Impact of delay in the diagnosis on the severity of celiac disease.

BACKGROUND AND AIM: Celiac disease (CeD) has now become a global disease with a worldwide prevalence of 0.67%. Despite being a common disease, CeD is often not diagnosed and there is a significant delay in its diagnosis. We reviewed the impact of the delay in the diagnosis on the severity of manifestations of CeD. METHODS: We reviewed clinical records of 726 consecutive patients with CeD from the Celiac Clinic database and the National Celiac Disease Consortium database. We extracted specific data including the demographics, symptoms at presentation, time of onset of symptoms, time to diagnosis from the onset of the symptoms, and relevant clinical data including fold-rise in anti-tissue transglutaminase antibody (IgA anti-tTG Ab) and severity of villous and crypt abnormalities as assessed using modified Marsh classification. RESULTS: The median duration between the onset of symptoms and the diagnosis of CeD was 27 months (interquartile range 12-60 months). A longer delay in the diagnosis of CeD from the onset of symptoms was associated with lower height for age, lower hemoglobin, higher fold rise in IgA Anti tTG titers, and higher severity of villous and crypt abnormalities. About 18% of patients presented with predominantly non-gastrointestinal complaints and had a longer delay in the diagnosis of CeD. CONCLUSIONS: There is a significant delay in the diagnosis of CeD since the onset of its symptoms. The severity of celiac disease increases with increasing delay in its diagnosis. There is a need to keep a low threshold for the diagnosis of CeD in appropriate clinical settings.

Quality of spirometry testing in a community setting: A study among elderly persons in a rural area of Haryana.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Early diagnosis and management of COPD require good quality spirometry testing, which is currently not available at primary care level in India. This study reports the quality of spirometry testing at the community level among elderly persons in a rural area. MATERIALS AND METHODS: A community-based cross-sectional study was conducted among 449 elderly persons in a rural area of Ballabgarh block of Haryana state by a trained investigator. A portable spirometer (MIR Spirolab®) was used. House-to-house visits were undertaken. A self-developed pretested semistructured interview schedule was administrated and spirometry was done according to the American Thoracic Society/European Respiratory Society (ATS/ERS) guidelines. RESULTS: Acceptable quality of spirometry tests was found among 87.3% (95% CI: 84.2%-90.4%) participants. Poor quality of spirometry was associated with low Body Mass Index (BMI) (aOR = 0.49, 95% CI = 0.26-0.93) and age ≥ 70 years (aOR = 0.45, 95% CI = 0.21-0.94) in multivariable analysis. CONCLUSION: Acceptable quality of spirometry can be performed in community settings by using a portable spirometer.

Prevalence of visual impairment and its association with vision-related quality of life among elderly persons in a resettlement colony of Delhi.

BACKGROUND: The population of India is ageing. The number and percentage of elderly persons is increasing. Visual impairment is common among elderly persons and affects their vision-related quality of life. The objective of this study was to estimate the prevalence of visual impairment among elderly persons aged 60 years and above residing in a resettlement colony of Delhi and study its association with socio-demographic variables and vision-related quality of life. METHODS: A total of 604 elderly participants were selected by simple random sampling. House-to-house visit was done, and a self-developed pre-tested semi-structured interview schedule was used to collect socio-demographic information. Visual acuity was measured using Snellen's chart, and distant direct ophthalmoscopy was done to diagnose cataract. Vision-related quality of life was assessed by Indian Vision Function Questionnaire-33 (IND-VFQ-33). RESULTS: Of the 604 participants, 555 (91.9%) were available for interview. The prevalence of visual impairment was 24.5% (95% CI: 20.9% - 28.1%). Cataract was the leading cause of visual impairment (50.7%), followed by uncorrected refractive error (36.8%). Illiteracy (aOR: 3.49, 1.37-8.87), economic dependence on family members (aOR: 1.92, 1.04 - 3.54), not currently working (aOR: 1.89, 1.20-2.98) and chewing of tobacco products (aOR: 2.56, 1.48-4.42) were significantly associated with visual impairment among study participants. Vison-related quality of life was worse among those with visual impairment. CONCLUSION: Burden of visual impairment is high among elderly persons living in urban resettlement colonies. It is largely avoidable. Eye-care services should be accessible and affordable to them.