Crohn’s disease is a chronic inflammatory disease of the digestive tract with extraintestinal manifestations, which include skin conditions, arthritis, ocular inflammation, and several autoimmune conditions. Dermatologic manifestations in Crohn’s disease complicate the treatment course and prognosis and should be addressed promptly. Here, we report a 20-year-old male with a history of Crohn’s disease, presenting with palpable purpura, consistent with Henoch-Schönlein purpura, upon administration of ustekinumab. The immunoglobulin A vasculitis was treated with prednisone and the discontinuation of ustekinumab. Due to the increased usage of biological agents in inflammatory bowel diseases, associations between biologics and vasculitides should be further studied in Crohn’s disease patients for alternative treatment strategies and to understand potential adverse effects caused by biologics in Crohn’s disease.

Background: Coronavirus disease 2019 (COVID-19) is often a mild disease, usually manifesting with respiratory complaints, and is sometimes mortal due to multiple organ failure. Hyperinflammation is a known COVID-19 component and is associated with organ dysfunction, disease severity and mortality. Controlling hyperinflammatory response is crucial in determining treatment direction. An important agent in providing this control is corticosteroids. This study aimed to determine whether dexamethasone and methylprednisolone, doses, administration time and duration in COVID-19 treatment are associated with improved treatment outcomes. Methods: This retrospective multicenter study was conducted with participation of 6 healthcare centers which collected data by retrospectively examining files of 1,340 patients admitted to intensive care unit due to COVID-19 between March 2020 and September 2021, diagnosed with polymerase chain reaction (+) and/or clinically and radiologically. Results: Mortality in the pulse methylprednisolone group was statistically significantly higher than that in the other 3 groups. Mortality was higher in older patients with comorbidities such as hypertension, diabetes mellitus, chronic kidney failure, coronary artery disease, and dementia. Pulse and mini-pulse steroid doses were less effective than standard methylprednisolone and dexamethasone doses, pulse steroid doses being associated with high mortality. Standard-dose methylprednisolone and dexamethasone led to similar effects, but standard dose methylprednisolone was more effective in severe patients who required mechanical ventilation (MV). Infection development was related to steroid treatment duration, not cumulative steroid dose. Conclusion Corticosteroids are shown to be beneficial in critical COVID-19, but the role of early corticosteroids in mild COVID-19 patients remains unclear. The anti-inflammatory effects of corticosteroids may have a positive effect by reducing mortality in severe COVID-19 patients. Although dexamethasone was first used for this purpose, methylprednisolone was found to be as effective at standard doses. Methylprednisolone administered at standard doses was associated with greater PaO 2 /FiO 2 ratios than dexamethasone, especially in the severe group requiring MV. High dose pulse steroid doses are closely associated with mortality and standard methylprednisolone dose is recommended.

Objective: We aimed to investigate uric acid and albumin ratio (UA/A) as a marker of short-term mortality in acute kidney injury (AKI). Both uric acid and albumin are strongly correlated with the development and mortality of AKI. Methods: The patients hospitalized from May 2019 to September 2019 for AKI were included in this study. The diagnostic odds ratio (DOR), Youden index (J), and the area under a receiver operating characteristic curve (AUROC) determined a cut-off UA/A ratio for mortality. Cox-regression analysis was performed to identify UA/A as a prognostic marker of the 30-day mortality rate. Results: A total of 171 patients with an average age of 69.20±13.0 (45.6% women) were included in the study. The average UA/A ratio was 3.3±1.5 mg/g and 2.5±1.0 mg/g in the non-survivor and survivor groups, respectively (P=0.001). The best cut-off UA/A ratio associated with mortality was determined as 2.4 mg/g with a specificity of 52% and a sensitivity of 77% (DOR, 3.6; J, 28.8; AUROC, 0.644). Thirty-day cumulative survival rates of the low and high UA/A ratio groups were 85.9±4.0% and 63.7±5.0%, respectively. The estimated survival times of the low and high UA/A ratio groups were 27.7 days (95% confidence interval [CI], 26.2–29.3) and 23.9 days (95% Cl, 22.0–25.9), respectively. Conclusion We found a direct correlation between 30-day mortality and UA/A ratio at initial presentation in AKI patients regardless of age, comorbidities, and clinical and laboratory findings, including albuminuria.

Objective: The use of noninvasive volume assessment methods to predict acute blood loss in spontaneously breathing patients remains unclear. We aimed to investigate changes in the pleth variability index (PVI), vena cava collapsibility index (VCCI), end-tidal carbon dioxide (EtCO2), pulse pressure (PP), and mean arterial pressure (MAP) in spontaneously breathing volunteers after acute loss of 450 mL blood and passive leg raise (PLR). Methods: This prospective observational study enrolled healthy volunteers in the blood donation center of an academic hospital. We measured the PVI, EtCO2, VCCI, MAP, and PP before blood donation; at the 0th and 10th minute of blood donation; and after PLR. The primary outcome was the changes in PVI, EtCO2, VCCI, MAP, and PP. Results: We enrolled thirty volunteers. There were significant differences among the four obtained measurements of the PVI, EtCO2, and MAP (P<0.001, P<0.001, P<0.001, respectively). Compared to the predonation values, post-hoc analysis revealed an increase in the PVI at the 0th min postdonation (mean difference [MD], 5.4±5.9; 95% confidence interval [CI], -7.6 to -3.1; P<0.001); a decrease in the EtCO2 and MAP at the 0th and 10th minute postdonation, respectively (MD, 2.4±4.6; 95% CI, 0.019 to 4.84; P=0.008 and MD, 6.4±6.4; 95% CI, 3 to 9.7; P<0.001, respectively). Compared with EtCO2 at the 10th minute, the value increased after PLR (MD, 1.8±3.2; 95% CI, 0.074 to 4.44; P=0.006). Conclusion The PVI and EtCO2 could detect early hemodynamic changes after acute blood loss. However, it remains unclear whether they can determine volume status in spontaneously breathing patients.

Objective: We aimed to investigate uric acid and albumin ratio (UA/A) as a marker of short-term mortality in acute kidney injury (AKI). Both uric acid and albumin are strongly correlated with the development and mortality of AKI. Methods: The patients hospitalized from May 2019 to September 2019 for AKI were included in this study. The diagnostic odds ratio (DOR), Youden index (J), and the area under a receiver operating characteristic curve (AUROC) determined a cut-off UA/A ratio for mortality. Cox-regression analysis was performed to identify UA/A as a prognostic marker of the 30-day mortality rate. Results: A total of 171 patients with an average age of 69.20±13.0 (45.6% women) were included in the study. The average UA/A ratio was 3.3±1.5 mg/g and 2.5±1.0 mg/g in the non-survivor and survivor groups, respectively (P=0.001). The best cut-off UA/A ratio associated with mortality was determined as 2.4 mg/g with a specificity of 52% and a sensitivity of 77% (DOR, 3.6; J, 28.8; AUROC, 0.644). Thirty-day cumulative survival rates of the low and high UA/A ratio groups were 85.9±4.0% and 63.7±5.0%, respectively. The estimated survival times of the low and high UA/A ratio groups were 27.7 days (95% confidence interval [CI], 26.2–29.3) and 23.9 days (95% Cl, 22.0–25.9), respectively. Conclusion We found a direct correlation between 30-day mortality and UA/A ratio at initial presentation in AKI patients regardless of age, comorbidities, and clinical and laboratory findings, including albuminuria.

Objective: The use of noninvasive volume assessment methods to predict acute blood loss in spontaneously breathing patients remains unclear. We aimed to investigate changes in the pleth variability index (PVI), vena cava collapsibility index (VCCI), end-tidal carbon dioxide (EtCO2), pulse pressure (PP), and mean arterial pressure (MAP) in spontaneously breathing volunteers after acute loss of 450 mL blood and passive leg raise (PLR). Methods: This prospective observational study enrolled healthy volunteers in the blood donation center of an academic hospital. We measured the PVI, EtCO2, VCCI, MAP, and PP before blood donation; at the 0th and 10th minute of blood donation; and after PLR. The primary outcome was the changes in PVI, EtCO2, VCCI, MAP, and PP. Results: We enrolled thirty volunteers. There were significant differences among the four obtained measurements of the PVI, EtCO2, and MAP (P<0.001, P<0.001, P<0.001, respectively). Compared to the predonation values, post-hoc analysis revealed an increase in the PVI at the 0th min postdonation (mean difference [MD], 5.4±5.9; 95% confidence interval [CI], -7.6 to -3.1; P<0.001); a decrease in the EtCO2 and MAP at the 0th and 10th minute postdonation, respectively (MD, 2.4±4.6; 95% CI, 0.019 to 4.84; P=0.008 and MD, 6.4±6.4; 95% CI, 3 to 9.7; P<0.001, respectively). Compared with EtCO2 at the 10th minute, the value increased after PLR (MD, 1.8±3.2; 95% CI, 0.074 to 4.44; P=0.006). Conclusion The PVI and EtCO2 could detect early hemodynamic changes after acute blood loss. However, it remains unclear whether they can determine volume status in spontaneously breathing patients.

Purpose: The main purpose of this study is to evaluate prognostic factors that affected the patients’ early (<30 days) and late (six months, one year, and overall) postoperative mortality following hip fracture surgery. Materials and Methods: This retrospective study included 515 patients older than 75 years old with surgically treated osteoporotic hip fracture. The demographic data, American Society of Anesthesiologists (ASA) classification, type of anesthesia, duration of hospital stay, and history of intensive care unit (ICU) stay were collected.An analysis of laboratory values was also performed to determine their relationship with mortality. The primary outcome was survival, determined as the time from the surgery to death or the end of the study. The patients were divided into four groups according to survival time: at the first month, six months, first year, and overall survival. An analysis of demographic and laboratory values was performed to determine their validity as prognostic factors for each group. Results: Postoperative C-reactive protein (CRP) level showed an independent association with a poor survival at the first month. ASA classification, admission to the ICU, and preoperative CRP levels showed an independent association with a poor survival for the first six months. Preoperative CRP level showed an independent association with a poor survival for the first year. ASA classification, admission to the ICU, and the preoperative CRP levels showed an independent association with a poor overall survival. Conclusion CRP level, a high ASA classification, and postoperative ICU admission were related to poorer overall survival rate following hip fracture surgery in the elderly.

Background: Internalized stigma, adoption of negative attitudes and stereotypes of the society regarding persons’ illness, has not been studied previously in pediatric psoriasis patients. Objective: We aimed to investigate the internalized stigma in pediatric psoriasis patients and to determine differences according to factors affecting internalized stigma compared to adult psoriasis patients. Methods: This multicenter,cross-sectional, comparative study included 125 pediatric (55 female, 70 male; mean age±standard deviation [SD], 14.59±2.87 years) and 1,235 adult psoriasis patients (577 female, 658 male; mean age±SD, 43.3±13.7 years). Psoriasis Internalized Stigma Scale (PISS), Dermatology Life Quality Index (DLQI), Perceived Health Status (PHS), and the General Health Questionnaire (GHQ)-12 were the scales used in the study. Results: The mean PISS was 58.48±14.9 in pediatric group. When PISS subscales of groups were compared, the pediatric group had significantly higher stigma resistance (p=0.01) whereas adult group had higher scores of alienation (p=0.01) and stereotype endorsement (p=0.04). There was a strong correlation between mean values of PISS and DLQI (r=0.423, p=0.001). High internalized stigma scores had no relation to either the severity or localization of disease in pediatric group. However, poor PHS (p=0.007) and low-income levels (p=0.03) in both groups, and body mass index (r=0.181, p=0.04) in the pediatric group were related to high PISS scores. Conclusion Internalized stigma in pediatric patients is as high as adults and is related to poor quality of life, general health, and psychological illnesses. Unlike adults, internalized stigma was mainly determined by psoriasis per se, rather than disease severity or involvement of visible body parts, genitalia or folds.

Objective: The history, electrocardiogram, age, risk factors, troponin (HEART), the thrombolysis in myocardial infarction (TIMI), and Global Registry of Acute Coronary Events (GRACE) scores are useful risk stratification tools in the emergency department (ED). However, the accuracy of these scores in the cancer population is not well known. This study aimed to compare the performance of cardiac risk stratification scores in cancer patients with suspected acute coronary syndrome (ACS) in the ED. Methods: This prospective cohort study recruited patients with cancer who visited the ED because of suspected ACS. The development of any major adverse cardiac events (MACE) within 6 weeks was recorded, with the study outcome being a MACE within 6 weeks of ED admission. Results: A total of 178 patients participated in this study, of whom 5.6% developed a MACE. Statistically significant differences were found between the mean HEART and TIMI scores in predicting MACE. The HEART score had the highest area under the curve (0.64; 95% confidence interval, 0.48–0.81), highest sensitivity (80%), and highest negative predictive value (97.5) in patients with cancer. Conclusion We found a similar rate of MACE in cancer patients with low-risk chest pain compared to that in the general population. However, the HEART, TIMI, and GRACE scores had a lower performance in cancer patients with MACE compared to that in the general population.

OBJECTIVES: The purpose of this study is to shorten the decellularization time of trachea by using combination of physical, chemical, and enzymatic techniques. METHODS: Approximately 3.5-cm-long tracheal segments from 42 New Zealand rabbits (3.5±0.5 kg) were separated into seven groups according to decellularization protocols. After decellularization, cellular regions, matrix and strength and endurance of the scaffold were followed up. RESULTS: DNA content in all groups was measured under 50 ng/mg and there was no significant difference for the glycosaminoglycan content between group 3 (lyophilization+deoxycholic acid+de-oxyribonuclease method) and control group (P=0.46). None of the decellularized groups was different than the normal trachea in tensile stress values (P>0.05). Glucose consumption and lactic acid levels measured from supernatants of all decellularized groups were close to group with cells only (76 mg/dL and 53 mg/L). CONCLUSION: Using combination methods may reduce exposure to chemicals, prevent the excessive influence of the matrix, and shorten the decellularization time.
Deoxycholic Acid ; DNA ; Freeze Drying ; Glucose ; Lactic Acid ; Rabbits ; Tissue Engineering ; Trachea