The relationship between tissue transglutaminase IgA antibodies and the clinical manifestations in a group of children, adolescent and adult patients with type -I diabetes mellitus

Background: Type-1 diabetes mellitus (T1-DM) is the commonest endocrine-metabolic disease in childhood. The prevalence of CD in type-1 DM ranges from 0.6 to 16.4% compared with 0.01–0.03% in the general population. The mechanism of association between the two diseases involves a shared genetic background of HLA genotype. Serum tissue transglutaminase IgA antibodies (tTG IgA) are considered specific and sensitive markers for screening of Celiac disease in more than 95 % of patients.Objective: Screening for the presence of serum tissue transglutaminase IgA antibodies (tTG ab) as a specific and sensitive biochemical marker for Celiac disease in patients with type-1DM and its relation to the clinical manifestations of those patients.Methods: One hundred-forty-nine patients with type-1 DM attending the out-patient clinic of endocrine and metabolism, Minia University Hospital were screened for the presence of serum tissue transglutaminase IgA antibodies during the period from March 2014 to November 2015.Results: Out of 149 patients 8 patients (5.3%) were positive for IgA tTG antibodies. They who were predominantly of female gender (75% were females). According to each age group, there were four sero-positive cases in children (with age group between 9 and ≤ 12 years); two cases in adolescents (with age group between 12 and ≤ 16 years) and two cases in adults (with age group 16-21 years). Intestinal manifestations, chronic diarrhea, recurrent abdominal pain/ distension, recurrent aphtha's stomatitis, anemia and bleeding tendency were significantly more common in sero-positive cases (P=0.001, 0.001, 0.016, 0.00, 0.001and 0.04 respectively). All sero-positive cases (100%) had lower BMIs than normal. There were no correlations between the tTG antibodies levels and HbA1c levels.Conclusions: The presence of tTG IgA antibodies is associated with significant changes in the clinical status of patient with type-1 DM. Celiac disease related manifestations like weight loss; anemia and chronic diarrhea were more common in sero-positive diabetic patients. Serological screening for CD should be performed in all patients with type-1DM for early diagnosis and prevention of complications.Keywords: Type-1 DM, tissue transglutaminase, IgA antibodie

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially