Efficiency of Ustekinumab in Crohn's Disease with Severe Psoriasiform Rash Induced by Biotherapies in an Adolescent.

Ustekinumab is approved for the treatment of psoriasis in adolescents and for the treatment of moderate to severe Crohn's disease (CD) in adults, but data are lacking in pediatric CD. We report a case of severe psoriasis induced by biotherapies in an adolescent with CD that improved after switching to ustekinumab (90 mg at weeks 0, 2, and 4 and then every 8 weeks). The patient had not experienced CD relapse after 1 year of follow-up. Ustekinumab can be an alternative therapy for psoriasis induced by biotherapies when conventional treatment fails and can maintain remission of CD.

Organ donation in the ICU - a survey on next of kin response in two Swiss academic centres.

AIM OF THE STUDY: In the Swiss population, attitudes to organ donation are mostly positive. However, a high refusal rate by the next of kin may be observed. We aimed to investigate potential underlying reasons. METHODS: In two independent Swiss tertiary care academic centres 167 next of kin were confronted with potential organ donation, over a period of 18 to 24 months. Of these, 147 could be contacted and were asked ≥6 months later to participate in a post-hoc survey (72-item questionnaire). Aspects related to conversations, time and care in the intensive care unit (ICU), underlying concepts for organ donation, impact on mourning, and other potential influencing factors were addressed. RESULTS: The overall return rate was 66%. Seventy four of 77 (96%) next of kin stated that the request for organ donation was appropriate and they agreed to address the issue. Personal attitudes of next of kin regarding organ donation correlated with the decision for or against organ donation (p <0.0001). Thirteen percent (8/62) reported that conversations with ICU physicians changed their decision. In 56% (18/32) of reports when organ donation was refused, the next of kin stated that presence of a documented will might have changed their decisions. Mourning was reported to be impaired by the request for organ donation in 8% (6/71), facilitated in 14% (10/71) and not affected in 77% (55/71) of cases. Twenty-seven percent (16/59) indicated that an opt-out policy for organ donation would subjectively have facilitated their decision and 81% (34/42) of consenting next of kin stated that an objection law should be put into place (p <0.0001). CONCLUSIONS: In this observational study, the majority of the next of kin stated that addressing organ donation did not affect mourning. Presence of a presumed will could likely facilitate grief and provide comfort for affected families. (Trial registration: ClinicalTrials.gov. Identifier: NCT03612024. Date of registration: 24 July 2018.).