Clinical Outcomes and Independent Risk Factors for 90-Day Mortality in Critically Ill Patients with Respiratory Failure Infected with SARS-CoV-2: A Multicenter Study in Turkish Intensive Care Units

Background:

There are limited data on the long-term outcomes of COVID-19 from different parts of the world.

Aims:

To determine risk factors of 90-day mortality in critically ill patients in Turkish intensive care units (ICUs), with respiratory failure.

Study design:

Retrospective, observational cohort.

Methods:

Patients with laboratory-confirmed COVID-19 and who had been followed up in the ICUs with respiratory failure for more than 24 hours were included in the study. Their demographics, clinical characteristics, laboratory variables, treatment protocols, and survival data were recorded.

Results:

A total of 421 patients were included. The median age was 67 (IQR: 57-76) years, and 251 patients (59.6%) were men. The 90-day mortality rate was 55.1%. The factors independently associated with 90-day mortality were invasive mechanical ventilation (IMV) (HR 4.09 [95% CI: [2.20-7.63], P < .001), lactate level >2 mmol/L (2.78 [1.93-4.01], P < .001), age ≥60 years (2.45 [1.48-4.06)], P < .001), cardiac arrhythmia during ICU stay (2.01 [1.27-3.20], P = .003), vasopressor treatment (1.94 [1.32-2.84], P = .001), positive fluid balance of ≥600 mL/day (1.68 [1.21-2.34], P = .002), PaO₂/FiO₂ ratio of ≤150 mmHg (1.66 [1.18-2.32], P = .003), and ECOG score ≥1 (1.42 [1.00-2.02], P = .050).

Conclusion:

Long-term mortality was high in critically ill patients with COVID-19 hospitalized in intensive care units in Turkey. Invasive mechanical ventilation, lactate level, age, cardiac arrhythmia, vasopressor therapy, positive fluid balance, severe hypoxemia and ECOG score were the independent risk factors for 90-day mortality.

The effect of helicobacter pylori eradication on atrophic gastritis and intestinal metaplasia : a retrospective single center research

BACKGROUND AND STUDY AIMS

Gastric cancer (GC) is one of the major causes of cancer-related deaths worldwide. Helicobacter pylori (Hp) plays an important role in gastric carcinogenesis by inducing precancerous changes such as atrophic gastritis (AG) and intestinal metaplasia (IM). In our study, we aim to compare the grade of AG and IM before and after Hp eradication in patients who underwent esophagogastroduodenoscopy (EGD) in our center.

PATIENTS AND METHODS

The data of 40.060 patients who underwent EGD for various reasons in our Endoscopy Unit between June 2011 and November 2017 were retrospectively evaluated. The grade of AG and IM before and after Hp eradication of patients meeting the study criteria were compared with each other. In addition, these findings were compared using OLGA and OLGIM staging systems.

RESULTS

A total of 175 patients, 89 (50.9%) women and 86 (49.1%) men, were included in the study. The mean age was 55±12 years. The mean time between two EGD examinations was 38±14 months. Significant improvement was observed in the grade of AG on corpus and antrum after Hp eradication (P=0.000, P=0.008). In the corpus and antrum, the grade of IM was regressed but this was not significant (P=0.80 and P=0.370 respectively). There was a decrease in OLGA stages after Hp eradication (P=0.000). There was also a reduction in the OLGIM stages, but this was not significant(P=0.341).

CONCLUSION

Our study demonstrates that Hp eradication may reduce the risk of developing GC by providing an improvement in AG and IM which are precancerous changes in GC.

Effects of penile fracture and its surgical treatment on psychosocial and sexual function

The current therapy for penile fracture is immediate surgical repair, but sexual and psychosocial effects of the repair have been poorly investigated. We aimed to assess the impact of surgical correction of penile fracture on psychosocial status, sexual function, and erectile quality. Sixty-four patients classified into two subgroups according to follow-up: 2-24 months (Group 1), and longer than 24 months (Group 2), and 28 healthy men (Control group). The mean overall follow-up period was 39.1±32.7 months. The number of sexual intercourse origin was 44 (68.8%), the mean time interval from incident-to-surgery was 13.6±9.3 h. The mean sexual relationship score decreased during first year (P=0.001), and significant recovery was observed over 12-24 months. The mean overall relationship scores and the mean self-esteem scores of the study groups decreased until the end of the 24 months (P<0.05). The mean erectile function domains remained stable in all groups (P>0.05). The mean EHS scores were lower but the difference was not significant in the study groups (P>0.05). Penile fracture repair have no detrimental effect on sexual function, but psychogenic aspect may be adversely affected. This article concludes lower complication rates can be reached with immediate surgical correction of the penile fracture whereas psychogenic recovery might prolonged.