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It has been demonstrated that the implementation of rapid response teams (RRT) may improve clinical outcomes. Nevertheless, predictors of mortality among patients admitted to the intensive care unit (ICU) or to the step-down unit (SDU) after a RRT activation are not fully understood. To describe clinical characteristics, resource use, main outcomes, and to address predictors of in-hospital mortality among patients admitted to the ICU/SDU after RRT activation. Retrospective single-center cohort study conducted in a medical-surgical ICU/SDU located in a private quaternary care hospital. Adult patients admitted to the ICU or SDU between 2012 and 2020 were compared according to in-hospital mortality. A multivariate logistic regression analysis was performed to identify independent predictors of in-hospital mortality. Among the 3841 patients included in this analysis [3165 (82.4%) survivors and 676 (17.6%) non-survivors], 1972 (51.3%) were admitted to the ICU and 1869 (48.7%) were admitted to the SDU. Compared to survivors, non-survivors were older [76 (64-87) yrs. vs. 67 (50-81) yrs.; p < 0.001], had a higher SAPS 3 score [64 (56-72) vs. 49 (40-57); p < 0.001], and had a longer length of stay (LOS) before unit admission [8 (3-19) days vs. 2 (1-7) days; p < 0.001). Non-survivors used more non-invasive ventilation (NIV) (42.2% vs. 20.9%; p < 0.001), mechanical ventilation (MV) (36.7% vs. 9.3%; p < 0.001), vasopressors (39.2% vs. 12.3%; p < 0.001), renal replacement therapy (15.5% vs. 4.3%; p < 0.001), and blood components transfusion (34.9% vs. 14.0%; p < 0.001). Independent predictors of in-hospital mortality were the SAPS 3 score, the Charlson Comorbidity Index, LOS before unit admission, immunosuppression, respiratory rate < 8 or > 28 ipm criteria for RRT activation, RRT activation during the night shift, and the need for high-flow nasal cannula, NIV, MV, vasopressors, and blood components transfusion. Multiple factors may affect outcomes of ICU/SDU-admitted patients after RRT activation. Therefore, efforts should be made to boost RRT effectiveness to improve patient safety.

Combined progress in oncology and critical care medicine has led to new aspirations and discussions in advanced life support modalities in the intensive care unit. Over the last decade, extracorporeal membrane oxygenation, previously considered unsuitable for oncologic patients, has become increasingly popular, with more diverse applications. Nevertheless, mortality remains high in critically ill cancer patients, and eligibility for extracorporeal membrane oxygenation can be extremely challenging. This scenario is even more difficult due to the uncertain prognosis regarding the underlying malignancy, the increased rate of infections related to intensive care unit admission, and the high risk of adverse events during extracorporeal membrane oxygenation support. With advances in technology and better management involving extracorporeal membrane oxygenation, new data on clinical outcomes can be found. Therefore, this review article evaluates the indicators for extracorporeal membrane oxygenation in different types of oncology patients and the possible subgroups that could benefit from it. Furthermore, we highlight the prognosis, the risk factors for complications during this support, and the importance of decision-making based on a multidisciplinary team in the extracorporeal membrane oxygenation indication.

The hemoglobin/red blood cell distribution width (Hb/RDW) ratio has emerged as a potential biomarker for acute kidney injury (AKI), particularly in patients with cardiovascular conditions. This study investigated the relationship between Hb/RDW ratio and AKI incidence in critically ill patients diagnosed with sepsis and heart failure (HF). A retrospective study was conducted with 119 critically ill patients with sepsis and 83 patients with HF, analyzed according to the presence or absence of kidney injury. Multivariable logistic regression identified independent predictors of AKI. Outcomes between higher and lower Hb/RDW groups were compared. Patients who developed AKI showed higher C-reactive protein levels, elevated RDW (15.7 ± 2.2 vs. 14.9 ± 1.8; p = 0.01), and higher SAPS 3 scores, along with markedly lower Hb concentrations and Hb/RDW ratios (75.1 ± 1.6 vs. 85.5 ± 1.9; p < 0.001). In multivariable analysis, serum urea (OR 1.016; 95% CI 1.005-1.027 per mg/dL), SAPS 3, and Hb/RDW ratio (OR 0.977; 95% CI 0.959-0.996) were independently associated with AKI. Patients with a lower Hb/RDW ratio had higher frequencies of AKI, kidney-replacement therapy, red-cell transfusion, and mortality. During a 7-year follow-up, progression to dialysis-dependent stage V chronic kidney disease (CKD-V) occurred in 10.8% of HF patients and 2.5% of sepsis patients, indicating that a lower Hb/RDW ratio was also associated with worse long-term renal outcomes. The Hb/RDW ratio is independently associated with AKI and may also reflect long-term kidney prognosis, representing a cost-effective and readily available ICU marker to identify patients at risk for both acute and chronic renal deterioration in sepsis or HF.

IntroductionThe hemoglobin/red blood cell distribution width (Hb/RDW) ratio has emerged as a potential biomarker for acute kidney injury (AKI), particularly in patients with cardiovascular conditions. This study investigated the relationship between Hb/RDW ratio and AKI incidence in critically ill patients diagnosed with sepsis and heart failure (HF).MethodsA retrospective study was conducted with 119 critically ill patients with sepsis and 83 patients with HF, analyzed according to the presence or absence of kidney injury. Multivariable logistic regression identified independent predictors of AKI. Outcomes between higher and lower Hb/RDW groups were compared.ResultsPatients who developed AKI showed higher C-reactive protein levels, elevated RDW (15.7 ± 2.2 vs. 14.9 ± 1.8; p = 0.01), and higher SAPS 3 scores, along with markedly lower Hb concentrations and Hb/RDW ratios (75.1 ± 1.6 vs. 85.5 ± 1.9; p < 0.001). In multivariable analysis, serum urea (OR 1.016; 95% CI 1.005-1.027 per mg/dL), SAPS 3, and Hb/RDW ratio (OR 0.977; 95% CI 0.959-0.996) were independently associated with AKI. Patients with a lower Hb/RDW ratio had higher frequencies of AKI, kidney-replacement therapy, red-cell transfusion, and mortality. During a 7-year follow-up, progression to dialysis-dependent stage V chronic kidney disease (CKD-V) occurred in 10.8% of HF patients and 2.5% of sepsis patients, indicating that a lower Hb/RDW ratio was also associated with worse long-term renal outcomes.ConclusionThe Hb/RDW ratio is independently associated with AKI and may also reflect long-term kidney prognosis, representing a cost-effective and readily available ICU marker to identify patients at risk for both acute and chronic renal deterioration in sepsis or HF.

Sporotrichosis is a neglected subcutaneous fungal infection that affects humans and animals worldwide caused by species belonging to the genus Sporothrix. This study aims to examine the range of genetic variations, assess molecular epidemiology significance, and explore potential modes of transmission of the Sporothrix species associated with the current sporotrichosis outbreaks in Espírito Santo, Brazil. In this investigation, 262 samples were evaluated, including 142 from humans and 120 from felines, collected between 2016 and 2021. The isolates were identified based on morphological and molecular characteristics. Sexual idiomorphs were determined by mating-type PCR using primers specific to the MAT1-1 and MAT1-2 loci. Amplified fragment length polymorphism (AFLP) was employed to assess the genetic variability of Sporothrix spp. Finally, antifungal susceptibility testing was performed following the CLSI M38-A2 protocol. Of the 142 human samples, 125 were identified as S. brasiliensis and 17 as S. schenckii s. str. The presence of S. brasiliensis was overwhelming (100%) during outbreaks, highlighting the significant role of domestic cats in the emergence of this species. Heterothallism was the only observed mating strategy. However, the MAT1-2 idiomorph was predominant in cases of cat-transmitted sporotrichosis (χ2 = 202.976; p < 0.0001). Our AFLP results show significant intraspecific variability observed among S. brasiliensis isolates in Espírito Santo. Different genotypes forming subgroups within the same population suggest that these isolates do not originate from a single ancestor, indicating multiple emergences. Furthermore, terbinafine was the antifungal with the best results in vitro. However, in clinical practice, itraconazole remains the primary treatment choice. Sporotrichosis continues to advance in the state; therefore, the health system must outline one-health strategies to contain the disease to prevent future epidemics.

Primordial odontogenic tumor (POT) was recently recognized in the 2017 World Health Organization (WHO) Classification as a distinct mixed odontogenic tumor most commonly observed in the posterior mandible of young patients. POT appears as an expansile radiolucency associated to an unerupted tooth. The aim of the present study was to perform a retrospective microscopic evaluation of pediatric odontogenic tumors diagnosed in an Oral Pathology Laboratory from Rio de Janeiro—Brazil, in order to reclassify potential cases as POT. From 150 cases of odontogenic tumors in children diagnosed in the last 50 years, one case filled the criteria for POT, being therefore better diagnosed as such. The patient was in the first decade of life and presented a well-defined expansile tumor in the posterior mandible, which had been initially diagnosed as immature complex odontoma. To the best of our knowledge, only 12 cases of POT have been reported in the English-language literature. We herein present an additional case of POT and review of its clinicopathological findings is offered.

Sporotrichosis is a neglected subcutaneous fungal infection that affects humans and animals worldwide caused by species belonging to the genus Sporothrix. This study aims to examine the range of genetic variations, assess molecular epidemiology significance, and explore potential modes of transmission of the Sporothrix species associated with the current sporotrichosis outbreaks in Espírito Santo, Brazil. In this investigation, 262 samples were evaluated, including 142 from humans and 120 from felines, collected between 2016 and 2021. The isolates were identified based on morphological and molecular characteristics. Sexual idiomorphs were determined by mating-type PCR using primers specific to the MAT1-1 and MAT1-2 loci. Amplified fragment length polymorphism (AFLP) was employed to assess the genetic variability of Sporothrix spp. Finally, antifungal susceptibility testing was performed following the CLSI M38-A2 protocol. Of the 142 human samples, 125 were identified as S. brasiliensis and 17 as S. schenckii s. str. The presence of S. brasiliensis was overwhelming (100%) during outbreaks, highlighting the significant role of domestic cats in the emergence of this species. Heterothallism was the only observed mating strategy. However, the MAT1-2 idiomorph was predominant in cases of cat-transmitted sporotrichosis (χ[sup.2] = 202.976; p < 0.0001). Our AFLP results show significant intraspecific variability observed among S. brasiliensis isolates in Espírito Santo. Different genotypes forming subgroups within the same population suggest that these isolates do not originate from a single ancestor, indicating multiple emergences. Furthermore, terbinafine was the antifungal with the best results in vitro. However, in clinical practice, itraconazole remains the primary treatment choice. Sporotrichosis continues to advance in the state; therefore, the health system must outline one-health strategies to contain the disease to prevent future epidemics.