The role of multimodality imaging in diagnosing acute perimyocarditis secondary to Crohn’s disease

Background Acute perimyocarditis is a rare extra-intestinal manifestation in Crohn’s disease which required multimodality imaging to confirm the diagnosis. Here we present a case of acute perimyocarditis as the first presentation of Crohn’s disease. To date, this is the first case presentation reporting the use of 18F-FDG PET/CT Scan for diagnosing such condition. Case presentation A 25-year-old male presented to our hospital with severe persistent pleuritic sharp left-sided chest pain. This was his second hospital admission in the past 4 months for chest pain and diarrhea. At the first hospitalization, he was diagnosed with viral perimyocarditis and irritable bowel syndrome. Laboratory findings, electrocardiogram, and cardiac magnetic resonance imaging results confirm the diagnostic of perimyocarditis. Virology, bacteriology, parasitology, and autoimmune evaluations were unremarkable. Colonoscopy, colorectal biopsy, and 18FGD PET findings confirmed manifestation of perimyocarditis, Crohn’s disease, and negative for sarcoidosis. Conclusions Looking at the overall clinical picture and investigation results of colonoscopy, colorectal biopsy findings, as well as multi-modality imaging with echocardiography, 18FDG PET—scan and CMRI, the patient was diagnosed to have perimyocarditis attending Chron’s disease flare up as a rare extra-intestinal manifestation.

Fistula-Related Cancer in Crohn’s Disease: A Systematic Review

Perianal fistulizing Crohn’s disease is a very disabling condition with poor quality of life. Patients with perianal fistulizing Crohn’s disease are also at risk of perianal fistula-related squamous cell carcinoma (SCC). Cancer arising at the site of a chronic perianal fistula is rare in patients with Crohn’s disease and there is a paucity of data regarding its incidence, diagnosis and management. A systematic review of the literature was undertaken using Medline, Embase, Pubmed, Cochrane and Web of Science. Several small series have described sporadic cases with perianal cancer in Crohn’s disease. The incidence rate of SCC related to perianal fistula was very low (<1%). Prognosis was poor. Colorectal disease, chronic perianal disease and HPV infection were possible risk factors. Fistula-related carcinoma in CD (Chron’s disease) can be very difficult to diagnose. Examination may be limited by pain, strictures and induration of the perianal tissues. HPV is an important risk factor with a particular carcinogenesis mechanism. MRI can help clinicians in diagnosis. Examination under anesthesia is highly recommended when findings, a change in symptoms, or simply long-standing disease in the perineum are present. Future studies are needed to understand the role of HPV vaccination in preventing fistula-related cancer.

Can asymptomatic Chron’s disease be diagnosed in patients with iron deficiency anemia by CT-enterograhpy?

It is difficult to diagnose Crohn's disease in the asymptomatic period. The aim of this study is to evaluate the diagnostic utility of CT enterography (CTE) in the diagnosis of asymptomatic Crohn's disease (CD) with small intestine involment in patients with iron deficiency anemia (IDA). 250 patients who underwent CTE examination between 2017 and 2018 were retrospectively scanned. 45 patients who had endoscopic examinations and diagnosed with IDA were included in the study. While one or more pathological findings to explain IDA were observed in 31 (68%) patients with endoscopic examinations, findings that could be explained as CD sequelae were observed in 4 (8.8%) patients. No lesions were observed by CTE in 10 (22.2%) patients. Diagnosis is difficult in mild forms of Crohn’s disease or in periods of remission. In this period, CTE can contribute to the diagnosis as it can also show extraluminal findings.

Recent Advances in the Synthesis and Development of Curcumin, its Combinations, Formulations and Curcumin-like Compounds as Antiinfective Agents

: Infectious diseases are caused by pathogenic microorganisms, such as bacteria, fungi, parasites and viruses. Such diseases mostly develop in tropical and sub-tropical climates and represent major health challenges. The pathogens of these diseases are able to multiply in human hosts, warranting their continual survival. Treatment is becoming extremely difficult, due to the absence of effective vaccines and the emergence of resistance by their causative pathogens to existing drugs. Several currently available drugs employ oxidative stress, resulting from the generation of reactive oxygen nitrogen species (RONS), as mechanism for exerting their pharmacological actions. RONS inhibit endogenous antioxidant enzymes, which ultimately eradicate the microbiota. Curcumin, a redox-active natural product, has for centuries been used in Asian traditional medicine for the treatment of various diseases. It is known for possessing multiple biological and pharmacological activities. Curcumin has been investigated extensively over the years for its anti-inflammatory, anticancer, antiparasitic, antiviral and antibacterial activities, and no toxicity is associated with the compound. Despite its potency and safety profile, curcumin is still in clinical trials for the treatment of diseases, such as tuberculosis, acquired immunodeficiency syndrome (AIDS), Chron’s disease, colorectal cancer and multiple myeloma, among many others, as it is yet to be qualified as a therapeutic agent. This review summarizes events over the last decade, especially, regarding the discovery of curcumin, an update of its synthesis, its pathogen specific mechanisms of action, and the pharmacological effects of its derivatives as potential antibacterial, antifungal, antiparasitic and antiviral agents for the treatment of various infectious diseases.

Pathophysiology of Crohn’s disease inflammation and recurrence

Chron’s Disease is a chronic inflammatory intestinal disease, first described at the beginning of the last century. The disease is characterized by the alternation of periods of flares and remissions influenced by a complex pathogenesis in which inflammation plays a key role. Crohn’s disease evolution is mediated by a complex alteration of the inflammatory response which is characterized by alterations of the innate immunity of the intestinal mucosa barrier together with a remodeling of the extracellular matrix through the expression of metalloproteins and increased adhesion molecules expression, such as MAcCAM-1. This reshaped microenvironment enhances leucocytes migration in the sites of inflammation, promoting a TH1 response, through the production of cytokines such as IL-12 and TNF-α. IL-12 itself and IL-23 have been targeted for the medical treatment of CD. Giving the limited success of medical therapies, the treatment of the disease is invariably surgical. This review will highlight the role of inflammation in CD and describe the surgical approaches for the prevention of the almost inevitable recurrence.

Role of therapeutic drug monitoring of azathioprine and thiopurine methyltransferase enzyme status in patients with inflammatory bowel disease: Indian scenario

Inflammatory bowel disease is mainly caused by dysragulated immune system. Inflammatory bowel disease incidences are rising in Asian countries with difficulty in their diagnosis and managements. There is rising the incidences and prevalence rate in India. Inflammatory bowel disease has two major subtypes Ulcerative colitis and chron’s disease. In ulcerative colitis inflammation occurs in lower part of large intestine that extend from anal verge to proximal colon while in case of chron’s disease there is transmural inflammation of gastrointestinal tract. This review is to provide comprehensive review focused on the current status of therapeutic drug monitoring of azathioprine metabolites in patients of inflammatory bowel disease.