ABSTRACT
Introduction: Cardiovascular disease is one of the leadingcauses of death among adult celiacs. Increased risk isattributed to unfavourable cholesterol profile. Studies on lipidprofile among celiacs have shown variable results. Effectof gluten free diet (GFD) on cardiovascular risk profile isfurther controversial. Knowledge among children can help inrisk stratification and timely modification of diet if needed.Current study objective was to record the lipid profile amongchildren with celiac and the impact of six months of glutenfree diet on it.Material and methods: In this single arm pre and postinterventional study, newly diagnosed symptomatic children1-14 years with Tissue Transglutaminase (tTG) IgA antibodypositive and biopsy proven (Marsh 3) celiac were enrolled.Sample size of 31 was calculated as per TC and HDL referencelevels. Fasting Lipid profile was evaluated at baseline and atsix months of GFD. Children with diabetes, hypothyroidism,nephrotic syndrome, congenital hyperlipidaemia and on drugscausing hyperlipidaemia were excluded. The data analysis wasdone using Statistical software R and Stata 15.0. Quantitativevariables were compared using Paired T test/Wilcoxon test.Qualitative variables were correlated using Chi-Square test/Fisher’s exact test.Results: Median age of children was 8 years (5-10 years).Median age at onset of symptoms was 6 (3.15 -8.75) yearsand median duration of illness prior to diagnosis was 12 (7.5-24) months. 83.87% presented with typical GI symptoms.Mean Total cholesterol (TC) was 131.8±39.7 mg/dl, meanHDL cholesterol was 41.2±12.6 mg/dl, mean Triglycerideswas 92.0±35.5mg/dl and mean LDL was 75 ± 32.3 mg/dl atdiagnosis. Average increase in HDL after GFD was 13 (4.9 to21.3) mg/dl. TC/HDL ratio was decreased significantly afterGFD {-0.5 (-0.9 to -0.03)}.Conclusion: Children with celiac have a normal lipid profile.GFD for six months increases HDL-C plasma concentrationand lowers TC/HDL ratios.
ABSTRACT
Upper gastrointestinal bleed (UGIB) is an unusual but potentially life-threatening emergency in children. Irrational use of medicines is one of most common cause. We, herein report a case of a three-month-old male child who presented with massive hematemesis and melena, probably due to the use of multiple antibiotics and analgesic use. On upper gastrointestinal endoscopy, multiple diffuse gastric and duodenal ulcers were detected. He was treated with proton pump inhibitors (PPI) and recovered completely within seven days.
ABSTRACT
Caroli’s disease and Caroli’s syndrome are rare congenital disorders. Caroli’s disease is characterized by multiple sequential cystic or saccular dilatations of the large intrahepatic biliary ducts while Caroli’s syndrome has small bile duct involvement and congenital hepatic fibrosis. The incidence of Caroli’s disease is as low as 1/1,000,000 people. The average age of presentation is early adolescence. Magnetic resonance cholangiopancreatography is a most valuable investigation in diagnosis. Here, we report the case of Caroli’s Type II without renal involvement as late as 6 years of age with severe portal hypertension and hypersplenism. The child had no history of jaundice or recurrent abdominal pain in the past.
ABSTRACT
Bluish discoloration of the skin and mucous membrane is known as cyanosis which is a clinical sign that occurs in many diseases. The causes of central cyanosis are cardiac shunts causing mixing of oxygenated and deoxygenated blood, lung diseases with ventilation-perfusion mismatch, polycythemia, and methemoglobinemia. Methemoglobin is the oxidized form of hemoglobin, which does not bind oxygen and increases the affinity of oxygen for the partially oxidized portion of hemoglobin. Methemoglobinemia may be congenital or acquired (usually drug induced). Congenital methemoglobinemia is a very rarely reported disease that is caused by a deficiency of nicotinamide adenine dinucleotide phosphate-cytochrome b5 reductase enzyme deficiency or by an abnormal hemoglobin called hemoglobin H. Acquired methemoglobinemia is caused by drugs, namely the sulfonamide group and local anesthetics such as benzocaine and prilocaine. Here, we present the case of a 4-year-old girl who presented with complaints of bluishness of the fingers and lips without any other associated symptoms and later on diagnosed as congenital methemoglobinemia.