Changing profile of GAD and IA-2 antibody positivity in Indian children with recently diagnosed type 1 diabetes mellitus

Introduction. Published literature on type 1 diabetes (T1DM) patients from India suggests that a substantial number of them are negative to GAD 65 and IA-2 an­tibodies. Antibody positivity rates have been linked to dietary and socio-economic factors and more recently, to changes in the enterobiome. Our anecdotal evidence indicated that antibody positivity rates among newly diagnosed T1DM children were rising. In this presen­tation we have formally collated our data on these antibodies, a first, we believe, in the Indian pediatric population. Material and methods. T1DM was diagnosed by stand­ard clinical criteria advocated by American Diabetes Association including in all patients, the presence of diabetic ketoacidosis (DKA). We used plasma blood glucose rather than A1C to diagnose the acute onset of type 1 diabetes in individuals with symptoms of hy­perglycemia. All patients with this diagnosis had GAD (glutamic acid decarboxylase) and IA-2 (insulinoma antigen 2) antibodies measured as a routine procedure from 2007. Data on patients between the ages of 1 and 16 years as on 31st August 2016 were collected for this study. The antibodies were measured by standard RIA kits from the same manufacturer and performed in the endocrinology laboratory of one of the institutions. Results. We included 694 T1DM cases from 2007 till 2016, out of which 296 were antibody positive. A total of 172 were GAD antibody positive, 62 were IA-2 anti­body positive and 90 exhibited dual antibody positivity (GAD positive + IA-2 positive). The chi-square test for trend analysis showed a significant rising trend for IA-2 antibody alone positive (p < 0.001, chi-square for trend = 17.437, df = 1) and either antibody positive percentages (p < 0.001, chi-square for trend = 22.71, df = 1), but not in the GAD antibody positivity (p = 0.059, chi-square for trend = 3.567, df = 1) and in dual antibody positive percentages (p = 0.486, chi-square for trend = 0.485, df = 1) over a period of 9 years i.e. from 2007 to 2016. Conclusion. Antibody positivity rates in recently di­agnosed T1DM children have changed fairly rapidly over the last nine years. This surge in autoimmunity may also be a significant contributing factor towards the recent increased incidence of T1DM in India

Incidence and treatment of splanchnic vein thrombosis in patients with acute pancreatitis: A systematic review and meta‐analysis

Background and AimThis meta-analysis aimed to estimate the incidence of splanchnic vein thrombosis (SVT) in patients with acute pancreatitis and assess the effects of therapeutic anticoagulation.MethodsSystematic searches of the Medline, Embase, and Cochrane databases were undertaken to identify studies reporting the incidence and outcomes associated with SVT in patients with acute pancreatitis. The pooled incidence, odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a random effects model. PROSPERO database registration no. CRD 42021230912.ResultsOnly 18 of the 238 studies identified met the inclusion criteria. Of the 943 patients who had SVT, 264 (28.0%) received anticoagulation. The pooled incidence of SVT at first presentation of acute pancreatitis was 15% (95% CI 5 to 26%), but was 17% (95% CI 14 to 20%) in all studies. Recanalization was more likely to occur in the anticoagulation-treated than in the untreated group (OR 0.51, 95% CI 0.31 to 0.83, P = 0.007). There were no differences in hemorrhagic complications (OR 2.27, 95% CI 0.81 to 6.37, P = 0.12) or overall mortality (OR 2.37, 95% CI 0.86 to 6.52, P = 0.10) in relation to the use of anticoagulation. The overall incidence of portal hypertension in patients was 60% (95% CI 55 to 65%). However, it was not possible to determine the incidence in each group.ConclusionsThe incidence of SVT in patients with acute pancreatitis is significant. Treatment with anticoagulants improved the odds of recanalization but did not increase the risk of hemorrhagic complications or overall mortality