Biliary heavy metal concentrations in carcinoma of the gall bladder: case-control study.

All subjects had recent infections with group A â haemolytic streptococci. The findings attributable to this particular inclusion criterion may widen our understanding of why most children with such infection escape a rheumatic attack while only a few do not. Our analyses adjusted for socioeconomic factors imply that low serum albumin concentrations and body iron stores may contribute to rheumatic fever. To rule out the possibility that differences in nutritional markers reflect differences in severity of inflammation, we adjusted for C reactive protein concentration in our analyses. Iron deficiency might have favoured rheumatic fever by predisposing the cases to frequent infections with group A â haemolytic streptococci. The target organ lesions in patients with rheumatic fever predominantly contain T cells. We speculate that the tissue damage caused by T cell infiltration may be favoured by protein deprivation because T cell mediated immunological functions become exaggerated under mild to moderate chronic protein or protein energy deprivation. Although case-control studies have inherent limitations, our results suggest that deficiency of albumin and iron is linked to susceptibility to rheumatic fever.