Primary Chest Wall Abscess Caused by Pseudomonas aeruginosa and Staphylococcus epidermidis.

Primary abscess of the thoracic wall is a very rare condition that occurs spontaneously due to hematogenous dissemination of bacterial, fungal, or mycobacterial pathogens, of which Mycobacterium tuberculosis is the most frequent agent. The authors describe a rare case of primary abscess of the thoracic wall. The patient presented with a painful, growing mass in the chest wall that later fistulized to the skin, draining a purulent exudate. Extensive analytical and imagiological workup was performed, showing no changes other than an expansive soft tissue formation extending from the skin surface and destructing the cartilage of the 7th right costal arch. Culture of the purulent exdudate identified Pseudomonas aeruginosa and Staphylococcus epidermidis. The patient improved under directed antibiotic treatment. The diagnosis of a primary abscess of the thoracic wall and the causative agents contribute to the rarity of this case.

Idiopathic Systemic Capillary Leak Syndrome: A Clinical Case.

Idiopathic systemic capillary leak syndrome (ISCLS) is a rare condition caused by the extravasation of intravascular fluids and proteins into the interstitial space due to increased vascular endothelium permeability. It is characterized by episodes of hypotension, hypoalbuminemia, and hemoconcentration with generalized edema. Its etiopathogenesis is unknown. However, it is associated with monoclonal gammopathy in more than 80% of cases. There is currently no targeted treatment, and the approach during a crisis is supportive, mainly to control blood pressure, maintain perfusion of vital organs, and prevent complications, such as acute pulmonary edema and organ failure due to ischemia, which are the primary causes of death. We present the case of a 72-year-old man with generalized edema and pleural, pericardial, and peritoneal effusions whose laboratory results showed hypoalbuminemia, hypoproteinemia, and immunoglobulin G kappa monoclonal gammopathy. Other etiologies for severe hypoalbuminemia with anasarca were excluded after an exhaustive complementary study, leading to the diagnosis of ISCLS associated with monoclonal gammopathy. The patient showed progressive clinical improvement with albumin and diuretic therapy. However, they were readmitted to the hospital due to hypotension with multiorgan dysfunction and died a few hours later.

A Phantom Opacity on Chest Radiograph.

The authors present a case of phantom tumour of the lung. This is a type of pleural effusion where fluids accumulate in the interlobar fissures, typically in the transverse fissure. Its prompt recognition avoids additional, unnecessary or expensive examination and treatment mistakes. LEARNING POINTS: Phantom tumour of the lung should be considered as a differential diagnosis for a radiographic opacity because it can be misdiagnosed as a lung mass or consolidation.Its rapid disappearance after management of the underlying condition, in this case of cardiac decompensation with diuretics, confirms the diagnosis.Prompt recognition avoids additional, unnecessary or expensive examination and treatment mistakes.

[Cytomegalovirus encephalitis in an HIV-negative patient]. / Encefalite a citomegalovírus em doente com vírus da imunodeficiência humana negativa.

Secondary immunodeficiences are associated with an increased incidence of infection and malignancy, as well with development of autoimmune disease. Immune system function is altered by many conditions, such as aging, malnutrition and mycobacterial infections. However, the treatment of the primary condition often results in the improvement of the immune compromise. The authors present a case of cytomegalovirus encephalitis and hepatitis, due to viral reactivation associated with development of secondary immunodeficience in an HIV-negative patient.

As imunodeficiências secundárias encontram-se associadas a elevada incidência de infecções e neoplasias, bem como ao desenvolvimento de doenças auto-imunes. O status imunológico pode ser alterado por diversas condições, tais como a idade avançada, a malnutrição e as infecções micobacterianas. Contudo, o tratamento da condição primária resulta frequentemente na melhoria do compromisso imunológico. Os autores apresentam um caso de encefalite e hepatite por citomegalovírus, decorrente de reactivação viríca associada ao desenvolvimento de imunodeficiência secundária em doente Vírus da Imunodeficiência Humana negativa.

Consumo de Benzodiazepinas en Ciego de Ávila / Consumption of Benzodiazepines in Ciego de Ávila Province

ntroducción: Estudios internacionales y en Cuba han señalado un aumento en el consumo de ansiolíticos e hipnóticos, así como un uso inadecuado en varios países, mayormente con las benzodiazepinas. El objetivo de este trabajo fue analizar el patrón de consumo de tres benzodiazepinas orales: Nitrazepam, Diazepam y Clordiazepóxido en la provincia de Ciego de Ávila entre los años 2006, 2007 y el primer trimestre del 2008. Métodos: Se realizó un estudio observacional transversal descriptivo con los datos sobre la distribución y el consumo de los tres medicamentos, utilizando el sistema MISTRAL implantado en la Droguería de Ciego de Avila, a las 92 farmacias comunitarias, se corroboraron con las ventas efectuadas en las diferentes farmacias ubicadas en el territorio. Las cantidades de cada medicamento se expresaron en dosis diarias definidas por 1.000 habitantes y día. Resultados: La utilización de benzodiazepinas fue alta en el periodo estudiado siendo el medicamento más utilizado el Nitrazepam, seguido del Diazepam. Conclusiones: Existe incremento del uso de Diazepam y Nitrazepam a expensa de algunos municipios, mientras que el consumo de Clordiazepóxido se mantuvo según la dosis diaria definida en nuestro país.

Introduction: National and International studies have indicated an increase in the consumption of hypnotic-ansiolitic drugs as well as an inadequate use of them in several countries, mainly the benzodiazepines. The objective of this work is to analyze the consumption pattern of three oral benzodiazepines: Nitrazepam, Diazepam and Clordiazepoxide in Ciego de Ávila province from 2006 to 2007 and the first trimester of 2008. Methods: a descriptive cross-sectional observational study was carried out with the data on the distribution and the consumption of the already mentioned three medicines, using the MISTRAL system implanted in the Drug store of Ciego de Ávila, to the 92 communitarian pharmacies; it was corroborated with the sales done in the different pharmacies located in the territory. The amounts of each medicine were expressed in daily doses defined by 1,000 inhabitants and day. Results: The use of benzodiazepines was high in the studied period being the Nitrazepam the most used medicine, followed by Diazepam. Conclusions: There was an Increase of the use of Diazepam and Nitrazepam in some municipalities, whereas the clordiazepoxide consumption stayed according to the daily dose defined in our country.

Consumo de Benzodiazepinas en Ciego de Ávila / Consumption of Benzodiazepines in Ciego de Ávila Province

ntroducción: Estudios internacionales y en Cuba han señalado un aumento en el consumo de ansiolíticos e hipnóticos, así como un uso inadecuado en varios países, mayormente con las benzodiazepinas. El objetivo de este trabajo fue analizar el patrón de consumo de tres benzodiazepinas orales: Nitrazepam, Diazepam y Clordiazepóxido en la provincia de Ciego de Ávila entre los años 2006, 2007 y el primer trimestre del 2008. Métodos: Se realizó un estudio observacional transversal descriptivo con los datos sobre la distribución y el consumo de los tres medicamentos, utilizando el sistema MISTRAL implantado en la Droguería de Ciego de Avila, a las 92 farmacias comunitarias, se corroboraron con las ventas efectuadas en las diferentes farmacias ubicadas en el territorio. Las cantidades de cada medicamento se expresaron en dosis diarias definidas por 1.000 habitantes y día. Resultados: La utilización de benzodiazepinas fue alta en el periodo estudiado siendo el medicamento más utilizado el Nitrazepam, seguido del Diazepam. Conclusiones: Existe incremento del uso de Diazepam y Nitrazepam a expensa de algunos municipios, mientras que el consumo de Clordiazepóxido se mantuvo según la dosis diaria definida en nuestro país (AU)

Introduction: National and International studies have indicated an increase in the consumption of hypnotic-ansiolitic drugs as well as an inadequate use of them in several countries, mainly the benzodiazepines. The objective of this work is to analyze the consumption pattern of three oral benzodiazepines: Nitrazepam, Diazepam and Clordiazepoxide in Ciego de Ávila province from 2006 to 2007 and the first trimester of 2008. Methods: a descriptive cross-sectional observational study was carried out with the data on the distribution and the consumption of the already mentioned three medicines, using the MISTRAL system implanted in the Drug store of Ciego de Ávila, to the 92 communitarian pharmacies; it was corroborated with the sales done in the different pharmacies located in the territory. The amounts of each medicine were expressed in daily doses defined by 1,000 inhabitants and day. Results: The use of benzodiazepines was high in the studied period being the Nitrazepam the most used medicine, followed by Diazepam. Conclusions: There was an Increase of the use of Diazepam and Nitrazepam in some municipalities, whereas the clordiazepoxide consumption stayed according to the daily dose defined in our country (AU)