scholarly journals Migraine as a Common Extra-Intestinal Presentation of Celiac Disease

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Maurizio Gabrielli ◽  
◽  
Veronica Ojetti ◽  
Marcello Candelli ◽  
Luca Santarelli ◽  
...  
Keyword(s):  
Celiac Disease ◽  
Current Evidence ◽  
Primary Headaches ◽  
Limited Data ◽  
Number Of Patients ◽  
High Prevalence ◽  
Adults And Children ◽  
Unselected Population ◽  
Larger Sample

Celiac disease (CD) is a common gluten-related enteropathy that presents several extra-intestinal manifestations. Migraine is globally recognized as one of the most diffuse primary headaches. The present paper aims to review the current evidence on the possible association between CD and migraine. Both adults and children having CD exhibit a high prevalence of migraine. However, screening for CD in an unselected population of migraineurs demonstrated contrasting results. Brain imaging may reveal cerebral calcifications and/or white matter abnormalities in a small number of patients having migraine with underlying CD. Limited data are available on the effects of gluten-free diet (GDF) on migraine in the patients affected by CD, suggesting the efficacy of such intervention on the migraine symptoms in both adults and children. Nonetheless, this inference requires verification with high-quality trials conducted with larger sample sizes and longer follow-up periods.

scholarly journals Migraine as a Common Extra-Intestinal Presentation of Celiac Disease

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Maurizio Gabrielli ◽  
◽  
Veronica Ojetti ◽  
Marcello Candelli ◽  
Luca Santarelli ◽  
...  
Keyword(s):  
Celiac Disease ◽  
Current Evidence ◽  
Primary Headaches ◽  
Limited Data ◽  
Number Of Patients ◽  
High Prevalence ◽  
Adults And Children ◽  
Unselected Population ◽  
Larger Sample

Celiac disease (CD) is a common gluten-related enteropathy that presents several extra-intestinal manifestations. Migraine is globally recognized as one of the most diffuse primary headaches. The present paper aims to review the current evidence on the possible association between CD and migraine. Both adults and children having CD exhibit a high prevalence of migraine. However, screening for CD in an unselected population of migraineurs demonstrated contrasting results. Brain imaging may reveal cerebral calcifications and/or white matter abnormalities in a small number of patients having migraine with underlying CD. Limited data are available on the effects of gluten-free diet (GDF) on migraine in the patients affected by CD, suggesting the efficacy of such intervention on the migraine symptoms in both adults and children. Nonetheless, this inference requires verification with high-quality trials conducted with larger sample sizes and longer follow-up periods.

scholarly journals Changes in Age at Diagnosis and Nutritional Course of Celiac Disease in the Last Two Decades

Nutrients ◽  
2020 ◽  
Vol 12 (1) ◽  
pp. 156 ◽  
Author(s):  
Mónica Villanueva ◽  
Amaya Oyarzún ◽  
Bárbara Leyton ◽  
Mónica González ◽  
Elizabeth Navarro ◽  
...  
Keyword(s):  
Celiac Disease ◽  
Nutritional Status ◽  
Gastrointestinal Symptoms ◽  
Failure To Thrive ◽  
Age At Diagnosis ◽  
Pediatric Hospitals ◽  
Geographical Variations ◽  
Number Of Patients ◽  
Antiendomysial Antibodies

The frequency of celiac disease (CD) has increased along time, with relevant changes reported in geographical variations, clinical presentation and nutritional repercussions. In recent years, some celiac patients are presenting overweight/obesity, but it is unclear how frequent this is and to what extent undernutrition remains a concern. This is relevant because CD tends to be overlooked in overweight patients. With this in mind, we assessed age at diagnosis, clinical characteristics and nutritional status of 155 celiac patients diagnosed between 1994–2017 in four pediatric hospitals in Santiago, Chile. Since 2003, the number of patients diagnosed has increased (p < 0.0033), coinciding with antitransglutaminase and antiendomysial antibodies becoming available to public health systems. In 2000, 4.5% of patients were asymptomatic at diagnosis, suggesting that active search is not routinely applied. Gastrointestinal symptoms plus failure to thrive were significantly more frequent under 2 years (p = 0.0001). Nutritional status has improved at diagnosis and during follow up, but undernutrition remains more frequent in children <2 and <5 years (p < 0.002 and p < 0.0036, respectively). Overweight at diagnosis was reported in 2002 and obesity in 2010. After initiating treatment, since 2010, patients changing from undernourishment to overweight has sometimes been observed after only 6 months on a gluten-free diet.

scholarly journals Narrative Review: Nutrient Deficiencies in Adults and Children with Treated and Untreated Celiac Disease

Nutrients ◽  
2020 ◽  
Vol 12 (2) ◽  
pp. 500 ◽  
Author(s):  
Johanna M. Kreutz ◽  
Marlou P. M. Adriaanse ◽  
Elisabeth M. C. van der Ploeg ◽  
Anita C. E. Vreugdenhil
Keyword(s):  
Celiac Disease ◽  
Management Strategies ◽  
Term Treatment ◽  
Nutrient Deficiencies ◽  
Nutrient Supplementation ◽  
Long Term Treatment ◽  
Adults And Children ◽  
Untreated Celiac Disease

Nutrient deficiencies are well recognized as secondary consequences of celiac disease (CD) and closely related to the clinical presentation of affected patients. Despite their clinical significance, consensus is lacking on the pattern and frequency of nutrient deficiencies in CD, the usefulness of their assessment at the time of diagnosis and during follow-up. This review aims to provide an overview of nutrient deficiencies among pediatric and adult CD patients at diagnosis and on a gluten-free diet (GFD), and their potential causes in CD. Secondly, we review their impact on CD management strategies including the potential of nutrient supplementation. A search of Medline, Pubmed and Embase until January 2019 was performed. Despite a high variability between the reported deficiencies, we noted that nutrient deficiencies occur frequently in children and adults with CD at diagnosis and during treatment with a GFD. Both inadequate dietary intake and/or diminished uptake due to intestinal dysfunction contribute to nutrient deficiencies. Most deficiencies can be restored with (long-term) treatment with a GFD and/or supplementation. However, some of them persist while others may become even more prominent during GFD. Our results indicate a lack of comprehensive evidence on the clinical efficacy of nutrient supplementation in CD management highlighting the need for further studies.

Day-case myringoplasty: five years’ experience

2003 ◽  
Vol 117 (10) ◽  
pp. 763-765 ◽  
Author(s):  
A. Karkanevatos ◽  
S. De ◽  
V. R. Srinivasan ◽  
N. J. Roland ◽  
T. H. J. Lesser
Keyword(s):  
Pure Tone Audiometry ◽  
Day Surgery ◽  
Graft Material ◽  
Success Rates ◽  
Day Case ◽  
Readmission Rates ◽  
Overnight Stay ◽  
Number Of Patients ◽  
Adults And Children

A retrospective study of patients who underwent myringoplasty as a day-case procedure in two freestanding day-surgery units during a five-year period was carried out.Their case notes were identified and details including age, site and size of perforation, grade of surgeon, surgical approach, graft material, post-operative dressings, overnight stay, complications, and outcome were noted and analysed.The total number of patients including both children and adults who had myringoplasty as a day case was 144. Of these, 125 patients with 143 procedures were included in this study. Their ages ranged from four to 74 years (mean = 31 years). The perforation size was small in 40 cases, medium in 61 cases, and large/subtotal in 42 cases. The overnight stay rate was 2.7 per cent and this was for immediate post-operative problems such as nausea and bleeding from the wound. The readmission rate for post-operative complications was 2.1 per cent. The follow-up ranged from six months to five years (mean = 19 months). The success rate was 83.3 per cent and thresholds on pure tone audiometry improved in 69.2 per cent of cases. The age of the patient, grade of the surgeon, and graft material did not influence the surgical outcome. There was no case of dead ear as a result of surgery.Myringoplasty can be safely performed in both adults and children as a day-case procedure with low overnight stay and readmission rates. Success rates are comparable to when the procedure is performed on an in-patient basis.

scholarly journals Evaluation and Management of Skeletal Health in Celiac Disease: Position Statement

2012 ◽  
Vol 26 (11) ◽  
pp. 819-829 ◽  
Author(s):  
Mona A Fouda ◽  
Aliya A Khan ◽  
Muhammad Sultan ◽  
Lorena P Rios ◽  
Karen McAssey ◽  
...  
Keyword(s):  
Celiac Disease ◽  
Position Statement ◽  
Current Evidence ◽  
Mineral Density ◽  
High Fracture ◽  
Skeletal Health ◽  
X Ray ◽  
Increased Risk ◽  
One Year

OBJECTIVE: To review the evaluation and management of skeletal health in patients with celiac disease (CD), and to make recommendations on screening, diagnosis, treatment and follow-up of low bone mineral density (BMD) in CD patients.METHODS: A multidisciplinary team developed clinically relevant questions for review. An electronic search of the literature was conducted using the MEDLINE and EMBASE databases from 1996 to 2010. All original studies, reviews and guidelines, both pediatric and adult, were included. A document summarizing the results of the review and proposed recommendations was prepared and underwent multiple revisions until consensus was reached.RESULTS: At diagnosis, approximately one-third of adult CD patients have osteoporosis, one-third have osteopenia and one-third have normal BMD. Children with CD have low bone mass at diagnosis. Adult and pediatric CD patients are at increased risk of fractures.DISCUSSION: For adults, serum calcium, albumin, 25(OH) vitamin D3, parathyroid hormone and 24 h urine calcium testing should be performed at diagnosis; patients with ‘classic’ CD and those at risk for osteoporosis should undergo a dual x-ray absorptiometry scan. An abnormal baseline dual x-ray absorptiometry scan should be repeated one to two years after initiation of a gluten-free diet (GFD). For children, BMD should be assessed one year after diagnosis if GFD adherence is not strict. A GFD is the most important treatment for bone loss. Supplemental antiresorptives may be justified in those who remain at high fracture risk (eg, postmenopausal women, older men) after implementation of a GFD.CONCLUSION: Current evidence does not support the screening of all CD patients for low BMD at diagnosis. Follow-up BMD assessment should be performed one to two years after initiation of a GFD.

A CONTINUED STUDY TO DERTERMINE THE ASSOCIATION BETWEEN CHRONIC KIDNEY DISEASE AND NON-ALCOHALIC FATTY LIVER DISEASE AND ITS EFFECT ON eGFR

2021 ◽  
pp. 133-136
Author(s):  
Arvind Gupta ◽  
Poonam Gupta ◽  
Anubha Srivastava ◽  
Amit Kumar Panday
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Physical Examination ◽  
Sample Size ◽  
Care Center ◽  
Tertiary Care ◽  
Ckd Stage ◽  
High Prevalence ◽  
Larger Sample

Background: The present study was conduct in Motilal Nehru Medical College, Swaroop Rani Nehru Hospital Prayagraj, a tertiary care center and data was collected over a period from January 2019 to April 2020. All 78 patients of CKD attending OPD & IPD of General Medicine and Nephrology, diagnosed by suggestive symptoms and conrmed by physical examination and laboratory investigations were taken , Among the subjects, those having NAFLD were grouped as cases. Patients of Chronic Kidney disease not having NAFLD were grouped as controls. Aim & Objective: To study the prevalence of NAFLD in patients of CKD and establish the association between NAFLD and CKD by studying the effect of NAFLD on eGFR. Methodology: This was a 16 month case control study. Total 78 patients with age 18-65 years , Either sex with Chronic kidney disease diagnosed by USG, KFT, physical examination and having NAFLD Patients with known diagnosis of metabolic syndrome, diabetes and/or hypothyroidism. Those on hepatotoxic medication (amiodarone, barbiturates, glucocorticoids, etc.). The data so collected was entered into computer using Microsoft Excel 2013 software and was subjected to statistical analysis. Result : The ndings of present study thus reafrm the observations of previous studies that highlight a high prevalence of NAFLD in CKD patients and link it to the deranged metabolic factors. In present study we could not found a convincing evidence supporting a relationship between NAFLD and its severity with progression of CKD, probably owing to three major factors – rst, owing to Discussion 71 limitation of study population in only CKD stage 3 and secondly, owing to absence of retrospective data tracing the time of development of NAFLD in these patients and thirdly, inability to carry out long-time follow-up of patients. In present study, though minor changes in eGFR values in patients were seen, however, during the limited period of follow-up no shift from Stage 3 to other stages of CKD was observed. All the patients were regular in follow-up and had a good medical compliance and in general did not show a phenomenal deterioration in renal function within the short span of study. Keeping in view these limitations, further studies are recommended on a larger sample size with inclusion of patients from different stages of CKD spanning over a longer duration of follow-up to see whether NAFLD presence and its severity has a relationship with long-term progression of CKD. Conclusion: The present study showed that, CKD patients had a high prevalence of NAFLD. The ndings also show that FIB-4 scores are useful noninvasive methods for detection of NAFLD in CKD patients. The ndings showed a possible signicant association between NAFLD and lower eGFR rates. One of the limitations of the present study was presence of only Stage 3 CKD patients, owing to which the linear correlations between eGFR and NAFLD severity could not be assessed properly. Further studies on larger sample size with inclusion of patients with other CKD stages too are recommended.

scholarly journals Celiac Disease: Are Endomysial Antibody Test Results Being Used Appropriately?

2007 ◽  
Vol 53 (10) ◽  
pp. 1775-1781 ◽  
Author(s):  
Kelly E McGowan ◽  
Martha E Lyon ◽  
Steven D Loken ◽  
J Decker Butzner
Keyword(s):  
Celiac Disease ◽  
Antibody Test ◽  
Gluten Free Diet ◽  
Intestinal Biopsy ◽  
Gluten Free ◽  
Test Results ◽  
Male And Female ◽  
Serum Iga ◽  
Number Of Patients

Abstract Background: The aim of this study was to retrospectively examine how positive IgA-endomysial antibody (EMA) test results for celiac disease were being interpreted and acted on by physicians in the Calgary Health Region. Methods: We reviewed consecutive EMA test results, with or without a serum IgA, obtained during a 17-month period. Seropositive tests were cross-referenced to the surgical database to determine the number of patients who underwent intestinal biopsy and the results of the biopsy. We sent questionnaires to the ordering physicians of positive tests with no record of intestinal biopsy. Results: Among 11 716 EMA tests in 9533 patients, 349 results were positive in 313 patients (3%). Intestinal biopsies were performed in 218 (70%) of the seropositive patients; 194 of them were diagnostic of celiac disease. Celiac disease was also found in 10 EMA-negative patients. Of the 109 positive tests performed in 95 patients with no subsequent biopsy, 28 had appropriate indications to not perform a biopsy; the most common reason being that the test had been ordered to follow up on a previous biopsy-proven diagnosis of celiac disease (n = 21). For 33 other positive test results without a subsequent biopsy, management appeared to be inappropriate, most commonly (n = 21) because of a recommendation to follow a gluten-free diet despite lack of a tissue diagnosis of celiac disease. For the remaining 48 positive EMA results, administrative issues prevented evaluation (n = 19), the patients refused further evaluation (n = 11), or physician surveys were not returned (n = 18). Conclusions: Celiac disease affected 2% of patients, with a similar prevalence in male and female patients. Most positive EMA tests (77%) were appropriately managed by physicians. Beginning a gluten-free diet without biopsy or failing to follow up on a positive EMA test remain common errors of management.

scholarly journals Management of Cancer Patients during Coronavirus Disease 2019 Pandemic: A Literature Review

2020 ◽  
Vol 14 (2) ◽  
pp. 69
Author(s):  
Andree Kurniawan ◽  
Nata Pratama Hardjo Lugito ◽  
Bernard Agung Baskoro ◽  
Devina Adella Halim
Keyword(s):  
Cancer Patients ◽  
Radiation Treatment ◽  
Elective Surgery ◽  
Case Reports ◽  
Current Evidence ◽  
Limited Data ◽  
Letters To The Editor ◽  
All Cause Mortality ◽  
Cancer Specific Mortality

Introduction: The number of confirmed cases of Coronavirus Disease 2019 (COVID-19) in the world has been increasing significantly since December 2019. Cancer patients are one of the vulnerable populations to become severe cases of COVID-19 or death when they are contacted with COVID-19. A treatment delay is associated with higher breast cancer-specific mortality and all-cause mortality. However, there is still limited data about how to manage cancer patients in this pandemic of COVID-19. This study aims to appraise the current evidence about the management of cancer patients during the COVID-19 pandemic.Method: We searched and found 16 articles evaluating the management of cancer patients during the COVID-19 pandemic by searching in PubMed and EMBASE databases. We only included articles discussing COVID-19 and cancer in adults. There were three observational trials, four review articles, two case reports, six letters to the editor, and one guideline.Results: There were several recommendations regarding patient care in the COVID-19 era. Firstly, outpatient visits, such as follow-up and surveillance of cancer patients, should be postponed. Alternatively, they can do teleconsultation, and their drugs will be delivered to their homes. Stratification and screening for the risk of COVID-19 infection should be done to those who needed urgent or emergency surgery. Otherwise, elective surgery should be postponed. However, several cases can be proceeded after discussion in the Multidisciplinary Team (MDT). Adjuvant and palliative chemotherapy should also be done as scheduled after discussing in MDT. Patients with ongoing radiation treatment should be continued as daily scheduled. Meanwhile, new patients should be carefully evaluated, and those with stable cancer can be postponed for treatment Conclusions: There is still scarce evidence related to the management of cancer patients during the COVID-19 pandemic. Further studies, in terms of stratification, risk, and management of cancer patients during the pandemic, need to be done to get better evidence on it.

scholarly journals Tratamiento ambulatorio de la diverticulitis aguda no complicada

2020 ◽  
Vol 50 (4) ◽  
Author(s):  
Ana Sánchez Gollarte ◽  
Ricardo Alvarado Hurtado ◽  
Cristina Vera Mansilla ◽  
Fernando Mendoza Moreno ◽  
Manuel Díez Alonso ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Antibiotic Therapy ◽  
Diverticular Disease ◽  
Outpatient Treatment ◽  
Acute Diverticulitis ◽  
Treatment Protocol ◽  
Major Complication ◽  
Current Evidence ◽  
Number Of Patients

Introduction. Acute diverticulitis is a major complication of diverticular disease. Antibiotic therapy has classically been considered the mainstay of treatment for these patients. The aim of this study is to present the results of the outpatient treatment protocol for mild acute diverticulitis in our centre, assess its results and understand if it is needed to modify said protocol based on the current evidence. Material and methods. Retrospective analysis of the patients included in the outpatient treatment protocol for uncomplicated acute diverticulitis in our centre in the period between the 1st of January and the 31 of December of 2018. The presence of complications in the same episode, the need for admission and recurrence rate until December 2019. Finally, the reports of the colonoscopies performed after the resolution of the process and the need or not for surgical treatment were studied. Results. A total of 64 patients were included in the outpatient protocol, representing 68% of the total of diverticulitis treated. During follow-up 6 patients required admission (9.3%) in the following days. Of the total number of patients studied, 5 (7.8%) presented recurrence throughout the years 2018-2019, only one of them was a severe recurrence and required surgical treatment. The data from our study indicate that the outpatient treatment of mild acute diverticulitis in our setting is safe with the current protocol, since 90.7% were treated successfully.

scholarly journals Late arrhythmia recurrence after atrial fibrillation ablation: incidence, mechanisms and clinical implications

2022 ◽  
Author(s):  
Nico Erhard ◽  
Andreas Metzner ◽  
Thomas Fink
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Veins ◽  
Treatment Strategies ◽  
Current Evidence ◽  
Cryoballoon Ablation ◽  
Number Of Patients ◽  
Long Term Follow Up ◽  
Time Point

Abstract Background and objectives Catheter ablation of atrial fibrillation (AF) has become a well-established and widely used therapy, with pulmonary vein isolation (PVI) being the key modality of ablation. However, arrhythmia recurrences after PVI are common, with a relevant number of patients undergoing repeat ablation. Arrhythmia recurrence after PVI may vary regarding time point and mode of recurrence. While early arrhythmia recurrences of AF after PVI are mostly found to be the product of electrical reconnection of the pulmonary veins, the exact mechanisms of very late arrhythmia recurrence, occurring later than 12 months after successful PVI, remain unclear. This review provides an overview on the current evidence on time point and mechanisms of arrhythmia recurrence after PVI focussing on late arrhythmia recurrence. Recent findings The incidence of late arrhythmia recurrence after PVI can lie at a rate of up to 30% according to long-term follow-up studies. Mechanisms of recurrence include electrical reconnection of previously isolated pulmonary veins and development of atrial fibrosis. The use of cryoballoon ablation is likely to be more effective in reducing late arrhythmia recurrences compared to radiofrequency ablation. Novel scores such as the MB-LATER score or the APPLE score may become useful tools in predicting arrhythmia recurrence after PVI. Results and conclusion Late arrhythmia recurrence after PVI is common and leads to a relevant impairment of long-term success. Relevant data are currently limited and exact mechanisms of arrhythmia recurrence remain unclear. Further studies are needed to elucidate pathogenetic mechanisms of late arrhythmia recurrence after PVI in order to improve treatment strategies.

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