Helena Duani

Background: The zoonotic epidemic of sporotrichosis caused by Sporothrix brasiliensis has expanded throughout Brazil and other countries, with a rise in deep forms of disease. Detailed comparative data on the presentation, treatment and outcomes of cutaneous and deep disease are needed to follow how Brazilian cohorts are evolving. Methods: The study involves a retrospective observational cohort of patients with sporotrichosis treated at a quaternary university hospital in Belo Horizonte between 2011 and 2026, restricted to culture-positive cases. Localized cutaneous disease was compared with deep infection using logistic regression adjusted for age and sex. Results: Of 313 patients, 213 had a positive culture. The median age was 41 years, and 54.0% were women. Lymphocutaneous disease predominated (54.0%), and contact with cats was reported by 53.1%. The median treatment duration was 150 days. Among the 101 patients with a defined outcome, 97 were cured (96.0%), with no documented treatment failure. All four sporotrichosis-related deaths occurred in the deep infection group, which was independently associated with comorbidity (OR 9.69; 95% CI 2.52 to 37.23) and an immunosuppressive condition (OR 6.61; 95% CI 1.89 to 23.09). Conclusions: Localized cutaneous sporotrichosis was cured in nearly all the patients with documented follow-up, whereas mortality was confined to deep infection associated with comorbidities and immunosuppression.

Background: The zoonotic epidemic of sporotrichosis caused by Sporothrix brasiliensis has expanded throughout Brazil and other countries, with a rise in deep forms of disease. Detailed comparative data on presentation, treatment and outcome of cutaneous and deep disease are needed to follow how Brazilian cohorts are evolving. Methods: Retrospective observational cohort of patients with sporotrichosis treated at a quaternary university hospital in Belo Horizonte between 2011 and 2026, restricted to culture-positive cases. Localized cutaneous disease was compared with deep infection using logistic regression adjusted for age and sex. Results: Of 313 patients, 213 had a positive culture. Median age was 41 years and 54.0% were women. Lymphocutaneous disease predominated (54.0%) and contact with cats was reported by 53.1%. Median treatment duration was 150 days. Among the 101 patients with a defined outcome, 97 were cured (96.0%), with no documented treatment failure. All four sporotrichosis-related deaths occurred in the deep infection group, which was independently associated with comorbidity (OR 9.69; 95% CI 2.52 to 37.23) and with an immunosuppressive condition (OR 6.61; 95% CI 1.89 to 23.09). Conclusions: Localized cutaneous sporotrichosis was cured in nearly all patients with documented follow-up, whereas mortality was confined to deep infection associated with comorbidity and immunosuppression.

Sporotrichosis is a globally distributed subcutaneous mycosis caused by fungi of the Sporothrix complex, and is associated with worse outcomes in immunocompromised individuals, including those with diabetes mellitus. The impact of diabetes mellitus on the clinical presentation and outcomes of sporotrichosis remains poorly characterized. We conducted a systematic review of individual participant data to assess this association. Eight databases (Cochrane Library, Embase, LILACS, MEDLINE/PubMed, Scopus, Global Index Medicus/WHO, SciELO, and Web of Science) were searched without restrictions on publication date, country, language, sex, or age. The retrieved case data were divided into two groups: (1) localized disease and (2) systemic disease. We identified 122 cases of sporotrichosis in patients with diabetes mellitus from 64 articles and from 28 unpublished cases from Brazil and Mexico. Most patients were male (62.3%), with a mean age of 56.6 years, and 73% were from hyperendemic countries. Among cutaneous presentations, lymphocutaneous and fixed cutaneous forms were most frequent (41%), while osteoarticular multifocal disease was the leading extracutaneous manifestation (22.1%). Alcohol use disorder was independently associated with systemic disease (adjusted OR 4.76, 95% CI 1.45–18.05; P = .014). Compared with localized disease, systemic disease more commonly presented with joint symptoms (40.6% vs. 13.5%; P < .001), lesions with lower limb involvement (80% vs. 20%; P < .001), head involvement (81.3% vs. 18.8%; P < .001), and trunk involvement (84.6% vs. 15.4%; P < .001). Itraconazole monotherapy was the main treatment (45.9%), followed by amphotericin B-based regimens (33.6%). There were better outcomes for patients with localized disease than for those with systemic disease (cure rate 86.6% vs. 56.4%; P < .001). Systemic disease carried a 20% mortality rate in this population. These findings underscore the challenges posed by sporotrichosis in patients with diabetes mellitus and highlight the need for further research on risk factors for systemic disease and optimal treatment strategies for this population.

Introduction: This scoping review protocol aims to examine the role of the Internal Regulation Core (IRC) as an intra-hospital governance structure that coordinates capacity and patient flow and may function as a strategic hub for disruptive innovation in hospital management. By integrating organisational routines, rules and, when available, enabling technologies, IRCs may strengthen operational efficiency and contribute to higher-quality care delivery. As hospitals face increasing operational complexity and constrained resources, clarifying what IRCs are, how they are implemented across settings, and what innovations and impacts are reported has become a priority. Methods and analysis: This scoping review will follow the Joanna Briggs Institute guidance and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. A comprehensive search will be conducted across five databases (MEDLINE/PubMed, Embase, Scopus, Web of Science and LILACS) and grey literature sources, without language or date restrictions. The searches were conducted up to 6 July 2025. Two reviewers will independently screen studies and extract data using a standardised form; disagreements will be resolved by consensus or a third reviewer. Findings will be synthesised descriptively and thematically, with results presented in tables and narrative summaries, including innovation streams. Trial registration number: Open Science Framework (10.17605/OSF.IO/HWZJS).

Revista Médica de Minas Gerais: artigos científicos de acesso aberto publicados pela Associação Médica de Minas Gerais.

Revista Médica de Minas Gerais: artigos científicos de acesso aberto publicados pela Associação Médica de Minas Gerais.

Background: Sporotrichosis is a subcutaneous mycosis caused by Sporothrix spp. , typically acquired through traumatic inoculation of fungal spores from soil, plants and infected cat scratches. The disease manifests in various clinical forms, including lymphocutaneous, ocular, bone, and disseminated infections. Standard treatment relies on prolonged administration of antifungals such as itraconazole, terbinafine, and potassium iodide, often requiring months for complete resolution. Moreover, treatment challenges include slow clinical response, recurrence, and potential drug toxicity. Hyperbaric oxygen therapy has been investigated as a potential adjuvant for invasive fungal infections due to its antimicrobial properties, enhanced tissue oxygenation, and immunomodulatory effects, which may contribute to improved healing and therapeutic outcomes. Methods: Patients with a confirmed diagnosis of cutaneous/lymphocutaneous sporotrichosis were divided into two groups to receive either itraconazole or itraconazole plus hyperbaric oxygen therapy. The primary outcomes were time to cure and therapeutic response. The intervention group was assessed weekly through clinical parameters and photographic records, and the control group was assessed monthly. Results: Patients who received hyperbaric oxygen therapy experienced a much shorter healing time than those who did not. The average time until a cure was 208.53 days in the itraconazole group compared to 57.54 days in the itraconazole plus hyperbaric oxygen therapy group. Patients in the Hyperbaric oxygen therapy group received an average of 18.23 hyperbaric sessions and were 65 times more likely to achieve faster healing than those who did not. Notably, with each additional year of age, the chances of rapid healing decreased by 2%. Conclusion: Our findings suggest that adjuvant hyperbaric oxygen therapy significantly accelerates the healing of fixed cutaneous/lymphocutaneous sporotrichosis. The results also highlight hyperbaric oxygen therapy´s potential to enhance treatment efficacy and reduce the burden of prolonged antifungal therapy. These results support further investigation of this valuable adjunctive treatment in the management of sporotrichosis.

Objective: To investigate if red blood cell distribution width (RDW) is a risk factor for hospital mortality in patients admitted to a public university hospital in Belo Horizonte, Minas Gerais, Brazil. Methods: This observational prospective study included patients over 16 years who had been hospitalized for COVID‐19 between May and October 2020. A descriptive and time‐to‐death analysis was performed using the Cox proportional hazards model. Results: Of the 161 patients included, 39 (24.2%) died during hospitalization. A total of 2227 blood counts were performed, an average of 13.8 tests per patient (standard deviation, SD 2.9). Upon admission, the RDW was normal (11.5% to 14.6%) in 115 patients (71.4%), elevated in 45 (28%), and low in 1 (0.6%). The mean RDW value at admission was 14.5 (SD 2.4), which falls within the normal reference range. Of the patients with normal RDW at admission, 82 (71.3%) maintained normal levels throughout their stay, while 33 (28.7%) showed increased RDW levels over time. Among those with elevated RDW at admission, 40 (88.9%) remained elevated, while 5 (11.1%) returned to normal levels. There was no significant difference in the mean RDW value at admission between survivors and nonsurvivors (14.4 [SD 2.4] for survivors vs. 14.9 [SD 2.4] for nonsurvivors; p = 0.2081). The risk for mortality in the group with high RDW upon admission was higher than in the group with normal RDW, but without statistical significance (31.1% vs. 21.7%; RR = 1.43; p = 0.413). When performing a multivariate analysis, the following continue to be risk factors for lower survival: age > 70 years, HR 4.8 (95% CI: 2.3; 10.3), p < 0.001; white race, HR 3.2 (95% CI: 1.2; 8.61), p = 0.018; and need for invasive MV, HR 3.8 (1.7; 8.7), p = 0.001. The presence of a chest X‐ray suggestive of COVID‐19, HR 3.5 (95% CI: 1.0; 11.5), p = 0.044, also appears to be a risk factor in this analysis. Conclusion: Alterations on RDW values on admission were not associated with higher mortality, and further increases in RDW during hospitalization were not linked to a higher risk of mortality across all age groups. Our findings suggest that while RDW may indicate disease severity, it may not serve as a reliable independent predictor of mortality when other factors are accounted for in this cohort.

Summary: This study investigated the role of red blood cell distribution width (RDW) as a risk factor for hospital mortality in COVID-19 patients at a public hospital in Minas Gerais, Brazil. The study included 161 patients over 16 years old hospitalized between May and October 2020, with 39 (24.2%) deaths. Key mortality risk factors identified were age over 70 years (RR=2.78; p<0.001), male sex (RR=2.28; p=0.005), cardiovascular disease (RR=1.8; p=0.044), and abnormal chest X-ray upon admission (RR=3.07; p=0.022). Although high RDW at admission did not significantly predict mortality (31.1% vs 21.7%; RR=1.43; p=0.413), it was linked to higher mortality in patients aged 70 and over (66.7% vs 33.3%; RR=2; p=0.029). High RDW during hospitalization was a strong mortality factor for the entire cohort (41.1% vs 10.2%; RR=4.03; p<0.001) and at any time during the stay (39.7% vs 9.6%; RR=4.14; p70 years (HR=4.8; p<0.001), white race (HR=3.2; p=0.018), need for invasive ventilation (HR=3.8; p=0.001), and abnormal chest X-ray (HR=3.5; p=0.044) were significant risk factors, but RDW was not associated with mortality.