Cystic fibrosis (CF) is the most common lethal, multisystemic genetic disorder in Caucasians. Mutations in the gene encoding the cystic fibrosis transmembrane regulator (CFTR) protein are responsible for impairment of epithelial anionic transport, leading to impaired fluid regulation and pH imbalance across multiple organs. Gastrointestinal (GI) manifestations in CF may begin in utero and continue throughout the life, resulting in a chronic state of an altered intestinal milieu. Inherent dysfunction of CFTR leads to dysbiosis of the gut. This state of dysbiosis is further perpetuated by acquired factors such as use of antibiotics for recurrent pulmonary exacerbations. Since the gastrointestinal microbiome and their metabolites play a vital role in nutrition, metabolic, inflammatory, and immune functions, the gut dysbiosis will in turn impact various manifestations of CF—both GI and extra-GI. This review focuses on the consequences of gut dysbiosis and its metabolic implications on CF disease and possible ways to restore homeostasis.

There is increasing prevalence of psychiatric disorders among inflammatory bowel Disease (IBD) population. Further, presence of psychiatric disorders has been shown as an independent predictor of quality of life among patients with IBD. We intended to explore the prevalence of various psychiatric disorders among pediatric and young adult population with IBD as a population-based analysis. We did a retrospective case control analysis using a deidentified cloud-based database including health care data across 26 health care networks comprising of more than 360 hospitals across USA. Data collected across different hospitals were classified and stored according to Systematized Nomenclature of Medicine-Clinical Terms. We preidentified 10 psychiatric disorders and the queried the database for the presence of at least one of the ten psychiatric disorders among IBD patients between 5 and 24 years of age and compared with controls. Total of 11,316,450 patients in the age group between 5 and 24 years and the number of patients with a diagnosis of IBD, Crohn's disease or ulcerative colitis were 58,020. The prevalence of psychiatric disorders was 21.6% among IBD mainly comprising of depression and anxiety disorder. Multiple logistic regression analysis showed, IBD is 5 times more likely associated with psychiatric disorders than controls, p<0.001). We showed a steady increasing trend in the incidence of psychiatric disorders among IBD patients (2% in 2006 to 15% in 2017). Largest population-based analysis demonstrated an increased prevalence of psychiatric disorders among IBD patients. Our study emphasizes the need for psychological and mental health services to be incorporated as a part of the routine IBD clinic.

Background: Congenital syphilis (CS) is a devastating yet preventable disease affecting the fetus. Recent increase in cases of CS in the United States has been reported by Centers for Disease Control and Prevention. There is a lack of data on hospitalization trends and healthcare utilization related to CS. We sought to describe CS hospitalization trends, morbidity and mortality during 2009 through 2016 and related healthcare expenditure. Methods: National inpatient level data collected from Kid’s Inpatient Database and National Inpatient Sample databases from 2009 to 2016 were analyzed. CS hospitalizations were identified using International Classification of Diseases codes in age less than 1 year. Related demographics, risk factors and outcomes were calculated. Infant mortality related to CS were calculated per number of hospitalizations. Results: From 2009 to 2016, there were a total of 5912 CS-related hospitalizations. The overall trends in hospitalizations related to CS was up trending since 2009. African American ethnicity, public insurance/uninsured, low socioeconomic status, geographic location (South and West hospital regions), prematurity and low birth weight were significantly associated with CS and remained as independent risk factors. The mean length of stay (12.38 ± 0.10 d vs. 3.42 ± 0.1 d) and mean hospitalization charges were significantly higher in CS (P < 0.001) as compared with other hospitalized infants without CS. The total inflation-adjusted hospitalization charges have more than doubled over the years ($120,665,203 in 2016 vs. $54,290,310 in 2009). The rate of in-hospital deaths in CS hospitalization was 0.54% (32 deaths among 5912 hospitalizations). Conclusions: The incidence of CS hospitalization has been increasing since 2009. CS contributes to a significant healthcare utilization burden; its prevention can save a large amount of healthcare-related expenditure.

Background: Adult studies demonstrated that extremes of nutritional status adversely impact clinical outcomes in acute pancreatitis (AP). With rising prevalence of undernutrition/obesity in children, we analyzed the effect of nutritional status on the clinical outcomes in children and adolescents with acute pancreatitis. Methodology: We analyzed the Kids’ Inpatient Database (KID) between 2003 and 2016 to include all patients with a primary diagnosis of AP using specific International Classification of Diseases (ICD) codes. We classified into (1) undernutrition, (2) obesity and (3) control groups, based on ICD codes, and we compared severe acute pancreatitis and healthcare utilization (length of stay and hospitalization costs). Results: Total number of AP admissions was 39,805. The prevalence of severe AP was higher in the undernutrition and obesity groups than the control group (15.7% vs. 5.8% vs. 3.5% respectively, p < 0.001). Multivariate analyses demonstrated that undernutrition and obesity were associated with 2.5 and 1.6 times increased risk of severe AP, p < 0.001. Undernutrition was associated with an additional six days of hospitalization and almost $16,000 in hospitalization costs. Obesity was associated with an additional 0.5 day and almost $2000 in hospitalization costs, p < 0.001. Conclusion: Undernutrition and obesity were associated with greater severity of AP, as well as prolonged hospitalization stay and costs. It is imperative for treating clinicians to be aware of these high-risk groups to tailor management and strive for improved outcomes.