ABSTRACT
Recent guidelines have proposed that there is a correlation between tissue transglutaminase [tTG] antibody titers and degrees of duodenal biopsy, and that duodenal biopsy can be omitted in some patients with high levels of tTG antibody. Using data of registered patients in a gastrointestinal clinic we aimed to assess the correlation between tissue transglutaminase antibody with duodenal histologic Marsh grading in Iranian patients with celiac disease. We retrospectively reviewed hospital files of registered patients in the gastrointestinal clinic of Firoozgar Hospital, Tehran, Iran. Demographic, laboratory, and histology data of those who had tTG titer and pathology reports of duodenal biopsy based on the modified Marsh classification were extracted and used for the study. 159 patients with available tTG titer and pathology reports were enrolled in our study. Mean +/- SD of the patients was 35.6 +/- 15.2 and 100 [62.9%] of them were women. 133 out of 153 patients had villous atrophy [Marsh IIIa-IIIc]. Anemia was the most common sign and bloating, abdominal pain, and diarrhea were the first three common symptoms in these patients. Mean tTG titers was significantly higher in patients graded as Marsh III [p for trend=0.003]. Our results showed that tTG titer more than 9 folds higher than the kit's cut-off value was about 97.2% sensitive for Marsh II and more duodenal damage. There was a correlation between tTG titers and degrees of duodenal damage in patients with celiac disease. Duodenal biopsy is not always necessary for diagnosing celiac disease and when tTG level is more than 9 folds higher than the manufacture's recommended cut-off value it can be avoided. Meanwhile in case of high clinical suspicion, low tTG levels do not exclude diagnosis of celiac disease and further investigations including small intestinal biopsy should be considered
ABSTRACT
The incidence of major risk factors of chronic kidney disease [CKD] in the world is on the rise, and it is expected that this incidence and prevalence, particularly in developing countries, will continue to increase. Using data on urinary sediment and microalbuminuria, we aimed to estimate the prevalence of CKD in northeast Iran. In a cross-sectional study, the prevalence of CKD in a sample of 1557 regionally representative people, aged >/= 18 years, was analyzed. CKD was determined based on glomerular _ltration rate [GFR] and microalbuminuria. Life style data, urine and blood samples were collected. Urine samples without any proteinuria in the initial dipstick test were checked for qualitative microalbuminuria. If the latter was positive, quantitative microalbuminuria was evaluated. 1557 subjects with a mean age of 56.76 +/- 12.04 years were enrolled in this study. Based on the modi_cation of diet in renal disease [MDRD] equation, 137 subjects [8.89%] were categorized as CKD stages III-V. Based on urine abnormalities, the prevalence of combined CKD stages I and II was 10.63%, and based on macro- and microalbuminuria it was 14.53%. The prevalence of CKD was significantly associated with sex, age, marital status, education, diabetes mellitus [DM], hypertension [HTN], ischemic heart disease [IHD], waist to hip ratio, myocardial infarction [MI], and cerebrovascular accident [CVA]. CKD and its main risk factors are common and represent a definite health threat in this region of Iran. Using and standardizing less expensive screening tests in low resource countries could be a good alternative that may improve the outcome through early detection of CKD
ABSTRACT
Major thalassemia is the most common form of anemia requiring blood transfusion in Iran. Since ribavirin provokes anemia in the treated patients, interferon monotherapy may be an appropriate treatment in major thalassemic patients. The aim of this study was to determine the safety and efficacy of interferon monotherapy in thalassemic patients with hepatitis C virus infection. Forty major thalassemic patients [20 male], with hepatitis C infection [detectable HCV RNA* by qualitative PCR** amplification assay] and elevated liver enzymes were enrolled. Liver biopsy was done for all patients. Then the patients were treated with interferon [3 MU, three times per week] for six months. They were followed by HCV RNA at the end of treatment, and at 6, 12, 24, 36, and 48 months later. Primary outcome measure was sustained virologic response defined by undetectable serum HCV RNA 6 months after end of treatment. Secondary endpoint was negative HCV RNA at the end of follow up [48 months posttreatment]. Mean age of the patient at the beginning of the study was 17.37 +/- 5 years. Three patients discontinued treatment because of interferon side effects. Twenty six [65% on intention to treat analysis] had undetectable HCV RNA 6 months after end of treatment but eleven of them became HCV RNA positive on follow up. Finally, 15 patients [37.5%] had undetectable HCV RNA at the end of follow up. Interferon monotherapy is an effective treatment for major thalassemic patients with HCV infection. Definition of sustained virologic response for hepatitis C may require revision in high risk patients