RESUMO
Non-celiac gluten sensitivity (NCGS) is clinically identified as a condition where a percentage of the population reports intestinal and/or extraintestinal symptoms caused by gluten and/or wheat ingestion, and they are tested negative for celiac disease (CD) on the basis of specific serology and histopathology. NCGS should be labelled after the exclusion of CD and wheat allergy. This population reports improved symptoms on a gluten-free diet. Despite great interest and work on NCGS, much remains unknown about its pathogenesis. A positive and improved response to a gluten-free diet for a limited period of time (e.g., six to eight weeks), followed by retrieval of symptoms in case of gluten intake, is presently considered to be the best strategy for confirmation of diagnosis. A middle-aged lady came for medical attention with concerns of weight loss, lethargy and abdominal discomfort. On investigations, her serum transglutaminase IgA was found to be largely raised. The patient was switched to a gluten-free diet with suspicion of CD. Upper GI endoscopy was done one week after being on a gluten-free diet. Both endoscopy with histopathology was negative for villous atrophy and increased intraepithelial lymphocytes. Later human leukocyte antigen (HLA) testing was found to be negative for CD, leading to a diagnostic conundrum. On the basis of remarkable symptom improvement on a gluten-free diet, drop in transglutaminase levels, negative biopsy and HLA testing, the diagnosis was made as possible NCGS. Considering gluten-related disorders are rising and not much is known about NCGS, we aimed to present this case to create awareness and raise questions regarding diagnosis, need for specific monitoring and implications on the management.
RESUMO
AIMS AND OBJECTIVE: To determine normal blood pressure (BP) in apparently healthy, asymptomatic school children in the age group of 6-16 years and to determine the correlation of BP values with different sex, weight, height, and body mass index (BMI) and also to find out prevalence of hypertension in school going population. MATERIALS AND METHODS: This prospective, observational study enrolled 3,302 urban children (1,658 boys and 1,644 girls) in the age group of 6-16 years. These were analyzed to study the distribution pattern of systolic blood pressure (SBP) and diastolic blood pressure (DBP) at different ages, sex, weight, height, and BMI. The SBP and DBP were noted as per age and sex. The association was seen between mean SBP and mean DBP with weight, height, and BMI. Information was collected about the family history of hypertension and was correlated with the obtained SBP and DBP readings. RESULTS: The mean SBP in males at 6 years was 99.69 ± 3.62 mm of Hg, at 10 years was 102.20 ± 2.16 mm of Hg, and at 16 years was 115.33 ± 1.26 mm of Hg. The mean SBP in females at 6 years was 96.55 ± 2.86 mm of Hg, at 10 years was 101.16 ± 2.12 mm of Hg, and at 16 years was 112.41 ± 1.06 mm of Hg. The correlation coefficient for relationship between age and SBP in males and females was 0.89 and 0.91, respectively, and for DBP was 0.92 and 0.90, respectively. The correlation coefficient for relationship between height and SBP in males and females was 0.91 and 0.93, respectively, and for DBP was 0.92 and 0.88, respectively. The correlation coefficient for relationship between weight and SBP in males and females was 0.92 and 0.92, respectively, and for DBP was 0.94 and 0.91, respectively. In the nomogram obtained in the study, 95% of study population fall between mean +2SD and -2SD. CONCLUSION: The blood pressure (BP) (SBP and DBP) tends to increase with age, weight, height, and BMI. The BP values (SBP and DBP) increases grossly after 11 years of age. The students with positive family history of hypertension had higher valve when compared to other student. The BP of children and adolescents can be evaluated using the reference table according to age. The table provided helps to classify as "normal" or "hypertension" (>+2SD).
