Mesalamine Intolerance in Three Children with Crohn's Disease

While standard therapeutic regimens for Kawasaki disease (KD) in children have exhibited some efficacy, they remain far from ideal. Thus, the pursuit of alternative or improved treatment modalities remis clinically critical. This study primarily aimed to assess the effect of dipyridamole (DIP) plus human intravenous immunoglobulin (IVIG) and aspirin (ASP) as to efficacy, antiplatelet aggregation factors, and inflammatory markers in children with KD. A total of 95 pediatric KD patients were selected from February 2021 to July 2024, with 44 cases in the control group treated with IVIG + ASP and 51 cases in the research group given DIP in addition to IVIG + ASP. The efficacy, symptom resolution time (defervescence, limb swelling, mucosal congestion, and cervical lymphadenopathy), coronary artery injury, coagulation function (thrombin time [TT], prothrombin time [PT], and activated partial thromboplastin time [APTT]), antiplatelet aggregation factors (erythrocyte sedimentation rate [ESR], white blood cell count [WBC], and platelet count [PLT]), and inflammatory factors (C-reactive protein [CRP], and tumor necrosis factor-α [TNF-α], interleukin-6 [IL-6]) levels were compared between the two groups. The research group exhibited a higher overall treatment efficacy rate, shorter symptom resolution times, and a significantly lower incidence of coronary artery injury compared to the control group. No significant differences were observed between the two groups or before and after treatment within the same group in coagulation function indices. Markedly reduced levels of anti-platelet aggregation factors and inflammatory markers were observed in the research group versus those in the control group. DIP in combination with IVIG and ASP significantly enhances treatment efficacy and improves levels of antiplatelet aggregation factors and inflammatory markers in children with KD.

Crohn's disease is widely described in the Western literature, but it has not been widely observed in the Middle Eastern community. We diagnosed Crohn's disease in seven Arabs, three whom were Saudi Nationals. Their mean age was 32.4 years (range, 18-40 years) and duration of symptoms varied from three months to ten years. The site of the disease was ileocolic in five patients and colonic in two. Mass lesions in the abdomen were seen in three patients. Four cases were diagnosed from histological specimens obtained at laparotomy and resection and the other three were diagnosed from colonoscopic biopsy specimens. Extraintestinal manifestations were found in three patients. Surgery alone was the treatment in two patients, whereas the remaining required medical therapy, mainly steroids, with or without surgery. We conclude that Crohn's disease does occur in the Arab population, but with milder systemic effects.

The present study aimed to investigate faecal calprotectin as a diagnostic marker to differentiate between patients with inflammatory bowel disease (IBD) and those with irritable bowel syndrome (IBS). A total of 20healthy control subjects, 26patients with IBS and 58patients with IBD, including 22with ulcerative colitis (UC) and 36with Crohn's disease (CD), were recruited for the present study. Calprotectin was analysed in stool samples, and C-reactive protein (CRP) and the erythrocyte sedimentation rate (ESR) were assessed in blood samples. CRP and calprotectin levels, and the ESR were observed to be significantly higher in patients with CD and UC compared with those of the healthy control subjects (P<0.0001). Furthermore, in patients with IBD and IBS, significant increases in faecal calprotectin and CRP levels were observed (694.8±685.0µg/g in IBD vs. 85.8±136.1µg/g in IBS and 0.851±1.200mg/dl in IBD vs. 0.16±0.23mg/dl in IBS, respectively; P<0.0001). Area under the receiver operating characteristic curve analysis revealed that, in patients with IBD, the levels of faecal calprotectin [0.931±0.029; 95% confidence interval (CI), 0.874‑0.987] were significantly higher than that of CRP (0.865±0.041; 95%CI, 0.785‑0.946) and the ESR (0.869±0.042; 95% CI, 0.786‑0.952). These findings indicate that faecal calprotectin may represent a novel biomarker for diagnosing IBD and may be effective in distinguishing between IBD and IBS.

Impaired iron absorption or increased loss of iron was found to correlate with disease activity and markers of inflammation in inflammatory bowel disease (IBD). Red cell distribution width (RDW) could be a reliable index of anisocytosis with the highest sensitivity to iron deficiency. The importance of RDW in assessment of IBD disease activity is unknown. In this study, we aimed to determine if RDW could be useful in detecting active disease in patients with IBD. A total of 74 patients with ulcerative colitis (UC) and 22 patients with Crohn's disease (CD) formed the study group with 20 age- and sex-matched healthy volunteers as the control group. CD activity index higher than 150 in patients with CD was considered to indicate active disease. Patients with moderate and severe disease according to the Truelove-Witts scale were accepted as having active UC. In addition to RDW, serum C-reactive protein (CRP) and fibrinogen levels, erythrocyte sedimentation rates (ESR), leukocyte, and platelet counts were measured. Fourteen (63.6%) of the patients with CD and 43 (58.1%) of the patients with UC had active disease. RDW, fibrinogen, CRP, ESR, and platelet counts were all significantly elevated in patients having active IBD compared with those without active disease and controls (P < 0.05). The study subjects were further classified into two subgroups: cases with active and inactive UC and those with active and inactive CD. A subgroup analysis indicated that for an RDW cutoff of 14, the sensitivity for detecting active UC was 88% and the specificity was 71% (area under curve [AUC] 0.81, P = 0.0001). RDW was the most sensitive and specific parameter indicating active UC. However, the same was not true for CD since CRP at a cutoff of 0.54 mg/dl showed a sensitivity of 92% and a specificity of 63% (AUC 0.92, P = 0.001), whereas RDW at a cutoff of 14.1 showed 78% sensitivity and 63% specificity to detect active CD. Among the laboratory tests investigated, including fibrinogen, CRP, ESR, and platelet counts, receiver operating characteristic (ROC) curve analysis indicated RDW to be the most significant indicator of active UC. For CD, CRP was an important marker of active disease.

84-Year-Old Man With Night Sweats, Weight Loss, and Diarrhea

Systemic inflammation has been implicated in cancer development and progression. This study sought to determine whether systemic inflammatory markers can predict postoperative outcome in soft tissue sarcoma (STS). A total of 162 cases of primary, localized STS were reviewed. Patients with evidence of infectious or inflammatory diseases were excluded. The mean follow-up period was 46.7 months. The level of serum C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and neutrophil-to-lymphocyte ratio (NLR) measured before surgery were evaluated for association with disease-specific survival and local recurrence. The mean values of CRP, ESR, and NLR were 0.79 mg/dL, 18.8 mm/h, and 2.12, respectively. Cutoff values derived from receiver-operating characteristic curve analysis were 0.20 mg/dL for CRP, 10.0 mm/h for ESR, and 2.50 for NLR. On univariate analysis, all inflammatory markers were associated with disease-specific survival (CRP: P = 0.007; ESR: P = 0.022; NLR: P = 0.030). On multivariate analysis, the CRP level (P = 0.019) and ESR (P = 0.013) remained significant. Elevation of multiple markers was a more significant prognostic factor than elevation of a single marker (P = 0.001). However, none of the inflammatory markers was associated with local recurrence (CRP: P = 0.345; ESR: P = 0.271; NLR: P = 0.570). Histologic grade was strongly correlated with inflammatory marker values (NLR: P < 0.001; ESR: P = 0.002; CRP: P = 0.007). Preoperative systemic inflammatory status, assessed by using multiple serum markers, predicted disease-specific survival in STS.

Prospective measurements were made of serum C-reactive protein levels and erythrocyte sedimentation rate in sixty-four patients with Crohn's disease and fifty with ulcerative colitis. The results were related to clinical assessment of disease activity. C-reactive protein levels were raised in both groups but were significantly higher in Crohn's disease than ulcerative colitis for all categories of disease severity: with mild disease the median and range of C-reactive protein concentration were 4, 0-65 mg/l in Crohn's disease v. 0, 0-15 mg/l in ulcerative colitis, P less than 0.01; in moderate disease the values were 15, 1-100 mg/l v. 3, 0-29 mg/l respectively, P less than 0.05 and in cases of severe disease, 85, 15-183 mg/l v. 12, 2-33 mg/l respectively, P less than 0.001. Erythrocyte sedimentation rate was also higher in Crohn's disease but did not closely reflect disease activity in individual patients. C-reactive protein levels corresponded closely with clinical and pathological indices of relapse, remission and response to therapy in patients with Crohn's disease. The precise assay of serum C-reactive protein provides an objective criterion of inflammatory activity, which may be useful in the assessment, management and study of Crohn's disease.

Natural History of Pediatric Crohn Disease T he natural history of pediatric Crohn disease (CD) remains unpredictable, although some trends are observed that differentiate children from adults. Pediatric CD often presents with more severe disease and more frequent need for immunosuppressive therapy (1). Growth failure, present in 15% to 20% of patients, is a unique characteristic of pediatric CD not seen in adult-onset CD (2). Colonic disease distribution is common in patients younger than 10 years (1). The need for surgical intervention also varies, with 1 study reporting the actuarial risk of having undergone an extensive intestinal resection being 48.6% 5% in a childhood-onset group versus 14.6% 2% in the adult-onset group (P< 0.001) (1). More recently, long-term follow-up of patients enrolled in pediatric registries shows a cumulative surgical rate of 14% to 17% at 5 years and 28% at 10 years (3,4).

Title: The Use of Preoperative CRP and ESR as Predictive Markers of Prosthetic Joint Infection in Primary Total Hip and Knee Arthroplasty Background Total hip (THA) and total knee (TKA) arthroplasty are two of the most performed orthopedic surgeries each year in the United States. Prosthetic joint infection (PJI) remains one of the most common serious complications among all patients undergoing total joint arthroplasty (TJA). There has been a significant amount of literature on the use of c-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) in the field of TJA, specifically for the diagnosis of PJI. However, there is much less data focused on the use of preoperative CRP and ESR in the setting of primary TJA. The purpose of this study was to further investigate any correlation that exists between preoperative CRP/ESR and PJI in primary TJA. Methods All patients of one of two surgeons who underwent primary THA or TKA between 2016 and 2020 at the same institution were identified and studied via a retrospective chart review. After exclusion criteria, 806 patients were included in the final cohort for analysis. Positive CRP was set at >0.3 mg/dL and ESR as >30 mm/hr. Results In our current study, which is the second-largest cohort to date that looks at preoperative inflammatory markers before primary TJA, we found no statistically significant correlation between pre-operative CRP or ESR and PJI. We did find that a higher proportion of patients with PJI had elevated preoperative CRP (70.6%) vs those with normal CRP (29.4%). However, among patients with no PJI, the preoperative CRP was still found to be elevated in half of all patients (49.7%). Conclusion This study is unable to validate the use of preoperative CRP/ESR as a predictive measure of future risk of PJI in primary total joint arthroplasty. However, it does provide quantitative insight into the prevalence of elevated preoperative inflammatory markers in all patients prior to TJA with a considerable proportion of patients having modifiable risk factors. Since there is such a large proportion of patients with elevated inflammatory markers that do not go on to develop PJI, we do not recommend cancellation of TJA unless there is an obvious identified modifiable risk factor that puts them at increased risk of PJI.

Correlation between levels of C-reactive protein and clinical activity in Crohn's disease

Cardiology Patient Page. C-reactive protein: a simple test to help predict risk of heart attack and stroke.

Background: The mean platelet volume (MPV) reflects the size of platelets. It has been shown to be inversely correlated with level of the inflammation in some chronic inflammatory diseases. This prospective study aims to show the usability of MPV as an inflammation marker in patients with active pulmonary tuberculosis (PTB) by comparison with healthy controls. In addition, its relationships with other inflammatory markers such as C-reactive protein (CRP) and the erythrocyte sedimentation rate (ESR) as well as with the radiological extent of disease were examined. Methods: This study included 82 patients with active PTB and 95 healthy subjects (control group). Whole blood counts, CRP level, and ESR were compared between the two groups. In the PTB group, the relationships between the radiological extent of disease and the MPV and other inflammation markers were investigated. Results: The MPV was 7.74 ± 1.33/μL in the PTB group and 8.20 ± 1.13/μL in the control group (p = 0.005). The blood platelet count, CRP level, and ESR were significantly higher in the active PTB group than in the control group (p &lt; 0.0001). In the PTB group, CRP levels (r = 0.26, p = 0.003) and ESR (r = 0.39, p = 0.003), but not MPV (p = 0.80), were significantly correlated with the radiologic extent of the disease. Conclusions: The MPV was lower in patients with PTB than in healthy controls, however, the difference was limited. The MPV does not reflect the severity of the disease. The use of MPV as an inflammation marker and a negative acute-phase reactant in PTB does not seem to be reliable.

Anemia is the most common systemic complication of inflammatory bowel disease, is more common in affected children than in adults, and is mediated in large part by chronic inflammation. Inflammation increases levels of the iron-regulatory protein hepcidin, which have been elevated in adults with Crohn disease. We measured serum hepcidin-25 and hemoglobin (Hgb) in 40 children and adolescents with Crohn disease at baseline and 10 weeks after initiation of anti-tumor necrosis factor (TNF)-α therapy. Measures of disease activity, inflammatory markers, and cytokines were obtained in all subjects. Anemia was defined by World Health Organization criteria. At baseline hepcidin and C-reactive protein levels were correlated, and 95% of subjects were anemic. After anti-TNF-α therapy, median (interquartile range) hepcidin concentrations decreased significantly and the distribution narrowed (27.9 [16.2, 52.9] vs 23.2 [11.1, 37.7] ng/mL, P = 0.01). Mean (standard deviation) Hgb also increased significantly (10.6 ± 1.2 to 10.9 ± 1.1 g/dL, P = 0.02), and the increase was sustained at 12 months, although 90% of participants continued to meet anemia criteria at 10 weeks. Disease activity and markers of inflammation also decreased and albumin levels increased. In generalized estimating equation analyses, higher TNF-α, interleukin 6, erythrocyte sedimentation rate, and C-reactive protein were associated with higher hepcidin concentrations (P = 0.04, P = 0.03, P = 0.003, and P < 0.001, respectively), and increased levels of disease activity were associated with higher hepcidin. In children with Crohn disease, anti-TNF-α therapy is associated with decreased levels of hepcidin and increased Hgb 10 weeks after induction. Improvement in anemia may be a secondary benefit for children who receive this therapy.

Laboratory markers have been investigated in inflammatory bowel disease (IBD) for diagnostic and differential diagnostic purposes, for assessment of disease activity and risk of complications, for prediction of relapse, and...

Comparison of iron status 28 d after provision of antimalarial treatment with iron therapy compared with antimalarial treatment alone in Ugandan children with severe malaria