Expression of Matrix Metalloproteinases in the Circulating Immune Cells in Children with Helicobacter pylori Infection-Correlation with Clinical Factors.

H. pylori gastritis is strongly associated with the upregulation of the expression of several matrix metalloproteinases (MMPs) in the gastric mucosa. However, the role of MMP-2 and MMP-9, and their inhibitors (tissue inhibitors of metalloproteinases -TIMPs) produced by immune cells in infected children have not been clearly defined. Moreover, the effects of H. pylori eradication therapy on MMPs and TIMPs production has not been evaluated. A total of 84 children were studied: 24-with newly diagnosed H. pylori gastritis, 25-after H. pylori eradication therapy (17 of them after successful therapy), 24-with H. pylori-negative gastritis, and 11-controls. Plasma levels of MMP-2, MMP-9, TIMP-1, and TIMP-2 by ELISA; MMPs and TIMPs expression in lymphocytes; neutrophils and monocytes in peripheral blood by multiparameter flow cytometry; and mucosal mRNA expression levels of MMPs and TIMP-1 in gastric biopsies by RT-PCR were evaluated. Children with H. pylori-related gastritis showed the following: (1) increased MMP-2 and TIMP-2 plasma levels, (2) increased intracellular expression of MMP-2 in the circulating lymphocytes and neutrophils, (3) low frequencies of circulating TIMP-1+ and TIMP-2+ leukocytes, and (4) high expression of mRNA for MMP-9 along with low expression of mRNA for MMP-2 in the gastric mucosa. Unsuccessful H. pylori eradication was associated with the following: (1) high plasma levels of MMP-9 and TIMP-1, (2) increased pool of TIMP-1+ lymphocytes as well as high expression of MMP-9 in circulating lymphocytes, and (3) high expression of mRNA for MMP-9 in the gastric mucosa. Our data suggest that MMPs are important contributors to stomach remodelling in children with H. pylori-related gastritis. Unsuccessful H. pylori eradication is associated with increased MMP-9 in plasma, circulating lymphocytes, and gastric mucosa.

Fever as the Only First Sign of Crohn's Disease-Difficulties in Diagnosis during the COVID-19 Pandemic.

We present a case of a nine-year-old girl with Crohn's disease whose only first manifestation was fever. The patient was treated with antibiotics for six weeks by her general practitioner via teleconsultations during the COVID-19 pandemic. However, no significant improvement was observed. Only the appearance of loose stools after six weeks of observation and the lack of effect of previous treatment allowed for targeting of the diagnostic process and an unequivocal recognition of Crohn's disease. Our aim is to emphasize the difficulties in diagnosis related to the atypical course of the disease, especially in the context of the ongoing COVID-19 pandemic. The described course of Crohn's disease occurs in a minority of patients; however, this disease should not be overlooked in the differential diagnosis of fever in paediatric patients.

A Severe Systemic Infection in a 14-Year-Old Boy That Took Place during the COVID-19 Pandemic.

INTRODUCTION: Since March 2020, the COVID-19 pandemic has been a global talking point. Access to health care has become more difficult, and such an obstacle increase the risk of inadequate medical care, especially among paediatric patients. CASE: This report describes the case of a previously healthy teenager who was staying home for 2 months due to a strict lockdown period in the COVID-19 pandemic and was admitted to hospital for fever, nausea and lumbar pain. He was diagnosed consecutively with meningitis, sepsis, paraspinal abscesses and endocarditis. Further investigation did not reveal any risk factors or immunodeficiency in the patient. DISCUSSION: Sepsis is defined as the presence of systemic inflammatory response syndrome (SIRS) associated with a probable or documented infection. It is the leading cause of death from infection, especially if not recognized and treated quickly. Sepsis may lead to various complications, such as infective endocarditis, meningitis and abscesses. Although such complications may initially be latent, they can promote internal organ dysfunction and the possibility of their presence should be considered in any patient with systemic infection. Any child with a fever should be treated as one with the possibility of developing a severe infection. CONCLUSION: The presented case shows that even a previously healthy child staying in long-term home isolation can develop a severe infection with multiorgan complications, and the COVID-19 pandemic should not extend the diagnostic process in patients with symptoms of infection.

Formulations of Topical Steroids in Eosinophilic Esophagitis-Current Treatment and Emerging Possibilities.

Eosinophilic esophagitis (EoE) is a chronic immune-mediated disorder characterised by eosinophilic inflammation and esophageal dysfunction symptoms. The recommended first-line treatment options are proton pump inhibitors and swallowed topical steroids (STS). However, current recommendations regarding STS are based on relatively few studies employing various doses and formulations. Our aim was to review the STS formulations currently used in the treatment of eosinophilic esophagitis, to demonstrate in a practical way the variety of exiting application methods, and to present emerging options for STS delivery to the esophagus. After the literature review, we established that the three most commonly used STS formulations include mist from an inhaler, viscous suspensions compounded with vehicles for oral use, and a recently introduced proprietary medication in the form of orodispersible tablets. Several drug delivery technologies with potential use in EoE are under investigation. To ensure optimal adherence, the choice of formulation should be based on efficacy, patient preferences and experience of the clinician, as well as current recommendations. Further studies are needed to compare the efficacy and acceptability of existing STS types, and to develop new, well-tolerated and effective drug formulations.