Visceral leishmaniasis caused by Leishmania infantum in a Spanish patient in Argentina: What is the origin of the infection? Case report

BACKGROUND: The question "Where have you been?" is a common one asked by doctors in Northern Europe and America when faced with clinical symptoms not typical of their country. This question must also arise in the clinics of developing countries in which non-autochthonous cases such as the one described here can appear. Important outbreaks of Leishmania infantum have been recorded in the last decade in several Latin American countries but its presence has not yet been recorded in Argentina. We report the first case of visceral leishmaniasis owing to L. infantum in this country. CASE PRESENTATION: A 71-year-old Spanish woman who has been living in Mendoza, Argentina, during the last 40 years presented with a history of high fever and shivering, anemia, leukopenia and splenomegaly over two years. Argentinian doctors did not suspect visceral leishmaniasis even when the histological analysis revealed the presence of "intracytoplasmatic spheroid particles compatible with fungal or parasitic infection". After a serious deterioration in her health, she was taken to Spain where she was evaluated and visceral leishmaniasis was established. Specific identification of the parasite was done by PCR-ELISA, isoenzyme electrophoresis and RAPD-PCR. CONCLUSION: We would like to point out that: i) cases such as the one described here, which appear in non-endemic areas, can pass unnoticed by the clinical physician. ii) in countries in which these introduced cases reside, in-depth parasitological studies are required into vectors and possible reservoirs to rule out the rare case of local infection and, once infection has taken place, to ensure that this does not spread by anthroponotic transmission or a competent reservoir

The unusual afterglow of the Gamma-Ray Burst 100621A

Aims. With the afterglow of GRB 100621A being the brightest detected so far in X-rays, and superb GROND coverage in the optical/NIR during the first few hours, an observational verification of basic fireball predictions seemed possible. Methods. In order to constrain the broad-band spectral energy distribution of the afterglow of GRB 100621A, dedicated observations were performed in the optical/near-infrared with the 7-channel “Gamma-Ray Burst Optical and Near-infrared Detector” (GROND) at the 2.2m MPG/ESO telescope, in the sub-millimeter band with the large bolometer array LABOCA at APEX, and at radio frequencies with ATCA. Utilizing also Swift X-ray observations, we attempt an interpretation of the observational data within the fireball scenario. Results. The afterglow of GRB 100621A shows a very complex temporal as well as spectral evolution. We identify three different emission components, the most spectacular one causing a sudden intensity jump about one hour after the prompt emission. The spectrum of this component is much steeper than the canonical afterglow. We interpret this component using the prescription of Vlasis et al. (2011) for a two-shell collision after the first shell has been decelerated by the circumburst medium. We use the fireball scenario to derive constraints on the microphysical parameters of the first shell. Long-term energy injection into a narrow jet seems to provide an adequate description. Another noteworthy result is the large (AV = 3.6 mag) line-of-sight host extinction of the afterglow in an otherwise extremely blue host galaxy. Conclusions. Some GRB afterglows have shown complex features, and that of GRB 100621A is another good example. Yet, detailed observational campaigns of the brightest afterglows promise to deepen our understanding of the formation of afterglows and the subsequent interaction with the circumburst mediu

Italian Study on Depressive Disorders (STudio Italiano MAlattia Depressiva, or STIMA-D): a nationwide snapshot of the status of treatment for major depression.

Major depression is a worldwide problem and often remains undetected and untreated. Given the low rates of detection plus the need to intervene in a short time, it is important to identify factors which are likely to improve treatment outcomes.STIMA-D was designed to provide the profile of patients with major depression in Italy (focusing on pathway to care, patient characteristics, drug therapy and treatment outcomes). The patients enrolled (M/F, aged between 18 and 65) experienced single/multiple episodes of major depression (DSM-IV-TR). Patients with lifetime or current bipolar syndrome or other mental disorders were excluded.44 of the 50 invited centers sent data concerning 1???140 patients. The majority of patients were women. Among working individuals, 52.5\% of them were absent from work due to depression in the previous 6 months. Recurrent episodes of major depression were very common and were associated with persistence of residual post-episodic symptoms, a family history of mood disorders and presence of anxiety. 59.6\% of the patients were treated with monotherapy (SSRI or SNRI), while 19.2\% of them were treated with SSRI plus SNRI. Only the 25.5\% on monotherapy had a complete response compared to 12.4\% of patients on dual therapy.Poor outcomes in major depression have profound implications on patients' quality of life and cost burden. New pharmacological approaches with novel modes of action are therefore urgently needed

Discriminative hypomania checklist-32 factors in unipolar and bipolar major depressive patients on behalf of come to me study group

Background: Although manic or hypomanic episodes define bipolar disorder (BD), most patients show a predominance of depressive symptomatology, often associated with delayed or disregarded BD diagnosis. The Hypomania Checklist-32 (HCL-32) has therefore been developed and tested internationally to facilitate BD recognition. Sampling andMethods: Five hundred seventy-one (563 eligible) patients diagnosed with a major depressive episode according to DSM-IV criteria were consecutively enrolled in a cross-sectional, multicenter, observational study (Come To Me). Lifetime manic or hypomanic features were assessed by the HCL-32, and severity of depressive and anxious symptomatology was assessed using the Zung's self-report questionnaires for depression and anxiety. Results: Among the patients diagnosed with BD (n = 119), either type I or type II, the occurrence of (hypo)manic symptoms was significantly higher compared to major depressive disorder (MDD) symptoms according to HCL-32 total and subscale scores obtained using a score of 14, which ensured an optimal discrimination between BD and MDD with a sensitivity of 0.85 and a specificity of 0.78. Conclusions: Although some false positives might occur, the HCL-32 was confirmed to be a useful instrument in the detection of past hypomania in MDD patients, finally contributing to proper therapeutic choices. Copyright © 2012 S. Karger AG, Basel