Coeliac disease.

Coeliac disease is an autoimmune disorder of the small bowel that occurs in genetically predisposed people of all ages from middle infancy. Most common period of presentation is between six month and two years of age. Coeliac disease is caused by a reaction to gliadin, a gluten protein found in wheat. Upon exposure to gliadin, the enzyme tissue transglutaminase modifies the protein and the immune system cross reacts with the bowel tissue, causing an inflammatory reaction that leads to flattening of the lining of the small intestine, which interferes with the absorption of nutrient's. Here we describe the case of Ibrahim age 12 years was admitted in BSMMU on 9th February 2008. He had loose mucoid stool, abdominal distension, bloating and history of loss of weight for two years. He was malnourished moderately pale with clubbing. His weight and height was far below the standard for the age. Along with the routine examinations foecal fat estimation, MT, USG of whole abdomen, Barium follow through, endoscopic biopsy and tissue transglutaminage IgA autoantibody was done. Histopathological report was in favour of immunoproliferative small intestinal disease. Tissue transglutaminage IgA autoantibody was in higher level though done in a gluten free state. Wheat and food made by wheat was totally withdrawn then gradually the patient improved. Symptoms of diarrhoea, abdominal distention and bloatedness gradually decreased. For patients presenting with alteration of bowel habit, abdominal distension, bloating and history of weight loss for long time, the importance of considering coeliac diseases as a differential diagnosis cannot be overemphasized.

Arsenic intake via water and food by a population living in an arsenic-affected area of Bangladesh.

More and more people in Bangladesh have recently become aware of the risk of drinking arsenic-contaminated groundwater, and have been trying to obtain drinking water from less arsenic-contaminated sources. In this study, arsenic intakes of 18 families living in one block of a rural village in an arsenic-affected district of Bangladesh were evaluated to investigate their actual arsenic intake via food, including from cooking water, and to estimate the contribution of each food category and of drinking water to the total arsenic intake. Water consumption rates were estimated by the self-reporting method. The mean drinking water intake was estimated as about 3 L/d without gender difference. Arsenic intakes from food were evaluated by the duplicate portion sampling method. The duplicated foods from each family were divided into four categories (cooked rice, solid food, cereals for breakfast, and liquid food), and the arsenic concentrations of each food category and of the drinking water were measured. The mean arsenic intake from water and food by all 18 respondents was 0.15 +/-0.11 mg/d (range, 0.043 - 0.49), that by male subjects was 0.18 +/- 0.13 mg/d (n = 12) and that by female subjects was 0.096 +/- 0.007 mg/d (n = 6). The average contributions to the total arsenic intake were, from drinking water, 13%; liquid food, 4.4%; cooked rice, 56%; solid food, 11%; and cereals, 16%. Arsenic intake via drinking water was not high despite the highly contaminated groundwater in the survey area because many families had changed their drinking water sources to less-contaminated ones. Instead, cooked rice contributed most to the daily arsenic intake. Use of contaminated water for cooking by several families was suspected based on comparisons of arsenic concentrations between drinking water and liquid food, and between rice before and after cooking. Detailed investigation suggested that six households used contaminated water for cooking but not drinking, leading to an increase of arsenic intake via arsenic-contaminated cooking water.