Celiac disease in Middle Eastern and North African countries:A new burden?

Celiac disease(CD) is now recognized as a common disorder among Middle Eastern(ME) and North African(NA) populations.The aim of this review is to assess the available data regarding CD in the ME and NA and to compare this information with that of Western countries.A literature review was performed using the electronic databases PubMed and Medline(1950-2008) as search engines,and "celiac disease" was used as a Mesh term.The search was limited to ME and NA countries.The prevalence of CD in ME and NA countries among low risk populations is similar to that of Western countries,but is higher in high risk populations such as those with type 1 diabetes.It is underestimated because of lack of clinical suspicion and lack of patient awareness.Clinical presentations in term of gastrointestinal,hematologic,skeletal,and liver manifestations are similar between both populations except for a high prevalence of short stature in some ME and NA countries.Few studies have addressed atypical or silent CD.As in the West,diagnosis is initially made by serological tests and is confirmed by small intestinal biopsies.Gluten-free diet is the main mode of treatment with a higher apparent adherence rate than in the West.Most disease complications result from malabsorption.The disease is strongly associated with HLA DQ2 and to a lesser extent with HLA DQ8 alleles.In conclusion,CD prevalence is underestimated,with little data available about its malignant complications.Disease parameters in the ME and NA are otherwise similar to those in Western countries.

Predictors of survival among 60 patients with tissue proven primary cardiac amyloidosis

Background: Cardiovascular involvement among patients with primary systemic amyloidosis (AL) is common and predicts poor prognosis. Different parameters have been used to predict outcome. We studied the prognostic significance of clinical, ECG and echocardiographic parameters of 60 patients with tissue proven primary cardiac amyloidosis. Method and Results: Records of 60 patients with primary amyloidosis and cardiac involvement documented by endomyocardial tissue biopsy were retrospectively evaluated. Patients mean age was 57.9 ± 10.2 years. 71.6% were male and 86.6% Caucasian. Patients’ median survival was 12.2 ± 4.4 months with only 50% of patients survived for more than 1 year. 60% of patients had CHF (NYHA II-IV). CHF (NYHA II-IV), IVS, LVPW and LVEF were significant on univariate survival analysis