Comparison of Endoscopic and Histological Findings between Typical and Atypical Celiac Disease in Children / 대한소아소화기영양학회지

PURPOSE: Celiac disease is a common non-communicable disease with varied presentations. Purpose of this study was to find the duodeno-endoscopic features in celiac disease and to compare duodeno-endoscopic and histological findings between typical and atypical celiac disease in children. METHODS: Hospital based observational study was conducted at Sir Padampat Mother and Child Health Institute, Jaipur from June 2015 to May 2016. Patients were selected and divided in two groups- typical and atypical celiac disease based upon the presenting symptoms. Upper gastrointestinal endoscopy and duodenal biopsy was performed for serology positive patients. Results were analysed using appropriate statistical test of significance. RESULTS: Out of 101 enrolled patients, 47.5% were male. Age ranged from 1 to 18 years. Study showed that 54.5% were typical and 45.5% were atypical. Patients presenting with atypical symptoms were predominantly of older age group. On endoscopy, scalloping, mosaic pattern, reduced fold height and absent fold height; and in histology, advanced Marsh stage were significantly higher in the typical group. CONCLUSION: Awareness of atypical presentations as well as duodeno-endoscopic features may have considerable practical importance for the diagnosis of celiac disease in children. Scalloping, mosaic pattern, reduced fold height and nodularity are main endoscopic markers of celiac disease in children. Endoscopic markers of duodenal mucosa may be important in early diagnosis of celiac disease, in children subjected to endoscopy for atypical presentations or indication other than suspected celiac disease.

Visual fields at presentation and after trans-sphenoidal resection of pituitary adenomas

To evaluate visual field changes in patients with pituitary adenomas following trans-sphenoidal surgery. Eighteen patients with pituitary adenomas underwent a complete ophthalmic assessment and visual field analysis using the Humphrey Field Analyzer 30-2 program before and after trans-sphenoidal surgical resection at the Himalayan Institute of Medical Sciences over a one year period. Visual acuity, duration of symptoms, optic nerve head changes, pattern of visual field defects, and variables such as mean deviation and visual field index were compared. Thirty-six eyes of 18 patients including 10 male and 8 female subjects with mean age of 35.1 +/- 9.9 years and histologically proven pituitary adenoma were included. Mean visual acuity at presentation was 0.29 logMAR which improved to 0.21 logMAR postoperatively [P = 0.305]. Of 36 eyes, 24 [66.7%] had visual field defects including temporal defects in 12 eyes [33.3%], non-specific defects in 10 eyes [27.8%], and peripheral field constriction in 2 eyes [5.6%]. Mean deviation of visual fields at presentation was -14.28 dB which improved to -11.32 dB postoperatively. The visual field index improved from 63.5% to 75% postoperatively. Favorable visual field outcomes were correlated with shorter duration of symptoms and absence of optic nerve head changes at presentation. Visual field defects were present in two thirds of patients at presentation. An overall improvement in vision and visual fields was noted after surgical resection. An inverse correlation was found between the duration of symptoms and postoperative visual field recovery, signifying the importance of early surgical intervention

Compound composite odontoma with unusual number of denticles-a rare entity

Compound odontoma is stated to be a hamartomatous lesion rather than a true odontogenic tumour. It has an unknown etiology and often suspected when there are retained deciduous teeth in children. Early detection and surgical enucleation of the tumour is recommended to prevent impaction of unerupted teeth. In this index case, multiple denticles or rudimentary teeth, numbering 37 were enucleated from the maxillary anterior region of a 17-year old male, which makes this case unusual. Evidence of concrescence, fusion and dilaceration were observed in the denticles enucleated, the size of which varied from 4 mm to 12.5 mm

DNA vaccine mechanistic insight and delivery strategies

DNA vaccines have proved to be potential candidates to be considered as a part of active immunity. These latest generation genetic tools have solved the problems associated with the traditional vaccines. However, there are number of infectious diseases like AIDS, Malaria and Tuberculosis against which no DNA vaccine has been established. This review describes multiple DNA vaccine applications and delivery systems for DNA antigen. Future strategies to improve the efficacy of DNA vaccine like route of administration and novel adjuvants are also discussed