Spontaneous Streptococcus mitis Meningitis in a Patient with Liver Cirrhosis: A Case Report and Literature Review

How to cite this paper: Villion, A., Lishner, M., Chowers, M. and Reisfeld, S. (2014) Abstract Streptococcus mitis is a component of the normal oropharynx, skin, gastrointestinal system, and genital tract florae. It is generally considered as a relatively benign bacterium. We present a case of spontaneous Streptococcus mitis meningitis in a patient with liver cirrhosis and no known risk factors for invasive infectious diseases

Plasma lipids and the progression of nephropathy in diabetes mellitus type II: Effect of ACE inhibitors

Plasma lipids and the progression of nephropathy in diabetes mellitus type II: Effect of ACE inhibitors. Ninety-four normotensive type II diabetics with normal renal function and microalbuminuria were randomized to receive enalapril 10 mg/day or placebo and were followed for five years. In the patients treated by enalapril plasma creatinine values and albuminuria remained stable throughout the observation period. Their plasma total cholesterol decreased from an initial value of 245 ± 27 mg/dl to mean study value of 236 ± 29 mg/dl, and to a fifth year value of 232 ± 27 mg/dl (P < 0.001). The changes in HDL cholesterol and triglyceride values were nonsignificant. In the placebo group there was a significant increase in albuminuria and a mean decline of 13% in reciprocal creatinine values during the five years. Plasma total cholesterol increased from an initial mean value of 246 ± 24 to a mean study value of 252 ± 25 mg/dl, and to a fifth year mean value of 259 ± 32 mg/dl (P < 0.001). There was a significant correlation between both initial and mean plasma total cholesterol values, and the decline in renal function and the rise in albuminuria in the placebo treated patients. This correlation persisted after stratification for blood pressure. Treatment with enalapril did not eliminate these correlations. Cholesterol may be an additional risk factor for diabetic nephropathy. ACE inhibitors may have a modest cholesterol lowering effect in diabetic patients mediated, in part, through the decline in albuminuria

Hair Cortisol and the Risk for Acute Myocardial Infarction in Adult Men

Acute stress is increasingly recognized as a precipitant of acute myocardial infarction (AMI). However, the role of chronic stress in developing AMI is less clear. We have developed a method to measure cortisol in hair, which allows longitudinal assessment of cortisol levels prior to an acute event. We aimed to evaluate the hypothesis that chronic stress, as assessed by hair cortisol content, is associated with the development of AMI. A prospective case-control study included 56 patients admitted to hospital with AMI and 56 control patients, admitted to internal medicine wards for other indications. An enzyme immunoassay technique was used to measure cortisol in the most proximal 3 cm of hair, considered to represent the most recent 3 months of exposure. Median hair cortisol contents (range) were 295.3 (105.4-809.3)ng/g in AMI patients and 224.9 (76.58-949.9)ng/g in controls (p = 0.006, Mann-Whitney U-test). After controlling for other risk factors for AMI using multiple logistic regression, log-transformed hair cortisol content remained the strongest predictor (OR 17.4, 95% CI 2.15-140.5; p = 0.007). We demonstrated elevated hair cortisol concentrations in patients with AMI. This suggests that chronic stress, as assessed by increased hair cortisol in the 3 months prior to the event, may be a contributing factor for AMI