Choroidal mass as an initial presentation of lung cancer

Choroidal mass may be a presenting sign of systemic malignancy. The diagnosis of metastatic ocular tumor is important because it can indicate poor prognosis. We report a case of a 45-year-old man presenting to our clinic with the complaint of decreased vision in the left eye, which is the initial finding of non-small cell lung-carcinoma.     

Effect of pulsed corticosteroids and tocilizumab on hyperinflammation in COVID-19 patients with acute respiratory distress syndrome

Objective: To compare the efficacy of pulsed-dose corticosteroids (≥250 mg methylprednisolone, 3 days) and tocilizumab in treating COVID-19-related hyperinflammation.Methods: This prospective observational study included RT-PCR positive COVID-19 patients with acute respiratory distress syndrome, who were admitted to the COVID-19 Adult Intensive Care Unit of Prof Dr. Murat Dilmener Emergency Hospital (Istanbul, Turkey) between December 1, 2020 and February 28, 2021. Clinical, laboratory and radiological examinations were used to diagnose COVID-19 associated hyperinflammation. Three cohort groups were formed: the pulsed-dose corticosteroids group (250 mg methylprednisolone for 3 days), the tocilizumab group (8 mg/day single dose or 400 mg/day for 2 days), and the combined group (pulsed-dose corticosteroid+tocilizumab). The difference in mortality rates among the groups was compared primarily. The most common cause(s) of death was determined. Furthermore, adverse events (secondary infection, acute kidney injury, arrhythmia, gastrointestinal system bleeding) for 28 days were recorded. Results: A total of 60 patients were included in this study, with 20 patients in each group. There was no statistically significant difference between the 3 groups in mortality rates (55％ in the pulsed corticosteroid group, 60％ in the tocilizumab group, 50％ in the combined group, χ2=0.404, P=0.817). Infectious causes were found to be the most common cause of mortality in all the three groups, and no difference was found between them (χ2=0.404, P=0.817). There was also no difference in the development of adverse events such as secondary infection, acute kidney injury, arrhythmia, and gastrointestinal bleeding among the groups (P>0.05). Conclusions: Corticosteroids can be used instead of tocilizumab to treat hyperinflammation in COVID-19 patients with acute respiratory distress syndrome .     

The cell based dressing with living allogenic keratinocytes in the treatment of foot ulcers: a case study.

In this study, we aimed to investigate the efficacy of cell based dressing with living allogenic keratinocytes in diabetic foot patients. To address this issue, the cultured keratinocytes were attached to the microcarriers produced from polyethylene and silica. The microcarriers were then applied to the wounds at 3-day intervals. Forty patients with grade II and III diabetic foot ulcers were included into the study. The patients were randomised into two groups (n=20). The treatment and control groups received cell based dressing and microcarriers kept in culture medium overnight, respectively. The wound size was recorded at 3 days intervals. The wounds were also categorised by a specific scoring system considering the wound contraction, granulation tissue formation, epithelisation and discharge from the wounds. The high score indicates better condition. The mean reduction of the wound area was 92% in the treatment group and 32% in the control group at the end of the 30 days treatment (p<0.001). When considered the complete healing, the mean number of dressings was 9.2+/-3.2 in the treatment group whereas it was 16.5+/-2.3 in the control group (p<0.001). The initial mean score of the treatment and control groups were 2.5 and 2.35, respectively. At the end of the 30th day, the mean score of the treatment group was 17.15+/-2.7 and of control group was 9.05+/-3. Allogenic keratinocyte treatment delivered with microcarriers can make significant contributions to wound healing in diabetic foot patients.     

Use of Vedolizumab in Inflammatory Bowel Disease: A Single-Center Experience

Background:Vedolizumab, which is a monoclonal antibody that selectively binds to α4β7 integrin in the gastrointestinal system, may be an effective and safe treatment alternative in those with anti-tumor necrosis factor-resistant inflammatory bowel disease.Methods:Patients administered vedolizumab due to anti-tumor necrosis factor resistant or anti-tumor necrosis factor side effects between August 2017 and November 2020 were included in the study. Crohn’s patients were evaluated using the Harvey–Bradshaw index and Simple Endoscopic Score for Crohn’s Disease, whereas ulcerative colitis patients were evaluated with the Partial Mayo Score Index and Rachmilewitz score. All patients were followed up for 3 months and their blood samples were taken every 3 months. Hemoglobin, white blood cell, leukocyte, lymphocyte, and platelet counts of the patients were performed. Albumin, C-reactive protein, and erythrocye sedimentation rate values were recorded. The side effect profile for vedolizumab was evaluated for all patients. Among the side effects, arthralgia and flu-like symptoms were observed.Results:A total of 48 patients (18 ulcerative colitis and 30 Crohn’s disease) were included in the study. Vedolizumab therapy was initiated in the patients due to anti-tumor necrosis factor resistance (17 ulcerative colitis and 26 Crohn’s disease) or anti-tumor necrosis factor side effects (1 ulcerative colitis and 4 Crohn’s disease). A total of 30 (63%) patients, including 15 (83%) ulcerative colitis and 15 (50%) Crohn’s disease, responded to treatment (both response and remission). The mean duration of response to treatment was 4.5 ± 1.5 months. A total of 20 (42%) patients in the vedolizumab therapy subgroup (10/10, ulcerative colitis/Crohn’s disease) went into remission. The mean Harvey–Bradshaw Index value was 9.8 ± 2.8 in the Crohn’s disease patients at the time of initial treatment. The mean Simple Endoscopic Score for Crohn’s disease value was 11.2 ± 3.1 at the time of initial treatment. The mean Harvey–Bradshaw Index value was 6.5 ± 3.0 and the mean Simple Endoscopic Score for Crohn’s disease value was 4.9 ± 3.6 at 6 months post-treatment. The mean Ulcerative Colitis Endoscopic Index (Rachmilewitz) value was 9.3 ± 1.2 at the time of initial treatment. In addition, the mean Partial Mayo Scoring Index was 6.4 ± 1.5 at the time of initial treatment. The mean Ulcerative Colitis Endoscopic Index (Rachmilewitz) value was 0 (0-6.0), and the mean Partial Mayo Scoring Index was 1.5 (0.3-4.0) at 6 months post-treatment.Conclusion:Vedolizumab therapy is effective in both induction and maintenance of remission in inflammatory bowel disease patients who are resistant to anti-tumor necrosis factor or who can not receive anti-tumor necrosis factor therapy due to side effects. No significant side effect was observed in the patients during follow-up.     

Caregiver Burden in Schizophrenia and Autism Spectrum Disorders: A Comparative Study

ObjectiveThere is no study comparing schizophrenia and autism spectrum disorders (ASD) in terms of caregiver burden. This study aims to compare the caregiver burden among family members of the patients with schizophrenia and ASD and investigate the predictive factors. MethodsA cross-sectional study with the family members living with and/or providing care to their patients was carried out. A sociodemographic form, the Beck Depression Inventory, the Self-Stigma Inventory for Families, and the Zarit Caregiver Burden Scale were utilized. Regression analyses were conducted to determine the predictive factors for higher burden. ResultsCaregiver burden in ASD was significantly higher than in schizophrenia. Regression analysis showed that the predictors of high caregiver burden were the need for self-care (OR=3.6), self-destructive behaviors (OR=3.4), self-stigma (OR=1.1), depression (OR=1.1), and level of income (OR=1.0) for all family members. When the diagnosis was removed from the equation, the factors determining the high burden did not change. ConclusionThis study suggests that characteristics of the illness are stronger predictors than family members’ characteristics in explaining high caregiver burden for both illnesses. Psychological, social, and economic supports should be provided for families to help alleviate their caregiving burden.