Critically ill patients with acute leukemia often require an intensive care unit (ICU) admission. As major therapeutic advances have been made during the last decades, the aim of this study was to assess temporal trends in ICU mortality, and identify prognostic factors to inform clinician decision-making. We conducted an individual participant data meta-analysis of studies including adults with acute leukemia admitted to the ICU. Patients with a history of allogeneic hematopoietic stem cell transplantation were excluded. Mixed-effects logistic regression models, accounting for center of ICU admission as a random variable, evaluated factors associated with ICU mortality, with particular focus on year of ICU admission, age (> 65 years) and invasive mechanical ventilation. A total of 2003 patients from 55 ICUs across 19 countries were included (median age 58 years [IQR 44–67]; 72
Neurocritical care (NCC) education involves integrating knowledge and skills into various complex areas. While the USA, Canada, and Europe regulate didactic core training for medical residencies and fellowships, the quantity and quality of these training programs in Brazil remain unclear. To assess how NCC training is currently integrated into neurology and intensive care residency programs in Brazil. A cross-sectional survey composed of 27 multiple-choice and short-answer questions was distributed by email to professionals registered in national congresses and medical organizations. Data regarding exposure to NCC training, duration, supervision, infrastructure, and self-perceived competencies were analyzed. A total of 208 responses from 82 centers across 14 Brazilian states were included. Respondents were primarily neurologists (58.2%) and intensivists (28.2%). Only 50.5% reported receiving NCC training during residency, typically lasting more than 4 weeks. Training predominantly occurred in intensive care units with 5 to 20 beds, supervised by intensivists. However, exposure to specialized skills was limited: 23% to transcranial Doppler, 21% to electroencephalogram (EEG) interpretation, and 24% to multimodal neuromonitoring. Confidence in managing complex cases was suboptimal, with 56% reporting confidence in postcardiac arrest care, 47% in refractory intracranial hypertension, and 40% in spinal cord trauma. Neurocritical care education in Brazil is heterogeneous and remains at an early stage of development. Most residents receive limited exposure to advanced neurocritical skills, resulting in low confidence to independently manage highly complex conditions. Standardized, competency-based training programs are urgently needed to enhance professional preparedness and potentially improve patient outcomes in NCC.
Low sociodemographic index (SDI) countries bear a disproportionate burden of aneurysmal subarachnoid hemorrhage (SAH) yet remain underrepresented in medical research. A retrospective multicenter cohort of 1145 patients from tertiary centers in Brazil and the USA (2012–2024). Demographics, clinical severity (WFNS, modified Fisher scale, mFs), treatment modality, and outcomes were compared. Primary outcomes were in-hospital mortality and poor functional outcome (mRS > 2); secondary outcome was hospital length of stay (LOS). Multiple imputation was used for missing at random (MAR)-type missingness; adjusted models incorporated Bonferroni correction. Mean age was 54.5 ± 14.4 years; 73.9
Glioblastoma (GBM) is an aggressive tumor with limited therapeutic options. Zika virus (ZIKV) has demonstrated activity against GBM; however, the cellular pathways behind this interaction remain unclear. We systematically reviewed open-access primary studies assessing differentially expressed genes (DEGs) in GBM models infected with wild-type or engineered ZIKV using transcriptomic approaches (inclusion criteria); reviews, restricted-access studies, commentaries, preprints, abstracts, and articles lacking data or not meeting these conditions were excluded (PROSPERO CRD420251077092). We performed a pathway analysis of reported DEGs. PubMed and Google Scholar were searched up to 5 March 2025; 139 records were identified and 5 met the eligibility criteria. Risk of bias was evaluated using an adapted ToxRTool for in vitro experiments and the SYRCLE RoB tool for in vivo models. Altogether, 4360 genes were reported as upregulated and 2072 as downregulated; 12 genes (DNAJB9, SESN2, PMAIP1, PPP1R15A, KLF4, ATF3, IFNB1, IFNL1, ANKRD33B, ZC3HAV1, OASL, and CCL5) were consistently upregulated, none were consistently downregulated. Pathway analysis of the studies providing complete DEG lists identified 23 commonly enriched pathways mostly related to interferon signaling. These findings may help guide future research in this field; nevertheless, methodological heterogeneity limits comparability, reinforcing the need for standardized protocols. Funding: ITpS, CNPq, and FAPEMIG.
