EBV, and to a lesser extent CMV, were more prevalent in patients with IBD than in HCs. Mucosal viral load was not influenced by the therapeutic regimen, did not differ between inflamed and noninflamed mucosa, and did not seem to be influenced by the endoscopic activity of the disease, suggesting that EBV may be more involved in the onset of IBD than in its severity and clinical evolution.

Diffuse alveolar haemorrhage related to an anti-neutrophil cytoplasmic antibody (ANCA)-associated small vessel vasculitis is an extremely rare form of presentation of breast cancer. Here we report the case of a 77-year-old woman with a histological diagnosis of a papillary ductal carcinoma of the breast presenting with a diffuse alveolar haemorrhage secondary to a perinuclear ANCA-associated vasculitis. To our knowledge, this is the first case ever reported of a diffuse alveolar haemorrhage related to an ANCA-associated small vessel vasculitis as a form of presentation of breast cancer. The therapeutic approach of this paraneoplastic vasculitis included the use of corticosteroids and plasmapheresis, a very useful technique to remove endothelial aggressors (circulating antibodies) as a strategy to earn time for a proper therapeutic decision specifically directed for disease modification, but that can also be associated with several severe adverse effects, which are illustrated in our case.

Shewanella algae is a rod-shaped, Gram-negative bacterium that is considered an emerging human pathogen. Traditionally associated with warmer climates, S. algae has now been isolated from patients worldwide, and reports of infection are increasing. In a regional hospital on the outskirts of Lisbon, Portugal, four cases have been detected in the past 10 years. Two of the patients were migrants from African countries with daily contact with water; the other two patients were Portuguese, and no epidemiological risk factors were found among them. These are the first cases reported in Portugal. Risk factors associated with S. algae infection in patients discussed in this paper include the following: human immunodeficiency virus (HIV) infection, chronic venous insufficiency, lower limb ulcers, chronic kidney disease, diabetes, arterial hypertension, dilated cardiomyopathy, atrial fibrillation, chronic hepatic disease, and chronic pancreatitis. One patient died in the intensive care unit with septic shock and disseminated intravascular coagulation from a fulminant infection secondary to S. algae bacteraemia. The four clinical cases presented in this case series highlight the clinical features of this infection so that other physicians can successfully identify and treat S. algae infections.

IntroductionDuring the coronavirus disease 2019 (COVID-19) pandemic, a high number of patients needed to be admitted to the intensive care units (ICUs). Such a high demand led to periods where resources were insufficient and the triage of patients was needed. This study aims to evaluate the performance of the Acute Physiology and Chronic Health Evaluation (APACHE) II as a predictor of mortality in periods where triage protocols were implemented. MethodsA single-center, longitudinal, retrospective cohort study was performed on patients admitted to the ICU between January 2020 and December 2021. Patients were divided into two periods: Period 1 (where patients needing ICU admission outnumbered the available resources) and Period 2 (where resources were adequate). The discriminative power of the APACHE II was checked using the receiver operating characteristic (ROC) curves. Calibration was accessed, and survival analysis was performed. ResultsData from 428 patients were analyzed (229 in Period 1 and 199 in Period 2). The area under the ROC curve (AUROC) was 0.763 for Period 1 and 0.761 for Period 2, reflecting a good discriminative power. Logistic regression showed the APACHE II to be a significant predictor of mortality. The Hosmer-Lemeshow test demonstrated good calibration. The Youden index was determined, and a log-rank test showed a significantly lower survival for patients with higher APACHE II scores in both periods. ConclusionsThe APACHE II score is an effective tool in predicting mortality in patients with COVID-19 admitted to the ICU in a period where resource allocation and triage of patients are needed, paving a way for the future development of better and improved triage systems.