Clinical manifestations and associated disorders in children with celiac disease in southern Iran

Background

Celiac disease (CD) is an immune mediated inflammatory enteropathy, triggered by gluten exposure in HLA-DQ2 and/or –DQ8 genetics. The presentation of celiac disease in children is changing, with increase in non-classical symptoms. We aim to evaluate the clinical presentations of celiac disease amongst children, diagnosed with CD.

Methods

In this cross sectional study, we investigated the clinical features of 130 celiac patients at hospitals affiliated with Shiraz University of Medical Sciences. We used their hospital charts and conducted an interview with patients and their parents to find out demographic data, symptoms, laboratory, and histopathology findings for Marsh grading.

Results

Celiac disease was detected more amongst females (63.8%). We found that 5.4% of the patients had BMI more than 95th percentile. The most common GI symptoms were abdominal pain, flatulence and constipation. Also, the most common extra intestinal manifestation included bone pain, long term fatigue and anemia. Flatulence, chronic diarrhea, and paresthesia were observed more amongst male participants. The most common comorbidities were type 1 diabetes mellitus and hypothyroidism.

Conclusion

The most common gastrointestinal symptoms amongst our patients were abdominal pain, flatulence and constipation. Furthermore, the most common extra intestinal manifestations included bone pain, long term fatigue and anemia. The most associated comorbidities with CD in our children were type 1 diabetes mellitus and hypothyroidism.

Prevalence of the CYP2C19*2 (681 G>A), *3 (636 G>A) and *17 (‑806 C>T) alleles among an Iranian population of different ethnicities

Polymorphisms in the cytochrome P (CYP) 450 family may cause adverse drug responses in individuals. Cytochrome P450 2C19 (CYP2C19) is a member of the CYP family, where the presence of the 681 G>A, 636 G>A and 806 C>T polymorphisms result in the CYP2C19*2, CYP2C19*3 and CYP2C19*17 alleles, respectively. In the current study, the frequency of the CYP2C19*2, CYP2C19*3 and CYP2C19*17 alleles in an Iranian population cohort of different ethnicities were examined and then compared with previously published frequencies within other populations. Allelic and genotypic frequencies of the CYP2C19 alleles (*2, *3 and *17) were detected using polymerase chain reaction (PCR)-restriction fragment length polymorphism analysis, PCR-single-strand conformation polymorphism analysis and DNA sequencing from blood samples of 1,229 unrelated healthy individuals from different ethnicities within the Iranian population. The CYP2C19 allele frequencies among the Iranian population were 21.4, 1.7, and 27.1% for the CYP2C19*2, CYP2C19*3 and CYP2C19*17 alleles, respectively. The frequency of the homozygous A/A variant of the CYP2C19*2 allele was significantly high and low in the Lur (P<0.001) and Caspian (P<0.001) ethnicities, respectively. However, the frequency of the homozygous A/A variant of the CYP2C19*3 allele was not detected in the Iranian cohort in the current study. The frequency of the heterozygous G/A variant of the CYP2C19*3 allele had the significantly highest and lowest frequency in the Fars (P<0.001) and Lur (P<0.001) groups, respectively. The allele frequency of the homozygous T/T variant of the CYP2C19*17 allele was significantly high in the Caspian (P<0.001) and low in the Kurd (P<0.05) groups. The frequency of the CYP2C19 alleles involved in drug metabolism, may improve the clinical understanding of the ethnic differences in drug responses, resulting in the advancement of the personalized medicine among the different ethnicities within the Iranian population.

Comparative Analysis of Wavelet-based Feature Extraction for Intramuscular EMG Signal Decomposition

BACKGROUND

Electromyographic (EMG) signal decomposition is the process by which an EMG signal is decomposed into its constituent motor unit potential trains (MUPTs). A major step in EMG decomposition is feature extraction in which each detected motor unit potential (MUP) is represented by a feature vector. As with any other pattern recognition system, feature extraction has a significant impact on the performance of a decomposition system. EMG decomposition has been studied well and several systems were proposed, but feature extraction step has not been investigated in detail.

OBJECTIVE

Several EMG signals were generated using a physiologically-based EMG signal simulation algorithm. For each signal, the firing patterns of motor units (MUs) provided by the simulator were used to extract MUPs of each MU. For feature extraction, different wavelet families including Daubechies (db), Symlets, Coiflets, bi-orthogonal, reverse bi-orthogonal and discrete Meyer were investigated. Moreover, the possibility of reducing the dimensionality of MUP feature vector is explored in this work. The MUPs represented using wavelet-domain features are transformed into a new coordinate system using Principal Component Analysis (PCA). The features were evaluated regarding their capability in discriminating MUPs of individual MUs.

RESULTS

Extensive studies on different mother wavelet functions revealed that db2, coif1, sym5, bior2.2, bior4.4, and rbior2.2 are the best ones in differentiating MUPs of different MUs. The best results were achieved at the 4th detail coefficient. Overall, rbior2.2 outperformed all wavelet functions studied; nevertheless for EMG signals composed of more than 12 MUPTs, syms5 wavelet function is the best function. Applying PCA slightly enhanced the results.

Evaluating the anatomical location of the posterior superior alveolar artery in cone beam computed tomography images

The purpose of this study was to examine the diameter, location, and frequency of the appearance of the posterior superior alveolar artery (PSAA) in preoperative cone beam computed tomography (CBCT) scans. Two hundred and eleven pre-implant CBCT scans were reviewed. The following criteria were considered in all subjects: (1) the location of the artery: intra-sinus or below the membrane (type I), intraosseous (type II), or superficial (type III); (2) the distance between the lower border of the artery and the alveolar crest; (3) the bone height measured from the floor of the sinus to the crest of the ridge; (4) the distance from the lateral wall of the artery to the medial wall of the maxillary sinus; and (5) the diameter of the artery (in millimetres). The distance between the artery and the medial sinus wall, as well as the diameter of the artery, were greater in patients with an alveolar bone height ≤10mm than in those with a bone height >10mm. The distance from the artery to the medial sinus wall and the diameter of the artery were positively correlated with the number of missing teeth. It was also found that the diameter of the PSAA increased with increasing age.