Incidence and prevalence of type 1 diabetes in children aged <15 yr in Castilla-Leon (Spain).

OBJECTIVES: To determine the incidence and prevalence of type 1 diabetes in children younger than 15 yr in the Autonomous Community of Castilla-Leon (Spain). RESEARCH DESIGN AND METHODS: All type 1 diabetic cases with onset at <15 yr of age were recorded during 2003-2004. Identified case subjects were ascertained from several sources and the capture-recapture method was used to estimate the completeness of ascertainment. For prevalence, all patients younger than 15 yr with type 1 diabetes at the beginning and at the end of the study were identified. RESULTS: Over the study period, 130 children aged 0-14 yr were diagnosed with type 1 diabetes. The average observed incidence of type 1 diabetes in this population was 22.22/100 000/yr (95% CI 14.57-29.81). Age-standardized incidence was 22.01/100 000/yr (95% CI 18.18-25.83). The highest incidence was observed in the 5-9 yr age-group (32.45/100 000/yr, 95% CI 24.31-40.59). The prevalence at the beginning and at the end of the study was 1.01/1000 and 1.18/1000, respectively. CONCLUSION: Castilla-Leon appears to have one of the highest incidences of childhood type 1 diabetes in Spain, with recent incidence approaching those of some northern European countries.

Utilidad de los anticuerpos antitransglutaminasa en el diagnóstico de la enfermedad celíaca / Usefulness of anti-transglutaminase antibodies in the diagnosis of celiac disease

Antecedentes: Los anticuerpos antitransglutaminasa tisular IgA (ATGA) se han propuesto como una prueba válida para el diagnóstico y el seguimiento de la enfermedad celíaca. Objetivo: Comparar la eficacia de los ATGA con los distintos anticuerpos clásicamente utilizados en el diagnóstico. Material y método: Se seleccionó a los pacientes sometidos a una biopsia duodenal por sospecha de enfermedad celíaca y a los que simultáneamente se realizó una serología completa en el momento del diagnóstico, en la que se incluyó anticuerpos antiendomisio IgA, ATGA, antigliadina IgG e IgA. Se estableció el valor diagnóstico de cada uno de ellos en función del diagnóstico final, se tomó como patrón la biopsia intestinal. Resultados: Se seleccionó a 122 pacientes con biopsia duodenal y marcadores serológicos para enfermedad celíaca; 36 eran niños (< 14 años) y 86 eran adultos. Se diagnosticó 41 casos, de los que 26 eran niños y 15 adultos. De los 15 adultos solamente 2 (13%) presentaban una clínica de malabsorción típica. La sensibilidad y la especificidad de los ATGA fueron del 100 y el 98%, respectivamente, comparadas con las de los anticuerpos antiendomisio IgA (el 97 y el 98%), de la antigliadina IgA (el 85 y el 97%) y de la antigliadina IgG (el 97 y el 92%). Conclusiones: Los ATGA presentan un elevado rendimiento diagnóstico en la enfermedad celíaca. Pueden ser de utilidad como prueba de cribado para seleccionar a los candidatos a biopsia duodenal

Background: Anti-transglutaminase antibodies have been proposed as a useful tool in the diagnosis and follow-up of celiac disease. Aim: To compare anti-transglutaminase antibodies with the classical antibodies used to diagnose celiac disease. Material and method: Patients who underwent duodenal biopsy for suspected celiac disease were selected if they had the following serum antibody samples: antiendomysial IgA, anti-transglutaminase IgA, antigliadin IgG, and antigliadin IgA. A diagnostic value of each of these antibodies was established according to the final diagnosis, taking the duodenal biopsy as the reference. Results: One hundred twenty-two patients with duodenal biopsy and serologic markers for celiac disease were selected. Thirty-six patients were children (< 14 years-old) and 86 were adults. A diagnosis of celiac disease was made in 41 patients (26 children and 15 adults). Of the 15 adults, only 2 (13%) presented typical malabsorption syndrome. The sensitivity and specificity of anti-transglutaminase antibodies was 100% and 98% respectively compared with values of 97% and 98% for antiendomysial IgA, 85% and 97% for antigliadin IgA, and 97% and 92% for antigliadin IgG antibodies. Conclusions: The diagnostic value of anti-transglutaminase antibodies is high in celiac disease. These antibodies may be useful as a screening test to select candidates for duodenal biopsy

[Usefulness of anti-transglutaminase antibodies in the diagnosis of celiac disease]. / Utilidad de los anticuerpos antitransglutaminasa en el diagnóstico de la enfermedad celíaca.

BACKGROUND: Anti-transglutaminase antibodies have been proposed as a useful tool in the diagnosis and follow-up of celiac disease. AIM: To compare anti-transglutaminase antibodies with the classical antibodies used to diagnose celiac disease. MATERIAL AND METHOD: Patients who underwent duodenal biopsy for suspected celiac disease were selected if they had the following serum antibody samples: antiendomysial IgA, anti-transglutaminase IgA, antigliadin IgG, and antigliadin IgA. A diagnostic value of each of these antibodies was established according to the final diagnosis, taking the duodenal biopsy as the reference. RESULTS: One hundred twenty-two patients with duodenal biopsy and serologic markers for celiac disease were selected. Thirty-six patients were children (< 14 years-old) and 86 were adults. A diagnosis of celiac disease was made in 41 patients (26 children and 15 adults). Of the 15 adults, only 2 (13%) presented typical malabsorption syndrome. The sensitivity and specificity of anti-transglutaminase antibodies was 100% and 98% respectively compared with values of 97% and 98% for antiendomysial IgA, 85% and 97% for antigliadin IgA, and 97% and 92% for antigliadin IgG antibodies. CONCLUSIONS: The diagnostic value of anti-transglutaminase antibodies is high in celiac disease. These antibodies may be useful as a screening test to select candidates for duodenal biopsy.

[Idiopathic perforation of the choledocus in childhood]. / Perforación idiopática de colédoco en la infancia.

The purpose of this report is to describe a seven-years-old patient with an idiopathic perforation of the common bile duct. This disorder is more frequent in the first weeks of life, and the clinical features are not well known. Properly treated, the majority of infants survive without sequelae. Furthermore, a review of the literature is made.