Homocysteine plasma levels as a marker of clinical severity in septic patients.

Objective: Homocysteine and sepsis are both associated with inflammation and endothelial activation. Therefore this study was aimed to evaluate if the plasma homocystein level is related with the septic patient clinical severity.

Methods: Severe sepsis or septic shock patients, with less than 48 hours from organ dysfunction start, were admitted to this prospective observational study.

Parasternum pleural-cutaneous fistula in a severely immunosuppressed HIV-positive patient.

Pleural tuberculosis occurs in 30% of patients with tuberculosis, and the percentage of patients with tuberculosis pleural effusions is comparable to human immunodeficiency virus HIV-positive and HIV-negative individuals, although pleural tuberculosis is rare in HIV-positive patients with CD4+ counts < 200 cells/mm(3). Pleural tuberculosis in HIV-positive patients is likely to happen in young patients, and is more frequent in intravenous drug abusers, with more acid-fast bacilli identifiable in pleural tissue. We report a rare case of pleural tuberculosis in a severely immunosuppressed HIV-positive patient, presented as two parasternum pleural-cutaneous fistula.