ABSTRACT
Background@#Celiac disease is frequently associated with uncontrolled blood sugar and impaired linear growth in a child with type 1 diabetes mellitus. @*Objective@#To study the impact of a gluten-free diet on several growth parameters in children with type 1 diabetes mellitus and celiac disease. @*Methodology@#Two hundred and fifty six patients with Type 1 diabetes mellitus were screened (149 males and 107 females) during the study period of two years. Patients were evaluated for the clinical signs, biochemical investigations and family history of celiac disease in a tertiary care health centre in Western Uttar Pradesh, India. @*Results@#Twenty four (9.3%) patients were diagnosed to have celiac disease; the mean age at diagnosis of diabetes was 9.37±7 years. Only one out of twenty four patients with celiac disease had been diagnosed before the detection of diabetes mellitus. Weight standard deviation score (SDS) increased from -0.12±1.3 at the start of gluten free diet to 0.8±0.9 after 12 months (p<0.004). Height SDS decreased from -2.46±1.1 at the start of gluten free diet to -2.14±0.9 after 12 months later (p=0.087). Bone age SDS increased from 9.2±6.3 at the start of gluten free diet to 10.3±6.7 after 12 months later. Height velocity increased from 4.7±0.7 cm/year in the year before treatment to 5.1+1.2 cm/year during treatment (p=0.05). The increase in Haemoglobin, serum calcium, and serum iron was statistically significant (p<0.05). @*Conclusion@#Patients with celiac disease associated with type 1 diabetes mellitus frequently have poor glycemic control and impairment in several growth parameters. When these patients are put on a gluten restricted diet, they show signs of improvement in terms of weight gain, height, serum Ca, serum iron, haemoglobin, and in height velocity.
Subject(s)
Diabetes Mellitus, Type 1ABSTRACT
Background@#Celiac disease is frequently associated with type 1 diabetes mellitus, but is usually ill-defined and not usually suspected until the disease becomes advanced. @*Objective@#To study the prevalence and clinical profile of celiac disease among patients with type 1 diabetes mellitus in a tertiary care referral centre in north India. @*Methodology@#Two hundred and fifty six patients were screened (149 males and 107 females) during the study period of two years, patients were evaluated for the clinical signs, biochemical investigations and family history of celiac disease in tertiary care health center in western Uttar Pradesh. @*Results@#Twenty four (9.37%) patients were diagnosed to have celiac disease; the mean age at diagnosis of diabetes was 9.34 ± 7.3 years. Only 1/24 patients with celiac disease had been diagnosed before detection of diabetes mellitus. The common manifestations were normocytic normochromic anemia (66.6%) followed by diarrhoea (62.5%), abdominal pain/bloating sensation (58.3%) and short stature (58.3%). Some uncommon manifestations were also observed in small number of patients: rickets (20.8%), recurrent hypoglycemia (16.6%), carpopedal spasm (8.3%), and night blindness (8.3%). @*Conclusion@#Celiac disease was found in about 10% of patients with type 1 diabetes, almost 10-20 times higher than that observed in general pediatric population. Atypical manifestations (rickets, recurrent hypoglycemia, carpopedal spasm and night blindness) were found to be common in patients with type 1 diabetes as compared to the general population. Unexplained anemia, diarrhoea, short stature and rickets should raise suspicion for the possibility of undiagnosed celiac disease in type 1 diabetes mellitus.
Subject(s)
Diabetes Mellitus, Type 1 , AnemiaABSTRACT
To compare hemodynamic stability, efficacy and extubation time by using fentanyl / isoflurane versus nalbuphine / Isoflurane for coronary artery bypass surgery. Intervention experimental study. The Department of Anesthesiology and Surgical Intensive Care Unit, Dow Medical College and Civil Hospital, Karachi from April 2003 to April 2004. Sixty patients, both sexes, with ejection fraction not less than 40%, elective coronary artery bypass surgery were randomly allocated to receive either fentanyl / isoflurane or albuphine. Hemodynamic stability, drugs supplemented and extubation time were recorded. During intubation, skin incision and sternotomy systolic blood pressure was 126, 47 +/- 7.45, 127.97 +/- 7.58 and 127.03 +/- 7. 10 in group A fentanyl/isoflurane] and 167.60 +/- 14.41, 169.50 +/- 12.99 and 165.83 +/- 11.79 in group B nalbuphine/isoflurane] respectively with [p < 0.05] which is significant. To maintain hemodynamic stability in group B, supplementation with propofol and glyceryltrinitrate infusion was required. Extubation time in group A was 8.2113.87, and in group B was 6.15 +/- 3.41 with [p<0.05] which is significant. Fentanyl/isoflurane provides better hemodynamic stability than nalbuphine / isoflurane, but nalbuphme / isoflurane leads to earlier tracheal extubation than fentanyl / isoflurane group