in patients undergoing hemodialysis (HD). Both exercise-based interventions and melatonin supplementation have demonstrated immunomodulatory and anti-inflammatory potential; however, their combined long-term effects remain unclear. This study investigated whether a 12-week intradialytic concurrent training (ICT) program with melatonin supplementation could improve hematological and immune cell profiles in HD patients.MethodsThirty HD patients were randomly allocated to ICT with melatonin (ICT-MEL), ICT with placebo (ICT-PLA), or control with placebo (C-PLA). ICT groups trained three times per week. During the intervention, participants received either 3 mg of melatonin (ICT-MEL) or placebo (ICT-PLA and C-PLA) nightly before nocturnal sleep. Pre- and post-intervention blood samples were analyzed for hematological parameters, adaptive lymphocyte subsets (CD4+ T cells, CD8+ T cells, and B cells), innate lymphocytes (natural killer [NK] cells), and monocyte subsets.ResultsHematological measures remained stable from pre-to post-intervention across all groups. In contrast, the ICT-MEL intervention induced significant within-group improvements in T-cell immunity, including increases in CD4+ percentage (p = 0.007), CD8+ T-cell count (p < 0.05), and CD8+ percentage (p < 0.001), accompanied by a decrease in the CD4+/CD8+ ratio (p < 0.05). One-way ANOVA of Δ changes confirmed a significantly greater reduction in the CD4+/CD8+ ratio in ICT-MEL compared with both ICT-PLA and C-PLA (p < 0.05), along with greater increases in CD4+ percentage, CD8+ count, and CD8+ percentage. Following the intervention, CD4+ T-cell count was significantly higher in the ICT-PLA group compared with the C-PLA group (p < 0.05). B-cell percentage increased significantly from pre-to post-intervention only in the ICT-PLA group (p = 0.017), with post hoc analyses indicating a greater increase compared with C-PLA (p < 0.05). NK-cell counts and percentages remained unchanged across all groups. Notably, intermediate monocytes (CD14++CD16+) decreased significantly from pre-to post-intervention in the ICT-MEL group in both absolute count (p = 0.02) and percentage (p = 0.017), while classical and non-classical monocyte subsets showed no significant changes.ConclusionICT combined with melatonin supplementation was associated with favorable changes in immune cell populations in patients undergoing HD, including improved T-cell profiles and reduced intermediate monocyte subsets. These findings suggest potentially beneficial immunological adaptations and are consistent with a synergistic effect of exercise and MEL supplementation in this population.

This study aimed to evaluate the in vitro biological activities of the polysaccharide derived from Opuntia stricta (Haw.) Haw. pulp (POS), as well as the wound healing efficacy in diabetic rats. The study involved a comprehensive evaluation of the antioxidant properties, ᾳ-amylase and acetylcholinesterase inhibitory potential, as well as the anti-inflammatory and anti-hemolytic effects of the POS. Additionally, the present work aimed to assess the wound healing efficacy of POS in a diabetic rat model. POS exhibited antioxidant activities, effectively neutralizing total antioxidants, nitric oxide radicals, and protecting DNA from damage. Furthermore, POS showed potent ᾳ-amylase inhibition with an IC50 value of 1968 µg/mL and an acetylcholinesterase inhibition with an IC50 value of 157.33 µg/mL. Moreover, the results demonstrated that POS showed potential anti-inflammatory activity, preserved the integrity of the erythrocyte membrane and inhibited hemolysis. The administration of POS to a diabetic wound model showed a substantial improvement in wound healing and expedited the closure of the wound site after 15 days of induction. Its wound healing effects are attributed to its ability to regulate the balance of inflammatory markers, inhibit oxidative stress parameters, and improve antioxidant enzyme activities. Histopathological examination also revealed reepithelialization and complete epidermal development in the treated wounds. Overall, these results highlight POS as a promising and effective agent for skin wound healing, providing valuable insights for its potential therapeutic application.

This study examines the neuroprotective and antioxidant effects of Urtica dioica ethanolic extract (UDExt) and melatonin (Mel) in mitigating chlorpyrifos (CPF)-induced toxicity in rats, with melatonin serving as a standard antioxidant. Male Wistar rats were divided into six groups: (I) Control, (II) UDExt (200 mg/kg), (III) Mel (20 mg/kg), (IV) CPF (10 mg/kg), (V) UDExt + CPF, and (VI) Mel + CPF. UDExt and Mel were administered for 7 days prior to CPF exposure, followed by a treatment of 14 days. The findings revealed that CPF exposure significantly impaired hematological parameters (WBC, PLT, LYM), increased lipid peroxidation and protein oxidation, and decreased antioxidant enzyme activities (SOD, CAT, GPx) in brain and cerebellar tissues compared to control rats. Behavioral tests, including the open field test, showed that CPF reduced locomotor activity and increased anxiogenic symptoms. The Y-maze test revealed impaired recognition memory, and the tail suspension test indicated increased depressive symptoms. Histological analysis revealed neuronal damage in the brain and cerebellum tissues. Treatment with UDExt or melatonin, following CPF exposure, significantly improved hematological parameters, reduced lipid peroxidation and protein oxidation, normalized antioxidant enzyme activities, and alleviated neurobehavioral alterations. Histopathological analysis also showed that UDExt or melatonin combined with CPF notably reduced neuronal damage in the brain and cerebellum. UDExt and melatonin mitigated the CPF-induced neurobehavioral alterations associated oxidative injury.

This study aims to investigate the effect of 8 weeks of ferrous sulfate supplementation (160 mg elemental iron/day) on fatigue and physical performance in young women with iron deficiency anemia (IDA). In this uncontrolled pilot clinical trial, twenty-three women with IDA aged between 18 and 30 years participated in this study. Aerobic fitness, muscle strength and muscle endurance were performed to evaluate physical capacities. Moreover, the multidimensional fatigue inventory (MFI-20) was used to assess general, physical, and mental fatigue, reduced activity and motivation. Due to multiple comparisons, the level of significance was set at 0.00625. The results of this study revealed that muscle endurance values increased significantly (P < 0.001) after 8 weeks of iron supplementation compared to pre-intervention values. In addition, scores of general (P < 0.001), physical (P < 0.001) and mental (P < 0.001) fatigue, and reduced activity (P < 0.001) and motivation (P = 0.006) decreased significantly in post- intervention compared to pre- intervention. However, there were no improvements in aerobic fitness (P = 0.008) and muscle strength (P = 0.086). In women of reproductive age with IDA, 8 weeks of iron supplementation improve muscle endurance, but not aerobic fitness or muscle strength. These improvements could be explained by the increase in hemoglobin (Hb) (by 17.62%) and serum ferritin (by 63.2%) concentrations and the decrease in fatigue scores after the supplementation period.

Stress is a natural coping mechanism triggered by external factors affecting one's professional or personal environment. However, prolonged or repeated exposure to stress can lead to detrimental physical and psychological consequences. This study aimed to evaluate the effects of chronic stress exposure on serum inflammatory biomarkers, oxidative damage to erythrocytes, and hematological parameters in vivo. Twenty-four adult rats were divided into four groups of six animals each: a control group; PI: rats exposed to permanent illumination (24/7); FW: rats with limited access to daily food and water; and FS: rats subjected to forced swimming stress (4 days/5). After 21 days of exposure, the results revealed significant hematological disturbances, including reduced red blood cell (RBC) counts in the PI and FW groups. Additionally, a notable genotoxic effect was observed in white blood cells, characterized by decreased leukocyte counts, reduced micronuclei frequency, and diminished cell viability. Furthermore, a significant decline in serum inflammatory protein levels was detected. These findings were supported by increased levels of erythrocyte lipid hydroperoxides, hydrogen peroxide, advanced oxidation protein products, protein carbonyls, and malondialdehyde, indicating the impact of stress exposure on blood parameters. These changes were most pronounced in the FS group, which underwent physical stress. Conversely, the antioxidant activities of superoxide dismutase and glutathione peroxidase in erythrocytes were elevated, highlighting the link between stress exposure and disruptions in erythrocyte redox balance. In conclusion, chronic stress exposure disrupts hematological, inflammatory, and oxidative balance, with physical strain exacerbating these effects. The observed changes in blood parameters and antioxidant responses highlight the potential of these biomarkers for early detection of occupational strain, particularly in caregivers. These findings underscore the need for proactive measures to mitigate stress-related health risks in high-stress professions.

Background: The study aimed to assess the antioxidant and wound healing properties of Urtica dioica essential oil (UDEO) through a comprehensive evaluation involving in silico, in vitro, and in vivo analyses. The phytochemistry of UDEO was also investigated to identify trace compounds crucial. Methods: Various injection methods of the multimode inlet (MMI) in chromatography were investigated to attain lower instrumental detection limits. Subsequently, in silico studies were employed to delve deeper into the potential biological activities of the identified compounds. Standard antioxidative tests, encompassing ABTS•+ and TAC, were performed. In vivo tests centered on wound healing were implemented using rat models. The rats were randomly allocated to four groups: saline solution, vaseline vehicle, cytol centella, and 5% UDEO ointment. Wound healing progress was evaluated through a chromatic study. Results: Gas chromatography combined with triple quadrupole mass spectrometry (GC-MS/MS) analysis revealed the presence of 97 thermolabile compounds in UDEO. Subsequent in silico studies unveiled the potential of identified compounds to inhibit COX-2, TNF-α, and IL-6, suggesting a possible enhancement of anti-inflammatory responses and healing processes. In vitro tests elucidated the notable antioxidant capacity of UDEO, a finding reinforced by wound healing data, revealing a substantial closure rate of 89% following the topical application of UDEO. Notably, fibrinogen and C-reactive protein (CRP) levels were significantly reduced, indicating minimized oxidative stress damage compared to control. Additionally, UDEO exhibited an increase in antioxidant enzyme activities compared to control. Conclusion: The study concludes that UDEO possesses significant antioxidant and wound-healing properties, supported by its rich phytochemical composition. The findings suggest its potential application in therapeutic interventions for oxidative stress and inflammatory conditions.

BACKGROUND:Urtica dioica (Urticaceae) has outstanding medicinal and pharmacological properties. This investigation was aimed to assess the chemical composition, the total polyphenol and flavonoid content, antioxidant, anti-proliferative, and anti-inflammatory effects of Urtica dioica essential oil (UDEO). METHODS:GC/MS analysis was performed to assess the chemical composition, standard antioxidative test, the DPPH assay, the reducing power assay, as well as the anti-proliferative capacities of UDEO against HeLa cell lines using the MTT test. In addition, the anti-inflammatory activities of UDEO were evaluated using paw thickness measurements in rats with carrageenan-induced paw edema and pathologic evaluation of inflammation in paw sections. RESULTS:GC/MS analysis revealed benzene dicarboxylic acid (14.69%), β-linalool (9.79%), phytol (9.52%), menthol (6.65%), borneol (6.45%), 3-Eicosene (E) (6.10%), 1-8 cineole (5.60%) and camphor (5.36%) as the major components of UDEO. In vitro results showed that UDEO contained 191 ± 2.04 mg GAE/g of polyphenols and 83.59 ± 4.7 mg CE/g of flavonoids. In addition, the UDEO showed a radical scavenging activity with IC50 = 0.14 ± 0.003 mg/mL and a ferric reducing antioxidant power (FRAP) (optical density = 0.556). A side from the UDEO's antioxidant properties, our findings revealed a reduction in ROS generation in the HeLa cell line. Furthermore, the anti-proliferative activity of UDEO is accompanied by a cytotoxicity effect (IC50 at 3.20 μg ml-1). Data from inflammation models revealed that UDEO has an anti-inflammatory effect. The pretreatment with UDEO or Indomethacin (Ind) reduced significantly the volume of edema induced by Carr, the level of C-reactive protein (CRP), the reactive thiobarbituric acid (TBARS), the conjugated dienes (CD), the carbonyl proteins (CP) and the advanced protein oxidation products (AOPP). Furthermore, it restored the hematology parameters such as white blood cells (WBC), lymphocytes (LYM), and platelets (PLT). In addition, it increased the activities of antioxidant enzymes, including superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx). In UDEO-treated rats, the histopathological examinations of the paws revealed little infiltration of inflammatory cells. CONCLUSION:The decrease in paw edema and human cell lines HeLa cytotoxicity showed that UDEO possesses anti-inflammatory and antioxidant properties, which could be attributed to the high amount of phenolic and flavonoid contents.

Objective: This study aimed to explore the effect of 8-week oral supplementation on postural control in young women with iron deficiency anemia (IDA). Methods: This study involved 15 women with IDA who received 160 mg of elemental iron daily in the form of dried ferrous sulfate capsules (80 mg twice daily) taken in two divided doses for 8 weeks. The mean velocity of oscillations of the center of pressure (CoPv) was recorded to evaluate postural control pre- and post-supplementation. In addition, simple reaction time (SRT) and weight discrimination tests were performed to assess attentional capacity and proprioceptive acuity, respectively. Results: This study revealed significant increases (P < 0.001, mean difference = 1.83, 95% CI: -17.25; -9.42) in proprioceptive acuity values, as well as decreases in CoPv [firm (EO (P < 0.01, mean difference = 0.52, 95% CI: 0.69; 2.92), EC (P < 0.05, mean difference = 0.75, 95% CI: 0.24; 3.45)) and foam (EO (P < 0.001, mean difference = 0.64, 95% CI: 1.71; 4.44) ; EC (P < 0.001, mean difference = 1.04, 95% CI: 3.51; 7.97))] and SRT (P < 0.001, mean difference = 59.31, 95% CI: 103.02; 168.71) values post-supplementation compared to pre-supplementation. Conclusion: This study showed significant improvements in postural control in young women with IDA after 8 weeks of oral iron supplementation. These improvements were probably related to the enhanced bioavailability of iron, which may have influenced neural processes inducing improvements in attention capacity and proprioceptive acuity.

Purposes: Retinal vein occlusion (RVO) is a major cause of vision loss. Its pathogenesis is still not completely understood. Our aim was to describe patients with RVO, to precise risk factors responsible to retinal vasculopathy in our population and to assess the prevalence of thrombophilia disorders patients with RVO, compared to population-based group of age- and sex-matched controls. Patients & methods: Our study was retrospective conducted from 1 January 2013, until 30 June 2019, including 57 patients with RVO compared to 105 controls patient’s age- and sex-matched free of any visual disorders. Among 57 RVO cases, 26 were men and 31 were women. Results: The mean age was 45.0±14.7 years. Among systemic and ocular risk factors for RVO we found hypertension in 12 patients (31.6%), dyslipidemia in four patients (10.5%), diabetes in four patients (10.5%), and smoking in six patients (16.2%). Three patients (9.7%) had glaucoma and two patients (6.5%) had diabetic retinopathy. Ophthalmology examination found unilateral RVO in 52 patients (91.0%) and bilateral RVO in five patients (11.1%). Retinal angiography showed ischemic signs in seven patients (18.4%). Non-ischemic RVO was retained in 31 cases (81.6%). Macular edema was present in 12 patients (38.7%). Six cases (19.4%) developed neovascular glaucoma and two cases (6.5%) presented reversible blindness. Measures of thrombophilia practiced in 57 patients revealed 13 abnormalities (22.8%): Isolated thrombophilia disorder in 11 patients (71.4%) and combined prothrombotic disorder in two others. Conclusions: Among systemic and ocular risk factors for RVO, we found hypertension in 12 patients (31.6%). Thrombophilia disorders were also common.

The purpose of this paper was to investigate the anti-inflammatory and anti-angiogenic activities of sulfated polysaccharide from C. tomentosum (PCT) using carrageenan (CARR)-induced paw edema in a rat model and anti-vasculogenic activity on a chorioallantoic membrane assay (CAM) model. Based on in vitro tests of anti-radical, total antioxidant, and reducing power activities, PCT presents a real interest via its antioxidant activity and ability to scavenge radical species. The in vivo pharmacological tests suggest that PCT possesses anti-inflammatory action by reducing paw edema and leukocyte migration, maintaining the redox equilibrium, and stabilizing the cellular level of several pro-/antioxidant system markers. It could significantly decrease the malondialdehyde levels and increase superoxide dismutase, glutathione peroxidase, and glutathione activities in local paw edema and erythrocytes during the acute inflammatory reaction of CARR. PCT pretreatment was effective against DNA alterations in the blood lymphocytes of inflamed rats and reduced the hematological alteration by restoring blood parameters to normal levels. The anti-angiogenic activity results revealed that CAM neovascularization, defined as the formation of new vessel numbers and branching patterns, was decreased by PCT in a dose-dependent manner, which supported the in silico bioavailability and pharmacokinetic findings. These results indicated the therapeutic effects of polysaccharides from C. tomentosum and their possible use as anti-proliferative molecules based on their antioxidant, anti-inflammatory, and anti-angiogenic activities.

Lancehead snakes of the genus Bothrops are responsible for 90% of the snakebites in Latin America. The objective of this study was to assess the LD50, physical, and hematological manifestations induced by B. atrox venom in male and female mice inoculated by different routes. B. atrox venom was inoculated in male and female mice by intramuscular (IM), subcutaneous (SC), intravenous (IV), and intraperitoneal (IP) routes. B. atrox venom LD50 was lower in male than female groups, regardless of the injection route. However, it was the lowest when the venom was inoculated by the IP route. Moreover, comparisons between male and female responses according to the injected venom dose showed higher edema-forming, local hemorrhagic, dermonecrotic, and myotoxic activities in male than in female mice. While the minimal hemorrhagic, and necrotic doses were not statistically different between the two groups, the difference between males and females was more pronounced at high venom doses. Hematological parameter changes were also more significant in male than in female mice. The venom decreased the levels of total leukocytes after 24 h of injection in male and female mice, with a more profound decrease in the male group. The micronucleus test, a tool for genotoxicity assessment, documented the mutagenic effects of B. atrox on leucocytes. We demonstrate the higher susceptibility of male mice to B. atrox venom than females. Sex differences must be considered when conducting experimental studies on snake venoms.

Objective: To examine the effects of self-paced combined high-intensity interval training and resistance training (HIIT-RT) on oxidative stress, inflammation lipid profile and body composition in people with multiple sclerosis (PwMS). Methods: Twenty-three PwMS were randomly assigned to either a control group (CG, n = 12) or a training group (TG, n = 11). The TG performed a 12-week self-paced HIIT-RT (3 times/week). Biomarkers of oxidative stress, inflammation, lipid profile and cellular damage as well as body composition were assessed pre- and post- intervention. Results: Comparatively with CG, the TG showed a decrease in advanced oxidation protein products (p = 0.002, Hedges'g (g) = 1.50) and total thiols (p = 0.0011, g = 1.57), as well as an increase in reduced glutathione (p = 0.03, g = 0.98). Neutrophils (p = 0.003, g = 1.38), lymphocytes (p = 0.038, g = 0.92) and low-density lipoprotein cholesterol (p < 0.001, g = 2.14) decreased in TG compared with CG. There was also a decrease in body weight (p = 0.003, g = 1.39), body mass index (p = 0.002, g = 1.45) and fat mass (p = 0.006, g = 1.27) in TG comparatively with CG. Conclusion: This study revealed the effectiviness of self-paced HIIT-RT in alleviating oxidative stress, inflammatory responses and hyperlipidaemia, as well as in improving body composition in PwMS. This combined training may be recommended to better counteract the damage related to multiple sclerosis.

INTRODUCTION:Ischemic Stroke in young adults is a real public health problem; it's a major cause of disability, alters quality of life and has a great socio-economic impact. AIM:determine risk factors and specify the etiology of arterial ischemic stroke in young Tunisian adults. METHODS:In this 5 years retrospective study (2015-2020), we included all young adults (18-50 years) admitted for arterial ischemic stroke (AIS). Risk factors were registered and analyzed. All patients were investigated using a standard protocol: biological tests, brain imaging, carotid ultrasound and cardiac assessment. Additional investigations were carried out at the discretion of the treating physician. The cause of ischemic stroke was classified according to the TOAST criteria. RESULTS:We collected 200 patients with AIS. The mean age was 41.37 years ± 6.99. Traditional vascular risk factors were observed in more than 1⁄4 patients. A definite cause of stroke was identified in 120 patients. Cardio-embolic causes were the most common among our patients (19%) followed by atherosclerosis of the large arteries (11.5%). Other determined etiologies were found in 27.5% of patients. The etiology remained unclear in 40% of cases: undetermined despite complete investigation in 17.5%, undetermined and incompletely investigated 14.5 % and more than one potential pathomechanisms in 8%. CONCLUSION:Through this study, we demonstrated the diversity of etiology of stroke in young Tunisian adults. Changes of lifestyle are responsible for the occurrence of the traditional risk factors at an early age. Rheumatic heart diseases remain a frequent cause of AIS in our area.

Topic: 33. Bleeding disorders (congenital and acquired) Background: Von Willebrand disease (VWD) is defined as a defective or dysfunctional Von Willebrand Factor (VWF) that mediates platelet adhesion and aggregation at vascular damage sites. A minority of patients, particularly with type 3 VWD, develops alloantibodies to exogenous VWF whose arising complications are challenging. These antibodies make replacement VWF therapy ineffective and even dangerous by producing anaphylactic reactions. Aims: Our study aims to evaluate the clinico-biological, therapeutic and evolutionary characteristics of VWD patients with alloantibodies. Methods: Our study is retrospective, it concerned patients with VWD who developed alloantibodies. Data were recorded from VWD registry which includes patients with VWD in south of Tunisia during 23 years (from January 2000 to December 2022). Anti-VWF and anti-FVIII testing were performed in case of ineffective substitution or when an allergic reaction was occurred during substitution. The screening and the titration of inhibitors were performed by the modified Bethesda method using the coagulation analyzer Sysmex® CS-2100i in the anti-VWF testing and the STA-R® Stago automate in the anti-FVIII testing. Results: During the study period, we collected 89 cases of VWD, 44 cases had type 3. Six patients had alloimmunization: 1 had anti-VWF, 2 had non neutralisant antibodies and 3 had both anti-VWF and anti-FVIII. Thus, anti-VWF was found in 14% of patients with type 3 VWD. Median age at diagnosis of alloimmunization was 30 years [4 years - 47 years] with a female predominance (sex ratio M/F= 0.2). Circumstance of the discovery of alloimmunization were persistent hemorrhagic symptoms despite adequate substitution in 4 cases, a preoperative evaluation in 1 case and an anaphylactic reaction secondary to VWF concentrate administration in 1 case. Our patients were on replacement therapy with cryoprecipitate or VWF/FVIII plasma concentrates (Immunate®). The first patient had a hemarthrosis of the elbow resistant to substitution. Anti-VWF antibodies tested positive with a titre of 5.8 Bethesda units (BU). Recovery test of infused VWF/VLFIII plasma concentrates was carried out with a total absence of recovery for VWF. She was treated with by-passing agent combined with immunosuppressor, which allowed an inhibitor level decrease to 0 UB and a reintroduction of immunate without incident. The 2nd and 3rd patients had a non-neutralizing anti-VWF discovered during an episode of gingivorrhagia resistant to substitution for one of them and during a preoperative evaluation for the other. The anti-VWF and anti-FVIII antibodies’ screening were negative. However, an anti-VWF, considered non-neutralizing, was determined since there were a total absence of recovery for VWF. They were treated with by-passing agent (Novoseven®) combined with corticosteroid therapy with good resolution of the bleeding episode. The last 3 patients had both anti-VWF and anti-FVIII antibodies. They were revealed during an allergic reaction to the replacement therapy in 1 case and a severe bleeding syndrome resistant to substitution in 2 cases. They were treated with by-passing agent combined with immunosuppressor with good clinical resolution. Summary/Conclusion: Alloimunization in VWD is more frequently reported in our patients (14% versus 5-10% in published series). Several types of antibodies were documented. In our knowledge, the coexistence of anti-VWF and anti-FVIII is extremely rare and isn’t yet reported. In this challenging situations, by-passing agents such as Novoseven®, recombinant FVIII and immunosupressive therapy may be useful. Keywords: Bleeding disorder, von Willebrand factor (vWF), Antibody, von Willebrand’s disease

Proprioception is essential to several conscious and unconscious sensations and automatic control of movement in daily life activities. Iron deficiency anemia (IDA) may alter proprioception as it could induce fatigue, and affect neural processes such as myelination, and neurotransmitters synthesis and degradation. This study aimed to explore the effect of IDA on proprioception in adult women. Thirty adult women with IDA and 30 controls participated in this study. The weight discrimination test was performed to assess proprioceptive acuity. Attentional capacity and fatigue were evaluated, too. Women with IDA had a significantly (P < 0.001) lower ability to discriminate weights compared to controls in the two difficult increments, and for the second easy weight (P < 0.01). For the heaviest weight, no significant difference was found. Attentional capacity and fatigue values were significantly (P < 0.001) higher in patients with IDA compared to controls. Moreover, moderate positive correlations between the representative proprioceptive acuity values and Hb (r = 0.68) and ferritin (r = 0.69) concentrations were found. Moderate negative correlations were found between the proprioceptive acuity values and general (r = − 0.52), physical (r = − 0.65) and mental (r = − 0.46) fatigue scores, and attentional capacity (r = − 0.52). Women with IDA had impaired proprioception compared to their healthy peers. This impairment may be related to neurological deficits due to the disruption of iron bioavailability in IDA. In addition, fatigue resulting from IDA due to the poor muscle oxygenation could also explain the proprioceptive acuity decrease in women suffering from IDA.