ABSTRACT
Necrotizing tracheobronchitis due to Aspergillus spp is a rare form of invasive aspergillosis. This infection is limited to or predominant in the bronchial tree. The clinical evolution is gradual: from mild non-specific manifestations of acute tracheobronchitis to severe acute respiratory insufficiency determined by a bronchial obstruction syndrome. We report a 38 years old female with systemic lupus erythematosus treated with methylprednisolone and cyclophosphamide. She developed an invasive aspergillosis, severe respiratory failure with predominant tracheobronchial damage and upper respiratory complications.
Subject(s)
Adult , Female , Humans , Aspergillosis/complications , Bronchitis/microbiology , Immunocompromised Host , Tracheitis/microbiology , Antifungal Agents/therapeutic use , Bronchoscopy , Fatal Outcome , Fingers/pathology , Lupus Erythematosus, Systemic/complications , Necrosis , Shock, Septic/complications , Toes/pathologyABSTRACT
BACKGROUND: We report two cases of paradoxical cerebral embolism associated with acute venous thromboembolic disease. CASE REPORT: The first case corresponds to a 49-year-old woman with sudden onset of dyspnea and syncope, followed by right upper extremity paresis, aphasia and dysarthria. The admission brain computed tomography (CT) was unremarkable, but lung CT showed multilobar and multisegmentary pulmonary embolism. Echocardiography showed dilated right ventricle with impaired systolic function, moderate tricuspid regurgitation, moderate pulmonary hypertension and positive bubble test, suggestive of a patent foramen ovale (PFO) which was successfully closed by endovascular Amplatzer device placement. The patient was discharged with anticoagulation therapy and permanent antiplatelet aggregation therapy. The second case is a 60-year-old woman found unconscious. Neurological examination revealed expressive aphasia, right hemianopsia, right central facial paralysis and right-sided paresis with a National institute of Health Stroke Scale of 19. Brain CT showed signs of acute left middle cerebral artery infarction. Later, she developed greater impairment of consciousness. A new brain CT showed significant edema with mass effect requiring a decompressive craniotomy. Echocardiography showed PFO and lower extremities' Doppler ultrasound showed a left infrapopliteal posterior tibial right deep venous thrombosis. An inferior vena cava filter was placed and two days after surgery, anticoagulation was started.
Subject(s)
Embolism, Paradoxical/diagnosis , Pulmonary Embolism/diagnosis , Brain/diagnostic imaging , Brain/pathology , Female , Foramen Ovale, Patent/diagnosis , Humans , Middle Aged , Radiography , Stroke/diagnosisABSTRACT
During the year 2012, 539 manuscripts were submitted to this journal, following an increasing trend in the recent decade. Rejection rate was 33%. This higher number of submissions demanded a larger number and wider scope of external reviews, retarding the editorial process. The mean time lapse from reception to acceptance (or rejection) was 6.3 months (range 2-14) and from acceptance to publication 5.3 months (range 3-7). Research articles were 43.9% of published manuscripts and the remaining articles were Reviews, Special Articles, Case Reports, articles on Medical Ethics, Medical Education, Evidence Based Medicine, Public Health, History of Medicine, Letters to the Editor and others. Thirty seven published manuscripts (14.6%) came from foreign countries and 9 of them were published with full text in English. The 2012 Impact Factor was 0.360, showing little variation from previous years, locating the journal in the upper part of quartil 4 in the ISI-JCR category "Medicine, General and Internal", while the SCImago Journal & Country Rank locates the Revista in quartil 2 of its category "Medicine (miscellaneous)". In contrast with the low citation rate, the number of visits to the open access electronic version in www.scielo.cl averages over 3 million visits per year, illustrating that the interest among readers outnumbers the country’s expectable readership. Only 22% of articles declared to have received financial help from entities external to the institution where the work was performed, coming mainly from Chilean Governmental competitive funds. The aim of Revista Médica de Chile is to provide readers and authors a valuable source of information about current relevant topics in general and internal medicine, progress in related specialties and updates in basic sciences, rendering them available to Health professionals in Chile and worldwide, following international standards of ethical and scientific quality in medical publications.
Subject(s)
Humans , Editorial Policies , Periodicals as Topic/standards , Bibliometrics , Biomedical Research/standards , Chile , Internet/standards , Journal Impact Factor , Time FactorsABSTRACT
During the year 2012, 539 manuscripts were submitted to this journal, following an increasing trend in the recent decade. Rejection rate was 33%. This higher number of submissions demanded a larger number and wider scope of external reviews, retarding the editorial process. The mean time lapse from reception to acceptance (or rejection) was 6.3 months (range 2-14) and from acceptance to publication 5.3 months (range 3-7). Research articles were 43.9% of published manuscripts and the remaining articles were Reviews, Special Articles, Case Reports, articles on Medical Ethics, Medical Education, Evidence Based Medicine, Public Health, History of Medicine, Letters to the Editor and others. Thirty seven published manuscripts (14.6%) came from foreign countries and 9 of them were published with full text in English. The 2012 Impact Factor was 0.360, showing little variation from previous years, locating the journal in the upper part of quartil 4 in the ISI-JCR category "Medicine, General and Internal", while the SCImago Journal & Country Rank locates the Revista in quartil 2 of its category "Medicine (miscellaneous)". In contrast with the low citation rate, the number of visits to the open access electronic version in www.scielo.cl averages over 3 million visits per year, illustrating that the interest among readers outnumbers the country's expectable readership. Only 22% of articles declared to have received financial help from entities external to the institution where the work was performed, coming mainly from Chilean Governmental competitive funds. The aim of Revista Médica de Chile is to provide readers and authors a valuable source of information about current relevant topics in general and internal medicine, progress in related specialties and updates in basic sciences, rendering them available to Health professionals in Chile and worldwide, following international standards of ethical and scientific quality in medical publications.
Subject(s)
Editorial Policies , Periodicals as Topic/standards , Bibliometrics , Biomedical Research/standards , Chile , Humans , Internet/standards , Journal Impact Factor , Time FactorsABSTRACT
Revista Médica de Chile was founded in 1872 and thus is one of the oldest medical journals being published since the 19th Century. The sponsoring institution--"Sociedad Médica de Santiago", founded in 1869--initially was the only scientific society in Chile, gathering medical doctors from every existing specialty. With the splitting of independent organizations representing specific specialties, including subspecial-ties of internal medicine, Sociedad Médica de Santiago focused its scope of action to become the "Chilean Society of Internal Medicine". Its official journal -Revista Médica de Chile--is currently a general and internal medicine journal that also publishes articles on scientific and technological advances in many fields of medicine and health sciences. While initially all authors were Chilean, the journal is now open to submissions from abroad and since the year 2000 articles are published in English when the local language of authors is not Spanish. The number of articles received determines an increasing administrative and editorial burden and, together with the high cost of publishing, will require changes in publication policies. The journal will participate in continuing medical education programs as soon as reaccreditation of medical specialties becomes officially organized in Chile.
Subject(s)
Periodicals as Topic/history , Societies, Medical/history , Bibliometrics , Chile , Editorial Policies , History, 19th Century , History, 20th Century , History, 21st Century , HumansABSTRACT
Revista Médica de Chile was founded in 1872 and thus is one of the oldest medical journals being published since the 19th Century. The sponsoring institution -"Sociedad Médica de Santiago", founded in 1869- initially was the only scientific society in Chile, gathering medical doctors from every existing specialty. With the splitting of independent organizations representing specific specialties, including subspecial-ties of internal medicine, Sociedad Médica de Santiago focused its scope of action to become the "Chilean Society of Internal Medicine". Its official journal -Revista Médica de Chile- is currently a general and internal medicine journal that also publishes articles on scientific and technological advances in many fields of medicine and health sciences. While initially all authors were Chilean, the journal is now open to submissions from abroad and since the year 2000 articles are published in English when the local language of authors is not Spanish. The number of articles received determines an increasing administrative and editorial burden and, together with the high cost of publishing, will require changes in publication policies. The journal will participate in continuing medical education programs as soon as reaccreditation of medical specialties becomes officially organized in Chile.
Subject(s)
History, 19th Century , History, 20th Century , History, 21st Century , Humans , Periodicals as Topic/history , Societies, Medical/history , Bibliometrics , Chile , Editorial PoliciesABSTRACT
In about 20% of patients admitted to an Intensive Care Unit (ICU) the indication of mechanical ventilation (MV) is a neurological disease. These patients have a prolonged MV stay and high mortality. The appropriate use of MV in patients with acute brain injury (ABI) is critical considering that MV by itself is able to induce or worsen an underlying lung injury. Patients with ABI have a higher risk to develop pulmonary complications. During endotracheal intubation the activation of airway reflexes should be prevented, because they may increase intracranial pressure. Tracheostomy is indicated to improve airway management and it is performed in about 33% of these patients. Indications for MV are loss of spontaneous respiratory effort, changes in lung compliance, gas exchange impairment and ventilatory failure due to muscle fatigue or neuromuscular junction dysfunction. During MV, hypoxemia should be avoided. The pC0(2) level has a critical role in cerebral blood flow regulation; therefore a normal pCO must be maintained in order to guarantee an optimal cerebral blood flow. Despite that, hypocapnia has been used in patients with increased intracranial pressure, at the present it is not recommended. Its use should be limited to the emergency management of intracranial hypertension, while the underlying cause is being treated. Non-conventional ventilatory modes as prone position ventilation, high-frequency oscillatory ventilation and extracorporeal C02 removal can be used in patients with ABI. All of them have specific risks and should be employed cautiously This paper reviews upper airway management and MV in patients with acute brain injury.
Subject(s)
Brain Injuries/therapy , Intubation, Intratracheal , Respiration, Artificial/methods , Female , High-Frequency Ventilation , Humans , Male , Middle Aged , Respiration, Artificial/adverse effects , Supine Position , TracheostomyABSTRACT
UNLABELLED: Invasive candidiasis (IC) epidemiology has changed in critically ill patients and limited data are available in Chile. OBJECTIVE: To describe the epidemiological and microbiological profile of IC in critically ill patients. METHODS: Observational prospective study conducted from October 2001 to August 2003 in critically ill adults with suspected or confirmed IC. RESULTS: 53 patients met criteria for IC, finding 18 (33.9%) candidemias, 22 (41.5%) disseminated IC, and 13 (24.5%) local IC. We identified 8 (44.4%) C. albicans and 10 (55.6%) non-albicans Candida in candidemias. C. tropicalis was the predominant non-albicans species (27.7%). An 88.8 % of Candidas sp recovered in candidemias were fluconazole susceptible. Overall hospital mortality was 24.5%. Mortality in candidemia was significantly lower than in disseminated IC (16.6 vs 31.8%, p = 0.02). CONCLUSIONS: A higher proportion of non-albicans Candida was observed in candidemias from critically ill patients. However, most of these strains were fluconazole susceptible. A lower overall mortality was observed in candidemias.
Subject(s)
Candidiasis, Invasive/mortality , Intensive Care Units/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Antifungal Agents/therapeutic use , Candidiasis, Invasive/drug therapy , Candidiasis, Invasive/microbiology , Female , Hospital Mortality , Hospitals, University , Humans , Male , Middle Aged , Prospective Studies , Risk Factors , Young AdultABSTRACT
Abstracts presented in scientific meetings are indispensable tools to diffuse the latest research in the field. They provide the authors with an opportunity to receive feedback from a critical audience so they can prepare a final manuscript to be submitted to a peer-reviewed journal. However, several studies in a wide range of medical specialties and other related sciences showed that no more than 50% of abstracts presented in annual meetings of learned societies are published in a 5-year follow up after the meeting. Therefore, abstracts are considered "preliminary publications" and it is recommended not to include them as bibliographic references unless they have been published recently (less than 3 years) in peer-reviewed journals (regular issues or supplements) or in their official websites. Databases dependent on the National Library of Medicine (USA) or SciELO do not index individual abstracts from a meeting. Authors and reviewers should be reminded that manuscripts that have shaped current knowledge probably had also been presented as abstracts in scientific meetings, sometime before their final publication.
Subject(s)
Abstracting and Indexing , Congresses as Topic , Databases, Factual , Publishing , HumansABSTRACT
Invasive candidiasis (IC) epidemiology has changed in critically ill patients and limited data are available in Chile. Objective: To describe the epidemiological and microbiological profile of IC in critically ill patients. Methods: Observational prospective study conducted from October 2001 to August 2003 in critically ill adults with suspected or confirmed IC. Results: 53 patients met criteria for IC, finding 18 (33.9 percent) candidemias, 22 (41.5 percent) disseminated IC, and 13 (24.5 percent) local IC. We identified 8 (44.4 percent) C. albicans and 10 (55.6 percent) non-albicans Candida in candidemias. C. tropicalis was the predominant non-albicans species (27.7 percent). An 88.8 percent of Candidas sp recovered in candidemias were fluconazole susceptible. Overall hospital mortality was 24.5 percent. Mortality in candidemia was significantly lower than in disseminated IC (16.6 vs 31.8 percent, p = 0.02). Conclusions: A higher proportion of non-albicans Candida was observed in candidemias from critically ill patients. However, most of these strains were fluconazole susceptible. A lower overall mortality was observed in candidemias.
La epidemiología de candidiasis invasora (CI) ha cambiado, lo cual no ha sido suficientemente estudiado en Chile. Objetivo: Describir el perfil epidemiológico y microbiológico de CI en pacientes críticos. Métodos: Estudio observacional prospectivo entre octubre 2001 y agosto 2003, en pacientes críticos adultos con sospecha o confimnación de CI. Resultados: 53 pacientes cumplieron criterios de CI. De ellos, 18 (33,9 por ciento) tuvieron candidemia, 22(41,5 por ciento) CI diseminada y 13(24,5 por ciento) CI local. Entre las candidemias, hubo 8 C. albicans (44,4 por ciento) y 10 Candida no albicans (55,6 por ciento), predominando C. tropicalis (27,7 por ciento). Un 88,8 por ciento de las candidemias fueron susceptibles a fluconazol. La mortalidad hospitalaria global fue 24,5 por ciento, significativamente menor en pacientes con candidemias vs CI diseminada (16,6 vs 31,8 por ciento, p = 0,02). Conclusiones: Se observó una mayor proporción de Candida no albicans en candidemias de pacientes críticos. Sin embargo, la mayoría de estas cepas fue susceptible a fluconazol. La mortalidad global fue menor en candidemias.
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Candidiasis, Invasive/mortality , Intensive Care Units/statistics & numerical data , Antifungal Agents/therapeutic use , Candidiasis, Invasive/drug therapy , Candidiasis, Invasive/microbiology , Hospital Mortality , Hospitals, University , Prospective Studies , Risk FactorsABSTRACT
In about20 percent of patients admitted to an Intensive Care Unit (ICU) the indica-tion of mechanical ventilation (MV) is a neurological disease. These patients have a prolonged MV stay and high mortality. The appropriate use of MV in patients with acute brain injury (ABI) is critica! considering that MV by itself is oble to induce or worsen an underlying lung injury. Patients with ABI have a higher risk to develop pulmonary complications. During endotracheal intubation the activation of airway reflexes should beprevented, because they may increase intracranialpressure. Tracheostomy is indicated to improve airway management and it is performed in about 33 percent of these patients. Indications for MV are loss of spontaneous respira-tory effort, changes in lung compliance, gas exchange impairment and ventilatory failure due to muscle fatigue or neuromuscular junction dysfunction. During MV, hypoxemia should be avoided. The pC0(2) level has a critica! role in cerebral blood flow regulation; therefore a normal pCO must be maintained in order to guarantee an optimal cerebral blood flow. Despite that, hypocapnia has been used in patients with increased intracranial pressure, at the present it is not recommended. Its use should be limited to the emergency management of intracranial hypertension, while the underlying cause is beingtreated. Non-conventional ventilatory modes asprone position ventilation, high-frequency oscillatory ventilation and extracorporeal C02 removal can be used in patients with ABI. All ofthem have specific risks and should be employed cautiously This paper reviews upper airway management and MV in patients with acute brain injury.
Subject(s)
Female , Humans , Male , Middle Aged , Brain Injuries/therapy , Intubation, Intratracheal , Respiration, Artificial/methods , High-Frequency Ventilation , Respiration, Artificial/adverse effects , Supine Position , TracheostomyABSTRACT
Abstracts presented in scientific meetings are indispensable tools to diffuse the latest research in thefield. They provide the authors with an opportunity to receive feedbackfrom a critica! audience so they can prepare a final manuscript to be submitted to a peer-reviewed journal. However, several studies in a wide range of medical specialties and other related sciences showed that no more than 50 percent of abstracts presented in annual meetings oflearned societies are published in a 5-year follow up after the meeting. Therefore, abstracts are considered "preliminary publications" and it is recommended not to include them as bibliographic references unless they have been published recently (less than 3 years) in peer-reviewed journals (regular issues or supplements) or in their official websites. Databases dependent ofthe National Library of Medicine (USA) or SciELO do not Índex individual abstracts from a meeting. Authors and reviewers should be reminded that manuscripts that have shaped current knowledge probably had also been presented as abstracts in scientific meetings, sometime before their final publication.
Subject(s)
Humans , Abstracting and Indexing , Congresses as Topic , Databases, Factual , PublishingABSTRACT
During the first semester of 2009 Revista Médica de Chile has received an increasing number of manuscripts. Close to 30% were rejected while most other are in the process of being improved by the authors after receiving criticisms by external peer reviewers and the editors. The time lag between acceptance and publication of manuscripts is on an average six months. During 2008, 10% of articles published were submitted by authors from countries other than Chile and most of them were printed in English. Impact factor and other indexes provided by the ISI Web of Knowledge showed a promising improvement in 2008. The International Advisory Committee and the National Editorial Committee were renewed, a new Section on Laboratory Medicine was incorporated and several minor changes were done in design and format, in the title page and the issues' content. The main problems to be faced relate to the increasing cost of editing and printing, with a reduction in commercial advertising historically contributed by the pharmaceutical industry. Another major concern is to stimulate governmental agencies, scientific societies and universities to establish a national independent registry of clinical trials, that should become a mandatory requisite for every manuscript submitted to Chilean medical journals, reporting clinical trials performed in the country; foreign manuscripts should document the satisfaction of an identical requisite in their original source.
Subject(s)
Biomedical Research/statistics & numerical data , Periodicals as Topic/statistics & numerical data , Chile , Editorial Policies , Journal Impact FactorABSTRACT
Background: Thrombotic thrombocytopenic purpura (TTP) is characterized by anemia, thrombocytopenia, neurological and renal involvement of variable severity and it has a dismal prognosis. Platelet-derived von Willebrand Factor-cleaving metalloprotease ADAMTS-13 activity may orient the diagnosis, but normal levels do not discard it. The most effective therapy thus known is plasmapheresis. Aim: To report the experience in 18 patients with TTP. Material and methods: Retrospective assessment of 11 patients and prospective assessment of seven subjects with TTP, aged 15 to 81 years. Results: All presented with anemia, thrombocytopenia and LDH elevation. Sixteen had neurological symptoms, five had fever, four had macroscopic urinary excretion of pigments, four had petechiae, and two had nosebleeds. Haptoglobin was low in 10 of 11 patients in whom it was measured. ADAMTS-13 had low activity in 15 of 17 patients (in 11, the inhibitor was found). Seventeen patients were treated with plasmapheresis and nine received steroids also. Seven patients died due to shock with respiratory involvement or múltiple organic failure. Conclusions: TTP has heterogeneous modes of presentation. If the diagnosis is strongly suspected, plasmapheresis can be started without laboratory confirmation. An ADAMTS-13 activity below 6 percent is almost exclusive of TTP .
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Purpura, Thrombotic Thrombocytopenic , ADAM Proteins/blood , Plasmapheresis , Prospective Studies , Purpura, Thrombotic Thrombocytopenic/diagnosis , Purpura, Thrombotic Thrombocytopenic/enzymology , Purpura, Thrombotic Thrombocytopenic/therapy , Retrospective StudiesABSTRACT
Microcirculation is severely compromised in sepsis, with a reduction of capillary density and flow impairment. These alterations have important prognostic implications, being more severe in non-survivors to septic shock. Today microcirculation may be assessed bedside, non-invasively using polarized light videomicroscopy a technique known as SDF (side dark field). We report a 54 year-old man with an extramembranous nephropathy that developed a necrotizing fasciitis associated to septic shock, in whom microcirculation was periodically assessed during his management. The patient was treated with fluids, vasoactive drugs, antibiotics and was operated for exploration and debridement. As the patient persisted in refractory shock despite treatment, high-volume hemofiltration was started. Before hemofiltration the patient had severe microcirculatory alterations that improved during and after the procedure. Physiologic endpoints of high-volume hemofiltration in septic shock remain unknown, but it has the capacity to clear inflammatory mediators. Since microcirculatory alterations are in part secondary to these mediators, their removal is beneficial. Like other authors, we found no relation between microcirculation and other haemodynamic and perfusion variables.
Subject(s)
Hemofiltration/methods , Microcirculation/physiology , Mouth Floor/blood supply , Shock, Septic/therapy , Sublingual Gland/blood supply , Humans , Inflammation Mediators/blood , Male , Microscopy, Video/methods , Middle Aged , Shock, Septic/bloodABSTRACT
Microcirculation is severely compromised in sepsis, with a reduction of capillary density and flow impairment. These alterations have important prognostic implications, being more severe in non-survivors to septic shock. Today microcirculation may be assessed bedside, non-invasively usingpolarized light videomicroscopy a technique known as SDF (side dark field). We report a 54 year-old man with an extramembranous nephropathy that developed a necrotizing fascitis associated to septic shock, in whom microcirculation was periodically assessed during his management. The patient was treated with Buids, vasoactive drugs, antibiotics and was operated for exploration and debridement. As the patient persisted in refractory shock despite treatment, high-volume hemofiltration was started. Before hemofiltration the patient had severe microcirculatory alterations that improved during and after the procedure. Physiologic endpoints of high-volume hemofiltration in septic shock remain unknown, but it has the capacity to clear inflammatory mediators. Since microcirculatory alterations are in part secondary to these mediators, their removal is beneficial. Like other authors, we found no relation between microcirculation and other haemodynamic and perfusion variables.
Subject(s)
Humans , Male , Middle Aged , Hemofiltration/methods , Microcirculation/physiology , Shock, Septic/therapy , Sublingual Gland/blood supply , Inflammation Mediators/blood , Microscopy, Video/methods , Shock, Septic/bloodABSTRACT
Background: Severe sepsis (SS) is the leading cause of death in the Intensive Care Units (ICU). Aim: To study the prevalence of SS in Chilean ICUs. Material and methods: An observational, cross-sectional study using a predesigned written survey was done in all ICUs of Chile on April 21st, 2004. General hospital and ICU data and the number of hospitalized patients in the hospital and in the ICU at the survey day, were recorded. Patients were followed for 28 days. Results: Ninety four percent of ICUs participated in the survey. The ICU occupation index was 66 percent. Mean age of patients was 57.7+18 years and 59 percent were male, APACHE II score was 15+7.5 and SOFA score was 6+4. SS was the admission diagnosis of 94 of the 283 patients (33 percent) and 38 patients presented SS after admission. On the survey day, 112 patients fulfilled SS criteria (40 percent). APACHE II and SOFA scores were significantly higher in SS patients than in non SS patients. Global case-fatality ratio at 28 days was 15.9 percent (45/283). Case-fatality ratio in patients with or without SS at the moment of the survey was 26.7 percent (30/112) and 8.7 percent (17/171), respectively p <0.05. Thirteen percent of patients who developed SS after admission, died. Case-fatality ratios for patients with SS from Santiago and the other cities were similar, but APACHE II score was significantly higher in patients from Santiago. In SS patients, the independent predictors of mortality were SS as cause of hospital admission, APACHE II and SOFA scores. Ninety nine percent of SS patients had a known sepsis focus (48 percent respiratory and 30 percent abdominal). Eighty five patients that presented SS after admission, had a respiratory focus. Conclusions: SS is highly prevalent in Chilean ICUs and represents the leading diagnosis at admission. SS as cause of hospitalization, APA CHE II and SOFA scores were independent predictors of mortality.
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Intensive Care Units , Sepsis/epidemiology , Chile/epidemiology , Epidemiologic Methods , Multiple Organ Failure/epidemiology , Sepsis/microbiology , Sepsis/mortalityABSTRACT
Acute pulmonary edema caused by thiazides is uncommon and of difficult diagnosis. It is considered an idiosyncratic reaction and the physiopathology or cardiac function changes are not well known. We report a 60 year-old female with a thiazide induced acute pulmonary edema who was followed with serial measurements of type B n-terminal natriuretic peptide fraction as marker for cardiac dysfunction. There was a significant elevation of the peptide, not associated to evidences of ventricular dysfunction. Its normalization paralleled the resolution of the clinical picture.
