Endocarditis is a type of infection that is common in internal medicine wards and in haemodialysis clinics. The location that is most affected are the heart valves. Herein, we report a case of an uncommon abscess, a sub-endothelial abscess between the transition of the superior vena cava and the right atrium. There were several emboli to the lung and foot, and the agent was related to Staphylococcus aureus and a double-lumen catheter. Usually, this type of abscess is located in valves, either the tricuspid valve if related to catheters or injection drug use or the mitral valve if related to other causes. An exhaustive review was made, but we found no information about the location of this abscess and the rarity of the event motivating the report of infection.

Objetivo: Relatar caso raro de neurocriptococose em paciente imunocompetente.  Detalhamento de caso: A infecção do sistema nervoso central pelo fungo Cryptococcus neoformans, também chamada neurocriptococose, é uma desordem rara mais comum em pessoas que possuem algum grau de comprometimento imunológico, seja primário ou secundário, atuando como infecção de caráter oportunista. Descrevemos um caso de paciente imunocompetente com achados laboratoriais compatíveis com neurocriptococose que se apresentava apenas com cefaleia de características migranosas, nódulo pulmonar isolado sem queixas clínicas e exames de imagem de sistema nervoso central inespecíficos. Considerações finais: Em pacientes imunocompetentes, infecções fúngicas são raras e podem cursar com sintomatologia não evidente, dificultando o diagnostico etiológico. É necessária história clínica minuciosa associada a exames complementares bem empregados com o intuito de chegar ao diagnostico etiológico de forma mais segura possível para assegurar a terapêutica correta. Ademais, se faz necessário emprego de técnicas mais rápidas e acessíveis ao diagnostico, como também para triagem, visto que parte desses pacientes são oligossintomaticos e se beneficiariam de tratamento precoce.

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Backgroung: the ideal access for hemodialysis is represented by arteriovenous fistulas both as initial access and in use and are determinants of health care parameters for chronic renal patients. Objective: to evaluate vascular access for hemodialysis. Methods: this is a cross-sectional study, with a sample of 2513 individuals on hemodialysis in Ceará. Data were collected on age, sex, time of treatment, underlying disease, initial access and access in use. The data were divided into two groups, the interior of the state and the Metropolitan Region of Fortaleza, in the State of Ceará, and compared using the Student’s Test (p<0.05). Results: the most common age group was between 19 and 64 years (73%). Men prevailed in both regions, 713 (63%) in the countryside and 792 (57%) in the metropolitan area. The most common cause of Chronic Kidney Disease was Hypertension 306 (27%), followed by Disease of undetermined cause 295 (26%) in the countryside; in the metropolitan region, Diabetes Mellitus 356 (26%) was the main cause, followed by Hypertension and Disease of undetermined cause, each with 344 (25%), p=0.001. In the countryside, 9% started treatment for fistula while in the metropolitan area 12%, p=0.011. 79% of patients in the countryside used fistulas and 81% in the metropolitan area, p=0.156. Conclusion: arteriovenous fistulas are more frequent as initial accesses in the metropolitan region than in the interior, but there is an equivalence of fistulas in use in both regions. Catheter is the main initial access route. The evaluation of vascular accesses in Ceará showed that hemodialysis services are able to maintain good parameters of care for patients with chronic kidney disease.

Background: The analysis of vascular access for haemodialysis is