Research is limited in describing the association between admission source and mortality in critically ill patients. Therefore, this study investigated how intensive care units (ICUs) admission source (emergency department (ED) or ward) correlates with mortality rates. This retrospective observational cross-sectional study was conducted in a tertiary pulmonology teaching hospital's ICU from January 1, 2018, to December 31, 2019. Patients were ICU patients admitted for acute respiratory failure. Demographic, comorbidities, diagnoses, APACHE II score, ICU admission (ED or ward), mechanical breathing support (invasive or noninvasive), length of stay, and mortality were recorded. Comparisons of ICU admission sources and mortality factors were established. A total of 2,173 ICU patients were studied; 1,011 (46%) were admitted from the ED and 1,162 (54%) from the ward. Their mean age was 70 years, and 66% of them were men. Pneumonia was the leading cause of ICU admission at 60% and Chronic Obstructive Pulmonary Disease (COPD) was the most common comorbidity at 54%. When both groups were evaluated in terms of respiratory support, non-invasive mechanical ventilation use was higher in patients admitted from the emergency room (ED: 50% vs. Ward: 35%), invasive mechanical ventilation was more frequently required in patients admitted from the ward compared to those admitted from the emergency department (ED: 17% vs. Ward: 25%). Length of ICU stay (2 vs. 3 days P < 0.001) and ICU mortality (odds ratio: 1.66, 95% confidence interval 1.297-2.124, P < 0.001) were higher in patients admitted from the ward than in patients admitted from the emergency department. In addition, pneumonia patients and those with malignancies, interstitial lung disease, or noninvasive mechanical ventilation (NIV) failure were associated with higher mortality. Our study suggests that ward-to-ICU patients had higher mortality rates compared to ED-to-ICU patients. Triage protocols to better identify potentially critically ill patients in the ED may improve outcomes by avoiding delays in care and better assignment of admission location.

Objective: Gastric neuroendocrine neoplasms (gNENs) are uncommon tumors, with growing understandings about the disease. Bibliometric analyzes have the advantage of visually depicting the dynamic evaluation of scientific knowledge of a specific topic. The aim of this study was to perform and report bibliometric analysis of gNENs, which was not formerly studied in the literature. Methods: Articles published between 1980 and 2022 within the database of Web of Science Core Collection were included in this bibliometric analysis. Vosviewer package program and Datawrapper were used for bibliometric data interpretation. Results: A total of 2270 articles about gNENs was detected with 63240 citations and an H index of 103. A remarkable increase was detected among the articles for years. Research have focused on gastroenterology and hepatology, endocrinology and metabolism, oncology, general medicine, pathology and surgery areas. Norwegian University of Science Technology was the leading institution about gNENs literature. Modlin IM, had the highest number of articles and citations among the authors. United States, Japan and Italy were the top three countries with the most published articles. Conclusion: This bibliometric study provides an engrossing, insightful conclusion to the research and development trajectory in gNENs with a future perspective.

Background: Although it has been suggested that papillary morphology and periampullary diverticulum (PAD) may affect the outcomes of endoscopic retrograde cholangiopancreatography (ERCP), the independent effects of these factors have not been clearly established. In this study, we aimed to evaluate the association of papillary morphology and PAD with ERCP success, procedural difficulty, and post-ERCP complications. Methods: Records of 1046 ERCP procedures performed at a single center were retrospectively reviewed. The primary analysis included 693 patients with native papillae and no prior sphincterotomy. Papilla morphology was available for 381 patients and periampullary diverticulum (PAD) status for 633. Outcomes included cannulation success, difficult cannulation, cannulation time, number of cannulation attempts, post-ERCP complications, and length of hospital stay. Multivariable Firth penalized logistic regression was used to evaluate independent associations with difficult cannulation, overall complications, cannulation failure, and post-ERCP pancreatitis (PEP), adjusting for papilla morphology, PAD status, age, sex, American Society of Anesthesiologists (ASA) physical status class, and Charlson Comorbidity Index (CCI). Results: Regular papilla morphology, compared with the pooled group of atypical papilla morphologies (Small, Bulging, Ridged), was associated with significantly higher cannulation success (97.4% vs. 91.2%; p = 0.012), shorter cannulation time (median 3.0 vs. 4.0 min; p = 0.009), fewer cannulation attempts (p = 0.007), and shorter hospital stay (median 5.0 vs. 6.0 days; p = 0.013). The presence of a PAD was not significantly associated with any procedural outcome or complication (all p > 0.05). CCI was independently associated with cannulation failure (adjusted OR 1.40 per one-point increase; 95% CI 1.03–1.91; p = 0.031) and was the only factor reaching statistical significance across the four multivariable models. The multivariable model showed modest discrimination for difficult cannulation (area under the receiver operating characteristic curve [AUC] = 0.596; 95% CI 0.515–0.675). Conclusions: Atypical papillary morphology was associated with lower cannulation success, longer cannulation time, and more cannulation attempts in univariable analyses; however, neither papillary morphology nor periampullary diverticulum was independently associated with ERCP outcomes. Among the variables evaluated, higher CCI was the only factor independently associated with cannulation failure; however, this finding should be interpreted cautiously given the small number of failure events.

Background/Aims: Patients with prior exposure to hepatitis B virus (HBV) (HBsAg [Hepatitis B surface antigen]-negative/anti-HBc [Hepatitis B core] immunoglobulin G (IgG)-positive) who receive immunosuppressive therapy (IST) remain susceptible to HBV reactivation (HBVr). Current clinical guidelines generally estimate HBVr risk according to the immunosuppressive potential of individual agents. However, evidence regarding the cumulative risk associated with the concurrent use of multiple agents within the same risk category remains limited. The current study investigated the effect of frequently used moderate risk IST combinations on the development of HBVr. Materials and Methods: A total of 406 HBsAg-negative/anti-HBc IgG-positive patients treated with moderate-risk IST were retrospectively analyzed. Patients were classified according to the treatment regimen into monotherapy (n = 178) and combination therapy (n = 228). HBVr was defined as either HBsAg seroconversion or the detection of HBV DNA during follow-up. The incidence of HBVr was compared between groups. Results: No significant differences were observed between the groups in baseline demographic and clinical features, including age, sex, and IST-related risk profiles. Among patients receiving combination therapy (58.7% female; mean age 62.8 ± 10.2 years), HBVr occurred in 6 patients, including 4 cases with HBV flare, whereas no reactivation occurred in the monotherapy group (62.3% female; mean age 63.6 ± 10.1 years). All patients who developed HBVr were anti-HBs-negative at baseline. HBVr occurred significantly more frequently among patients receiving combination therapy (P < .05). Conclusion: The use of combination IST and baseline anti-HBs negativity were identified as 2 important factors associated with increased risk of HBVr in HBsAg-negative/anti-HBc IgG-positive patients. In this subgroup, a clinical approach favoring antiviral prophylaxis may be considered. Further prospective studies with larger sample sizes are needed to fully elucidate this association. Cite this article as: Sadeçolak M, Düzenli T, Durak İ, et al. Increased risk of hepatitis B virus reactivation in patients with resolved hepatitis B virus infection receiving combination immunosuppressive therapy: The role of anti-HBs status. Turk J Gastroenterol. Published online June 2, 2026. doi: 10.5152/tjg.2026.26167.