Current ESPGHAN guidelines for celiac disease in pediatric age, tertiary care center experience: a proposal for further simplification

According to the 2012 ESPGHAN criteria for diagnosis of celiac disease (CD), duodenal biopsy (DB) can be avoided in children with a clear malabsorption syndrome, anti-tissue transglutaminase IgA (tTG2) ≥ 10x the cut-off, anti-endomysium IgA (EMA) and HLA DQ2/DQ8 genes. The aim of this study is to report our experience and evaluate the accuracy of the actual guidelines. Patients and methods: This is a retrospective study conducted on all patients diagnosed CD from 2012 to 2018 in our Center. For all patients enrolled were analyzed: data of family history, symptoms, serology, genetics, Marsh grade and follow-up. Results: A total of 481 children [mean age 6,4 yrs; F:M= 1.8:1] were included in the study. The mean age of patients who were not subject to DB was lower (4.51 yrs) comparing with patients that received DB (6.48 yrs). Out of the 256 patients with anti-tTG2 ≥ 10 fold, 121 underwent DB because of mild symptoms (84/121) or no symptoms (37/121). In all cases Marsh type 3 was found and HLA haplotypes was compatible with CD diagnosis. Conclusions: Our study confirms that the serology has a primary importance to diagnose CD, regardless of the symptoms. These data suggest that biopsy and HLA haplotypes search, in presence of anti-tTG2 IgA ≥ 10x the cut-off, are wasteful and unhelpful for the patients

Chemical Treatment Fosters Zero Discharge by Making Cooling Water Reusable

Over the past decade, the water requirements for cooling industrial manufacturing processes have changed dramatically. Once-through cooling has been largely replaced by open recirculating cooling water methods. This approach reduces water consumption by increasing the use of recycled water. Simplistically, the circulating cooling water flows through heat exchanger equipment and is cooled by passing through a cooling tower. The recycled water is cooled by evaporation of some of the circulating water as it passes through the tower. As a result of the evaporation process, the dissolved solids in the water become concentrated. The evaporated water is replaced by fresh makeup water. The dissolved solids content of the water is maintained by the rate of water discharge (blowdown). As the amount of dissolved solids increases, their solubility is exceeded and the solids tend to precipitate from the cooling water. The precipitated scale adheres to heat transfer surfaces and reduces heat transfer efficiency. In order to achieve zero discharge of water, it is paramount that the potential for scale formation and deposition be minimized. This can be accomplished through physical separation of scale-forming ions and particulate matter. Two widely used mechanical methods in this category are lime-soda side stream softening and vapor compression blowdown evaporation. Another approach is chemical treatment to promote scale inhibition and dispersion