for the BaSICS investigators and the BRICNet members IMPORTANCE Slower intravenous fluid infusion rates could reduce the formation of tissue edema and organ dysfunction in critically ill patients; however, there are no data to support different infusion rates during fluid challenges for important outcomes such as mortality.OBJECTIVE To determine the effect of a slower infusion rate vs control infusion rate on 90-day survival in patients in the intensive care unit (ICU). DESIGN, SETTING, AND PARTICIPANTS Unblinded randomized factorial clinical trial in 75 ICUs in Brazil, involving 11 052 patients requiring at least 1 fluid challenge and with 1 risk factor for worse outcomes were randomized from May 29, 2017, to March 2, 2020. Follow-up was concluded on October 29, 2020. Patients were randomized to 2 different infusion rates (reported in this article) and 2 different fluid types (balanced fluids or saline, reported separately).INTERVENTIONS Patients were randomized to receive fluid challenges at 2 different infusion rates; 5538 to the slower rate (333 mL/h) and 5514 to the control group (999 mL/h). Patients were also randomized to receive balanced solution or 0.9% saline using a factorial design. MAIN OUTCOMES AND MEASURESThe primary end point was 90-day survival.RESULTS Of all randomized patients, 10 520 (95.2%) were analyzed (mean age, 61.1 years [SD, 17.0 years]; 44.2% were women) after excluding duplicates and consent withdrawals. Patients assigned to the slower rate received a mean of 1162 mL on the first day vs 1252 mL for the control group. By day 90, 1406 of 5276 patients (26.6%) in the slower rate group had died vs 1414 of 5244 (27.0%) in the control group (adjusted hazard ratio, 1.03; 95% CI, 0.96-1.11; P = .46). There was no significant interaction between fluid type and infusion rate (P = .98).CONCLUSIONS AND RELEVANCE Among patients in the intensive care unit requiring fluid challenges, infusing at a slower rate compared with a faster rate did not reduce 90-day mortality. These findings do not support the use of a slower infusion rate.

Human infection by Cunninghamella bertholletiae occurs almost exclusively in immunocompromised patients. Infections due to this microorganism have been most frequently diagnosed in patients with hematological malignancies, with neutropenia and in diabetes mellitus patients. This work reports a case of fungal infection by Cunninghamella bertholletiae isolated from blood in a man with a complex clinical picture, involving diabetes and pharmacological immunosupression. Blood culture at room temperature and at 37 degrees C on Sabouraud agar grew a single mold with characteristic properties of Cunninghamella. In the microscopic morphology, were found wide, non-septate, branching hyphae with erect sporangiophores terminated in swollen vesicles and sporangioles borne off the vesicles. C. bertholetiae was identified after subculture on Sabouraud dextrose agar at 45 degrees C. The patient died 15 days after the beginning of amphotericin B therapy.

We propose to assess integrative seminar (IS) as a learning tool. In this descriptive quantitative study, 84 out of 107 (78%) first-year medical students from the Universidade Federal de Goiás responded to a self-administered semi-structured questionnaire. The item "Integration with the community" received the highest score (3.3-3.6), demonstrating that IS deepened the relationship between students and the community. The positive assessments of the items "Preparation of a written essay" (3.3-3.5), "IS as a learning resource" (3.2-3.5), "Oral presentation," and "Interpersonal relationships" (3.1-3.4 in both) suggest that teacher guidance and adequate time for preparation enable IS use as a teaching-learning strategy that stimulates communication development and interpersonal relationships. The low scores for the items "Tool Moodle" (2.6-2.7) and "Assessment of preparation and seminar presentation" (2.7-3.0) suggest that the evaluation process and feedback preparation by teachers did not meet students' expectations. IS was well accepted by students. The high score for "Integration with the community" demonstrates the importance of shared learning, because it facilitates problem recognition and feedback to the community. However, the low score for "Tool Moodle" points out that this learning instrument needs adjustments to virtual learning environments based on the community.

Resumo: Introdução: A Faculdade de Medicina da Universidade Federal de Goiás (FM-UFG) iniciou um novo processo de mudança curricular em 2014. As disciplinas de Semiologia I e II passaram a adotar metodologias ativas de ensino para adequação às necessidades da reforma curricular. O objetivo deste artigo foi avaliar a percepção dos discentes do primeiro ano da FM-UFG sobre o ambiente educacional das disciplinas de Semiologia I e II. Método: Trata-se de um estudo descritivo, do tipo corte transversal, envolvendo 86 alunos. O instrumento de coleta de dados foi o questionário Dundee Ready Education Environment Measure (Dreem), versão em português. Os resultados foram considerados em três níveis: questões individuais, cinco dimensões e Dreem global. Calcularam-se a média, o desvio padrão e os respectivos intervalos de confiança de 95%. Obteve-se a confiabilidade interna do Dreem pelo cálculo do alfa de Cronbach, avaliou-se a distribuição dos dados da amostra pelo teste de Shapiro-Wilk e realizou-se a comparação entre os percentuais da média dos escores dos domínios e do DRREM global pela ANOVA, seguida do teste de Tukey. Resultados: A média do Dreem global foi de 134,83/200 ± 17,42, uma percepção mais positiva que negativa. As cinco dimensões tiveram os seguintes resultados: percepção da aprendizagem (32,74 / 48 ± 5,59 / uma visão mais positiva); percepção dos docentes (32,71 / 44 ± 6,23 / na direção certa); percepção dos resultados acadêmicos (20,22 / 32 ± 4,09 / sentimento positivo); percepção do ambiente geral (31,74 / 48 ± 5,69 / atitude positiva); percepção das relações sociais (17,42 / 28 ± 3,83 / não é tão ruim). Foram encontrados alguns pontos problemáticos em relação a fatos memorizáveis, metodologia de ensino prévio e cansaço para cursarem a disciplina. A dimensão com mais áreas fortes foi a percepção dos docentes. Houve significância estatística quando os percentuais da média dos escores dos domínios e do Dreem global foram comparados. Conclusão: O ambiente educacional das disciplinas de Semiologia I e II da Faculdade de Medicina da UFG criado pelas inovações metodológicas foi avaliado positivamente pelos discentes participantes, com destaque para o domínio percepção dos docentes.

Background Nosocomial sepsis is a major healthcare issue, but there are few data on estimates of its attributable mortality. We aimed to estimate attributable mortality fraction (AF) due to nosocomial sepsis. Methods Matched 1:1 case–control study in 37 hospitals in Brazil. Hospitalized patients in participating hospitals were included. Cases were hospital non-survivors and controls were hospital survivors, which were matched by admission type and date of discharge. Exposure was defined as occurrence of nosocomial sepsis, defined as antibiotic prescription plus presence of organ dysfunction attributed to sepsis without an alternative reason for organ failure; alternative definitions were explored. Main outcome measurement was nosocomial sepsis-attributable fractions, estimated using inversed-weight probabilities methods using generalized mixed model considering time-dependency of sepsis occurrence. Results 3588 patients from 37 hospitals were included. Mean age was 63 years and 48.8% were female at birth. 470 sepsis episodes occurred in 388 patients (311 in cases and 77 in control group), with pneumonia being the most common source of infection (44.3%). Average AF for sepsis mortality was 0.076 (95% CI 0.068–0.084) for medical admissions; 0.043 (95% CI 0.032–0.055) for elective surgical admissions; and 0.036 (95% CI 0.017–0.055) for emergency surgeries. In a time-dependent analysis, AF for sepsis rose linearly for medical admissions, reaching close to 0.12 on day 28; AF plateaued earlier for other admission types (0.04 for elective surgery and 0.07 for urgent surgery). Alternative sepsis definitions yield different estimates. Conclusion The impact of nosocomial sepsis on outcome is more pronounced in medical admissions and tends to increase over time. The results, however, are sensitive to sepsis definitions.