ABSTRACT
Introducción: Si bien la biopsia intestinal es la técnica-patrón para el diagnóstico de la Enfermedad Celíaca (EC), los ensayos serológicos son un importante complemento en el screening, diagnóstico y seguimiento de la misma. Estos son anticuerpos anti-Transglutaminasa IgA (aTgt), anticuerpos anti-endomisio IgA (EMA) y anticuerpos anti-péptidos de gliadina-deaminados IgG (a-DGP). Nuestros objetivos fueron evaluar la exactitud diagnóstica de a-DGP en pacientes adultos con diagnóstico de EC que concurrieron al Hospital Córdoba y comparar la concordancia de a-DGP con aTgt y EMA. Materiales y métodos: Se realizó un estudio experimental en el Hospital Córdoba. Se analizaron sueros conservados a - 20° C, de 54 pacientes (Marzo de 2015 a Diciembre 2017) sometidos a biopsia intestinal. Las muestras de tejido permitieron determinar los siguientes grupos:´ Grupo Enfermedad Celíaca (GEC): 25 pacientes con biopsia positiva para EC, de acuerdo a la clasificación de Marsh. Grupo Control (GC): 29 pacientes con biopsia negativa para EC. Se determinaron niveles de: a-DGP y aTgt por ELISA comercial, EMA por Inmunofluorescencia indirecta e Ig A sérica por inmunoturbidimetría. Análisis estadísticos de los datos: Se utilizaron los programas estadísticos "InfoStat" y "MedCalc" 10.2.0.0. La concordancia se determinó por el índice kappa (κ). Un valor de p <0,05 fue considerado estadísticamente significativo. Resultados: El valor de corte para a-DGP fue de 15,4 U/ml. La exactitud diagnostica para el título de corte fue de 94,44%. El valor de corte para aTgt fue de 9,3 U/ml. La exactitud diagnostica fue de 92,59 %. La concordancia entre a-DGP y aTgt fue sustancial (κ= 0.740) y casi perfecto entre a-DGP y EMA (κ=0,851). Conclusiones: El ELISA para a-DGP demostró una elevada exactitud diagnóstica. Se observó una mejor concordancia de a-DGP con EMA que con aTgt. Los resultados obtenidos confirman el potencial clínico de este marcador serológico como complemento diagnóstico de EC.
Introduction: Although intestinal biopsy is the standard technique for the diagnosis of Celiac Disease (CD), serological tests are an important complement in the screening, diagnosis and follow-up of the same. These are antibodies IgA to transglutaminase antibodies (aTgt), Ig A antibodies to endomysium (EMA) and antibodies to deamidated gliadin peptides (a-DGP). Our objectives were to evaluate the diagnostic accuracy of a-DGP in adult patients with a diagnosis of CD who attended the Córdoba Hospital and compare the concordance of a-DGP with aTgt and EMA. Materials and methods: An experimental study was carried out at the Hospital Córdoba. Serums conserved at -20 ° C were analyzed, from 54 patients (March 2015 to December 2017) submitted to intestinal biopsy. The tissue samples allowed to determine the following groups: Celiac Disease Group (GEC): 25 patients with a positive biopsy for CD, according to the Marsh classification. Control Group (GC): 29 patients with negative biopsy for CD. Levels of: a-DGP and aTgt were determined by commercial ELISA, EMA by indirect Immunofluorescence and serum IgA by immunoturbidimetry. Statistical analysis of the data: Statistical programs "InfoStat" and "MedCalc" 10.2.0.0 were used. The concordance was determined by the kappa index (κ). A value of p <0.05 was considered statistically significant. Results: The cut-off value for a-DGP was 15.4 U / ml. The diagnostic accuracy for the cutoff title was 94.44%. The cut-off value for aTgt was 9.3 U / ml. The diagnostic accuracy was 92.59%. The agreement between a-DGP and aTgt was substantial (κ = 0.740) and almost perfect between a-DGP and EMA (κ = 0.851). Conclusions: The ELISA for a-DGP demonstrated a high diagnostic accuracy. A better concordance of a-DGP with EMA was observed than with aTgt. The results obtained confirm the clinical potential of this serological marker as a diagnostic complement of CD.
ABSTRACT
We report a case in which a 21-week pregnant woman was stung by a Euscorpius flavicaudis (De Geer, 1778) scorpion. Symptoms and signs experienced by the patient were the same as those documented in the literature and with no ill-effects for the pregnancy. Envenoming was local and of low degree of intensity. It is important to emphasize that the patient was stung in her home, which differs from stings in most other parts of the world, in which scorpionism is mostly a risk in outdoor areas.(AU)
Subject(s)
Scorpions , Signs and Symptoms , Pregnant Women , Scorpion StingsABSTRACT
In the period between June 2008 and August 2009, three cases of stings of Euscorpius scorpions indigenous to Italy were treated at two different emergency departments (ED) in hospitals of the Piedmont region, northwest Italy: Santa Croce e Carle General Hospital in Cuneo, and Santissima Annunziata Hospital in Savigliano. Scorpion stings in Italy are rare and not well documented in the literature; this situation may raise doubts among medical personnel as to how such lesions are best treated. Analysis of the incidents confirms that the venom of Euscorpius do not provokes systemic poisoning in humans and in these cases even dermatological reactions were not significant.(AU)