Pericardial effusion in celiac disease

Celiac disease is an autoimmune disorder that affected 1% of all population in United State. Classic manifestations of disease consist of early childhood diarrhea, malabsorption, steatorrhea and growth retardation but disease can affects adult at any age. In adult anemia is a more frequent finding. This patient was a 40-year-old lady with progressive fatigue and lower extremities pitting edema. Iron deficiency anemia and celiac disease were diagnosed on the basis of low serum ferritin, elevated serum level of IgA endomysial and tissue transglutaminase anti-bodies and histologic findings in small bowel biopsies. Pericardial effusion in her evaluation was detected incidentally. Asymptomatic pericardial effusion in this patient was only detectable with imaging. After starting of gluten free diet and iron supplement fatigue, peripheral edema and pericardial effusion on echocardiography decreased. It should be noted that asymptomatic pericardial effusion may be seen in adults with celiac disease

Vitiligo and autoantibodies of celiac disease

Vitiligo is an acquired, idiopathic disorder characterized by circumscribed depigmented macules and patches. The exact etiology and pathogenesis of vitiligo is not clear. Many theories have been presented regarding this subject among them aautoimmune theory is the most important one. The association of vitiligo with other autoimmune disorders has been reported, but the relationship between vitiligo and celiac disease is controversial. The aim of this study was to study the frequency of celiac autoantibodies in a group of vitiligo patients compared with control. This was a cross sectional case control study that involved 128 individuals, 64 vitiligo patients and 64 individuals as control group. The means age of participants was 30.3 +/- 14.4 years. IgA anti Endomysial antibody and IgA anti-glutaminase antibody were measured by ELISA method in the serum of all participants. Data were analyzed by SPSS software version 15. The serum of two vitiligo patients [3.1%] was positive for antibodies. All control groups were seronegative for these antibodies [P < 0.05]. There was nosignificant effect of sex and job on seropositivity. There may be a relationship between celiac disease and vitiligo. This may indicate a common basic autoimmune mechanism that is an explanation for few case reports that gluten free diets were effective in the treatment of vitiligo patients. Both T test and exact fisher test showed no effect of age, sex and job anseropositivity of these patients [p=0.56 and p=0.74, respectively]

study of the relationship between myocardial performance index and left ventricular end-diastolic pressure in patients with left ventricular systolic dysfunction

Doppler echocardiography is used to evaluate global myocardial performance. An index of myocardial performance [Tei Index] can be of great prognostic value in heart failure. This study was performed to assess the correlation between Tei Index [TI] and left ventricular end diastolic pressure [LVEDP]. The study group consisted of 38 patients. Each patient underwent ventriculographic evaluation [all had EF<%45]. Eighteen patients had LVEDP< 15 [14 males, 4 females, 57 +/- 6 years old] and 20 subjects [15 males, 5 females, 56 +/- 7 years old] had LVEDP>15. Using Doppler echocardiography. TI was determined for all patients and compared. Mean TI value was significantly different between subjects with LVEDP<15 and those with LVEDP > 15 [0.55 +/- 0.18 vs. 0.76 +/- 1 0.19, P<0.001, T 4.1]. In patients with systolic heart failure [EF <% 45], Tei was significantly lower in subjects with LVEDP<15 compared to those with LVEDP>15. Thus, Tei may be useful for noninvasive assessment of LVEDP in heart failure