PURPOSE: This study aimed to evaluate a possible association between the anti-tissue transglutaminase antibody (anti-tTG) titer and stage of duodenal mucosal damage and assess a possible cut-off value of anti-tTG at which celiac disease (CD) may be diagnosed in children in conjunction with clinical judgment. METHODS: This observational study was conducted at a gastroenterology clinic in a tertiary hospital from April 2012 to May 2013. Seventy children between 6-months and 18-years-old with suspected CD underwent celiac serology and duodenal biopsy. Statistical analyses were done using SPSS 16. Diagnostic test values were determined for comparing the anti-tTG titer with duodenal biopsy. An analysis of variance and Tukey-Kramer tests were performed for comparing the means between groups. A receiver operating characteristics curve was plotted to determine various cut-off values of anti-tTG. RESULTS: The mean antibody titer increased with severity of Marsh staging (p<0.001). An immunoglobulin (Ig) A-tTG value at 115 AU/mL had 76% sensitivity and 100% specificity with a 100% positive predictive value (PPV) and 17% negative predictive value (NPV) for diagnosis of CD (p<0.001, 95% confidence interval [CI], 0.75–1). CONCLUSION: There is an association between the anti-tTG titer and stage of duodenal mucosal injury in children with CD. An anti-tTG value of 115 AU/mL (6.4 times the upper normal limit) had 76% sensitivity, 100% specificity, with a 100% PPV, and 17% NPV for diagnosing CD (95% CI, 0.75–1). This cut-off may be used in combination with clinical judgment to diagnose CD.
Antibodies ; Biopsy ; Celiac Disease ; Child ; Diagnosis ; Diagnostic Tests, Routine ; Duodenitis ; Gastroenterology ; Humans ; Immunoglobulins ; Judgment ; Observational Study ; ROC Curve ; Sensitivity and Specificity ; Tertiary Care Centers ; Wetlands

Purpose: Attention deficit hyperactivity disorder (ADHD) is among the most prevalent neurodevelopmental disorders in childhood, and its incidence has increased in recent years. However, the frequency of ADHD varies significantly across different countries and regions. This study aimed to determine the prevalence of ADHD among primary school children in Hyderabad, India, as well as to raise awareness about ADHD among teachers. Methods: This descriptive cross-sectional study included 700 school-aged children between 5 and 12 years old, selected according to specific inclusion and exclusion criteria. The teachers' version of the Vanderbilt Assessment Scale, a rating scale grounded in Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnostic criteria, was employed to diagnose ADHD. Results: The prevalence of ADHD in this study was 9.57% (67 out of 700), with a mean age of 8.9 years. ADHD was more prevalent in boys than in girls, with a sex ratio of 3:1. The combined type of ADHD was the most common (52.3%), followed by the attention deficit type (29.8%) and the hyperactive-impulsive type (17.9%). Conclusion The prevalence of ADHD among schoolchildren in middle-income countries, such as India, is sufficiently high to impose a significant societal burden. Therefore, it is imperative that all elementary school teachers receive training on how to screen for indicators of ADHD.