There are very few reports of elevated lipase in pediatric inflammatory bowel disease (IBD). Symptoms of pancreatitis may be masked by abdominal pain in pediatric IBD. During the initial presentation of IBD in our patient, lipase was elevated to more than 3 times the upper limit of normal. Normalization of values coincided with remission of IBD. This may be due to extraintestinal involvement of the pancreas as part of the inflammatory process or due to leakage of pancreatic enzymes from an inflamed gut or mediated by inflammatory cytokines. Checking pancreatic enzymes during initial presentation of IBD may, therefore, be important to determine if pancreatic involvement has resulted from the inflammation in IBD or as an adverse effect of therapy. If unchecked, recurrent subclinical pancreatitis may be masked by IBD symptoms and missed prior to starting IBD therapy. This may result in chronic pancreatic insufficiency as reported in 50% of adults with IBD. Early detection of elevated pancreatic enzymes in IBD may help direct the management strategy, as treatment of the underlying inflammation in IBD may be the most important management for resolution of pancreatitis instead of cessation of therapy for fear of iatrogenic medication-induced pancreatitis.

Objectives: 1. To measure and compare granulocytemacrophage colony-stimulating factor (GM-CSF) antibodies and peripheral regulatory T cells (Tregs) cells as non-invasive biomarkers in active inflammatory bowel disease (IBD) and remission in pediatric IBD. 2. To determine the ability of these biomarkers to predict severity/type and choice of therapy in pediatric IBD. Methods:We hypothesized that patients with severe IBD requiring biologics will have higher circulating GM-CSF antibodies and lower Foxp3+ Tregs at baseline, with subsequent improvement in response to therapy. 28 patients were prospectively analyzed. Blood collected preand post-treatment was analyzed for GM-CSF antibodies by ELISA and Tregs by flow cytometry. Clinically, PCDAI and PUCAI were scored. Wilcoxon Rank Sum tests were used to compare baseline values between groups, and paired signed-rank tests used to compare pre-and posttreatment values.Results: Median GM-CSF antibodies trended higher (0.50 µg/mL vs. 0.37) and Tregs lower (5.23% vs. 6.71%) in the biologic cohort with no significant difference between cohorts. In response to biologics, 37% showed decrease in GM-CSF antibodies and 75% showed increase in Tregs. GM-CSF antibodies trended higher in Crohn's disease (CD) than ulcerative colitis (UC) (0.81 vs. 0.31, p=0.073). Activity indices showed significant improvement in the biologic cohort of UC patients (p=0.04). Conclusion:GM-CSF antibodies and peripheral Tregs may reflect disease activity and thereby guide IBD therapy. Although no individual biomarker could predict need for biologics, their trend favors their use in a predictive model to identify the most effective treatment strategy in pediatric IBD.

In this study, we examined the spread of SARS-CoV-2 infection and the dose-dependent efficacy of the COVID-19 vaccine Covishield (Oxford/AstraZeneca). During the period between December 2020 and February 2021, we tested the level of natural infection among individuals by estimating the reactivity of their sera towards SARS-CoV-2 spike (S) and nucleoprotein (N) proteins. The seropositivity of the population in different communities ranged from 17% to 51%, depending on their connectivity to the nearest metropolis Kolkata (population 14.85 million), the disease epicenter. We further found that while 90% of the people administered with two doses of Covishield developed antibody against SARS-CoV-2, only 55% developed antibody after one dose. Primarily those who had developed antibody through natural infection remained seropositive after the first vaccine dose in contrast to those with undetected infection. Our experimental findings not only contribute to a better understanding of COVID-19 epidemiology in India but also pave the way for an effective vaccination strategy involving the individual history of infection.