Anti-endomysial and anti-tissue transglutaminase serological test compared with small bowel biopsy in the diagnosis of celiac disease

Celiac is an autoimmune disease that is characterized by an immune-system-related damage in the intestinal tissue after consumption of gluten. There is not any general agreement for gold standard. The Purpose of this study was the evaluation of specificity and sensitivity of anti-endomysial [EMA] and anti-tissue transglutaminase [TTG] Serological test compared to small-bowel biopsy. In the cross sectional study, we took blood specimen from 1825 patients with gastrointestinal disease. All the samples were tested by TTG and EMA kits using ELISA. The patients were studied in two groups. First, the individuals whom their serologic test was positive but their tissue condition was normal and second, those with positive serologic test with pathologic tissue results that show they have celiac disorder. The mean of EMA and TTG shows that the level of antibodies in group 2 is significantly higher than that of the first group [P <0.001]. There is positive correlation between modified marsh criteria of small-bowel biopsy and the two tests. The Sensitivity of EMA and TTG tests for celiac diagnosis is 92%. The specificity of EMA, TTG tests are 100% and 98.5%, respectively. EMA-IgA serology with cut-off point of more than 66 together with TTG-IgA serology with cut-off point of above 30 can be helpful to distinguish a wide range of patients who need small-bowel biopsy

[Differentiated dendritic cell with TGFbeta in reaction with TCD4+]

Dendritic cells are professional antigen presenting cells that obtain necessary regulatory signals for T cells. T regulatory cells are effective cells in reaction with dendritic cells and have an important role in treating of diseases. To evaluate the effect of TGF-beta [Transforming Growth Factor beta] Cytokine in dendritic cell generation and capacity of these cells in regulatory T cells development in culture media. In this experimental study blood samples were obtained from 5 volunteers then peripheral blood mononuclear cells were isolated by using Phicole Hypaque dendritic cells of peripheral blood monocyte were produced by GM-CSF IL-4 and TGF-beta in comparison with control group. Mixed leukocyte reaction was accesed in allogenic T cell and dendritic cell. The number of CD4+CD25+ T cells CD14+ and their surface markers were evaluated by Flowcytometry. In this study dendritic cells produced in presence and without presence of TGF-beta cytokine. The proliferation level of T cells decreased in mixed leukocyte reaction with dendritic cell-treated TGF-beta in comparison with control group. In addition the number of T CD25+ cells increased 27 percent in culture media including dendritic cell-treated TGF-beta in comparison with control group[p and amp;lt;0.05]. The TGF-Beta molecule caused effect on the dendritic cells and producted cells with inhibiting of immune responses in mixed leukocyte reaction. So it concluded that these cells can have an important role in preventing of unwanted immune reaction invitro

Gastroenterology and hepatology training in the Islamic Republic of Iran

Training in internal medicine has significantly evolved alongside the development of science, technology and new facilities during the past fifty years. After the specially of internal medicine, there are multiple subspecialty training programs which have started since 1985 in the Islamic Republic of Iran. In this manuscript we want to define the characteristics of the gastroenterology subspecialty training program in our country. The characteristics of approved gastroenterology training centers were gathered through a questionnaire. The questionnaire was consisted; the establishment date, the number and academic rank of trainers, the number of trainees, hospital beds, the number and types of diagnostic and therapeutic procedures in a year, the characteristics of training programs and their curriculum composition. The collected data was discussed and revised in a focused group of gastroenterologists from training centers and the board members of Iranian Association of Gastroenterology and Hepatology [IAGH]. There are 11 training centers with 94 trainers and 65 trainees, with a ratio of trainers to trainees of 1.36. Fifty four percent of trainers are assistant professor. Yearly, 36 new fellows are admitted. Four centers have adequate facilities for training in advanced gastroenterology, and in three centers there are facilities for liver transplantation. The duration of training in internal medicine is four years, whereas in gastroenterology it is two years. The admission for this subspecially is not university based and with other subspecialty programs, there is a national entrance examination. There are adequate well known training centers with a suitable ratio of trainer to trainee in the Islamic Republic of Iran. The duration of the GI fellowship is short and implementation of post subspecialty programs for completing the required capabilities of fellows is necessary. The capacity of fellowship admission should be revised according to needs of the country in the fields of health maintenance, research and medical education programs

primary diffuse large B-cell lymphoma of appendix

Primary appendiceal lymphomas are exceedingly rare neoplasms mostly ignored until histological examination of appendices. We report a case of primary appendiceal lymphomas in a 22-year-old man. Appendectomy was performed under diagnosis of acute appendicitis. Macroscopically a fleshy intramural mass in middle third portion of appendix was observed. Microscopic examination revealed a diffuse large B-cell lymphoma inducing acute appendicitis. Further medical workups of the patient was unremarkable and the disease was restricted to appendix. After initial simple appendectomy, the patient underwent adjuvant chemotherapy and was healthy after two years. This case emphasized great value of detailed histological examination of all appendices