Idiopathic autoimmune hemolytic anemia due to lecithin overdose: a case report.

INTRODUCTION: Idiopathic Autoimmune Hemolytic Anemia is a potentially fatal condition which requires prompt and potent treatment. Diagnosis of idiopathic autoimmune hemolytic anemia requires both serologic evidence of autoantibody presence and hemolysis. Although most of the times it is considered idiopathic, several underlying causes have been identified, like autoimmune and connective tissue diseases, viral infections, drugs or hyper function of the immune system. To our knowledge, this is the first case in the international literature describing lecithin-induced autoimmune hemolytic anemia. CASE PRESENTATION: This case report is to highlight a rare but dangerous adverse reaction to overdose of lecithin. A 38 year old white female from Greece, presented to our emergency room with progressive fatigue over a period of ten days and icteric discoloration of her skin and conjunctiva. The patient had been taking lecithin supplements (1200 mg, 3 capsules a day) over a period of ten days for weight loss. She reports that the last 3 days, prior to the examination, she took 5 capsules/day, so that the supplement would take effect more rapidly. Her past medical, social and family history showed no disturbance. Relatives of the patient were requested to submit any blood-tests taken over a period of 20 days prior to the onset of symptoms caused by Lecithin. All tests proved that all functions were within normal scale. Her physical examination revealed pallor and jaundice without palpable hepatosplenomegaly. Blood biochemistry tests showed total bilirubin 7.5 mg/dl, with indirect bilirubin 6.4 mg/dl and complete blood count showed hemoglobin 7.6 g/dl with blood levels 21.4%. CONCLUSION: In every case of idiopathic autoimmune hemolytic anemia the administration of pharmaceutical substances should always be examined, except for the standard reasons that cause it. In this case the cause of hemolysis was attributed to the excessive intake of lecithin capsules for the loss of body weight. It is important that clinicians and immunologists are aware of this adverse effect.

Merkel cell carcinoma of the upper extremity: case report and an update.

BACKGROUND: Merkel cell carcinoma is a rare but aggressive cutaneous primary small cell carcinoma. It is commonly seen in elderly affecting the head, neck, and extremities. Macroscopically may be difficult to distinguish MCC from other small cells neoplasms especially oat cell carcinoma of the lung. CASE PRESENTATION: It is presented a case report concerning a 72 years old male with a MMC on the dorsal aspect of the right wrist. The patient underwent a diagnostic excisional biopsy and after the histological confirmation of the diagnosis a second excision was performed to achieve free margins. No postoperative radiation or adjuvant chemotherapy was given and within 9 years follow up no recurrence was reported. CONCLUSION: Although most cases present as localized disease treatment should be definitive due to high rates of local or systemic recurrence. Treatment includes excision of the lesion, lymphadenectomy, postoperative radiotherapy and chemotherapy depending on the stage of the disease. Even when locoregional control is achieved close surveillance is required due to high rates of relapse.

Elevated serum triglycerides is the strongest single indicator for the presence of metabolic syndrome in patients with type 2 diabetes.

BACKGROUND: Patients with diabetes already fulfill one diagnostic criterion for MS according to the existing classifications. Our aim was to identify one single clinical parameter, which could effectively predict the presence of MS in patients with type 2 diabetes. METHODS: We studied all patients with type 2 diabetes who attended our Diabetes Outpatient Clinic during a three-month period. Waist circumference, blood pressure and serum lipids were measured. Establishment of MS diagnosis was based a) on National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria and b) on International Diabetes Federation (IDF) criteria. Receiver operating characteristic (ROC) analysis was applied in order to identify the clinical parameter with the highest predictive capability for MS. Among the 500 participating patients (231 males, 269 females), MS was diagnosed in 364 patients (72.8%) according to the NCEP ATP III criteria and in 408 patients (81.6%) according to the IDF criteria. RESULTS: For the NCEP ATP III classification, serum triglycerides (in the overall population), waist and HDL (in female population) demonstrated the highest predictive capability for MS (AUCs:0.786, 0.805 and 0.801, respectively). For the IDF classification, no single parameter reached an AUC > 0.800 in the overall population. In females, HDL displayed a satisfactory predictive capability for MS with an AUC which was significantly higher than the one in males (0.785 vs. 0.676, respectively, p < 0.05). CONCLUSION: Elevated serum triglycerides strongly indicate the presence of MS in patients with type 2 diabetes. In female patients with type 2 diabetes, central obesity was the second stronger predictor of MS besides hypertriglyceridemia.

Increased prevalence of diabetes mellitus in a rural Greek population.

INTRODUCTION: Diabetes mellitus (DM) is becoming a modern epidemic due to the high prevalence of obesity and physical inactivity. Previous studies in Greece in urban and mixed urban and rural populations, reported a prevalence of DM of less than 3%. However data concerning the prevalence of DM in exclusively rural areas of Greece are lacking. The purpose of this study was to investigate the prevalence of DM in a representative rural area of Greece. METHODS: The group studied consisted of the resident population of the villages Saint Demetreus, Adami and Metohi of the district of Argolida, Greece, according to the 2001 Greek Census. In total, 880 subjects, aged 1-99 years (410 males [46.6%] mean age [+/- standard deviation, SD] 46.7 +/- 26 yrs, 470 females-mean age [+/- SD] 48.2 +/- 24.3 years) were screened for the presence of DM. Body mass index (BMI), waist to hip ratio (WHR), personal and family history were recorded at baseline. After an overnight fast, blood samples were drawn for the determination of plasma glucose (FPG) and serum lipid profile. In the case of FPG >126 mg/dL a second determination was performed one week later. Subjects with FPG <126 mg/dL on repeated test, and those with FPG between 110 and 126 mg/dL, were invited to undergo an oral glucose tolerance test. Diagnosis of DM was based on the 1999 WHO criteria. RESULTS: The prevalence of DM was 7.8 % (95% CI: 5.9-12.5), with known diabetics being 5.3% of the population and undiagnosed diabetes being 2.5%. No significant differences were detected between males and females (7.1% vs 7.6%, p>0.05). There was a significant increase in the prevalence of DM with increasing age (age 41-50 years: 6.4% vs 71-80 years 14.1%, p<0.05). Impaired glucose tolerance was diagnosed in 3.9%, while impaired fasting glucose was diagnosed in 1.9%. Furthermore, the prevalence of obesity (BMI>30 kg/m2<) was 20.8%, while central obesity (WHR >0.90 males, >0.85 in females) was observed in 63%. Age, obesity, family history of DM, arterial hypertension and elevated triglyceride levels were significantly associated with the presence of DM (p<0.001). CONCLUSION: The prevalence of DM has significantly increased in the rural population of Greece. Age, hypertension, obesity, family history of diabetes and elevated triglyceride levels were significantly associated with prevalent diabetes. These subjects should be a primary target for preventive intervention strategies.