Coeliac autoimmunity in type I diabetes mellitus

Coeliac autoimmunity [CA] has a known association with type 1 diabetes mellitus [T1DM] for which screening is routinely recommended but less frequently followed. The impact of CA in T1DM has been variably reported. The aims of this study are as follows: [1] to study the prevalence of CA in patients with T1DM and [2] to study the impact of CA not only on nutritional parameters but also on glycaemic control, endocrine axes and bone health. Patients and Eighty-six consecutive patients with T1DM were screened for CA using immunoglobulin A [IgA] tissue transglutaminase as a marker [TTG; IgG anti-gliadin in IgA-deficient case]. CA positive [CA+] cases were compared with age-matched and sex-matched CA negative [CA-] T1DM cases for anthropometry, glycaemic control [assessed by glycated haemoglobin [HbA1c] and hypoglycaemic/ hyperglycaemic episodes], endocrine [thyroid function, cortisol, growth hormone [GH] axis, gonadal axes], haematological [haemoglobin, iron profile and vitamin B12 status] and calcium metabolism parameters and bone densitometry [by dual-energy X-ray absorptiometry [DXA]]. Consenting patients with CA also underwent upper gastrointestinal [GI] endoscopy with duodenal biopsy. Out of 86 patients, 11 [12.75%] screened positive for CA [seven patients underwent duodenal biopsies which were suggestive of Marsh grade III[2], II[3] and I[2] disease]. The CA+ T1DM patients were comparable with CA- T1DM in terms of anthropometry. CA+ patients had higher HbA1c [10.7 +/- 1.8 vs. 8.4 +/- 1.0 [93 +/- 19 vs. 68 +/- 11 mmol/mol]; p < 0.01], more hypoglycaemic episodes [five vs. two; p < 0.05], higher prevalence of iron and vitamin B12 deficiency, lower insulin-like growth factor-1 [IGF- 1] levels and lower bone mineral density [BMD] z-score at total body [-1.91 +/- 1.05 vs. -0.63 +/- 0.73; p < 0.05] and lumbar spine [-1.69 +/- 0.92 vs. 0.36 +/- 0.93; p < 0.05]. The incidence of fractures in the past 3 years was also more in CA+ patients than in CA- patients [four vs. one; p < 0.05]. CA has an important autoimmune association with T1DM. The concomitant presence of CA adversely affects stature, bone health, glycaemic control and iron and B[12] levels in T1DM. IgA sufficiency should be ensured before using an IgA-based screening test for CA

Trividha Snehapaka of Panchagavya Ghrita: A critical comparative evaluation.

Backgorund: The three stages of Snehapaka formulations namely Mridu, Madhyama and Khara Paka have been characteristically advocated for different routes of administration—Nasya, Pana/Basti and Abhyanga, respectively. Guidelines or established method for post-formulation characterization for the same is hardly available. Objective: The present communication is the comparative study of Mridu, Madhyama and Khara Paka of Panchagavya ghrita (PGG). Materials and Methods: Laboratory prepared samples of PGG following classical method were analyzed for different physicochemical, spectroscopic, chromatographic parameters, and antioxidant activity. Results: No significant difference was found among Mridu, Madhyama and Khara Paka in physicochemical parameters as well as chromatographic profiles. The ratio of absorbance at 240 and 294 nm showed steady increase from Mridu to Madhyama to Khara Paka in the ultraviolet (UV)-visible spectra of unsaponifiable matter. The high performance thin layer chromatography (HPTLC)-2,2 Diphenyl-1-picryl hydrazil (DPPH) bioautography assay revealed presence of two antioxidant compounds in low concentration in all the samples. This was further supported by estimation of total reducing power and DPPH assay. No significant difference was found among the three samples. Conclusion: Comparison of various physicochemical parameters, chromatographic profiles, and in vitro antioxidant activity determination is of little help in establishing any significant difference among the samples. However, spectrophotometric analysis of unsaponifiable matter reveals some encouraging characteristic findings which will be useful in establishing difference among the three stages of processing of PGG as well as Snehapaka in general.

Jejunal Leiomyoma Presenting as Intussuception

Tumors of the small intestine are rare. Even though the small bowel accounts for 80% of the length and 90% of the mucosal surface of the gastrointestinal tract, only 3% to 6% of gastrointestinal tumors and 1% of gastrointestinal malignancies arise from the small bowel. Leiomyoma, adenoma, lipoma, haemangioma, fibroma and hamartoma of the small intestine are considered to be benign neoplasm. Most small bowel tumors are incidental findings at operation or autopsy. Here we present a case of benign tumour of the small intestine, histologically diagnosed as leiomyoma, presented in Surgery Emergency Ward with intestinal obstruction, treated conservatively with no improvement and hence subjected to emergency exploratory laparotomy which revealed intusussception and leading cause of which was a benign leiomyoma. The literature is revised emphasizing issues of pathophysiology, specific characteristics and the treatment of this tumour.

Cysticercosis Breast - A Rare Entity

It is unusual for cysticercosis to occur in the substance of the breast. Diagnosis is usually made incidentally. Only few cases are described in the literature. We here report a case of cysticercosis perched on fibroadenoma of breast found on surgical excision in a 16-year-old unmarried female patient. The patient had no discernible evidence of cysticercosis in the other organs. Surgical excision was performed and histological examination demonstrated the presence of cysticercus cellulosae larvae. Characteristic features of this uncommon location are discussed based on a review of the literature. Thus the possibility of cysticercosis of the breast should be kept in mind while considering the differential diagnosis for a breast lump.

Ellis Van Creveld syndrome.

Ellis Van Creveld syndrome is a rare disorder and is a form of short-limbed dwarfism. It is an autosomal recessive disorder characterized by tetrad of disproportionate dwarfism, post-axial polydactyly, ectodermal dysplasia and heart defects. This case report presents a classical case of a seven-year-old boy with Ellis Van Creveld syndrome presented with discrete clinical findings.