Purpose: Sepsis is a condition with high mortality rates and its diagnosis remains a challenge. We assessed epidemiological, clinical data, multiple biomarker profiles, and blood culture with respect to sepsis diagnosis and predictors of outcome. Methods: In total, 183 patients who were suspected of having sepsis and underwent blood culture collection were followed up for 7 days. Sepsis-related Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores were calculated daily; biomarkers and blood culture test results were evaluated. Results: In total, 78 (43%) had sepsis, 50 (27%) had septic shock, and 55 (30%) had no sepsis. Blood culture was positive in 28% and 42% of the sepsis and septic shock groups, respectively ( P < .001). Regarding clinical profiles and biomarker values, there were no differences between the sepsis and non-sepsis groups, but significant differences were observed in the septic shock group. Multivariate logistic regression models revealed that age, serum albumin level, APACHE II, and SOFA 1 st day scores were the independent variables for death. Conclusions: The challenge in the diagnosis of sepsis continues as clinical and laboratory differences found between the groups were due to septic shock. Older aged patients with lower albumin levels and higher APACHE II and SOFA 1 st day scores have a greater probability of mortality.

Objective To describe the clinical and epidemiological features of patients with and without sepsis at critical care units of a public hospital. Methods A cross-sectional study was carried out from May 2012 to April 2013. Clinical and laboratory data of patients with and without sepsis in the intensive care units were reviewed of medical records. Results We evaluated 466 patients, 58% were men, median age was 40 years, and 146 (31%) of them were diagnosed with sepsis. The overall mortality was 20% being significantly higher for patients with sepsis (39%). The factors associated with intensive care unit mortality were the presence of sepsis (OR: 6.1, 95%CI: 3.7-10.5), age (OR: 3.6, 95%CI: 1.4-7.2), and length of hospital stay (OR: 0.96, 95%CI: 0.94-0.98). Pulmonary (49%) and intra-abdominal (20%) infections were most commonly identified sites, and coagulase-negative staphylococci and enteric Gram negative bacilli the most frequent (66%) pathogens isolated. Conclusion Although the impact of sepsis on mortality is related to patients’ clinical and epidemiological characteristics, a critical evaluation of these data is important since they will allow the direct implementation of local policies for managing this serious public health problem.

-Context -Colorectal cancer is the second most prevalent cancer worldwide, and the liver is the most common site of metastases. Surgical resection of colorectal liver metastases provides the sole possibility of cure and the best odds of long-term survival. Objective -To describe surgical outcomes and identify features associated with disease prognosis in patients submitted to synchronous colorectal cancer liver metastasis resection. Methods -Retrospective study of 59 patients who underwent surgery for synchronous colorectal cancer liver metastasis. Actuarial survival and disease-free survival were assessed, depending on the prognostic variable of interest. Results -Postoperative mortality and morbidity rates were 3.38% and 30.50% respectively. Five-year disease-free survival was estimated at 23.96%, and 5-year overall survival, at 38.45%. Carcinoembryonic antigen levels ≥50 ng/mL and presence of three or more liver metastasis were limiting factors for disease-free survival, but did not affect late survival. No patient with liver metastases and extrahepatic disease had disease-free interval longer than 20 months, but this had no significance or impact on long-term survival. None of the prognostic factors assessed had an impact on late survival, although no patients with more than three liver metastases survived beyond 40 months. Conclusion -Although Carcinoembryonic antigen levels and number of metastases are prognostic factors that limit disease-free survival, they had no impact on 5-year survival and, therefore, should not determine exclusion from surgical treatment. Resection is the best treatment option for synchronous colorectal liver metastases, and even for patients with multiple metastases, large tumors and extrahepatic disease, it can provide long-term survival rates over 38%. HEADINGS -Liver neoplasms, surgery. Colorectal neoplasms, surgery. Neoplasm metastasis.

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Introdução. Casos que associam COVID-19 e Síndrome de Guillain-Barré (SGB) em pacientes críticos foram raramente evidenciados na literatura. Objetivo. Nesse contexto, esse artigo (aprovado pelo Comitê de Ética em Pesquisa, 56769722.7.0000.0020) visa relatar o caso de JIB. Relato de Caso. Paciente masculino, 75 anos, internado na Unidade de Terapia Intensiva, teve o diagnóstico de SGB confirmado pelos achados clínicos (rápida instalação da tetraparesia, tetraplegia flácida bilateral simétrica e déficits sensoriais), pela hiperproteinorraquia no líquido cefalorraquidiano (LCR) e pela polirradiculoneuropatia desmielinizante aguda na eletroneuromiografia. Após o diagnóstico, recebeu tratamento com imunoglobulina 0.4g/Kg/dia por 5 dias e, na alta hospitalar, já apresentava resolução completa dos sintomas.

Paciente masculino, 67 anos, previamente sem comorbidades, com história de cefaleia frontal há 1 ano e ptose palpebral direita associada à diminuição da acuidade visual há 4 meses. Nega febre e perda de peso. RNM de crânio (IMAGEM 1) com lesão expansiva (4x2x2cm) extra-axial com base de implantação dural na grande asa do esfenoide à direita. Realizado microcirurgia em outro serviço para tumor cerebral, onde foi verificada invasão do seio cavernoso e órbita direita, englobando artéria carótida com efeito de massa. Realizada ressecção parcial da lesão. Lâmina da biopsia na IMAGEM 2. Qual é o Diagnóstico?

We report a case of ascending aortic trauma, in a 60 years old patient by barbed wire. Primary exam revealed Beck's triad, generating the hypothesis of a cardiac tamponade, which was confirmed with FAST. It was quickly performed a laparotomy in order to discard abdominal injuries, including pericardical window, followed by sternotomy which confirmed the laceration of ascending aorta. Primary suture of the lesion was performed and the patient evolved well postoperatively. To our knowledge, this is the first reported case of penetrating trauma to the ascending aorta by barbed wire.

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