Can High Titres of Anti Tissue Transglutaminase Antibodies Reduce the Need for Intestinal Biopsy for Diagnosis of Celiac Disease?

Traditionally small intestinal biopsy has been considered a gold standard for the diagnosis of celiac disease (CD). But now data has shown that serological markers like anti-tissue-transglutaminase antibodies (tTGA) can be used to make the diagnosis with great sensitivity and specificity. The objective of the present study was to evaluate whether patients with high probability of CD and high titre of tTGA, have a high probability of intestinal damage and may not require biopsy for final diagnosis. All the cases with tTGA levels ≥15 IU/ml and who subsequently underwent biopsy from July 2010 to June 2013 were selected. Histopathological findings graded as per Marsh classification were correlated with serum tTGA levels. Grade 3 lesions were considered diagnostic for the disease. Out of total 731 patients 470 had serum tTGA levels >100 IU/ml and 261 patients had <100 IU/ml. Highest levels of tTGA (219.3 IU/ml) were seen in grade 3c which was >12 times the normal cutoff value. Mean serum tTGA in higher histological grade i.e. 3 (3a, 3b, 3c) was 186.7 IU/ml (>12 times the normal cut off value) as compared to grade 1 which was 108.9 IU/ml (>7 times the normal cut off value). Using a tTGA cutoff value of 70 IU/ml, sensitivity was found to be 83.9% while specificity was 56.10% with an overall accuracy of 77.7%. This study confirms that a small intestinal biopsy is not always necessary for the diagnosis of CD in symptomatic patients with high tTGA levels (>70 IU/ml).     

Are hsCRP Levels and LDL/HDL Ratio Better and Early Markers to Unmask Onset of Dyslipidemia and Inflammation in Asymptomatic Subclinical Hypothyroidism?

The implications of subclinical hypothyroidism (SCH) are many amongst which the most important is progression to overt hypothyroidism. Other debatable aspects are its association with cardiovascular risk, neuromuscular and psychiatric dysfunction, increased predisposition to developing metabolic syndrome and an underlying pro-inflammatory state. We aimed to study the lipid profile, lipoprotein(a) [Lp(a)] and hsCRP levels and insulin resistance in a group of patients with SCH in a referral hospital and see if any significant differences exist between them and euthyroids. This is a case–control study where the selection of controls and cases was based on the thyroid profile. Subjects were selected on their visit to clinical biochemistry lab for thyroid function tests. 33 euthyroids were taken as controls (Group I) and 38 patients comprising of subclinical hypothyroids were grouped as cases (Group II). Serum thyroid stimulating hormone (TSH) was in the range of 0.5–5.0 mIU/L for euthyroids and for subclinical hypothyroids the concentration of TSH was more than 5 mIU/L. The concentration of tri-iodothyronine (T₃) and thyroxine (T₄) were in normal reference range in both the groups. Individual lipid profile parameters failed to show a significant p value between cases and controls. The LDL/HDL ratio was highly significant (p value < 0.0001) and hsCRP was also statistically between the two groups (p value = 0.0054). Lp(a) and insulin resistance did not differ significantly. SCH is a common disorder that frequently progresses to overt hypothyroidism. This study underlines the importance of LDL/HDL ratio rather than measurement of individual lipid profile parameters in bringing to light the dyslipidemic state associated with SCH. Moreover the use of hsCRP to detect an underlying pro-inflammatory state in SCH can also be emphasized.     

Acid base status in chronic obstructive pulmonary disease patients

348 patients of chronic obstructive pulmonary diseases (COPD) were studied for their acid base profile using ABL-3 blood gas analyser (Radiometer, copenhagan). 185 patients (53.1%) had simple disorders (respiratory acidosis—53%, respiratory alkalosis—25.4%, metabolic acidosis—11.3%, metabolic alkalosis—10.2%). Mixed disorders were present in 131 patients (34.9%) (respiratory acidosis and metabolic acidosis—75.2%, respiratory acidosis and metabolic acidosis—14%, metabolic acidosis and metabolic alkalosis—5.7%, metabolic alkalosis and respiratory alkalosis—4.9%). Hypoxemia without other acid base abnormalities was observed in early patients of GOPD (42 patients—12%). Chronic respiratory acidosis was the most common finding in advanced cases of COPD (98%). An almost equal number of such patients had a mixed disorder of respiratory acidosis with metabolic alkalosis (91%). Salt restriction, prolonged use of steriods and hypokalemia were often related to metabolic alkalosis in such patients.     

Unequal opportunities in accessing employability-related programmes: South Asian graduates' experiences in Australia

Limited scholarly work has been conducted on obtaining equal opportunities to participate in employability-related programmes by international students while studying in Australia. Drawing on a qualitative study, 20 South Asian postgraduates were interviewed to explore their experiences in accessing employability-related programmes. Based on the findings, South Asian graduates have experienced unequal opportunities in accessing employability-related programmes as postgraduate international students in Australia. They are disadvantaged by generic career advice and resume assistance offered by their university career office, and companies invited to university career fairs offer internships, placements or graduate programme opportunities mostly to domestic students. As a result, South Asian graduates were unable to gain employment in their field of studies. South Asian graduates have also offered several useful recommendations to facilitate more equal chances of developing employability and thereby gaining successful employment in Australia. These include partnerships with companies in providing employment opportunities, diversification of university career office roles, and establishing connections with alumni. The paper also discusses implications for Australian higher education institutions and higher education policy and practice in Australia.     

Incidence of microalbuminuria in hypertensive patients

The prevalence of microalbuminuria was assessed in 174 albustix negative hypertensive patients by estimating albumin in the morning random urine samples by immunoturbidimetric method within four hours of voiding of urine. The urine samples were not stored and collected without any preservatives. The urinary albumin was calculated in terms of ratio with respect to urinary creatinine and expressed as albumin creatinine ratio (mg/g). Out of 174 albustix negative hypertensives, 58 (33.3%) patients were found to have microalbuminuria. The prevalence of microalbuminuria in males and females was found to be 34% and 30.7% respectively. No correlation was found between the Body Mass Index (BMI) and albumin excretion (r² = 0.0271) and between duration of hypertension and urinary albumin excretion (r² = 0.0042). Prevalence of microalbuminuria in nonsmokers and non-alcoholic hypertensives was 20%. The prevalence in alcoholics, smokers and both smokers and alcoholics was found to be 35%, 42% and 41% respectively. The high prevalence of microalbuminuria than the various reported studies on the subject demands establishment of a screening programme for microalbuminuria, implementation of specific intervention methods and education of hypertensive patients about the consequences of smoking and alcohol on possible involvement of renal system.     

Factors associated with staff perceptions towards inclusive education in Singapore

In this study, we sought to examine the perceptions of teachers and other school professionals towards the inclusion of secondary school students with special educational needs (SEN), and the associated factors. The Sentiments, Attitudes and Concerns about Inclusive Education Revised scale (SACIE-R) was completed by 131 teachers and school professionals from two mainstream secondary schools in Singapore. The findings revealed an overall neutral attitude towards inclusion. Together, confidence in teaching students with SEN, the level of training SEN support, as well as experience teaching students with SEN account for a large proportion of the variance in ratings of inclusive perceptions. Further analyses revealed that confidence in teaching or supporting students with SEN was found to be a significant predictor of inclusive perceptions. The findings suggest that schools seeking to engage in inclusive practices should focus on ways to develop the confidence of personnel to support students with SEN. Professional development and mentorship were suggested as possible avenues.     

Inclusive assessment for linguistically diverse learners in higher education

As classrooms become increasingly diverse in higher education, educators are emphasising inclusive practices in teaching and learning to accommodate the needs of diverse learners. There is also an emerging need for an inclusive approach in assessment for accessibility, opportunity, relevance and engagement. This study, using design-based research guidelines with student–faculty partnership, designed, developed, implemented and evaluated contextually sensitive assessment protocol as inclusive and fair assessment. Data from students’ reflections and face-to-face interviews with open-ended questions suggested that, despite concerns such as potential bias, time and accommodation challenges, such assessment practices can make valuable contributions in creating a positive learning environment, improving relatedness and self-esteem and motivating and engaging students for better effort and effective learning. Implications for higher education practitioners with diverse learners are discussed.     

Demonstration of a new biosensing concept for immunodiagnostic applications based on change in surface conductance of antibodies after biomolecular interactions

We report an important observation that the surface conductivity of antibody layer immobilized on polylysine-coated glass substrate decreases upon the formation of complex with their specific antigens. This change in conductivity has been observed for both monoclonal and polyclonal antibodies. The conductance of monoclonal mouse IgG immobilized on polylysine-coated glass substrate changed from 1.02×10⁻⁸ Ω⁻¹ to 1.41×10⁻¹¹ Ω⁻¹ at 10 V when complex is formed due to the specific biomolecular interactions with rabbit anti-mouse IgG F(ab′)₂. Similar behavior was observed when the same set up was tested in two clinical assays: (1) anti-Leishmania antigen polyclonal antibodies taken from Kala Azar positive patient serum interacting with Leishmania promastigote antigen, and (2) anti-p21 polyclonal antibodies interacting with p21 antigen. The proposed concept can represent a new immunodiagnostic technique and may have wide ranging applications in biosensors and nanobiotechnology too.     

Academics' attitudes towards use of electronic journals: A case study of Punjab and Chandigarh

The article examines academics attitude towards e-journal use. A well structured questionnaire was designed to elicit the opinions of the users. Responses were gathered from 542 faculty members of five universities. The results of the study showed that the characteristics that affect the choice of e-format over print in order of preference are ‘faster access’, ‘available from desktop’, ‘convenience’, ‘remote access’, ‘timeliness’, ‘available at all times’, ‘hyperlinks’, ‘multi-user access’, ‘currency of information’, ‘inclusion of audio–video material’, ‘interactivity’ and ‘animation of graphics’. The characteristics that affect the choice of print format over electronic in order of priority are ‘physical comfort’, ‘portability’, ‘ability to underline’, ‘familiarity with format’ and ‘ability to browse’. A majority of the teachers use e-journals for ‘research’, ‘teaching’, ‘writing reports’, ‘current awareness’, ‘background research’ and ‘internal/external presentations’. The problems faced in accessing e-journals are ‘access difficulties’, ‘discomfort of reading from computer screen’, ‘lack of IT knowledge/skill’, ‘information overload’ etc. A majority of the teachers want future e-journals to have features such as ‘full text index of every article’, ‘searching capability across a wide range of journal articles’, ‘searching capability within an article, display relationship between a wide range of works’ and ‘links to multimedia files’, etc. On the basis of the findings, some suggestions are made for maximizing the use of e-journals.