Clinical characteristics, complications and outcomes of critically ill patients with Dengue in Brazil, 2012-2024: a nationwide, multicentre cohort study.

Background: Dengue outbreaks are a major public health issue, with Brazil reporting 71% of global cases in 2024.

Purpose: This study aims to describe the profile of severe dengue patients admitted to Brazilian Intensive Care units (ICUs) (2012-2024), assess trends over time, describe new onset complications while in ICU and determine the risk factors at admission to develop complications during ICU stay.

Methods: We performed a prospective study of dengue patients from 253 ICUs across 56 hospitals.

The Association of ICU Acuity and Organizational Factors With Outcomes of Low-Risk Patients.

Objective: Outcomes of low-risk patients may be affected by the overall acuity of the ICU to which they were admitted. Studies addressing this topic are very scarce and the underlying mechanisms supporting this association remain incompletely understood. Here, we investigated the effects of ICU acuity (defined as the mean Simplified Acute Physiology Score 3 of all admitted patients in the bimester in which a given patient was admitted) and organizational factors on the outcomes of patients with a low risk of dying admitted to ICUs.

Brazilian Research in Intensive Care Network (BRICNet): shaping the landscape of critical care research in Brazil and beyond.

Critical illnesses such as sepsis and acute respiratory distress syndrome lead to millions of deaths globally, with a higher burden in low- and middle-income countries. Conducting multicentric clinical studies is essential to help minimize the burden of critical illnesses, particularly in areas where their impact is greater. However, conducting large-scale multicentric studies is challenging, and most large multicentric studies in critical care are from high-income countries, which limits their relevance in other contexts.

Comparison of cerebrospinal fluid biomarkers in patients with severe COVID-19 neurological outcomes and Alzheimer's disease.

Background: COVID-19 induces acute and long-term neurological symptoms. Links between COVID-19 neurological disturbance and Alzheimer's disease (AD) have been hypothesized because neuroinflammation plays a significant role in both diseases. However, it is unknown if COVID-19 patients with neurological disturbance present molecular alterations related to AD pathology.

The spatiotemporal ecology of Oropouche virus across Latin America: a multidisciplinary, laboratory-based, modelling study.

Background: Latin America has been experiencing an Oropouche virus (OROV) outbreak of unprecedented magnitude and spread since 2023-24 for unknown reasons. We aimed to identify risk predictors of and areas at risk for OROV transmission.

Methods: In this multidisciplinary, laboratory-based, modelling study, we retrospectively tested anonymised serum samples collected between 2001 and 2022 for studies on virus epidemiology and medical diagnostics in Bolivia, Brazil, Colombia, Costa Rica, Ecuador, and Peru with nucleoprotein-based commercial ELISAs for OROV-specific IgG and IgM antibodies.

Risk factors, impact on outcomes, and molecular epidemiology of infections caused by carbapenem-resistant Enterobacterales in intensive care patients: a multicenter matched case-control study in Brazil.

Objective: To evaluate risk factors, molecular profiles, and hospital mortality of carbapenem-resistant Enterobacterales (CRE) infections in intensive care unit patients.

Methods: In this retrospective, multicenter cohort study, intensive care unit admissions from 52 intensive care units between January 2019 and December 2020 were analyzed in a nested case-control design. Patients with carbapenem-resistant Enterobacterales infections were propensity score-matched 1:1 to those with carbapenem-susceptible Enterobacterales infections.

Does viral circulation in slums have a global impact? The lesson learned from SARS-CoV-2 circulation in , Rio de Janeiro, Brazil.

Because of growing inequalities, more than one-third of the worldwide population is expected to live in slums by 2050. Although slum dwellers are at increased risk of infectious diseases, this population may have been overlooked with respect to the sustainability of virus evolution. In this study, we aimed to analyze the genetic diversity and evolution of SARS-CoV-2 in the slum, Rio de Janeiro, Brazil, and assess its impact on the global spread of the virus.

IL-1β enhances susceptibility to atrial fibrillation in mice by acting through resident macrophages and promoting caspase-1 expression.

Atrial fibrillation (AF) is more prevalent in patients with elevated interleukin (IL)-1β levels. Here we show that daily administration of IL-1β for 15 days sensitizes mice to AF, leading to fibrosis, accumulation of β-pleated sheet proteins in the left atrium, and systemic inflammation, resembling the pathophysiological changes observed in patients with AF. IL-1β administration creates a positive feedback loop, dependent on the IL-1 receptor (IL-1R) activity in cardiac resident macrophages.

Ventriculitis incidence and outcomes in patients with aneurysmal subarachnoid hemorrhage: a prospective observational study.

Objective: To define the incidence of ventriculostomy-associated infections and their impact on the mortality and functional outcomes of patients with aneurysmal subarachnoid hemorrhage.

Methods: We prospectively included all consecutive adult aneurysmal subarachnoid hemorrhage patients admitted to the neurological intensive care units of the Instituto Estadual do Cérebro Paulo Niemeyer (Rio de Janeiro, Brazil) and Hospital Cristo Redentor (Rio Grande do Sul, Brazil) who required external ventricular drains from July 2015 to December 2020. Daily clinical and laboratory variables were collected at admission and during the hospital stay.

Ambient temperature and dengue hospitalization in Brazil: A 10-year period case time series analysis.

Background: Dengue has an increased worldwide epidemic potential with the global rising temperature due to climate change. Heat and rainfall are known to influence seasonal patterns of dengue transmission over the course of weeks to months. However, there is a gap in knowledge about the short-term effect of heat on dengue severity.

The burden, clinical features and outcomes of SARS-CoV-2, Influenza and co-infections during concurrently out-of-season outbreaks in Brazil.

Objectives: Little is known about the burden and the clinical presentation and prognosis of individuals with Influenza and SARS-CoV-2 during concurrent outbreaks. We aimed to describe the burden, clinical characteristics and outcomes of hospitalized adults during the Influenza A/H3N2 and Omicron outbreaks in Brazil.

Study Design: Cross-sectional analysis of national surveillance data.

Persistent carbapenem resistance in mechanically ventilated ICU patients: A before-and-after analysis of the COVID-19 surge.

Background: The evolution of antimicrobial resistance among critically ill patients before, during, and after the COVID-19 surge remains unclear.

Methods: We retrospectively analyzed critically ill mechanically ventilated adult patients admitted to 8 Brazilian hospitals from Jan 1, 2018 to Apr 30, 2023. We stratified the patients into 3 periods: pre-surge (Jan 01, 2018-Mar 01, 2020), surge (Mar 01, 2020-Oct 01, 2021), and post-surge (after October 01, 2021).

Prediction of multidrug-resistant bacteria (MDR) hospital-acquired infection (HAI) and colonisation: A systematic review.

Background: Hospital-Acquired Infections (HAI) represent a public health priority in most countries worldwide. Our main objective was to systematically review the quality of the predictive modeling literature regarding multidrug-resistant gram-negative bacteria in Intensive Care Units (ICUs).

Methods: We conducted and reported a Systematic Literature Review according to the recommendations of the PRISMA statement.

Comparing causal random forest and linear regression to estimate the independent association of organisational factors with ICU efficiency.

Purpose: Parametric regression models have been the main statistical method for identifying average treatment effects. Causal machine learning models showed promising results in estimating heterogeneous treatment effects in causal inference. Here we aimed to compare the application of causal random forest (CRF) and linear regression modelling (LRM) to estimate the effects of organisational factors on ICU efficiency.

Changes in neuroinflammatory biomarkers correlate with disease severity and neuroimaging alterations in patients with COVID-19 neurological complications.

COVID-19 induces acute and persistent neurological symptoms in mild and severe cases. Proposed concomitant mechanisms include direct viral infection and strain, coagulopathy, hypoxia, and neuroinflammation. However, underlying molecular alterations associated with multiple neurological outcomes in both mild and severe cases are majorly unexplored.

Impact of the first year of COVID-19 vaccination strategy in Brazil: an ecological study.

Objectives: No consensus exists about the best COVID-19 vaccination strategy to be adopted by low-income and middle-income countries. Brazil adopted an age-based calendar strategy to reduce mortality and the burden on the healthcare system. This study evaluates the impact of the vaccination campaign in Brazil on the progression of the reported COVID-19 deaths.

Data challenges for international health emergencies: lessons learned from ten international COVID-19 driver projects.

The COVID-19 pandemic highlighted the importance of international data sharing and access to improve health outcomes for all. The International COVID-19 Data Alliance (ICODA) programme enabled 12 exemplar or driver projects to use existing health-related data to address major research questions relating to the pandemic, and developed data science approaches that helped each research team to overcome challenges, accelerate the data research cycle, and produce rapid insights and outputs. These approaches also sought to address inequity in data access and use, test approaches to ethical health data use, and make summary datasets and outputs accessible to a wider group of researchers.

Prevention of lipid droplet accumulation by DGAT1 inhibition ameliorates sepsis-induced liver injury and inflammation.

Background & Aims: Lipid droplet (LD) accumulation in cells and tissues is understood to be an evolutionarily conserved tissue tolerance mechanism to prevent lipotoxicity caused by excess lipids; however, the presence of excess LDs has been associated with numerous diseases. Sepsis triggers the reprogramming of lipid metabolism and LD accumulation in cells and tissues, including the liver. The functions and consequences of sepsis-triggered liver LD accumulation are not well known.

Evidence-Based Checklist to Delay Cardiac Arrest in Brain-Dead Potential Organ Donors: The DONORS Cluster Randomized Clinical Trial.

Importance: The effectiveness of goal-directed care to reduce loss of brain-dead potential donors to cardiac arrest is unclear.

Objective: To evaluate the effectiveness of an evidence-based, goal-directed checklist in the clinical management of brain-dead potential donors in the intensive care unit (ICU).

Design, Setting, And Participants: The Donation Network to Optimize Organ Recovery Study (DONORS) was an open-label, parallel-group cluster randomized clinical trial in Brazil.