A right atrial myxoma presenting with misleading features of acalculous cholecystitis.

Diffuse thickening, a layered appearance of the gallbladder wall and the accumulation of surrounding fluid are considered as sensitive and relatively specific imaging findings of gallbladder inflammation. In the absence of gallstones, the diagnosis of acalculous cholecystitis can be further supported by the presence of fever, epigastric pain, right upper abdominal quadrant (RUQ) tenderness on inspiration and elevated markers of inflammation. In this report, we describe a 35-year-old schoolteacher who presented with all of the above clinical, laboratory and imaging findings that were eventually attributed to gallbladder oedema and liver congestion (abdominal imaging and RUQ tenderness) caused by an atrial myxoma interfering, with the atrioventricular circulation of the right heart and causing constitutional manifestations (fever and elevated markers of inflammation).

Influence of protein intake from haem and non-haem animals and plant origin on inflammatory biomarkers among apparently-healthy adults in Greece.

Intake of different types of protein may be associated with differences in biomarkers among various populations. This work investigated the influence of protein intake from haem and non-haem animals as well as protein from plants on haematological and biochemical parameters in inflammation among apparently-healthy adults living in Greece, a Mediterranean country. Four hundred and ninety apparently-healthy subjects (46 +/- 16 years, 40% men), who consecutively visited Polykliniki General Hospital for routine examinations, voluntarily agreed to participate in the study (participation rate 85%). Demographic, anthropometric and lifestyle characteristics were recorded. Participants completed a valid, semi-quantitative food frequency questionnaire. Protein intake was classified into three sources: protein from haem animals, protein from non-haem animals, and protein from plant origin. Fasting blood samples were taken from all participants; uric acid, creatinine, lipids, cystatin C, haptoglobin, haemoglobin, haematocrit, iron, ferritin, white blood cells, monocytes, platelets, and C-reactive protein were measured. Protein intake from only haem animals was associated with increased haemoglobin and haematocrit levels (p < 0.05) whereas intake of protein from non-haem animals and plant origin was not associated with the investigated haematological and biochemical markers of low-grade chronic inflammation when lifestyle factors and overall dietary habits were taken into account. Intake of protein from only haem animals seems to be consistently associated with haematological markers. The confounding role of dietary habits and lifestyle variables on the tested parameters deserves further attention in future research.

Vitamin D status and health correlates among apparently healthy participants in an urban, sunny region.

AIM: To assess vitamin D status and health correlates in a sample of apparently healthy Caucasian participants residing in an urban area, Athens, with latitude 370 58' 0" N and longitude 230 43' 0" E, after taking into consideration a broad range of purported biological, behavioural and environmental factors. METHOD: Men and women 35+ years from a selected population (n = 490) were studied. Participants completed a detailed questionnaire regarding socio-demographic, lifestyle, clinical and dietary characteristics. Biomarkers were measured after 12 h fasting. Linear and multinomial regression models were used to evaluate the association between 25(OH)D and determinants of vitamin D status. RESULTS: Results revealed that one hour increase of sunlight exposure decreased the odds of having D deficiency (i.e., < 20 ng/mL) by 70% (OR = 0.30, 95% Cl: 0.20-0.45), adjusted for age, sex, family status, physical activity, smoking habits, BMI, triglycerides, parathyroid hormone, uric acid, haptoglobin, folate acid and haemoglobin, as compared to sufficient levels (i.e., >30 ng/mL). Regarding biomarkers, parathyroid hormone and haptoglobin were found to be related with the odds of having vitamin D deficiency (OR = 1.11, 95% CI: 1.05-1.16; OR = 1.02, 95% CI: 1.00-1.03, respectively) as compared to the sufficient levels. CONCLUSIONS: Sufficient serum vitamin D levels were observed among participants with characteristics associated with reduced cardiovascular risk, such as normal BMI, increased physical activity, decreased parathyroid hormone and decreased inflammatory markers. Even a slight increase in sunlight exposure could have beneficial effects on serum vitamin D concentrations and eventually on haemoglobin and inflammatory markers levels, thus providing a simple and inexpensive lifestyle intervention that promotes public health.

The impact of demographic characteristics and lifestyle in the distribution of cystatin C values in a healthy greek adult population.

Background. The aim of the present study was to examine sources of variation for serum cystatin C in a healthy Greek population. Methods. Cystatin C together with basic clinical chemistry tests was measured in a total of 490 adults (46 ± 16 yrs, 40% males) who underwent an annual health check. Demographic, anthropometric, and lifestyle characteristics were recorded. Results. Higher values of cystatin C were observed among males (P = .04), participants aged over 65 years (P < .001), current smokers (P = .001) and overweight/obese participants (P = .03). On the contrary, alcohol consumption and physical activity seemed to have no influence on cystatin C levels (P = .61; P = .95, resp.). Conclusions. In interpreting serum cystatin C values in a healthy adult population, age, gender, Body Mass Index, and cigarette smoking need to be considered, and determination of reference ranges among distinct subpopulations seem to be prudent.

Associations of acute-phase reactants with metabolic syndrome in middle-aged overweight or obese people.

BACKGROUND: Metabolic syndrome, i.e. the clustering of visceral obesity, dyslipidemia, hyperglycemia, and hypertension, has become a major public-health challenge worldwide. An acute-phase reactant is one whose level increases by 25% of the standard value during inflammation. Associations of acute-phase reactants with the components of metabolic syndrome among overweight or obese patients has rarely been examined. MATERIAL/METHODS: The CRP, ferritin, fibrinogen, haptoglobin, and ESR levels of 117 consecutive overweight or obese patients were measured. Metabolic syndrome was defined if central obesity was combined with at least two of the following factors: triglyceride level > or = 150 mg/dl or specific treatment for this abnormality, HDL cholesterol < 40 mg/dl in males and < 50 mg/dl in females or specific treatment for this abnormality, systolic/diastolic blood pressures > or = 130/85 mmHg or treatment of previously diagnosed hypertension, and fasting plasma glucose > or = 100 mg/dl or previously diagnosed type 2 diabetes. RESULTS: Eighty-two patients were characterized as having metabolic syndrome and 35 as healthy controls. CRP, haptoglobin, and ESR levels increased with increasing number of components of metabolic syndrome. Ferritin and fibrinogen, in contrast, were increased in patients with metabolic syndrome but did not correlate with the number of components. CONCLUSIONS: CRP, haptoglobin, and ESR may add significant information regarding the severity of metabolic syndrome among overweight and obese patients.

An inverse relationship between cumulating components of the metabolic syndrome and serum magnesium levels.

Metabolic syndrome has been defined as the presence of abdominal obesity combined with 2 of the following factors: hypertension, dyslipidemia, and impaired glucose tolerance, or diabetes mellitus. Magnesium is an essential cofactor for more than 300 enzymes involved in carbohydrate and lipid metabolism. In this study, we enrolled 117 consecutive overweight and obese patients and we measured serum magnesium levels together with fasting serum glucose, high-density lipoprotein cholesterol, and triacylglycerols. A strong inverse relationship between magnesium levels in serum and the presence of metabolic syndrome was noticed. Moreover, magnesium levels decreased as the number of components of metabolic syndrome increased. Also, there is an inverse relationship between serum magnesium levels and high-sensitivity C-reactive protein. We concluded that decreased levels of serum magnesium are associated with increased risk for metabolic syndrome, perhaps by a low-grade inflammation process.

Vertebral osteomyelitis and native valve endocarditis due to Staphylococcus simulans: a case report.

BACKGROUND: Staphylococcus simulans is a common animal pathogen that occasionally can colonize human skin. Unlike other coagulase-negative staphylococci, S. simulans tends to cause more severe infections that resemble those caused by S. aureus. We present a case of vertebral osteomyelitis and endocarditis due to S. simulans. To the best of our knowledge, this is the first report of vertebral osteomyelitis associated with native valve endocarditis rather than orthopedic surgery. CASE PRESENTATION: A 46-year-old male butcher was admitted to the hospital with a 4-week history of high fever with profound sweating. He reported weakness in his legs and low back pain that compromised his walking ability. Blood cultures yielded Gram-positive cocci on Gram stain. These cocci were identified to the species level as S. simulans, a coagulase-negative staphylococcus. The patient was treated with antibiotics, which were discontinued after 6 months. CONCLUSION: This case illustrates the importance of identifying coagulase-negative staphylococci to the species level. Accurate identification of S. simulans would further help investigations defining its pathogenic role in human infections.