Mesalamine Intolerance in Three Children with Crohn's Disease

OBJECTIVE

To present the mesalamine-induced acute exacerbation of symptoms and inflammatory markers in children with Crohn's disease (CD).

CLINICAL PRESENTATION AND INTERVENTION

Three children who presented with CD had acute exacerbation of colitis symptoms or elevated inflammatory markers when mesalamine was added to treatment while tapering/ceasing steroid treatment. While on steroid treatment, the patients maintained clinical and laboratory remission, but with the initiation of mesalamine treatment, they had abdominal pain and bloody mucoid diarrhoea and/or elevation of white blood cell count, C-reactive protein level and erythrocyte sedimentation rate. Bacterial pathogens were excluded from the urine, throat and blood cultures, parasites with stool examination, viral pathogens with serology. Within 3-7 days after the mesalamine treatment had been stopped, the patients showed improvement of colitis symptoms and normalisation of white blood cell count, C-reactive protein level and erythrocyte sedimentation rate.

CONCLUSION

In this study mesalamine mimicked CD relapse in children with CD while tapering or after stopping steroid treatment. Awareness of this side effect of mesalamine could prevent a misdiagnosis of steroid dependency.

Subclinical cardiac dysfunction in children with coeliac disease: is the gluten-free diet effective?

Objectives. The aim of this study is to investigate the effects of coeliac disease on cardiac function in children using conventional transthoracic echocardiography (TTE) and tissue Doppler echocardiography (TDE). Methods. Coeliac disease patients were evaluated in two different groups based on serum endomysial antibody (EmA) titers (EmA (+) and EmA (−)), and the data obtained by conventional and TDE studies were compared between the patient groups and healthy controls. Results. There was no significant difference between EmA (+) and EmA (−) groups in terms of the conventional TTE parameters, including ejection fraction (EF), fractional shortening (FS), and left ventricle end diastolic diameter (LVEDD), that show the left ventricular systolic function (P = 0.727, P = 0.317, P = 0.118). TDE showed a significant difference in left ventricle (LV) isovolumic relaxation time (LV IVRT) and LV myocardial performance index (LV MPI) parameters between EmA (+) and EmA (−) patient groups (P < 0.0001). Conclusion. The measurement of LV MPI and LV IVRT parameters by TDE would be beneficial in early determination of the cardiac involvement and establishing appropriate treatment and followup of patients with coeliac disease as well as in making distinction between EmA (+) and EmA (−) patients.

Acute tetraventricular hydrocephalus caused by mumps meningoencephalitis in a child

Mumps is one of the common causes of childhood aseptic meningitis and encephalitis. Although central nervous system involvement is a common manifestation, hydrocephalus is a very rare complication of mumps, with just a few cases reported in the literature to date. Here we report on an 8-year-old boy with acute tetraventricular hydrocephalus caused by mumps meningoencephalitis and treated by external ventricular drainage and following ventriculoperitoneal shunt.

Investigation of human colostrum Helicobacter pylori IgA content in lactating women

OBJECTIVE

The objective was to investigate the colostral H. pylori-specific IgA content in a sample of the female population in Turkey where a high endemicity for H. pylori has always been reported.

MATERIALS AND METHODS

One hundred and sixty-one pregnant women with positive serum H. pylori IgG antibody at the time of the last trimester were enrolled into the study. During the initial postpartum 24h, we obtained colostrum samples from each mother to test the presence and concentration of H. pylori-specific IgA. Breast milk antibody concentrations of H. pylori were measured by commercial ELISA tests. Sample absorbance/cut-off absorbance (s/c) ratio was used for semiquantitative interpretation. Ratios >1.1 were considered positive, ratios < or =1.1 negative. The statistical significance was tested by the Mann-Whitney U-test, and p < 0.05 was regarded as statistically significant.

RESULTS

At least 2 ml of colostrum was obtained and analyzed (mean volume 2.5+/-0.45 ml). The results indicated the absence of H. pylori-specific IgA in 64 colostral samples (39.8%). However, the rest of the women (n = 97; 60.2%) had a mean H. pylori-specific IgA s/c ratio of 4.31+/-2.51 (range 1.2-10.3) in their colostral milk samples. The mean gestational age at the time of delivery was 38 weeks and 5 days, and the mean birth weight was 3, 224+/-433 g (range 4, 300-1, 940 g). Gestational age at birth and mode of delivery were not correlated with the colostral-specific IgA levels.

CONCLUSIONS

Most of the lactating women (60.2%), who were seropositive for H. pylori, had some IgA in their colostral milk. Colostral milk theoretically can decrease H. pylori and perhaps many other enteric infections, whether or not it contains H. pylori-specific IgA. Therefore, breastfeeding is of utmost importance for neonates and should be encouraged. The H. pylori-specific IgA antibody concentration of colostral milk should be investigated in large-scale prospective studies for its effectiveness in the protection against neonatal transmission of this infection.