Introduction: Common causes of pericardial effusions include malignancy, renal failure, autoimmune disease or infection. Infection is one of the commonest causes of pericardial effusion. It is most often viral in aetiology and non-purulent. When the pericardial fluid is purulent, the presence of bacteria is likely.

Case presentation: We report a 72 years old Chinese man presented with mild symptoms of heart failure. He had no history of fever, weight or appetite loss, chest pain or history of tuberculosis contact. On auscultation, the heart sounds were muffled and there were minimal basal crackles over both lungs. His echocardiography showed signs of cardiac tamponade though clinically he is relatively well. Pericardiocentensis was not performed due to narrow window with thin effusion at ventricular apex. Pericardial window was done via left posterolateral thoracotomy. Intraoperatively, 500cc of purulent fluid was drained. Microbiology screens were all negative.

Discussion: We present the atypical clinical course of this elderly man presenting with a large pyopericardium. Patient with pyopericardium often present in an extreme end of spectrum with septic shock with high mortality risk. However in current case, the presentation is atypical. Thus, careful and detailed evaluation with echocardiography is essential to unmask this potentially lethal disease. A simple surgical intervention of pericardial window will be an important life-saving option for patients presented with this condition.

Conclusion: Pyopericardium can present in an atypical milder disease spectrum with relatively minor symptoms of heart failure. Careful and detailed evaluation with echocardiography is essential to unmask this potentially lethal condition.

Computer model simulating the coupled blood pressure dynamics in magisterial and small arteries with the heart electrical dynamics has been suggested. The Fermi-Pasta-Ulam auto recurrence in the description of the electrical activity of the heart has demonstrated the universal role of the FPU recurrence in the study of dynamical systems. The heart electrical dynamics was described by the coupled Van der Pol differential equations with a time lags, linked with two additively coupled non linear differential equations circumscribing the blood pressure dynamics in the networks of magisterial and small arteries. The arterial blood pressure dynamics was interpreted as coupled FPU recurrences showing a rich variety of resulting FPU spectra, which were referred to different states of Cardio Vascular System. Synchronous registering of the real ECG and Pulse Wave Fourier dynamic images allowed unifying the characteristic Fourier pictures of the heart electrical activity with the hydrodynamic blood parameters developing in the networks of two types of arteries. The computer study of the suggested model and comparison of its resultswith the real data proved that the ECG Fourier parameters coupled with the Pulse Wave Fourier parameters form the FPU spectra that increase stability of Cardio Vascular System and can be used for diagnostics as well as for evaluation of the therapeutic arrangements results.

Infarction code is a strategic plan implemented in the IMSS in order to reduce the times of medical care processes from First Medical Contact (FMC) to discharge and rehabilitation of the patient with ST-segment Elevation Myocardial Infarction (STEMI). Recent developments have provided a unique opportunity for the organization of regional networks of STEMI receiving centers. Due to the fact that the cumulative evidence has shown that Percutaneous Coronary Intervention (PCI) primary is the most effective for the STEMI reperfusion strategy, the development of integrated networks using “control centers” could extend the benefits the primary PCI to one much larger Mexican population segment. Control center is a call center equipped with appropriate internet technology to receive not only the call but digital data such as ECG and other laboratory parameters in order to speed up Triage and inter-hospital patient transfer. Factors that favor the development of regional networks include results from recently published clinical trials, a vision of current patterns of treatment of STEMI from observational records, the experience with the current system for trauma in United States of America (USA) and the technological advances. 

Currently, new classes of lipid-lowering drugs have been developed. Some of them are available for clinical practice. The convertase intended / kexintype pro-proteina 9 (PCSK9) inhibitor increases the expression of the Low Density Lipoprotein (LDL) receptors on hepatocytes through improved recycling of LDL receptor. Now is accepted that Statins have proven to be a very effective and safe treatment in many and various types of studies including controlled, clinical trials and treatment of first line against the atherogenic dyslipidemia. However and to weights of a treatment optimal with Statins, 60% to 80% of risk cardiovascular residual persists. Thus, patients with Familial Hypercholesterolemia with a very high level of cholesterol in Lipoproteins of Low Density (LDL-C) and patients who do not tolerate or do not respond to Statins are other barriers to treatment with Statins. The inhibitor of PCSK9 recently showed results promising of down in form significant C-LDL in the Hypercholesterolemia Family (HF) of them patients of the phase of trials to long term III. MTP inhibitor and against ApoB antisense oligonucleotide were approved for the treatment of homozygous familial hyperlipidemia but it still needs more evidence strengthened by the hepatic safety as hepatosteatosis.

Introduction: Histoplasmosis is a systemic mycosis present in an endemic state in many tropical or temperate regions. It is a pathology induced by Histoplasma capsulatum, dimorphic fungus thriving in wetlands and at moderate temperatures. In immunocompetent subjects, 95% of clinical forms are asymptomatic. The preferred sites for this dissemination are pulmonary, medullary, hepatic, splenic and ganglionic. Exceptionally, the fungus can reach the eye.

Materials and methods: We report a case of ocular histoplasmosis in a 62-year-old patient.

Observation: It is a patient aged 62 years, diabetic under insulin for 5 months (discovery inaugural), amputated on the right side for a diabetic foot in October 2016, which showed a decrease in visual acuity appeared for 5 months . A complete ophthalmologic examination was carried out as part of the degenerative assessment of his diabetes, and he objectified: visual acuity at 1/10 at right eye, 2/10 at left, ocular tone at 16 mmhg at right eye and 14 mmhg at left, biomicroscopic examination didn’t find tyndall in the anterior chamber, examination in the bottom of eye showed: the presence of choroidal depigmented white at the retinal periphery with blamed hemorrhages, the absence of inflammation and inflammatory cells in the vitreous in both eyes, and the presence of peripapillary atrophy in the left eye.

Discussion: Ocular Histoplasmosis Syndrome (SS) is a deep mycosis with a pulmonary entry portal characterized by chorio retinal disorder caused by Histoplasma capsulatum, which is commonly found in endemic areas. The ocular damage remains quite exceptional since only 1.6 to 5.3% of patients with histoplasmosis are affected. The diagnosis of ocular histoplasmosis is made by clinical examination. The fundus of the eye can find histo spots, peripapillary atrophy, macular disciform lesions active or not and never finds inflammatory cells in the vitreous and the anterior segment. The systemic antifungal treatments used in the treatment of histoplasmosis have little use in the treatment of ophthalmologic involvement because the fungus does not appear to be in the eye at the time of ophthalmologic diagnosis. The treatment of eye damage is therefore very specific.

Conclusion: Ocular histoplasmosis is a fungal infection that has long been underestimated because of the asymptomatic or benign character of the primary infection. Indeed, this ophthalmological pathology, of random evolution and with heavy clinical consequences, is very little known and rarely sought, whereas an early diagnosis improves its management and hence its functional prognosis.