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• Several cardiovascular/hemostatic disturbances haves been reported in patients with COVID-19, but the real frequency and their potential association with the pathogenic mechanisms of SARS-CoV-19 still remain to be defined. • We investigated the relative frequency of acute coronary syndrome, deep venous thrombosis, pulmonary embolism, stroke and upper gastrointestinal bleeding in COVID patents attending emergency departments (EDs), before hospitalization and compared them with frequencies in the general ED population attending 50 Spanish EDs. • We found that the risk of pulmonary embolism is clearly increased in COVID patients, with an OR of 4.53 with respect to non-COVID patients (95% confidence interval 4.03- 5.10). Additionally, the diagnosis of pulmonary embolism was 2 fold more frequent among ED comers in 2020 compared to 2019, suggesting a SARS-CoV-2 role in such increment of cases.. The remaining entities studied were not found to be unequivocally increased in the present study and need further investigation.

Biologic therapy has become standard therapy for pediatric Inflammatory Bowel Disease (IBD) patients with moderate-to-severe disease. Despite medical management, many patients still require surgical intervention. We aim to identify the risk of postoperative complications within 30 days in pediatric IBD patients treated with biologic therapy who require intra-abdominal surgery. A retrospective chart review was completed of pediatric IBD patients on biologic therapy at Children’s National Hospital. Mann–Whitney U test and Fisher’s exact test were used for statistical analysis. Two hundred and sixty-nine pediatric IBD patients on biologic therapy age were identified. In total, 5.2% of patients required surgical intervention despite medical management with biologic therapy. All patients identified were diagnosed with Crohn’s disease; the majority of patients requiring surgical intervention were female and of Caucasian race. Twenty-one percent of patients who required surgical intervention developed postoperative complications related to infectious etiology. All patients had biologic therapy held perioperatively. Those in delay with re-initiation of therapy were at risk for nonresponse or anaphylaxis. Presence of anemia was significantly associated with postoperative complications (p = 0.05). A minority of IBD patients on biologic therapy required surgical intervention despite treatment with biologic therapy. Presence of anemia may be associated with risk of postoperative complications. More studies are needed to further these findings.

Introduction. Celiac disease, an autoimmune enteropathy, occurs in susceptible individuals and is treatable with a gluten-free diet. These may not be supplemented with vitamins. Objective. To assess the nutritional health of children who have biopsy-proven celiac disease. Methods. Charts were reviewed between July 1, 2007, and June 30, 2017. Results. A total of 252 children ages 0 to 21 years had biopsy-proven celiac disease, mean age 11 ± 4.1 years. Body mass index Z-score was 0.2 ± 1.2 at diagnosis. Except for vitamin D, few had deficiencies at diagnosis. At 1-year follow-up, there was no significant change in anthropomorphics or vitamin status. Adherence to follow-up was poor; at 5 years after diagnosis, 39% adhered to follow-up. Conclusion. Despite a rigorous, proactive protocol for contacting and following children with celiac disease, adherence to follow-up was poor. New strategies, such as follow-up through the primary care provider, are needed.

Iron may be an important factor in the pathogenesis of non-alcoholic steatohepatitis (NASH) as it catalyzes the production of potent reactive oxygen species. We aim to examine iron status in pediatric NASH.Serum indices of NASH patients (N = 36) were compared to those in the U.S. National Health and Nutrition Examination Survey database (N = 802). Iron related gene expression was examined in NASH livers and normal livers, using microarray and quantitative real-time PCR (10 NASH livers and 6 controls). Transferrin and catalase expression were also examined in hydrogen peroxide treated HepG2 cells.Serum iron concentration (P0.01) and soluble transferrin receptor 1 (P0.0001) were decreased while serum ferritin was elevated in NASH patients (P0.01). No detectable iron was observed in NASH liver by Perls' Prussian blue staining. Transferrin (P0.01) and transferrin receptor 2 (P0.01) mRNA were elevated in NASH patients. Of particular interest, transferrin mRNA was positively correlated with catalase mRNA (r = 0.9338, P0.0001). H2O2 treatment of HepG2 cells induced mRNA expression of transferrin and catalase.Pediatric NASH patients exhibited decreased serum iron concentration and no detectable iron was observed in any NASH liver by Perls' Prussian blue staining. These changes are consistent with the facts that most NASH patients are obese and exhibit chronic inflammation. In line with a status of iron deficiency, gene expression studies suggested decreased expression of transferrin and transferrin receptor 2 in NASH livers. Induction of transferrin by H2O2, and consequently, decreased iron absorption, suggests a novel mechanism for iron deficiency in NASH patients.