Evaluation of peripheral arterial disease in prediabetes

The prevalence of prediabetes in the world continues to increase. These patients have elevated the risk of atherosclerosis. The current study was designed to assess the prevalence of peripheral arterial disease [PAD] and its related risk factors in prediabetes patients. This was the case-control study in which 135 adults in three groups: Diabetes, prediabetes, and normal were studied. We evaluated the prevalence of PAD through the measurement of ankle-brachial index [ABI]. All the patients were interviewed about demographic and medical data, including age, sex, disease duration, body mass index, hypertension [HTN], fasting blood glucose, hemoglobin A1C [HbA1C], lipid profile, and medication use. The prevalence of PAD in diabetes patients was higher than the normal group [8.5%vs. 0.0%] [P < 0.05], but the differences between prediabetes compared with diabetes and normal group were not significant. The mean level of ABI in normal, prediabetes, and diabetes group was [1.11 +/- 0.11], [1.09 +/- 0.12], and [1.05 +/- 0.03] respectively [P < 0.1]. There were marginally significant differences of ABI observed between the normal group and the diabetes group. The observed differences between groups in the ABI were significant after adjusting the effects of age and sex [P < 0.05]. There was an association observed between ABI and HbAlC in diabetes patients [r= 0.249, P < 0.01] and a significant association seen between PAD and HTN in the prediabetes group [P < 0.01]. Peripheral arterial disease is common in asymptomatic diabetes and prediabetes patients. Management of hypertensive prediabetes patients and early detection of PAD in this group as well as in asymptomatic patients is important

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