ABSTRACT
OBJECTIVE: The aim of this study was to determine the prevalence of celiac disease among the adult population of Madrid by measuring antibodies against tissue transglutaminase as serologic screening method. POPULATION AND METHODS: 2,215 subjects participated voluntarily in this study. All of them completed a clinical questionnaire. We determined the levels of total IgA and antibodies to tissue transglutaminase (tTG). An intestinal biopsy by endoscopy was proposed to all subjects who were tTG-positive. The histologic lesion was classified in accordance to Marsh. RESULTS: Three known CD cases were identified by the questionnaire. Eleven donors with tTG positivity were detected, all of them asymptomatic. Four subjects rejected the intestinal biopsy. Seven out of 11 positive subjects consented to undergo a duodenal biopsy -3 had villous atrophy and 4 had increased intraepithelial lymphocyte counts with normal villi. In our study the number of donors with biopsy-proven CD was 6, and the prevalence was 1/370. If we include the subcategories of gluten sensitive enteropathy (Marsh I), the prevalence would be 1/222. When we considered antibody positivity the prevalence of gluten sensitivity was 1 in 201, and it reached 1 in 158 when the three known CD cases were included. CONCLUSIONS: Data on CD prevalence in this study confirm that CD is a first-line healthcare problem that may warrant universal screening. We detected a high number of lymphocytic enteritis cases, and thus some sort of action is mandatory.
Subject(s)
Blood Donors/statistics & numerical data , Celiac Disease/epidemiology , Adult , Atrophy , Autoantibodies/blood , Autoantibodies/immunology , Celiac Disease/blood , Celiac Disease/diagnosis , Celiac Disease/diet therapy , Comorbidity , Diabetes Mellitus, Type 1/epidemiology , Duodenum/ultrastructure , Female , GTP-Binding Proteins , HLA Antigens/analysis , Humans , Immunoglobulin A/blood , Immunoglobulin A/immunology , Male , Microvilli/ultrastructure , Prevalence , Protein Glutamine gamma Glutamyltransferase 2 , Spain/epidemiology , Thyroiditis, Autoimmune/epidemiology , Transglutaminases/immunologyABSTRACT
Objetivo: conocer la prevalencia de enfermedad celiaca en la población adulta de la Comunidad de Madrid utilizando como método de despistaje los anticuerpos frente a la transglutaminasa tisular. Población y métodos: han participado de modo voluntario 2.215 donantes de sangre. Todos ellos rellenaron una encuesta. Se determinó la IgA sérica total y los anticuerpos antitransglutaminasa tisular. A los donantes con anticuerpos positivos, se les ofreció la realización de biopsia intestinal por endoscopia. La histología de la mucosa intestinal se graduó según los criterios de Marsh. Resultados: mediante la encuesta se identificaron tres celiacos diagnosticados previamente. Once donantes presentaban anticuerpos positivos, todos ellos asintomáticos. Cuatro rechazaron la biopsia intestinal. De los siete en los que se realizó, tres tenían atrofia vellositaria y cuatro infiltrado linfocitario con vellosidades normales. En nuestro estudio el número total de donantes con enfermedad celiaca confirmada por biopsia fue de seis, lo que supone una prevalencia del 1/370. Considerando el grado I de Marsh, la prevalencia de la enteropatía por gluten sería de 1/222. La respuesta inmunológica anómala al gluten medida por la positividad de los anticuerpos fue de 1/201 que alcanza valores de 1/158 si consideramos los tres celiacos diagnosticados previamente. Conclusiones: los datos de prevalencia hallados en este estudio confirman que la enfermedad celiaca constituye un problema sanitario de primer orden, que podría justificar la instauración de un programa de despistaje universal. Se ha detectado un alto número de casos de enteritis linfocitaria lo que obliga a plantearse la actitud a seguir
Objective: the aim of this study was to determine the prevalence of celiac disease among the adult population of Madrid by measuring antibodies against tissue transglutaminase as serologic screening method. Population and methods: 2,215 subjects participated voluntarily in this study. All of them completed a clinical questionnaire. We determined the levels of total IgA and antibodies to tissue transglutaminase (tTG). An intestinal biopsy by endoscopy was proposed to all subjects who were tTG-positive. The histologic lesion was classified in accordance to Marsh. Results: three known CD cases were identified by the questionnaire. Eleven donors with tTG positivity were detected, all of them asymptomatic. Four subjects rejected the intestinal biopsy. Seven out of 11 positive subjects consented to undergo a duodenal biopsy 3 had villous atrophy and 4 had increased intraepithelial lymphocyte counts with normal villi. In our study the number of donors with biopsy-proven CD was 6, and the prevalence was 1/370. If we include the subcategories of gluten sensitive enteropathy (Marsh I), the prevalence would be 1/222. When we considered antibody positivity the prevalence of gluten sensitivity was 1 in 201, and it reached 1 in 158 when the three known CD cases were included. Conclusions: data on CD prevalence in this study confirm that CD is a first-line healthcare problem that may warrant universal screening. We detected a high number of lymphocytic enteritis cases, and thus some sort of action is mandatory
Subject(s)
Humans , Blood Donors/statistics & numerical data , Celiac Disease/epidemiology , Transglutaminases/analysis , Antibodies/analysis , Lymphocyte Activation , Cross-Sectional Studies , Mass ScreeningABSTRACT
The incidence of MRSA infections in Spain had remained in a low level through the years, being MRSA usually less than 1.5% of all S. aureus isolates. Since October 1988, we have detected in our hospital a MRSA outbreak. The epidemic started in the surgical wards, and spread through the rest of the institution. The incidence of cases was higher in the ICU's, areas that act as "multipliers" of the outbreak. In spite of standard control measures, the total number of patients with MRSA was 245 in April 1990. We studied prospectively a sample of 100 MRSA patients: thirty-six percent were colonized and 46% infected. The more common source of infection was the lower respiratory tract and primary bacteremia. The infection-related mortality was 30%. Our MRSA strain belong to phage type III, and shows a characteristic multiple antibiotic resistant pattern, the MRSA strain is sensitive to vancomycin, fusidic acid, phosphomycin and cotrimoxazole. Over the entire outbreak period, the MRSA strain developed resistance to rifampin, imipenem-cilastatin and ciprofloxacin. In spite of all control measures implemented, the outbreak can not have been totally controlled, and MRSA is now an endemic pathogen in our institution. Therefore, major changes in therapeutic approach to nosocomial infections have been since then introduced.
