Estado actual del diagnóstico y presentaciones clínicas de enfermedad celíaca: Estudio multicéntrico / Diagnosis and clinical presentations of celiac disease: A multicenter study

Background: Ample use of serological markers of high sensitivity and specificity led to relevant changes in the epidemiology of celiac disease. The impact of these changes in our country is poorly known. Aim: To assess the diagnostic procedures, clinical presentations and follow up of celiac disease as conducted in current pediatric practice. Material and methods: A multicentric retrospective study of patients diagnosed between 2000 and 2005 in five pediatric hospitals in Santiago, Chile. Data was obtained from clinical records, recorded in electronic spreadsheets and analyzed by descriptive statistics. Results: Seventy four of 83 identified patients fulfilled the inclusion criteria and were analyzed. Mean time to reach the diagnosis was 2.1 years. Cases younger than 10 years presented digestive manifestations such as chronic diarrhea and abdominal distension. Twenty one percent of older patients had atypical presentations (mainly short stature, refractory anaemia). Ten percent of cases were screened because a first degree relative had celiac disease. All patients had significant duodenal/jejunal lesion. IgA-antiendomysial antibodies (n =65) and IgA-antigliadin antibodies (n =23) were the most commonly used screening tests used but often, they were not available for follow up. A second biopsy was planned in all patients but only 26 had it due to repeated dietary transgressions, often due to unnoticed consumption of gluten in poorly labeled products. Conclusions: Digestive manifestations were the main presentation form for celiac disease among patients under 10 years of age. Atypical symptoms become relevant in patients older than 10 years. Antiendomysial and antitransglutaminase antibody measurement should be incorporated for routine screening and follow up of celiac disease in public hospitals. To improve food labeling about their gluten content is needed.

Raising rheumatoid factor cutoff helps distinguish rheumatoid arthritis.

The presence of rheumatoid factor (RF) is one of the clinical criteria for the diagnosis of rheumatoid arthritis (RA). The cutoff point of RF assays is usually based on a reference level obtained from normal subjects in the same population as the patients. We evaluated 63 rheumatoid arthritis (RA), 25 other arthritis patients and 110 blood donors. Their rheumatoid factors (RF) ranged from < 9.9 to 2,264, < 9.9 to 262, and < 9.9 to 66 mIU/ml, respectively. The sensitivity at different cutoff points of 15, 20, and 25 mIU/ml was 92.1%, 90.5%, and 88.9%, respectively. The specificity at the same cutoff points was 81.5%, 84.4%, and 85.2%, respectively. Having minimally sacrificed the sensitivity, we recommend using a higher RF cutoff to increase specificity.

Effects of recombinant human erythropoietin pretreatment on anti HLA antibody titer: a preclinical experience in rats

Erythropoietin [EPO] was first known as a factor for red blood cell proliferation and differentiation. New studies show the effects of EPO on immune system. In this study, the effects of pretreatment with recombinant human erythropoietin [rHuEPO] on the anti-human leukocyte antibody [anti-HLA] titer were determined. Three groups of rats were sensitized with human lymphocytes. Two of the groups were given 20 or 100 IU/Kg rHuEPO after two sensitizations with human lymphocytes. Control group did not receive rHuEPO. Microlymphocytotoxicity method was used to detect anti-HLA antibodies. Treatment with rHuEPO caused a significant decline in anti-HLA antibody titer compared to control group. Also, pretreatment with rHuEPO suppressed antibody response after repeated antigenic stimulation. Such results could be due to the effects of rHuEPO on the number or the activity of the B and the T cells. Moreover, the dose of rHuEPO and the length of treatment might affect anti-HLA antibody titer

Immune modulation in polytrans fused Egyptian children with thalassemia

Fifteen children with beta thalassemia major, with no evidence of infection, were evaluated for their interleukin-2 [IL-2] production, complement [C[3]] level, as well as immune complex formation. Eight healthy children served as control subject. The study revealed a significant decrease in IL-2 production and a significant increase in immune complexes formation in thalassemic children. Regarding C[3] level, it shows marked decrease in children with thalassemia when compared to normal one. from the immunological point of view, the present work shows some interesting findings, that poly transfused beta-thalassemic children are presented by certain functional immune deficiency determined by a defect in T cell response, as denoted by reduction in IL-2 level. Decrease in C[3] level is also observed which is the result of the increase in immune complex formation obtained in children with thalassemia