Descripción de la afectación de la destreza y función manual en pacientes con distonía focal de la mano / Alterations in dexterity and manual function in patients with focal hand dystonia

Introducción: La distonía focal de la mano es un trastorno del movimiento cuya sintomatología produce una alteración en el desempeño de tareas que requieren un nivel de destreza alto. Actualmente no se dispone de un modelo de interpretación de la enfermedad y son escasos los estudios que identifican las dificultades de las personas con distonía al desempeñar las actividades de la vida diaria (AVD). Por todo ello, el objetivo del estudio es describir la destreza manipulativa y su influencia en las AVD de los pacientes con distonía focal de la mano.Material y métodoSe realizó un estudio observacional, transversal, tipo casos y controles. Se reclutaron 24 participantes: 12 pacientes y 12 sujetos control. Los pacientes fueron derivados por el Servicio de Neurología del Hospital Ramón y Cajal. Se obtuvieron datos sociodemográficos y clínicos retrospectivos en el grupo de casos. Posteriormente, se administraron pruebas de evaluación, en el siguiente orden: Nine Hole Peg Test (NHPT), Box and Blocks Test (BBT), Purdue Pegboard Test (PPT) y Jebsen-Taylor Test of Hand Function (JTTHF).ResultadosEn la muestra del estudio participaron un total de 24 personas, siete mujeres y 17 hombres, con una media de edad de 50,79 ± 14,40 años. Del total de participantes con distonía focal se observó que, aunque la mitad de la muestra no identificó signos de afectación neuromuscular, ni problemas psicoemocionales, un menor porcentaje de estos pacientes identificaron dificultades asociadas con el hombro derecho (25%) y el estado ansioso (33,3%).ConclusionesLos hallazgos encontrados en el presente trabajo señalan que la distonía focal de la mano afecta a la destreza manipulativa de estos pacientes, presentando una peor ejecución y requiriendo más tiempo para su ejecución. (AU)

Introduction: Focal hand dystonia is a movement disorder whose symptoms cause alterations in the performance of tasks requiring a high level of dexterity. Currently, there is no model for interpreting the disease and few studies have identified the difficulties of patients with dystonia in carrying out activities of daily living (ADL). This study aims to describe manipulative dexterity and its influence on ADLs in patients with focal hand dystonia.Materials and methodsWe performed an observational, cross-sectional, case-control study including 24 participants (12 patients with focal hand dystonia and 12 controls). The patients were referred by the neurology department of Hospital Ramón y Cajal. We gathered sociodemographic data, as well as retrospective clinical data for patients. We subsequently administered evaluation tests, in the following order: Nine-Hole Peg Test (NHPT), Box and Blocks Test (BBT), Purdue Pegboard Test (PPT), and Jebsen-Taylor Test of Hand Function (JTTHF).ResultsThe study sample included a total of 24 participants, 7 women and 17 men, with a mean age (standard deviation) of 50.79 (14.40) years. In the patient group, neuromuscular involvement or psycho-emotional problems were not detected in half of cases; smaller numbers of patients presented difficulties associated with the right shoulder (25%) and anxious state (33.3%).ConclusionsOur results indicate that focal hand dystonia affects manipulative dexterity in these patients, who showed poorer performance and required more time to complete the tasks. (AU)

Alterations in dexterity and manual function in patients with focal hand dystonia.

INTRODUCTION: Focal hand dystonia is a movement disorder whose symptoms cause alterations in the performance of tasks requiring a high level of dexterity. Currently, there is no model for interpreting the disease and few studies have identified the difficulties of patients with dystonia in carrying out activities of daily living (ADL). This study aims to describe manipulative dexterity and its influence on ADLs in patients with focal hand dystonia. MATERIALS AND METHODS: We performed an observational, cross-sectional, case-control study including 24 participants (12 patients with focal hand dystonia and 12 controls). The patients were referred by the neurology department of Hospital Ramón y Cajal. We gathered sociodemographic data, as well as retrospective clinical data for patients. We subsequently administered evaluation tests, in the following order: Nine-Hole Peg Test (NHPT), Box and Blocks Test (BBT), Purdue Pegboard Test (PPT), and Jebsen-Taylor Test of Hand Function (JTTHF). RESULTS: The study sample included a total of 24 participants, 7 women and 17 men, with a mean age (standard deviation) of 50.79 (14.40) years. In the patient group, neuromuscular involvement or psycho-emotional problems were not detected in half of cases; smaller numbers of patients presented difficulties associated with the right shoulder (25%) and anxious state (33.3%). CONCLUSIONS: Our results indicate that focal hand dystonia affects manipulative dexterity in these patients, who showed poorer performance and required more time to complete the tasks.

Incidence of pulmonary embolism in non-critically ill COVID-19 patients. Predicting factors for a challenging diagnosis.

Recent studies suggest that thrombotic complications are a common phenomenon in the novel SARS-CoV-2 infection. The main objective of our study is to assess cumulative incidence of pulmonary embolism (PE) in non critically ill COVID-19 patients and to identify its predicting factors associated to the diagnosis of pulmonary embolism. We retrospectevely reviewed 452 electronic medical records of patients admitted to Internal Medicine Department of a secondary hospital in Madrid during Covid 19 pandemic outbreak. We included 91 patients who underwent a multidetector Computed Tomography pulmonary angiography(CTPA) during conventional hospitalization. The cumulative incidence of PE was assessed ant the clinical, analytical and radiological characteristics were compared between patients with and without PE. PE incidence was 6.4% (29/452 patients). Most patients with a confirmed diagnosed with PE recieved low molecular weight heparin (LMWH): 79.3% (23/29). D-dimer peak was significatly elevated in PE vs non PE patients (14,480 vs 7230 mcg/dL, p = 0.03). In multivariate analysis of patients who underwent a CTPA we found that plasma D-dimer peak was an independen predictor of PE with a best cut off point of > 5000 µg/dl (OR 3.77; IC95% (1.18-12.16), p = 0.03). We found ninefold increased risk of PE patients not suffering from dyslipidemia (OR 9.06; IC95% (1.88-43.60). Predictive value of AUC for ROC is 75.5%. We found a high incidence of PE in non critically ill hospitalized COVID 19 patients despite standard thromboprophylaxis. An increase in D-dimer levels is an independent predictor for PE, with a best cut-off point of > 5000 µg/ dl.

Alterations in dexterity and manual function in patients with focal hand dystonia. / Descripción de la afectación de la destreza y función manual en pacientes con distonía focal de la mano.

INTRODUCTION: Focal hand dystonia is a movement disorder whose symptoms cause alterations in the performance of tasks requiring a high level of dexterity. Currently, there is no model for interpreting the disease and few studies have identified the difficulties of patients with dystonia in carrying out activities of daily living (ADL). This study aims to describe manipulative dexterity and its influence on ADLs in patients with focal hand dystonia. MATERIALS AND METHODS: We performed an observational, cross-sectional, case-control study including 24 participants (12 patients with focal hand dystonia and 12 controls). The patients were referred by the neurology department of Hospital Ramón y Cajal. We gathered sociodemographic data, as well as retrospective clinical data for patients. We subsequently administered evaluation tests, in the following order: Nine-Hole Peg Test (NHPT), Box and Blocks Test (BBT), Purdue Pegboard Test (PPT), and Jebsen-Taylor Test of Hand Function (JTTHF). RESULTS: The study sample included a total of 24 participants, 7 women and 17 men, with a mean age (standard deviation) of 50.79 (14.40) years. In the patient group, neuromuscular involvement or psycho-emotional problems were not detected in half of cases; smaller numbers of patients presented difficulties associated with the right shoulder (25%) and anxious state (33.3%). CONCLUSIONS: Our results indicate that focal hand dystonia affects manipulative dexterity in these patients, who showed poorer performance and required more time to complete the tasks.

Eficacia de un programa intensivo de terapia ocupacional para niños amputados / Efficacy of an intensive occupational therapy programme for amputated children

Objetivo: Analizar si los niños con prótesis mioeléctricas pueden mejorar sus destrezas motoras necesarias para la realización de las actividades de la vida diaria (AVD) de manera independiente. Material y método: Se realizó un programa estructurado de terapia ocupacional, basado en actividades de coordinación motora fina y gruesa, así como un refuerzo constante de las AVD, durante 6 días en 10 niños amputados (4 chicos y 6 chicas) usuarios de prótesis mioeléctricas, con edades comprendidas entre 4-0 años. Se administró el Assessment of Process and Motor Skills (AMPS) para evaluar las destrezas motoras al inicio y al finalizar la estancia en el campamento. Resultados: En la primera valoración y en la segunda obtuvieron respectivamente los siguientes resultados por destrezas: alcanza (2,0-1,4), se inclina (1,8-1,2), manipula (2,1-1,6), coordina (2,3-2,0), mueve (2,1-1,7), posiciona (2,0-1,7), camina (1,2-1,1), transporta (1,7-1,6). Todos los participantes mejoraron en las habilidades referidas a la posición corporal, obtener y sujetar objetos, y movilización de si mismos y de los objetos. Conclusiones: Los programas intensivos de terapia ocupacional en los niños usuarios de prótesis mioeléctricas son eficaces, ya que mejoran la calidad en la realización de las AVD lo que redunda en la mejora de la autoestima y en la calidad de vida de los niños (AU)

Objective: To analyse myoelectric prostheses in amputated children on fulfilling activities of daily life (ADL) independently. Material and method: A structured occupational therapy programme was performed, based on fine and gross motor coordination activities as well as constant reinforcement of ADL for 6 days in 10 amputated children (4 boys and 6 girls) using myoelectric prostheses, aged within 4-0 years. The Assessment of Process and Motor Skills (AMPS) was administered to evaluate motor skills at the start and at the end of stay in the camp. Results: The following results were obtained in the first and the second assessment, by skills, respectively: reaches (2.0-1.4), bends (1.8-1.2), manipulates (2.1-1.6), coordinates (2.3-2.0), moves (2.1-1.7), positions (2.0- 1.7), walks (1.2-1.1), carries (1.7-1.6). All participants improved their skills referring to body position, obtaining and holding objects and moving themselves and objects. Conclusion: Invasive occupational therapy programmes in children using myoelectric prostheses are effective, as they improve quality in fulfilling ADL, leading to an improved self-esteem and quality of life of children (AU)

Drogodependencias en personal sanitario, una visión desde la medicina del trabajo (I): aspectos jurídico-legales y epidemiológicos / No disponible

Los problemas de drogodependencias en personal sanitario suponen un gran reto para la responsabilidad profesional del médico del trabajo, que tiene que abordar la rehabilitación laboral (y personal) del profesional sanitario drogodependiente, evitando que ocasione daños a los pacientes en el ejercicio de su profesión, un equilibrio difícil de conseguir. Se pretende elaborar un procedimiento de actuación útil, para lo cual se revisan todos los aspectos legales que se puedan ver afectados durante el manejo de drogodependientes (marco legal, responsabilidades, derechos y deberes), las políticas sanitarias y programas de ayuda actuales y los datos epidemiológicos (Prevalencia de drogodependencias y recaídas en personal sanitario)

The problems of drug addiction in health personnel pose a great challenge to the professional responsibility of the medical officer, who has to deal with the rehabilitation work (and staff) health professional drug addicts, preventing cause harm to patients in the exercise of their profession, a difficult balance to achieve. The aim is to develop a useful procedure for action, which would review all the legal issues that may be affected during the handling of drug addicts (legal, responsibilities, rights and duties), health policies and programmes to assist current and data epidemiological (prevalence of relapses into drug addiction and health personnel)

Hipersensibilidad A los alimentos en la infancia, definición, clasificación y epidemiología. La marcha atópica / Food hypersensitivity in childhood: definition, classification and epidemiología. Natural history

En los últimos años, los estudios epidemiológicos sugieren un incremento progresivo de la alergia a alimentos. La terminología utilizada para caracterizar las reacciones adversas a alimentos es confusa y recientemente se he revisado su nomenclatura. Las reacciones alérgicas a los alimentos son difíciles de clasificar y se ha propuesto una clasificación basada en la fisiopatología que incluye los cuadros clínicos descritos hasta el momento actual. La hipersensibilidad a alimentos es común en los primeros años de vida y a mayor frecuencia ocurre entre los 18 meses y los 3 años, edades en las que aparecen el 25% de las reacciones adversas. En España los alimentos implicados con mayor frecuencia son la leche de vaca, huevo y pescado, seguidos por frutas, frutos secos, legumbres y otros vegetales. La mayoría de estas alergias se pierden con el tiempo pero los niños que comienzan con alergia a 1 alimento tienen elevadas posibilidades de desarrollar alergias a otros alimentos así como a alérgenos ambientales y dermatitis atópica

Recent epidemiology studies suggest that food allergy is increasing in the last years. The terminology used to characterize allergic and allergy-like reactions is confusing and recently a nomenclature for allergy, has been revised. A classification of gastrointestinal hypersensitivities to ffod according to pathophysiology has been proposed. Several studies have showed that food hipersensitivity is common in infancy and early childhood. The highest prevalence occurs between 1.5 and 3 years of age, when up to 2,5% of adverse reactions to ffod have been reported. In spain, the principal fooda involved in allergic reactions are: eggs, fish, and cow´s milk followed in frequency by fruits, nuts, legumes and other vegetables. Most food allegy is lost over time but children who begin with one food allergy have a high chance of developing additional food allergy as well as atopic dermatitis and inhalant allergies

Manifestaciones gastrointestinales de la hipersensibilidad a alimentos no mediada por IgE / Gastrointestinal manifestation of non-IgE mediated food hypersensitivity

La alergia alimentaria se caracteriza por una respuesta inmunológica anormal a proteínas de la dieta. La mayoría de estas reacciones de hipersensibilidad están mediadas por IgE pero en otras ocurren mecanismos inmunológicos no IgE mediados. Los cuadros clínicos incluyen la enterocolitis enteropatía y proctocolitis inducidas por proteínas alimentarias. Nuestro conocimiento sobre su patogenia es incompleto. Los alimentos implicados son limitados e incluyen leche de vaca, huevo, pescado, arroz, soja y frutos secos. Las pruebas cutáneas y los estudios inmunológicos tienen escasa utilidad en su diagnóstico y para ello es preciso, la mayoría de las veces, realizar pruebas de eliminación y de provocación con el/los alimento/s implicado/s. En algunas entidades la biopsia gastrointestinal es precisa. La evitación del alimento o alimentos implicados es el único tratamiento eficaz. A lo largo del tiempo muchos pacientes alcanzan la tolerancia a los alergenos alimentarios

Food allergy is characterized by an abnormal immunologic reactivity to food proteins. IgE-mediated hypersensitivity reactions account for the majority of well-documented food allergy reactions but non-Ige immune mechanisms cause some hypersensitivity disorders. Clinical presentations include protein-induced enterocolitis syndrome, enteropathy and proctocolitis. For many of these conditions, our understanding of the pathophysiology is complete. A limited number of foods are responsible for majority of these allergic reactions: cow´s milk, egg, fish, rice, soy and tree nuts. In non IgE mediated disease, skin tests and immunological studies are not helpful. A definitive diagnosis of gastrointestinal food allegy often requires a proof of reactivity through elimination diets and oral food challenges. Depending on the clinical presentation, gastrointestinal biopsies may be required. One properly diagnosed, strict avoidance of the implicated food or foods is the only proven form of treatment. Clinical tolerance to food allergens will develop in many patients over time

Immunopathogenesis of celiac disease

La Enfermedad Celiaca (EC) o Enteropatía Sensible al Gluten,es una alteración del intestino delgado proximal producida por una intolerancia inmunológica permanente a las prolaminas del gluten. La EC provoca una intolerancia a la ingesta de cereales habituales en la dieta occidental: el trigo, el centeno, la cebada y, posiblemente, la avena. La EC es la enfermedad crónica gastrointestinal más frecuente, afectando al 1% de la raza caucásica.El contacto con el gluten desencadena una inflamación crónica intestinal de base autoinmune, cuya lesión histológica característica es una atrofia vellositaria reversible. Requiere para su manifestación un contexto genético conferido por la presencia dedeterminados alelos del HLA. El diagnóstico se basa en la demostración de una relación causal entre la ingesta de gluten y la presencia de una enteropatía característica. El único tratamiento es la difícil exclusión del gluten de la dieta. La hipótesis patogénica más aceptada consiste en el desarrollo de una respuesta inmune aberrante al gluten y el desencadenamiento de una enteropatía mediada por linfocitos T activados localmente. Aunque los mecanismos que desencadenan la EC no se conocen, se ha descrito una reacción inmune de los linfocitosCD4+ de la lámina propia frente a péptidos del gluten deamidados por la enzima transglutaminasa tisular (tTG) y presentados por HLA-DQ2 o DQ8, así como una reacción en el epitelio intestinal mediada por linfocitos intraepiteliales (LIE) CD8+ citotóxicos.El estudio de los mecanismos inmunológicos que subyacenen la EC podría permitir el avance en el conocimento de la patogenia de otras enfermedades inflamatorias y autoinmunes, además de abrir nuevas vías terapéuticas para la EC (AU)

Celiac Disease (CeD), or Gluten Sensitive Enteropathy (GSE),is an immunologically-mediated intolerance to dietary prolamins.A cellular immune response against these cereal-derived proteins impairs the absorption of nutrients by the small intestine and leads to a loss of the normal mucosal architecture and subsequent clinical and metabolic complications. Prolamins are a component of gluten, present in wheat, rye, barley and oats, common ingredients of Western diets, and CeD is the commonest chronic gastrointestinal disease in Caucasians (1% prevalence).Ingestion of gluten provokes a chronic inflammatory response that induces a flattening of intestinal villi in genetically-conditioned subjects. This auto-aggression is reversible when gluten is withdrawn from the diet, and a radical avoidance of those cerealsis the only available management of CeD. The temporal association between gluten intake and histological changes constitutes the basis for the diagnosis.The most accepted pathogenic mechanism of CeD is the presentation of gluten peptides by HLA-DQ2 and -DQ8-bearing antigenpresenting cells (APC) to T lymphocytes in the intestinal mucosa.Those peptides would be modified by the enzyme tissue transglutaminase(tTG) and become high-avidity binders for those HLA molecules. The ensuing immune reaction would involve CD4+lymphocytes in the lamina propria and CD8+ cytotoxic intraepitheliallymphocytes (IEL) in the epithelium.Further research is needed to define the mechanisms that lead to the absence of immunologic tolerance to gluten and to develop potential strategies to restore it (AU)

Immunopathogenesis of celiac disease

La Enfermedad Celiaca (EC) o Enteropatía Sensible al Gluten,es una alteración del intestino delgado proximal producidapor una intolerancia inmunológica permanente a las prolaminasdel gluten. La EC provoca una intolerancia a la ingesta decereales habituales en la dieta occidental: el trigo, el centeno, lacebada y, posiblemente, la avena. La EC es la enfermedad crónicagastrointestinal más frecuente, afectando al 1% de la raza caucásica.El contacto con el gluten desencadena una inflamación crónicaintestinal de base autoinmune, cuya lesión histológica característicaes una atrofia vellositaria reversible. Requiere para sumanifestación un contexto genético conferido por la presencia dedeterminados alelos del HLA. El diagnóstico se basa en la demostraciónde una relación causal entre la ingesta de gluten y la presenciade una enteropatía característica. El único tratamiento esla difícil exclusión del gluten de la dieta.La hipótesis patogénica más aceptada consiste en el desarrollode una respuesta inmune aberrante al gluten y el desencadenamientode una enteropatía mediada por linfocitos T activadoslocalmente. Aunque los mecanismos que desencadenan la EC nose conocen, se ha descrito una reacción inmune de los linfocitosCD4+ de la lámina propia frente a péptidos del gluten deamidadospor la enzima transglutaminasa tisular (tTG) y presentadospor HLA-DQ2 o DQ8, así como una reacción en el epitelio intestinalmediada por linfocitos intraepiteliales (LIE) CD8+ citotóxicos.El estudio de los mecanismos inmunológicos que subyacenen la EC podría permitir el avance en el conocimento de la patogeniade otras enfermedades inflamatorias y autoinmunes, ademásde abrir nuevas vías terapéuticas para la EC

Celiac Disease (CeD), or Gluten Sensitive Enteropathy (GSE),is an immunologically-mediated intolerance to dietary prolamins.A cellular immune response against these cereal-derived proteinsimpairs the absorption of nutrients by the small intestine and leadsto a loss of the normal mucosal architecture and subsequent clinicaland metabolic complications. Prolamins are a component ofgluten, present in wheat, rye, barley and oats, common ingredientsof Western diets, and CeD is the commonest chronic gastrointestinaldisease in Caucasians (1% prevalence).Ingestion of gluten provokes a chronic inflammatory responsethat induces a flattening of intestinal villi in genetically-conditionedsubjects. This auto-aggression is reversible when gluten iswithdrawn from the diet, and a radical avoidance of those cerealsis the only available management of CeD. The temporal associationbetween gluten intake and histological changes constitutesthe basis for the diagnosis.The most accepted pathogenic mechanism of CeD is the presentationof gluten peptides by HLA-DQ2 and -DQ8-bearing antigenpresenting cells (APC) to T lymphocytes in the intestinal mucosa.Those peptides would be modified by the enzyme tissue transglutaminase(tTG) and become high-avidity binders for those HLAmolecules. The ensuing immune reaction would involve CD4+lymphocytes in the lamina propria and CD8+ cytotoxic intraepitheliallymphocytes (IEL) in the epithelium.Further research is needed to define the mechanisms that leadto the absence of immunologic tolerance to gluten and to developpotential strategies to restore it

Abceso retrofaríngeo / Retropharyngeal abscess

El absceso retrofaríngeo es una patología poco frecuente y potencialmente letal. Presentamos dos casos de absceso retrofaríngeo que ilustran las dificultades que puede suponer llegar a un diagnóstico correcto de esta entidad (AU)

Retropharyngeal abscess is a rare and potentially lethal disease. We present two cases of retropharyngeal abscess that illustrate the difficulties that may exist to reach a correct diagnosis of this entity (AU)

Síndrome de Turner y ductopenia biliar / No disponible

La elevación asintomática de los enzimas hepáticos ha sido observada en algunas ocasiones en pacientes con síndrome de Turner. Comunicamos una paciente de 18 años de edad con síndrome de Turner, tratada con GH, desde los 8 años hasta los 16 años, y con estrógenos desde los 12 hasta los 18 años. Un año antes de comenzar el tratamiento estrógeno y estando asintomática se objetivó una elevación oscilante de los enzimas hepáticos que persiste durante 6 años. La ecografía hepática fue normal. En la biopsia hepática se observó una leve ductopenia biliar. Se suspendió el tratamiento hormonal y se inició la administración de ácido ursodeoxicólico, existiendo una clara mejoría analítica a los 4 meses. La asociación de ductopenia biliar y síndrome de Turner no ha sido descrita anteriormente. A propósito de esta paciente se analizan las posibles causas de elevación de los enzimas hepáticos en los pacientes de síndrome de Turner así como la necesidad de vigilar y realizar periódicamente pruebas de funcionalismo hepático (AU)

Asymptomatic elevation of hepatic enzymes has been observed in some occasions in patients with Turner Syndrome. We report an 18 year old patient with Turner Syndrome, treated with GH, from 8 to 16 years, and with estrogens from 12 to 18 years. One year before beginning estrogen treatment and being asymptomatic, an oscillating elevations of the hepatic enzymes that persists during 6 years was observed. The hepatic echography was normal. In the hepatic biopsy, mild biliary ductopenia was observed. Hormone treatment was discontinued and administration of ursodeoxycolic acid initiated, there being a clear analytic improvement at 4 months. The association of biliary ductopenia and Turner Syndrome has not been previously described. Based on this patient, the possible causes of elevation of hepatic enzymes in Turner patients as well as the need to control and periodically perform hepatic functionalism tests are analyzed (AU)

Los linfocitos intraepiteliales en el diagnóstico de la enfermedad celíaca latente-potencial / Intraepithelial lymphocytes in the diagnosis of latent-potential celiac disease

No disponible

Anti-transglutaminase IgA ELISA: clinical potential and drawbacks in celiac disease diagnosis.

BACKGROUND: Since the identification of tissue transglutaminase (tTG) as the antigen for the anti-endomysial antibodies (EMA), several antigen-specific immunoassays have been reported for celiac disease (CD) screening. A first objective was to evaluate the suitability for CD screening of three different IgA tTG ELISAs, two of them based on guinea pig liver tTG (gp-tTG) (an in-house ELISA with a partially purified extract and a commercial ELISA with purified gp-tTG antigen) and a third recombinant human tTG (rh-tTG) ELISA. The results are compared with EMA and with the final clinical diagnosis. A second objective was to analyze antibody reactivities in those patients with anti-tTG and EMA discrepancies. METHODS: ELISA and EMA tests were used to measure IgA anti-tTG levels in sera from 259 patients (107 had CD and 72 had Type I diabetes mellitus). RESULTS: The purified gp-tTG ELISA was highly sensitive (97.7%) and specific (98.8%) in the detection of CD, almost equaling EMA. Rh-tTG ELISA did not improved the sensitivity of EMA, but its specificity was slightly superior. Immunoblot analysis with partially purified gp-tTG extract, the antigen most frequently used for anti-tTG detection, showed that the majority of false positives were due to IgA reactivities to contaminant proteins present in the liver antigenic extract. This low specificity was particularly problematic in diabetics. CONCLUSION: Purified tTG ELISAs, either with purified guinea pig liver or recombinant human antigens, can be used as quantitative and observer-independent alternatives to the traditional and time-consuming EMA in the screening of CD.