Étude de l’auto-immunité chez des patients tunisiens adultes atteints de maladie cœliaque : résultats d’une étude prospective comparative

Aim

To determine the frequency of autoantibodies in patients with celiac disease and identify factors associated with the higher prevalence of autoimmunity in these patients.

Materials and methods

We conducted a prospective study involving 50 adult patients with celiac disease and 50 healthy controls. We systematically searched for the presence of the following autoantibodies: antinuclear, anti-smooth muscle, anti-keratin, anti-islet-cell, anti-DNA, rheumatoid factor, thyroid peroxydase, thyroglobulin and glutamate decarboxylase.

Results

At least one autoantibody was detected in 88% of the patients and 54% of controls (p = 0.0001). In patients with celiac disease, we found a higher prevalence of the following antibodies: antinuclear (44 vs 16%; p = 0.002), anti-ENA (22 vs 2%; p = 0.01), rheumatoid factor (42 vs 15%; p = 0.008) and anti-islet-cell (12 vs 0%; p = 0.01). Factors associated with the presence of anti-thyroid antibodies were older age (37.3 ± 5.7 vs 30.3 ± 9.3 years; p = 0.005) and the lack of IgA anti-gliadin antibodies (37 vs 76%; p = 0.04). Factors associated with the presence of islet-cell antibodies were younger age (22.5 ± 5.7 vs 30.3 ± 9.3 years; p = 0.005) and male gender (67 vs 14%; p = 0.01).

Conclusion

Autoimmunity is frequent in celiac disease. Autoantibodies should be useful in screening for several autoimmune diseases, particularly thyroid disorders and diabetes.     

Association entre les performances cliniques des étudiants et leur réussite aux Épreuves classantes nationales informatisées : une étude de cohorte rétrospective monocentrique

IntroductionBefore attending residency, 6th-year French medical students must validate a final examination including a practical clinical test in their faculty. However, the national ranking that determines their future specialty and region solely relies on a computerized knowledge test. Our goal was to investigate the association between the final faculty test and the national ranking test.MethodsIn our faculty, the final examination includes a computerized theoretical test (similar to the national one) and a practical test: a standardized evaluation of semiology skills at the bedside and a standardized assessment of relational skills with role plays. The agreements between the national test and faculty computerized and practical tests were analyzed by intraclass correlation coefficients (ICC).ResultsData from 1806 students who underwent the three examinations from 2017 to 2021 were analyzed. There was a good agreement between the ranks in the faculty and national computerized tests: ICC 0.83 (95% CI 0.81–0.85). By contrast, the agreement between the ranks in the faculty practical test and the national computerized test was poor: ICC 0.13 (95% CI 0.08–0.17). Results were stable over the years.ConclusionThe agreement between the ranking of the current national test and the clinical skills assessed by a specific faculty test is poor. This could relate to a true independence or to different levels of motivation to perform well. Indeed, the result of the national test is the most important one as it determines their career. Incorporating a clinical assessment into the national ranking test will motivate students to acquire clinical skills and value those who perform well this practical dimension.     

Étude de la corrélation entre la sensibilité à l’insuline et les paramètres anthropométriques et métaboliques dans le diabète de type 2

AimThe aim of the study was to evaluate correlations between insulin sensitivity and insulinosecretion with anthropometric and metabolic parameters in type 2 diabetics.Materials and methodsWe conducted a cross-sectional study among patients with type 2 diabetes mellitus treated with oral antidiabetic medications. The evaluation of insulin resistance and insulinosecretion was based on the calculation of the HOMA-IR and HOMA-β indices.ResultsThe mean age for the 100 diabetes recruited was 56.4 ± 8.4 years. The mean body mass index (BMI) and waist circumference (WC) were 30.5 ± 5.7 kg/m² and 101.2 ± 11.9 cm respectively. The HOMA-IR and HOMA β indices were respectively 3.5 ± 2.8 and 48.9 ± 45.5. We have found a significantly positive correlation between HOMA-IR index and weight (r = 0.406, p < 10⁻³), BMI (r = 0.432, p < 10⁻³) and WC (r  =  0.412, p < 10⁻³). We noticed a significant negative correlation between HOMA β index and fasting glucose (r = −0.457, p < 10⁻³) and A1 C (r = −0.399, p < 10⁻³). A positive statistically significant correlation was noted between HOMA-IR and HOMA-β (r = 0.400, p < 10⁻³).ConclusionInsulin resistance is very related to overweight, especially the android distribution of fat hence the need for adequate management of this android obesity. It would also be interesting to evaluate the effects of weight loss on insulin resistance parameters.