Association of Celiac Disease With Idiopathic Pulmonary Hemosiderosis; Lane Hamilton Syndrome

Introduction: Idiopathic Pulmonary Hemosiderosis (IPH) is a rare cause of alveolar hemorrhage, which is seen primarily in childhood. Celiac disease is defined as a chronic, immune-mediated enteropathy of the small intestine, caused by exposure to dietary gluten in genetically pre-disposed individuals. Association of IPH and celiac disease is known as Lane Hamilton syndrome. There are limited number of case reports of this syndrome in literature. Case Presentation: Although there were no growth and developmental delay and gastrointestinal symptoms like chronic diarrhea, chronic constipation, vomiting, abdominal bloating and pain in the two patients with IPH, they were diagnosed with Lane Hamilton Syndrome. After initiation of gluten-free diet, their IPH symptoms disappeared and hemoglobin levels were observed to return to normal. Conclusions: Even if there were no gastrointestinal symptoms in a patient with IPH, celiac disease should be investigated. These patients may benefit from gluten free diet and IPH symptoms may disappear.

Evaluation of the Correlation Between tTG-IgA Titer and Duodenal Biopsy Findings in Children With Suspected Celiac Disease

Background: Celiac disease is an immune-mediated inflammation of the small intestine caused by sensitivity to dietary gluten in genetically sensitive individuals. Objectives: In this study, we aimed to evaluate the predictive value of tissue transglutaminase (tTG) antibodies for the diagnosis of celiac disease in a pediatric population in order to determine if duodenal biopsy can be avoided. Patients and Methods: The subjects were selected among individuals with probable celiac disease, referring to a gastrointestinal clinic. After physical examinations and performing tissue transglutaminase-immunoglobulin A (tTG-IgA) tests, upper endoscopy was performed if serological titer was higher than 18 IU/mL. Therapy started according to pathologic results. Results: The sample size was calculated to be 121 subjects (69 female and 52 male subjects); the average age of subjects was 8.4 years. A significant association was found between serological titer and pathologic results; in other words, subjects with high serological titer had more positive pathologic results for celiac disease, compared to others (P < 0.001). Maximum sensitivity (65%) and specificity (65.4%) were achieved at a serological titer of 81.95 IU/ml; the calculated accuracy was lower in comparison with other studies. As the results indicated, lower antibody titer was observed in patients with failure to gain weight and higher antibody titer was reported in diabetic patients. Conclusions: As the results indicated, a single serological test (tTg-IgA test) was not sufficient for avoiding intestinal biopsy.

The Prevalence of Diabetes and Prediabetes Among Elementary School Children in Birjand

Background: Diabetes is associated with increased cardiovascular disease, mortality and morbidity. Objectives: The present study aimed at assessing fasting blood sugar (FBS) in elementary school students in Birjand, 2012. Materials and Methods: This cross-sectional and descriptive study was done on 1530 elementary school students who had been selected through multiple cluster sampling. FBS of these students was tested applying the enzymatic process. The obtained data was analyzed by means of SPSS software (v15) and statistical tests t and X2. Results: In this study, 833 girls and 697 boys were evaluated. Mean FBS of the whole study population was 86.9 ± 8.8 mg/dL; FBS was higher in boys compared to girls. FBS of 1453 (95%) children was < 100 mg/dL, the mean being 85.8 ± 6.8 mg/dL. FBS of 698 (45.6%) students of the above population was 86-99 mg/dl. It was 100-125 mg/dL in 72 (4.7%) individuals. Five (0.3%) students had FBS >126 mg/dL. Mean FBS increased in proportion to age, which was statistically significant. Conclusions: Although the prevalence of diabetes is not considerable; however, based on the relatively high portion of those children with high degree of blood glucose in the range in which the risk of diabetes and prediabetes in the following years rises dramatically, the need for further care of health authorities, an extensive screening activity, and undertaking intervening measures to prevent the epidemic of diabetes and consequently cardiovascular disease is emphasized.

Prevalence of diabetic retinopathy in type II diabetic patients in a health facility in Karachi, Pakistan

Purpose: To study the prevalence of diabetic retinopathy in known diabetic patients attending the diabetes outpatient department (OPD) of Sind Government Hospital (SGH), New Karachi Township (NKT), Pakistan. Methods: A cross-sectional observational study was carried out at the diabetic OPD of SGH, NKT over the period of 17 months from March 2013 to August 2014. The selected patients were interviewed based on a questionnaire; laboratory investigations were performed and examination of the eye was conducted by a specialist ophthalmologist. One hundred and fifty four (154) subjects out of 305 patients contacted fully completed the study. Stratification of the data on gender basis was done, after which one-way ANOVA, χ2 test of correlation, binary logistic regression and relative risk analyses were carried out using SPSS-20. Results: It was found that 66 % men of normal weight (χ2 = 4.667, p < 0.05) and 60.7 % overweight women (χ2 = 5.143, p < 0.05) were more likely to present with diabetic retinopathy (DR). Prevalence of DR in this target population was 42.86 % (N = 66). Background DR (56 %) and maculopathy (23 %) were more prevalent than advanced conditions of the disease. There was no gender-based preponderance for the presentation of DR (χ2 = 0.663; p > 0.05), nor was this seen in different ethnic groups. Conclusion: DR is prevalent in the target population and, therefore, emphasis should be on the education of the local population of New Karachi Township on how to attain euglycemic state with regular medication, diet and exercise to avoid development and progress of DR.

Prevalence of chronic diseases in private healthcare sector of South Africa: A threat to public health

Purpose: To evaluate the prevalence of patients suffering from registered chronic disease list (CDL) conditions in a section of the South African private health sector from 2008 - 2012. Methods: This study was a retrospective analysis of the medicine claims database of a nationally (South African) representative Pharmacy Benefit Management (PBM) company data between 2008 and 2012. Statistical analysis was used to analyse the data. Descriptive analysis was performed to calculate the prevalence of CDL conditions for the entire population, and stratified by age and gender. However, MIXED linear modelling was used to determine changes in the average number of CDL conditions per patient, adjusted for age and gender from 2008 - 2012. Results: An increase of 0.20 in chronic diseases was observed from 2008 - 2012 in patients having any CDL condition, with an average of 1.57 (1.57 - 1.58, 95 % CI) co-morbid CDL conditions in 2008 and 1.77 (1.77 - 1.78, 95 % CI) in 2012. This increase in average number of CDL conditions per patient between 2008 and 2012 was statistically significant (p < 0.05), but with no large practical significance (d < 0.8). Conclusion: Prevalence of patients with CDL conditions along with risk of co-morbidity has been increasing with time in the private health sector of South Africa. Risk of increased co-morbidity with age and among different genders was prevalent.