Female patient aged 30, at 7 months of pregnancy, admitted to gynecology for genital pain associated with pruritus that has been evolving for one week . On clinical examination, she presents a vulvar edema, ulceration with polycyclic contours and some vesicles on the periphery. The diagnosis of herpes genital was confirmed. The patient took an antiviral treatment. Genital herpes is a sexually transmitted disease caused by the herpes simplex virus (HSV). It is the most frequent cause of genital ulceration worldwide.

A 22 year old male student was seen by a psychiatrist for the complaint of having no interest in studying for his final college examination accompanied with loss of appetite and sleep disturbance. Upon taking psychiatric history, his symptoms were: diminished interest in daily activities of three months duration, fatigue, insomnia of sixth months duration, anorexia of two months duration and feelings of worthlessness. His physical examination and laboratory tests were normal with no abnormality. Thus, the diagnosis of major depressive disorder was made based on the psychiatric evaluation and he was prescribed Escitalopram 10 mg daily. On the third day of the Escitalopram therapy, bilateral severe mydriasis was observed by the patient, after contacting the psychiatry department, he was referred for ophthalmological examination. Upon ophthalmological examination, his examination revealed a right pupil diameter of 8 mm and a left pupil diameter of 8 mm with room light. Pupillary responses were equal with light exposure. The ophthalmological examination was reported as normal except for the unexplained bilateral mydriasis that was not ophthalmological in origin.

Pagets disease was first described by Sir Paget in 1874 as an eczema-like lesion of the nipple linked to an underlying cancer. This is a rare entity that affects only 1 to 4% of breast cancers. It mainly affects menopausal women with an average age of 62.6 years. No clinical or epidemiological factors are recognized as predisposing to the development of this disease. Clinically, Pagets mammary disease manifests itself as a scaly, thickened, sometimes pigmented, patchy plaque with irregular edges. This lesion can be limited to the nipple or extended to the areola and even to the surrounding skin. In the case of an eczematous lesion, the main differential diagnosis of Pagets disease is nipple eczema. But unilaterality, scalability and lack of response to corticosteroid therapy help to correct the diagnosis. Other differential diagnoses, such as psoriasis, superficial basal cell carcinoma and melanoma, may also be discussed and only histology will confirm the diagnosis. Mastectomy has long been considered the appropriate treatment because of its frequent association with multifocal or multicenter breast cancer. Currently, the majority of teams adopt conservative treatment.

Introduction: Ventilate patients during microlaryngeal surgery confronts several problems. Jet ventilation with conventional ventilatory frequencies allows the use of small diameter endotracheal catheters to provide adequate oxygen volumes and better operating conditions than the traditional method. Objective: Evaluate the safety and effectiveness of jet ventilation with conventional ventilatory frequencies for elective microlaryngeal surgery. Methods: A comparative, single-blind, randomized and parallel study was performed. It was used a prototype of jet ventilation device (with an exceptional use permit in humans conferred by the Center for the State Control of Medication, Dispositive and Medical Equipment) in a study group of 45 patients (group E) and compared with a control group (group C) of 15 patients using the traditional ventilation method. Results: Oxygenation was higher in group E. Group C eventually required extubation, transitory apnea and reintubation, which impacted against the anatomophysiological integrity of patients, the operative field and teaching. A greater hemodynamic stability was evident among the subjects of group E. The intrapulmonary pressures produced by jet ventilation did not cause obvious injuries or clinical repercussions. Conclusions: Applying jet ventilation with conventional ventilatory frequencies was safe and effective. For the first time, experiences of using a jet ventilation method in the country were obtained. The group in which traditional ventilation method was applied suffered more frequent and dangerous complications. It is necessary to assimilate jet ventilation´s technologies to raise the quality of medical attention in times of peace, war or disasters, in elective or emerging contexts as the challenge of a difficult airway.

In the literature there are still few cases of endocarditis caused by non-HACEK gram negative bacteria, particularly by Klebsiella pneumoniae carbapenemasi producing. The few cases reported mostly concern patients who were already hospitalized for other causes. In this article we report two cases of endocarditis arising in non-hospitalized patients. One of the two patients died decayed. The death due to the consequences of the ischemic instinct that was the cause of the hospitalization. The other patient was subjected to aortic valve replacement and you have subsequent checks showing no signs of infections and the valve works regularly. Both cases were treated with ceftazidime avibactam plus gentamicin.