ABSTRACT
Gluten sensitive enteropathy [celiac disease [CD]] has a strong association with diabetes mellitus [type 1DM]. Since, 2-3% of CD patients have selective IgA deficiency, the majority of the available tests may fail to show the auto-antibodies [the IgA endomysial antibody [EMA]. To prevent such a false negativity, a new Enzyme Linked Immune Sorbent Assay [ELISA] test has been introduced to detect both IgG and IgA antibodies reactive with tissue transglutaminase [tTG], an autoantigen in CD patients. This study has been conducted to detect celiac disease among Sudanese patients with type 1 autoimmune diabetes using anti-tissue transglutinamase antibodies as a diagnostic tool. Samples were collected from sixty nine randomly selected patients [38 males and 31 females] and their age ranged between 3-22 years with DM type 1 who were attending the outpatient clinics in Gabir Abu Eliz diabetic Center and Omdurman Pediatric Emergency Hospital. Blood samples were collected from 25 healthy individuals as controls. Levels of tTG specific IgA, tTG specific IgG and anti-endomysial antibodies of IgA class were measured in sera collected from both cases and from controls. All the results were analyzed using Statistical Packages of Social Sciences [SPSS] version 17 and MicroSoft office excel. Seven out of 69 patients with DM type 1 [10.1%] were identified as having CD using IgG anti-tTG and 5 [7.2%] of them were positive for IgA anti-tTG and IgA anti-endomysial antibodies. The mean of both anti-tTG IgA and IgG titers were higher in diabetic patients [M +/- SD = 12.30 +/- 41.0 and 7.2 +/- 13.1 respectively] when compared with the control group [M +/- SD =1.8 +/- 1.1 and 1.8 +/- 0.9 respectively], however, only anti-tTG IgG antibodies titer achieved statistical significance. The present study revealed that patients with DM type I have an increased tendency to develop CD. The increased association of CD and selective IgA deficiency is a potential source of false-negative IgA, therefore testing for IgG class autoantibodies is recommended if celiac disease is suspected. Antibodies to tTG antigen fall once a gluten-free diet has begun, thus facilitating monitoring of dietary compliance. Thus, anti-tTG antibodies are highly sensitive marker for celiac disease with 95- 100% sensitivty, and specificity of 90 to 97%
ABSTRACT
Asthmatic patients may perceive their symptoms inadequately putting them at a risk of a fatal attack because the severity of an exacerbation may be underestimated. The present study is intended to detect if disease duration affects the perception of asthma symptoms. The relation between asthma activity and evaluation methods commonly used in clinical practice, like presence of symptoms and asthma control test [ACT], was evaluated. The study involved 100 asthma patients with ages less than 40 years. Presence of symptoms, ACT score and spirometry were recorded to assess asthma activity at the time of examination. Cross tabulation of patients groups was used to screen for significant differences in the means using analysis of variance. ACT score was higher while National Asthma Education and Prevention Program [NAEPP] class was lower in symptoms free compared with symptomatic asthmatic patients [P = 0.000 and 0.005 respectively]. ACT score correlated negatively, while NAEPP correlated positively with age implying that asthma severity increases with age [CC = 0.41, P = 0.000 and CC = 0.28, P = 0.007]. Asthma duration was significantly higher in well controlled compared with both poorly controlled and uncontrolled asthmatic patients [P = 0.000 for both]. 5.7% of asymptomatic patients were suffering from severe persistent asthma and 24.5% from moderate persistent asthma according to NAEPP classification. Presence or absences of symptoms sometimes does not indicate asthma severity. Clinicians must therefore pay attention when comparing groups of asthma patients for whom severity categorization is largely based on symptomatology