The interplay of oxidative stress and immune dysfunction in Hashimoto's thyroiditis and polycystic ovary syndrome: a comprehensive review.

In recent years, there has been a significant increase in the concomitant incidence of Hashimoto's thyroiditis (HT) and polycystic ovary syndrome (PCOS), both in terms of incidence, etiology, and clinical consequences. PCOS patients suffering from autoimmune thyroid diseases show insulin resistance, impaired glucose tolerance, weight gain, and metabolic and reproductive complications. Studies have shown that chronic stress and its consequence, i.e. oxidative stress, play an important role in the pathomechanism of both disorders. It has also been shown that long-term exposure to stress triggers biological mechanisms, in particular related to the regulation of the inflammatory cascade, which plays a key role in autoimmune diseases. The paper is a review of the literature on the role of chronic stress, oxidative stress, and immune processes in the pathogenesis of HT and PCOS. In addition, the review is a source of knowledge about the treatment of these diseases, and in particular the use of antioxidants in therapeutic management.

Pancreatic Involvement in the Course of Inflammatory Bowel Disease in Children-A Multi-Center Study.

The coexistence of inflammatory bowel disease (IBD) with pancreatic pathology is rare in children. A retrospective analysis of data from 1538 children diagnosed with IBD in 2014-2021 was conducted to determine the frequency and causes of pancreatitis and asymptomatic hyperlipasemia (HL) or hyperamylasemia (HA) in this group of patients. Among the 176 children (11.4%) with pancreatic involvement (PI), acute pancreatitis (AP) was diagnosed in 77 children (43.8%), and HA or HL was observed in 88 children (50.0%). Only a few patients were diagnosed with autoimmune or chronic pancreatitis (6.2%). PI was observed at the time of the IBD diagnosis in 26.1% of the cases. A total of 54.5% of the patients had moderate to severe IBD, and 96% had colonic involvement at the time of diagnosis of PI. Idiopathic PI was the most common (57%), followed by drug-induced PI (37%) and azathioprine (AZA). In patients with AZA-induced AP, the successful introduction of 6-mercaptopurine (6-MP) to therapy was noted in 62.5% of the children. Our results suggest that routine monitoring of pancreatic enzymes in patients with IBD should be performed, especially after the initiation of the AZA treatment. The presence of transient HA/HL in IBD does not necessarily indicate pancreatic pathology.

The Impact of Chronic Stress Related to COVID-19 on Eating Behaviors and the Risk of Obesity in Children and Adolescents.

During the COVID-19 pandemic, an increase in the incidence of overweight and obesity in children was observed. It appears that unhealthy food choices, an unbalanced diet, and a sedentary lifestyle, as well as experiencing stress related to the pandemic, may be contributing to this disturbing trend. Chronic stress is a significant factor contributing to eating disorders and obesity in youngsters, involving medical, molecular, and psychological elements. Individuals under chronic stress often focus on appearance and weight, leading to negative body image and disrupted relationships with food, resulting in unhealthy eating behaviors. Chronic stress also impacts hormonal balance, reducing the satiety hormone leptin and elevating the appetite-stimulating hormone ghrelin, fostering increased hunger and uncontrolled snacking. Two systems, the hypothalamic-pituitary-adrenal axis and the sympathetic system with the adrenal medulla, are activated in response to stress, causing impaired secretion of noradrenaline and cortisol. Stress-related obesity mechanisms encompass oxidative stress, neuroinflammation, insulin resistance, and neurohormonal and neurotransmission disorders. Stress induces insulin resistance, elevating obesity risk by disrupting blood sugar regulation and fat storage. Stress also affects the gut microbiome, potentially influencing chronic inflammation and metabolic processes linked to obesity. In conclusion, chronic stress is a multifaceted risk factor for eating disorders and obesity in children, necessitating a comprehensive understanding of effective preventive and intervention strategies amid the escalating prevalence of childhood overweight and obesity.

Clinical Significance of Serum Elafin in Children with Inflammatory Bowel Disease.

BACKGROUND: The role of elafin in the pathophysiology of inflammatory bowel disease (IBD) has not been not elucidated. We aimed to evaluate serum elafin in children with IBD and assess its relationship with disease activity. METHODS: We enrolled children with IBD in the study group and children with functional abdominal pain in the control group. We evaluated serum elafin using enzyme-linked immunosorbent assay kits. RESULTS: In children with IBD, serum elafin (mean ± SD: 4.192 ± 1.424 ng/mL) was significantly elevated compared with controls (mean ± SD: 3.029 ± 1.366 ng/mL) (p = 0.0005). Elafin was significantly increased in children in the active phase of IBD (mean ± SD: 4.424 ± 1.449 ng/mL) compared with the control group (p = 0.0003). In IBD remission, only children with ulcerative colitis (mean ± SD: 4.054 ± 1.536 ng/mL) had elevated elafin compared with controls (p = 0.004). ROC analysis revealed that the area under the curve (AUC) of serum elafin was 0.809 while discriminating patients with ulcerative colitis from the control group, and the AUC was 0.664 while differentiating patients with Crohn's disease from the control group. CONCLUSIONS: Serum elafin was found to be elevated in our cohort of children with IBD, depending on disease activity. Serum elafin was increased in the active phases of both ulcerative colitis and Crohn's disease, but only in the remission of ulcerative colitis. Elafin appears to be a potential candidate for a biomarker of ulcerative colitis.

The Impact of Digital Screen Time on Dietary Habits and Physical Activity in Children and Adolescents.

Background: Over the last few decades, the time children spend using electronic devices has increased significantly. The aim of the study was to evaluate the impact of screen time on dietary behaviors and physical activity in children and adolescents. Methods: An online survey was conducted among parents of preschool and school-aged children during the COVID-19 lockdown in Poland. There were 3127 surveys used in the analysis. Results: Survey responses referred to 1662 (53%) boys and 1465 (47%) girls, with a mean age of 12.1 ± 3.4 years. During a routine weekday, most children (71%) spent >4 h on educational activities using electronic devices, and 43% of children spent 1−2 h using devices for recreational purposes. The majority of children (89%) were exposed to screens during meals, and ate snacks between main meals (77%). There was an association between screen time and the exposure to screens during meals, and between screen time and time spent performing physical activity. Conclusions: This study revealed that the majority of children were exposed to screens during meals, which is a risk factor of obesity. The promotion of the judicious use of digital devices and healthy dietary habits associated with the use of screens may be an important component of obesity prevention strategies.

Is It Inflammatory Bowel Disease Flare or Pediatric Inflammatory Multisystem Syndrome Temporally Associated with COVID-19?

BACKGROUND: Pediatric inflammatory multisystem syndrome temporally associated with COVID-19/multi-system inflammatory syndrome in children (PIMS-TS/MIS-C) is a potentially life-threatening complication of SARS-CoV-2 infection in children. Gastrointestinal manifestations are prominent in children with PIMS-TS/MIS-C. Thus, it is challenging to differentiate this condition from an exacerbation of inflammatory bowel disease (IBD). We aimed to present the clinical characteristics, and diagnostic and therapeutic difficulties in patients with overlapping IBD and PIMS-TS/MIS-C; Methods: We reviewed medical records of children hospitalized due to overlapping IBD and PIMS-TS/MIS-C in a single pediatric hospital from December 2020 to December 2021; Results: There were four children with overlapping IBD flare and PIMS-TS/MIS-C. In three cases, IBD recognition preceded PIMS-TS/MIS-C onset and PIMS-TS/MIS-C occurred during anti-inflammatory therapy of IBD. All children presented with gastrointestinal symptoms at PIMS-TS/MIS-C onset. All patients received IVIG and ASA treatment. In three children there was a need to use steroids to resolve PIMS-TS/MIS-C symptoms. One child was vaccinated against COVID-19; Conclusions: SARS-CoV-2 infection may affect patients with underlying inflammatory conditions such as IBD, inducing systemic symptoms of PIMS-TS/MIS-C, and probably triggering IBD after PIMS-TS/MIS-C. The resemblance of clinical presentations is the main source of diagnostic and therapeutic challenges in PIMS-TS/MIS-C in patients with underlying IBD.

The condition of the oral cavity at the time of diagnosis of inflammatory bowel disease in pediatric patients.

Changes in the oral mucosa can appear in the course of inflammatory bowel disease in both children and adults. They often precede the appearance of gastrointestinal symptoms. The aim of the study was to determine the nature of changes in the oral cavity at the time of diagnosis of inflammatory bowel disease in children compared to children without systemic diseases. 49 children diagnosed with inflammatory bowel disease and 60 children without systemic diseases were examined. The prevalence of the aphthae stomatitis and angular cheilitis was 24.5% in the examined group and 10% in the control group (p = 0.0772). Changes in the oral mucosa occurred more frequently in children with Crohn's disease 35.3% than with ulcerative colitis 18.7%. In children with Crohn's disease, the most frequently observed lesion was aphthous stomatitis 23.5%, and in ulcerative colitis, angular cheilitis 12.5%. Changes in the oral mucosa are a therapeutic problem requiring in general diseases patients both local and systemic treatment and interdisciplinary cooperation between dentists, paediatricians and gastroenterologists. The finding of repeated changes in the oral mucosa during a dental examination should be the reason for referring the patient to a paediatrician for the foreclosure or make a diagnosis of inflammatory bowel diseases.

Dark side of laundry pods: Analysis of exposure to laundry detergent capsules in children.

AIM: We aimed to evaluate the epidemiological characteristic and clinical features of laundry detergent capsule (LDC) exposure in children. METHODS: Retrospective review of medical records of patients hospitalised due to the exposure to LDC at the Department of Paediatrics and Gastroenterology, Medical University of Lublin, Poland, from 2014 to 2019 was conducted. RESULTS: During the study period, 38 children including 19 (50%) boys and 19 (50%) girls were admitted to our department due to exposure to LDC. The age of patients ranged from 11 months to 9 years, with a mean 48.61 ± 28.85 months of age. About 66% of patients were younger than 5 years. The major route of exposure was ingestion (n = 37; 97%). Most patients (n = 27; 71%) exhibited symptoms of exposure to the LDC. The most common symptoms were vomiting (n = 23; 60%), cough (n = 7; 18%) and salivation (n = 5; 13%). Seven patients required gastroscopy. Abnormalities were subsequently identified in three children. CONCLUSIONS: Accidental exposure to LDC usually occurs in children younger than 5 years. Although the majority of cases had mild or moderate clinical outcomes, ingestion of LDC may lead to some severe consequences. Improvements in parental education regarding the risks of LDC, and in the packaging of LDC may prevent serious injury.

Interleukin 6: Biological significance and role in inflammatory bowel diseases.

Cytokines affect a number of processes in the living body. Interleukin 6 (IL-6) is a cytokine involved in inflammation, infection response and also regulation of metabolism. It stimulates target cells through a membrane-bound IL-6 receptor. Inflammatory bowel diseases (IBD) are autoimmune diseases whose incidence and prevalence are increasing worldwide. It is a group of chronic gastrointestinal disorders characterized by multifactorial, still unknown pathogenesis, varied symptomatology, course with periods of exacerbation and remission, and polymorphic infiltration in histopathological examination. As it is known, pro-inflammatory cytokines, including IL-6, in IBD initiate, intensify and support the development of the inflammatory process in the intestine. Our knowledge of IL-6 biology has important consequences for therapeutic strategies. Elevation of IL-6 concentration can be considered as an early and sensitive, although non-specific marker for various inflammatory conditions and may be used in the diagnosis and monitoring of patients with IBD.

Interleukin 10 and interleukin 10 receptor in paediatric inflammatory bowel disease: from bench to bedside lesson.

BACKGROUND: The differences between adults and children in inflammatory bowel disease (IBD) phenotype, severity, complications, co-morbidities, and response to the therapy resulted in the extraction of paediatric IBD. It has been revealed that the substantial role in the development of IBD in children under 6 years of age plays a single genetic mutation (monogenic IBD). On the other hand, in older children and adolescents IBD is usually associated with number of interactions between susceptibility loci (polygenic IBD). MAIN BODY: Until now there have been described about 60 monogenic defects which affect the variety of immune mechanisms in IBD pathogenesis including epithelial barrier, function of neutrophil granulocytes and phagocytes, T- and B-cell selection and activation, immune inhibitory mechanisms, or apoptosis. Il-10 is an anti-inflammatory cytokine which modulates innate and adaptive immunity affecting expression of pro-inflammatory molecules and function of the variety of immune cells. Patients with identified defects in Il-10 pathway manifest with life-threating colitis with perianal lesions which occurs within first months of life. Allogenic hematopoietic stem cell transplantation is curative therapy in children with Il-10 signalling defects. CONCLUSION: Clinical awareness of Il-10 signalling defects enables early recognition and prompt management of the disease.

Acute Pancreatitis as a Complication of Antiepileptic Treatment: Case Series and Review of the Literature.

Acute pancreatitis (AP) appears to be rare disease in childhood. In children, it has a different aetiology and course, and requires different management than in adult patients. The diagnosis of AP is based on at least two of the three criteria, which include typical clinical symptoms, abnormalities in laboratory tests and/or imaging studies of the pancreas. There are many known causes leading to AP in children including infections, blunt abdominal trauma, genetic factors, gallstone disease, metabolic disorders, anatomical defects of the pancreas, systemic diseases, as well as drugs, including antiepileptic drugs, and especially preparations of valproic acid. In our study, we present four cases of young patients diagnosed with acute pancreatitis as a complication of valproic acid therapy and we present a review of the literature. We believe that the activity of pancreatic enzymes should be monitored in children treated with valproate preparations in the case of clinical symptoms suggesting AP.

Cathelicidin - A Novel Potential Marker of Pediatric Inflammatory Bowel Disease.

INTRODUCTION: Cathelicidin is a multifunctional host defense peptide which may also exert pro-inflammatory signals and contribute to the development of autoimmune disorders. We aimed to assess serum concentration of cathelicidin in children with inflammatory bowel disease (IBD) compared to healthy controls and to evaluate its relationship with disease activity and phenotype. PATIENTS AND METHODS: The study group included 68 children with IBD. The control group comprised 20 children with functional abdominal pain. All patients and controls were tested for complete blood count, C-reactive protein, erythrocyte sedimentation rate and cathelicidin. Stool samples were collected to assess calprotectin. RESULTS: Cathelicidin was significantly increased in patients with ulcerative colitis (1073.39±214.52 ng/mL) and Crohn's disease (1057.63±176.03 ng/mL) patients compared to controls (890.56±129.37 ng/mL) (H=16.28; p=0.0003). Cathelicidin was significantly elevated in children with active IBD (1044.90±176.17 ng/mL) and IBD remission (1098.10±227.87 ng/mL) compared to controls (Z=3.21; p=0.001; Z=-4.12; p<0.0001, respectively). Negative correlation between cathelicidin and calprotectin in children with ulcerative colitis was found (R=-0.39; p=0.02). Cathelicidin exhibited AUC of 0.815 for differentiation children with ulcerative colitis from the control group. CONCLUSION: Serum cathelicidin is increased in children with Crohn's disease and ulcerative colitis regardless of clinical activity of the disease suggesting that it may be a potential biomarker of IBD. Inverse correlation between cathelicidin and fecal calprotectin may imply a disparate role of these molecules in the pathophysiology of pediatric ulcerative colitis.

Serum interleukin 17A and interleukin 17F in children with inflammatory bowel disease.

Interleukin 17A (IL-17A) and interleukin 17F (IL-17F) appear to play important role in pathogenesis of some autoimmune diseases. However, their role in inflammatory bowel disease (IBD) has not been yet fully elucidated. We aimed to determine serum IL-17A and IL-17F in children with IBD and to assess their association with IBD activity. Recruited children underwent blood tests including complete blood count, C-reactive protein, erythrocyte sedimentation rate, IL-17A and IL-17F and stool sampling for calprotectin. The study group comprised 68 children with IBD, including 43 with ulcerative colitis and 25 with Crohn's disease. Control group included 20 healthy children. IL-17A was significantly increased in children with IBD (median: 10.95 pg/ml; range: 0.65-200.54 pg/ml) compared to controls (median: 4.09 pg/ml; range: 0.67-26.20 pg/ml) (p = 0.002). IL-17A was significantly increased in patients with active phase of ulcerative colitis (median: 14.58 pg/ml; range: 0.65-200.54 pg/ml) compared to those in ulcerative colitis remission (median: 8.13 pg/ml; range: 1.61-58.56 pg/ml) (p = 0.04). There were no significant differences in IL-17A among patients with active and inactive Crohn's disease (p = 0.18). IL-17F did not differ significantly between children with IBD (median: 15.11 pg/ml; range: 0.09-189.84 pg/ml) and controls (median: 11.56 pg/ml; range: 0.19-32.49 pg/ml) (p = 0.33). Our study suggests that interleukin 17A may diverse active phase from remission only in ulcerative colitis but not in Crohn's disease.

Biomarkers and Hematological Indices in the Diagnosis of Iron Deficiency in Children with Inflammatory Bowel Disease.

Inflammation may affect many routinely available parameters of iron homeostasis. Thus, the recognition of iron deficiency in inflammatory bowel disease (IBD) remains a diagnostic challenge in a clinical routine. The aim of the study was to detect the most efficient marker of iron deficiency in IBD children. In a group of 75 IBD children, we evaluated the sensitivity, specificity, accuracy, and positive and negative predictive values of erythrocytes' indices, including MCV, MCH, MCHC and RDW, and biochemical markers, including iron, transferrin, sTfR and sTfR/log ferritin, for identifying iron deficiency. Receiver operating characteristic (ROC) analysis was used to compare the ability of these parameters to detect iron deficiency. The best predictors of iron deficiency were sTfR/log ferritin, with accuracy 0.86, sensitivity 0.98, specificity 0.63, positive predictive value 0.83 and negative predictive value 0.94, and sTfR, with accuracy 0.77, sensitivity 0.82, specificity 0.67, positive predictive value 0.82 and negative predictive value 0.67. Moreover, sTfR/log ferritin exhibited the largest area under ROC (0.922), followed by sTfR (0.755) and MCH (0.720). The sTfR/log ferritin index appears to be the most efficient marker of iron depletion in pediatric IBD, and it may give an added value in the management of IBD patients.

Soluble transferrin receptor and soluble transferrin receptor/log ferritin index in diagnosis of iron deficiency anemia in pediatric inflammatory bowel disease.

BACKGROUND: There is no single reliable marker of iron homeostasis in inflammatory bowel disease. AIMS: To determine diagnostic usefulness of soluble transferrin receptor and soluble transferrin receptor/log ferritin index in iron deficiency anemia in children with inflammatory bowel disease. METHODS: We assessed soluble transferrin receptor in serum and calculated soluble transferrin receptor/log ferritin index in 75 children with inflammatory bowel disease. Diagnostic ability to identify iron deficiency anemia was examined by receiver operating characteristic analysis. RESULTS: Study group comprised 27 cases of iron deficiency anemia, 6 anemia of chronic disease with iron deficiency, 5 anemia of chronic disease. Soluble transferrin receptor was significantly increased in children with iron deficiency anemia (median: 1.63 µg/ml) compared to non-anemic children (median: 1.02 µg/ml). Soluble transferrin receptor/log ferritin index was significantly higher in iron deficiency anemia (median: 1.76) than in anemia of chronic disease (median: 0.55), anemia of chronic disease with iron deficiency (median: 0.68) or patients without anemia (median: 0.72). Soluble transferrin receptor and its index were not correlated with disease activity or inflammatory markers. Diagnostic power for soluble transferrin receptor/log ferritin index (0.864) was superior to soluble transferrin receptor (0.768) in iron deficiency anemia recognition. CONCLUSION: Soluble transferrin receptor/log ferritin index has better diagnostic utility than soluble transferrin receptor for iron deficiency anemia detection in pediatric inflammatory bowel disease.

Selected risk factors for atherosclerosis in children and their parents with positive family history of premature cardiovascular diseases: a prospective study.

BACKGROUND: The aim of the study was to evaluate serum parameters of lipid metabolism, homocysteine, soluble adhesion molecules and common carotid artery wall thickness in children from families with early symptoms of atherosclerosis. METHODS: The first stage included 137 pairs of mothers and newborns, and the second 18 children from the same group (age 18-30 months) and their parents (age 21-46 years) with a history of premature coronary artery disease (CAD), as well as 12 age- and sex-matched controls. RESULTS: During the first stage, inverse correlations were found between birthweight, cord blood concentrations of triglycerides (TG), VLDL cholesterol and apolipoprotein B (Apo B). Serum concentrations of total cholesterol (TC), apolipoprotein A1 (Apo A1), LDL and HDL cholesterol and were significantly higher in female than in male newborns. During the second stage, children from families with a history for premature CAD were shown to present with significantly higher serum concentrations of TG, VLDL cholesterol and lipoprotein A (Lp(a)) than the controls. Furthermore, their TC correlated positively with vascular cell adhesion molecule-1 (Rs=0.717, p<0.05) and intracellular adhesion molecule-1 (sICAM-1) levels (Rs=0.833, p<0.05). Moreover, positive correlations were found between maternal carotid intima media thickness (IMT) and TC (Rs=0.831, p<0.01), as well as between paternal IMT and Apo B (Rs=0.692, p<0.05), TG and sICAM-1 (Rs=0.912, p<0.01), TG and sE-selectin (Rs=0.678, p<0.05). CONCLUSIONS: Serum Lp(a) may serve as a maker of cardiovascular risk in children and adolescents.

Cord blood lipid profile in healthy newborns: A prospective single-center study.

BACKGROUND: Atherosclerosis may originate during the fetal period, therefore it is reasonable to identify early risk markers of lifestyle diseases. OBJECTIVES: The aim of the study was to determine the relationship between fetal and maternal factors, and the neonatal cord blood lipid profile in term newborns. MATERIAL AND METHODS: In the study group, there were 206 healthy Polish newborns. Newborn characteristics included sex, gestational age at birth, Apgar score, and anthropometric data (weight and length at birth, neonatal ponderal index, head, chest and abdominal circumferences, placenta weight, and placental-fetal weight ratio). Cord blood samples were collected for total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglycerides (TG). Information regarding selected maternal factors was collected. RESULTS: The cord blood concentration of TC (p = 0.0007), HDL (p = 0.001) and LDL (p = 0.003) was higher in girls than in boys. A significant positive correlation was found between TG and gestational age (p < 0.0001; r = 0.29). Significant negative correlations between maternal preconception BMI and TC (p = 0.03; r = -0.14), HDL (p = 0.04; r = -0.13) and LDL (p = 0.02; r = -0.15) were observed. CONCLUSIONS: In our study group, the influence of the newborns' gender, gestational age and mothers' preconception BMI on lipid concentration was observed. Further investigations are needed to determine markers in cord blood that may predict future metabolic disorders.

Alcohol intoxication among adolescents and children in urban and rural environments - a retrospective analysis.

INTRODUCTION AND OBJECTIVE: Drinking alcohol by adolescents and children poses a risk of long-term psychological and sociological consequences, often leading to addiction in adulthood. A steady increase in the number of young people reaching for alcohol is worrying. The study analyzes the age and gender of the children, concentration of alcohol in the blood, depending on the origin of the youth (urban or rural). MATERIAL AND METHODS: The study was a retrospective analysis of 402 patients hospitalized due to alcohol intoxication in the Department of Paediatrics at Medical University in Lublin, Poland between 2004 - 2013. RESULTS: During the study period a continuous increase in admissions of patients after alcohol consumption was observed: from 27 children in 2004 to 53 in 2012 and 2013. The youngest patient hospitalized after drinking was 7.6 years old and came from the rural environment, the oldest 18 years old and came from the urban environment. In 2004 - 2007, boys dominated among children intoxicated with alcohol; since 2008, a slight prevalence of girls has been observed, especially in the urban environment. Among patients coming from the country, boys always predominated. In the study period there was noted a similar number of children consuming alcohol from rural and urban environments. CONCLUSIONS: The results suggest the need to introduce appropriate educational programmes in schools to prevent the consumption of alcohol at a young age.

Serum Hepcidin in Children with Inflammatory Bowel Disease.

BACKGROUND: Hepcidin is a major regulator of iron homeostasis and a mediator of innate immunity. To date, the role of hepcidin in inflammatory bowel disease (IBD) children is not clearly established. We aimed to assess serum hepcidin concentration in IBD children and correlate hepcidin with iron status parameters and inflammatory markers. METHODS: The study group included 46 pediatric patients with ulcerative colitis and 29 with Crohn's disease. In control group, there were 21 children with functional gastrointestinal disorders. The complete blood count, high-sensitivity C-reactive protein, erythrocyte sedimentation rate, iron, ferritin, transferrin, hepcidin, soluble transferrin receptor, transferrin saturation, and interleukin-6 were measured. The study was approved by the local bioethical committee (KE-0254/22/2013). RESULTS: Mean serum hepcidin concentration was significantly decreased in IBD children (5.98 ng/mL) compared with controls (10 ng/mL) (P = 0.03). Hepcidin did not differ significantly between patients with Crohn's disease (6.9 ± 4.5 ng/mL) and ulcerative colitis (5.4 ± 5.3 ng/mL) (P = 0.07). Hepcidin was significantly decreased in IBD children with iron deficiency (4.9 ± 3.2 ng/mL) compared with healthy controls (10.5 ± 10 ng/mL) (P = 0.02). In anemic children with IBD, serum hepcidin (5.3 ± 4.4 ng/mL) was significantly reduced compared with healthy controls (10.5 ± 10 ng/mL) (P = 0.04), but comparable to nonanemic IBD children (6.6 ± 5.6 ng/mL) (P = 0.62). In IBD, children hepcidin was correlated solely with ferritin (P = 0.007; R = 0.3). CONCLUSIONS: In our study, serum hepcidin concentration was significantly decreased in IBD children compared with controls. Hepcidin correlated positively with ferritin, but not with any of inflammatory markers. It may suggest that in our cohort, hepcidin was regulated predominantly by iron storage level.

Exceptional manifestation of polyautoimmunity in a very young girl - a case report.

Polyautoimmunity is defined as the presence of more than one autoimmune disease in a single patient. The exact pathogenic mechanisms responsible for the coexistence of distinct autoimmune diseases within an individual have not been clearly explained. We report a case of a very young girl with the extremely rare co-existence of four distinct autoimmune diseases i.e. juvenile idiopathic arthritis, type 1 diabetes mellitus, coeliac disease and autoimmune hepatitis, recognized based on validated international classification criteria. The best to our knowledge there has been no case reporting coexistence of these particular four disorders in an individual. Moreover, all these diseases occurred during first three years of life, which also cause that case unique. Molecular studies of human leukocyte antigen (HLA) class II in our patient showed the presence of the HLA DRB1*01, HLA DRB1*03, HLA DQB1*02, HLA DQB1*05 molecules, which may suggest immunogenetic links between those autoimmune diseases. The presented case highlights the importance of active screening for other autoimmune diseases, if a patient with one autoimmune disease manifests with new or nonspecific symptoms.