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Previous studies have shown a higher prevalence of malignancy in patients with diabetes mellitus (DM) and chronic kidney disease (CKD). The purpose of this study was to investigate the prevalence of adenomatous colon polyps (ACP) as they occur in subjects with DM and coexisting CKD. This is a retrospective cohort study of patients with DM (n=565) who had undergone colonoscopy between 2000-2010. The cohort was further bifurcated into those with CKD (n=296) and those with normal renal function (n=269). Presence or absence of ACP was measured in both groups. Concentrations of serum parathyroid hormone (PTH), Calcium (Ca), and phosphorous (P) were recorded for the CKD group. The levels of these variables in patients with ACP (n=171) were compared with the levels from those without ACP (n=175). Nonparametric statistical methods were applied with statistical significance suggested by p<0.05 (two-sided). The presence of CKD in this cohort demonstrated a significant association with ACP (OR: 2.96; 95% CI: 2.02 to 4.34; p<0.0001). We did not detect a statistically significant difference in P or Ca between the groups. There was, however, a statistically significant difference in PTH; for the group with ACP, PTH: 387.7±351.3 ng/L vs. 172.2±196.7 ng/L; p<0.0001. This data suggests that CKD is associated with ACP in subjects with DM and those with ACP exhibit higher PTH levels when compared to those without ACP., (© 2016 by the Association of Clinical Scientists, Inc.)

Studies have demonstrated low serum levels of total protein (TP) and albumin (ALB) in patients with Clostridium difficile infection (CDI), especially with refractory and recurrent disease. However, it is not known whether low TP and/or ALB levels are a risk factor for CDI or merely a result of diarrheal loss. The aim of this study is to determine if low TP and/or ALB level is an antecedent or sequela of CDI, which would be useful in risk stratification of hospitalized or nursing home patients. A retrospective cohort study was conducted in a 700-bed tertiary care teaching hospital. Records of all hospitalized patients with CDI from 2006-2011 were analyzed. The inclusion criteria for the final cohort (n=46) were: subjects not diagnosed with HIV; onset of CDI at least one week after hospitalization; serial values of TP and ALB available on three occasions (at onset of CDI, seven days prior, and post-onset of CDI). Seven days prior to the onset of CDI, 40/46 (87%) subjects had low ALB levels with a mean of 2.6±0.7 g/dL and 37/46 (80.4%) had low TP with a mean of 5.8±1.0 g/dL. At the onset of CDI, 45/46 (97.8%) subjects had low ALB (group: 2.1±0.6 g/dL) and 41/46 (89.1%) had low TP (group: 5.1±1.0). Seven days post-onset of CDI, 45/46 subjects continued to have decreased ALB (group: 2.0±0.6) and 39/46 (84.8%) had low TP (group: 5.2±1.2). The pre-onset data for ALB and TP were significantly different than the comparable data at onset and seven days post-onset (p<0.0001 for both ALB and TP). No significant difference was observed between onset and seven days post-onset. Most patients are hypoproteinemic prior to the onset of hospital-acquired CDI. Although some subjects lost protein after the onset of CDI, this was not statistically significant. This study suggests that antecedent low levels of ALB and TP may be a risk factor for the acquisition of CDI.

Eosinophilic cholecystitis (EC) is a rare entity that presents in a manner comparable to acute cholecystitis. The diagnosis is based on classical symptoms of cholecystitis with the presence of >90% eosinophilic infiltration within the gallbladder. We report the case of a 29-yr-old man who presented with unremitting right upper quadrant pain, chills, and loss of appetite. After confirmation of the diagnosis with ultrasound and hepatobiliary scan (HIDA), a cholecystectomy was performed. Pathologic examination of the excised gallbladder demonstrated submucosal infiltration with eosinophils, consistent with EC. Peripheral eosinophilia was not observed; the subject's blood eosinophil count did not exceed 3% during the period of observation. The patient was discharged with no further symptoms. Cases of EC have been infrequently reported since its original description in 1949. EC has been reported alone or in combination with manifestations such as eosinophilic cholangitis, hypereosinophilic syndromes (HES), and parasitic infestations. The patient described herein gave no indications of such previously suggested causes of EC. This report illustrates an authentic case of idiopathic EC.